Invasive Ductal Carcinoma Treatment

Your cancer treatment should not be a "one-size-fits-all." At Penn Medicine’s Abramson Cancer Center, our multidisciplinary team will work with you to create a treatment plan that may include one or a combination of the following treatments.

Surgery for Invasive Ductal Carcinoma (IDC)

Breast-conserving Surgery

Breast-conserving surgery removes only the affected part of the breast and a surrounding margin of normal tissue. The amount of tissue removed depends on the size and location of the tumor as well as other factors.

Partial mastectomy, quadrantectomy and lumpectomy are all types of breast-conserving surgery. If cancer cells are found at any of the edges of the tissue removed, it is said to have positive margins. When no cancer cells are found at the edges of the tissue, it is said to have negative or clear margins. The presence of positive margins means that some cancer cells may have been left behind after surgery. If the pathologist finds positive margins in the tissue removed by breast-conserving surgery, the surgeon may need to go back and remove more tissue. If the surgeon can't remove enough breast tissue to get clear surgical margins, a total mastectomy may be needed.

Radiation therapy is often given after breast-conserving surgery.

Mastectomy Surgery

Mastectomy involves removing all of the breast tissue, sometimes along with other nearby tissues. In a simple or total mastectomy, the surgeon removes the entire breast, including the nipple, but does not remove underarm lymph nodes or muscle tissue from beneath the breast.

A nipple-sparing mastectomy removes all of the breast tissue but leaves the nipple and skin of the breast intact. Not all patients with DCIS are candidates for this procedure and this should be discussed with your surgeon.

A modified radical mastectomy is a simple mastectomy plus removal of axillary (underarm) lymph nodes.

For some women considering immediate breast reconstruction, a skin-sparing or nipple-sparing mastectomy can be done.

Choosing Between Lumpectomy and Mastectomy

Many women with early-stage cancers can choose between breast-conserving surgery and mastectomy.

The main advantage of a lumpectomy is that it allows women to keep most of their breast. A disadvantage is the usual need for radiation therapy — most often for five to six weeks — after surgery. A small number of women having breast-conserving surgery may not need radiation while a small percentage of women who have a mastectomy will still need radiation therapy to the breast area.

When deciding between a lumpectomy and mastectomy, it is important for women to get all the facts, weigh their options and ask questions in order to arrive at the best treatment option for them.

Reconstruction Surgery

Breast reconstruction is a surgical procedure to recreate the shape and appearance of the breast, usually done as part of a mastectomy surgery to remove an entire breast as treatment for breast cancer.

Breast reconstruction is a surgical procedure performed to recreate the shape and appearance of a woman's breast following a mastectomy. At Penn, we believe that restoration of the breast following mastectomy is an integral part of the holistic treatment of breast cancer.

There are two types of breast reconstruction:
  • Tissue flap
  • Breast implant

Surgeons at Penn Medicine are pioneers in tissue flap reconstruction, which uses a woman’s own tissue to reconstruct the breast.

Radiation Therapy for Invasive Ductal Carcinoma (IDC)

Conformal Radiation Therapy

Modern radiation therapy is designed with 3-dimensional virtual reality computer programs. The imaging technology used by radiation oncologists shape the radiation treatment beams to the shape of the breast. Known as conformal radiation therapy, this technology gives doctors more control when treating breast cancer.

In conformal radiation, a special computer uses CT imaging scans to create 3-D maps of the breast and the normal organs to be avoided, like the lung and heart. The system permits delivery of radiation from several directions and the beams can then be shaped, or conformed, to match the shape of the breast. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.

Deep Inspiration Breath Hold

This very specialized method for breast radiation is used for women with left-sided breast cancer.

The radiation is timed carefully to the respiration cycle of the woman — during a deep inspiration.

This method may cause the lung to expand and move the heart farther away from the left breast than without a breath hold. In this way, less dose is given to the heart.

A woman is given special training in how to do this and works with her therapists to do this correctly every day of treatment.

Image-Guided Radiation Therapy (IGRT)

Image-guided radiation therapy (IGRT) uses frequent imaging during a course of radiation therapy to improve the precision and accuracy of the delivery the radiation treatment. In IGRT, the linear accelerators (machines that deliver radiation) are equipped with imaging technology that take pictures of the tumor immediately before or even during the time radiation is delivered.

Specialized computer software compares these images of the tumor to the images taken during the simulation to establish the treatment plan. Necessary adjustments can then be made to the patient's position and/or the radiation beams to more precisely target the breast and avoid the healthy surrounding tissue.

Intensity-Modulated Radiation Therapy (IMRT)

Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy utilizing computer-controlled linear accelerators to deliver precise radiation doses to tumors or specific areas within the tumors.

Using 3-D computed tomography (CT) images of the patient in conjunction with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the three-dimensional shape of the breast tumor by controlling—or modulating—the intensity of the radiation beam in multiple small volumes. The therapy allows higher radiation doses to be focused to regions within the breast while minimizing the dose to surrounding normal critical structures.

IMRT may be used in some cases of IDC instead of 3D conformal planning when the greater computer-assisted planning will help shape the dose treating the breast or spare normal tissue better.

MammoSite

MammoSite is an internal method of partial breast radiation.

MammoSite is a targeted radiation therapy treatment in which a small, soft balloon attached to a thin catheter is placed inside the lumpectomy cavity through a small incision in the breast. The implant is placed while the patient is in a hospital operating room.


During therapy, the portion of the catheter that remains outside of the breast is connected to a computer-controlled high dose rate machine that inserts a radiation "seed" to deliver the therapy to the area where cancer is most likely to recur.

The patient is not radioactive in between treatments outside the room or home. After the radiation is finished, the catheter is easily removed in the office.

Partial Breast Radiation Therapy

There has been research for over a decade into decreasing the target for radiation to the area immediately around the lumpectomy cavity. This is because most recurrences are in the vicinity of the original lumpectomy location.

The risk of breast cancer in other parts of the breast away from the lumpectomy site may be very low in some patients.

Women with very favorable outcomes may now be candidates for accelerated partial breast irradiation (APBI). APBI may also reduce cost of post-lumpectomy radiation, and will improve the convenience of radiation therapy by reducing the overall length of time required to one week.

There are two ways APBI can be delivered.
  • External beam radiation therapy, or
  • Delivery of radiation through sources placed inside temporary internal catheters inside the breast.
External beam APBI is non-invasive and can treat most lumpectomy cavity shapes and locations and breast sizes.

Internal catheter APBI also gives a highly conformal and localized dose to the lumpectomy site but requires a source to be placed in the breast.

Prone Position

For many women with large or pendulous breasts, and left-sided breast cancer, radiation can be planned and delivered with the patient lying on her stomach instead of her back.

The breast hangs down with gravity into an opening in the treatment table. This method can reduce the dose to the heart from radiation.

There may also be less immediate skin reactions from radiation with prone position in common areas like the underside of the breast by reducing skin folds.

Proton Therapy

Proton therapy is an external method of partial breast radiation.

Unlike conventional radiation that can affect surrounding healthy tissue as it enters the body and targets the tumor, proton therapy's precise, high dose of radiation is extremely targeted. This targeted precision causes less damage to healthy, surrounding tissue.

When aimed at cancer tumors, protons pack impressive power. Protons release their energy completely once they enter a tumor, limiting the radiation dose beyond the tumor, causing less damage to the healthy surrounding tissues and resulting in fewer side effects.

Even if you've already had a course of conventional radiation and are unable to receive more, you may still be able to receive proton therapy.

More facts about proton therapy:
  • Proton therapy offers fewer reported side effects and complications
  • Normal, healthy, surrounding tissues receive 50% to 70% less radiation
  • Proton therapy offers an increased safe dose delivered to tumors
  • Cure rates may be increased with proton therapy
  • Proton therapy can re–treat tumors after recurrences
  • Thanks to its marvelous precision, proton therapy is perhaps the most advanced treatment for cancer tumors located close to critical organs and highly sensitive areas, such as the spinal cord, heart and brain.
Proton therapy is also an important treatment option for cancers that cannot be completely removed by surgery.

Whole Breast Radiation Therapy

Radiation therapy stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells.

For more than 25 years, breast-conserving surgery and radiation therapy have been standard alternatives to mastectomy for women with early stage breast cancer. Radiation after a lumpectomy reduces the risk of a recurrence in the breast.

Historically, radiation therapy after lumpectomy has treated the whole breast — this may make sense as radiation was replacing another whole breast treatment (mastectomy). For many women, after radiation is given to the whole breast, an additional more focused dose of radiation is given to the lumpectomy cavity, called a cone down or boost.

Shorter Radiation Schedule with Hypofractionation

Conventional treatment schedules involve daily radiation Monday through Friday for five to six weeks.

Hypofractionation, however, uses fewer, larger dose radiation treatments (also called fractions) usually given over a shorter time period when compared to standard radiation fraction sizes.

This type of radiation therapy reduces the length of a course of treatment by two to three weeks compared to standard schedules. This reduced length of treatment reduces cost, reduces travel or lost days of work, and reduces the inconvenience of a course of radiation. In addition, studies show that there are no significant differences in cosmetic appearance of the breast or other negative side effects in women treated with a shorter course of radiation.

Chemotherapy and Other Biologic Therapies for Invasive Ductal Carcinoma (IDC)

Chemotherapy

Chemotherapy uses drugs to attack cancer cells, slowing or stopping their ability to grow and multiply.

Chemotherapy is usually given:

  • Orally: taking pills or capsules by mouth
  • Intravenously (IV): injecting medication into a vein
  • Intramuscularly (IM): injecting medication into a muscle
  • Subcutaneously: injecting medication under the skin

Chemotherapy is not a "one-size-fits-all" cancer treatment.

The wide range of cancer-fighting drugs attack different types of cancer cells at varying stages of cell development.

Penn medical oncologists are experts at determining which drug or combination of drugs will be the most effective in treating your breast cancer.

For a comprehensive list of most commonly used chemotherapy agents, please visit OncoLink.

Hormone Therapy

Estrogen promotes the growth of about two out of three breast cancers — those containing estrogen receptors (ER-positive cancers) and/or progesterone receptors (PR-positive cancers). Because of this, several approaches to blocking the effect of estrogen or lowering estrogen levels are used to treat ER-positive and PR-positive breast cancers. Hormone therapy does not help patients whose tumors are both ER- and PR-negative.

Hormone therapy is used to help reduce the risk of breast cancer recurrence after surgery in cancers that are ER and/or PR positive. Hormone therapy is not the same as hormone replacement therapy used after menopause. Certain types of hormone replacement therapy are associated with increasing risk for breast cancer. Hormone therapy for IDC is anti-estrogen therapy and decreases the risk of cancer recurrence.

Immunotherapy

Immunotherapy is designed to repair, stimulate, or enhance the immune system's responses.

Your immune system helps prevent disease, but it can also play a role in preventing cancer from developing or spreading.

The goal of immunotherapy is to enhance the body's natural defenses and its ability to fight cancer.

Immunotherapy often has fewer side effects than conventional cancer treatments because it uses your own immune system to:

  • Target specific cancer cells, thereby potentially avoiding damage to normal cells
  • Make cancer cells easier for the immune system to recognize and destroy
  • Prevent or slow tumor growth and spread of cancer cells

Immunotherapy treatments for breast cancer is still being studied.

Clinical Trials at Penn Medicine for Invasive Ductal Carcinoma (IDC)

Clinical trials benefit patients by offering access to breakthrough therapies and treatments.

Because more and more treatments for cancer are becoming available, it’s important to speak with your doctor about available clinical trials throughout your entire cancer treatment.

Advantages of Clinical Trials

Being in a clinical trial offers you the opportunity to be treated with treatments, medications or agents that are not otherwise available.

It also gives you the opportunity to be treated by, and have your case reviewed by experts who are directly involved with the design of the treatment.

Through clinical trials:

  • Diagnosing cancer has become more precise

    Radiation and surgical techniques have advanced

  • Medications have been improving
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes
  • Strategies to address the late effects of cancer and its treatment have been developed to improve the quality of life

Learn more about clinical trials, frequently asked questions about clinical trials, and available clinical trials at the Abramson Cancer Center.

Complementary and Integrative Therapies for Invasive Ductal Carcinoma (IDC)

In addition to standard treatments and clinical trials, you may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy.

These therapies do not have curative intent, and are designed to complement standard treatments — not take their place.

Integrative Oncology Services

Our integrative oncology services can supplement traditional cancer treatments such as chemotherapy.

While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer you and your family ways to minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

We are knowledgeable of and support complementary cancer treatments.

Our cancer teams work with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

Our integrative supportive services include: