Breast Cancer: How Is Invasive Ductal Carcinoma (IDC) Treated?

Invasive ductal carcinoma (IDC) happens when cancerous cells begin to grow outside the milk ducts of your breast into the surrounding fatty tissue.

IDC is the most common form of breast cancer, accounting for 80 percent of all cases, notes Johns Hopkins Medicine. (1)

The type of treatment you receive for IDC will depend on the size of your cancer, other biological features such as hormone receptor status, and whether or not it has spread to lymph nodes or other organs. Many women will also sometimes opt for a combination of therapies.

RELATED: Study Reveals a Strategy to Reduce Heart Damage Linked to the Breast Cancer Drug Herceptin

What Are the Treatment Options for IDC?

Surgery

Sometimes surgery is the first treatment doctors will recommend for women with IDC. But if your tumor is very large or has spread, other treatments, such as chemotherapy, immunotherapy or targeted therapy, and hormonal therapy, may first be used to shrink the cancer, according to BreastCancer.org. (2)

There are several types of surgical procedures for IDC, including:

• Lumpectomy or Partial Mastectomy Surgeons remove only the tumor and some of the tissue surrounding it. Underarm lymph nodes, known as axillary nodes, may also be taken out.
• Partial Mastectomy Surgeons remove up to a quarter of your breast. Lymph nodes are also resected.
• Total or Simple Mastectomy The entire breast that contains the tumor is removed. Some lymph nodes may also be taken out, but the muscle beneath the breast is left alone.
• Modified Radical Mastectomy Surgeons remove the breast, the lining of the chest wall muscle, and some underarm lymph nodes.

The type of surgery your doctor recommends will depend on where the cancer is located, the size of the tumor, and how much of the breast is affected by the cancer.

Many women who have breast cancer surgery choose to undergo breast reconstruction during or after the procedure, particularly if they undergo mastectomy. This technique is used to rebuild the shape of your breast with implants or tissue transfers, notes Moffitt Cancer Center. (2,3)

Radiation

Radiation therapy delivers either high-energy X-rays called photons or high energy particle beams to shrink tumors and kill cancer cells.

This treatment is usually given after a lumpectomy to decrease the chance of having cancer cells regrow in the breast, also known as a local recurrence. Women over age 65 may not always need radiation after a lumpectomy because they tend to have less aggressive disease than younger women.

The decision to recommend radiation therapy after a mastectomy depends on a number of factors, including the biology of the breast cancer type, the size of the tumor, lymph node status, whether there were breast cancer cells in the tissue surrounding the lump, and the patient's age.

Having radiation after surgery lowers the risk that your cancer will come back in the breast or area where lymph nodes drain, per the American Cancer Society. (4)

There are different ways of delivering radiation after breast surgery, including:

• External Whole Breast Radiation With or Without Lymph Node Treatment This type of radiation uses an external machine called an accelerator to deliver treatment. Historically, radiation therapy for breast cancer has been given daily for five to seven weeks. More recent clinical trials have shown comparable outcomes and side effects when radiation therapy is given over three weeks or even one week when higher doses are delivered per day, decreasing the need for as many treatments. A radiation oncologist can explain the different options and take the patient's choices into consideration. The decision often also depends on the treatment preference of the radiation therapy center.
• External Partial-Breast Irradiation This technique involves delivering external beam radiation to the area of the breast tissue that’s at the highest risk of recurrence. Treatment usually last only five days, given once or twice per day depending on the physician's preference. There are quality, randomized clinical trials that show, in certain patients, partial breast irradiation is equivalent to full breast radiation in terms of outcomes.
• Brachytherapy With this treatment, radioactive materials like pellets or seeds are temporarily placed in or around the area where the tumor was located. The seeds emit radiation.

The most important thing people should know is that we are evolving our use of radiation therapy to more closely match the biology of breast cancer a patient has, taking into consideration the type of cancer, whether it is receptor positive or negative, and also the patient's age, says Michele Halyard, MD, a radiation oncologist at Mayo Clinic in Phoenix, Arizona. "Also, we have increasing data that patients may be treated with higher doses per day with overall less number of treatments with equivalent outcomes in appropriately selected patients."

Hormone Therapy

If your doctor tells you that your cancer is hormone-receptor positive, treatment with endocrine therapy, such as tamoxifen or an aromatase inhibitor, may help lower your risk for recurrence. Typically, endocrine therapy is taken for a minimum of five years after breast cancer surgery. (4)

Chemotherapy

Chemotherapy, or “chemo” for short, involves using anticancer drugs to kill cancer cells. It’s given by injection into a vein.

In some situations, doctors recommend chemotherapy before breast cancer surgery to shrink tumors and stop cancer cells from growing quickly. Chemo can also be given after surgery to target any leftover cancer and to lower your chances of recurrence, notes Moffitt Cancer Center. (5) For certain patients with triple negative breast cancer, chemotherapy can be given before surgery along with immunotherapy to further reduce the risk of cancer recurrence.

Targeted Treatment

Targeted treatments home in on specific cancer cell traits to stop the cells from growing rapidly.

Generally, targeted approaches are less likely to kill healthy cells in your body compared with chemo and are often easier to tolerate.

Some of these treatments work for specific types of breast cancer. For example, if your IDC is labeled “HER-2 positive,” you may benefit from certain targeted therapies like Herceptin (trastuzumab) and Perjeta (pertuzumab), according to BreastCancer.org. (6)

Clinical Trials Designed for IDC

Women with IDC may choose to enroll in a clinical trial to receive a new treatment that’s not yet available to the general public.

Additionally, clinical trials help scientists determine if up-and-coming therapies are safe and effective.

Talk to your doctor about the benefits and risks of participating in a research study. You can also search for clinical trial near you at ClinicalTrials.gov, says Moffitt Cancer Center. (7)

Alternative Approaches to Help You Cope With IDC

While no alternative treatments have been proved to cure IDC, many can help you cope with stress, anxiety, and treatment side effects.

According to Mayo Clinic, some common methods include: (8)

• Exercise
• Yoga or tai chi
• Meditation
• Massage
• Acupuncture
• Hypnosis
• Music therapy
• Aromatherapy

Making Treatment Decisions

Deciding on a treatment for IDC isn’t always easy. You and your doctor will work together to make the best choice possible.

Often, your physician will suggest a treatment based on:

• The size of your cancer
• How much your cancer has spread
• What type of tumor you have
• Your family history
• Whether you have a gene mutation that increases your risk for breast cancer

You may have many concerns about your condition and the suggested treatments. Writing them down is a good idea.

Here are some questions to ask your healthcare provider:

• What treatment would you recommend for my cancer?
• Why do you suggest this particular therapy?
• How effective is this treatment in women with a similar diagnosis?
• Does this option give me the best chance of survival?
• Is there a more or less aggressive option that would work just as well?
• What are the side effects or downsides of this treatment?
• Am I at risk for having the cancer come back? What happens if the cancer comes back?
• What lifestyle changes should I make?
• Should I get a second opinion?

Finding a doctor you’re comfortable with is important. Don’t hesitate to schedule an appointment with another physician if you feel like your practitioner isn’t meeting your needs.

Finally, remember that although your provider may make recommendations, treatment decisions are ultimately yours. (8)