Ductal carcinoma in situ (cancer confined to the milk ducts of the breast)
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Sometimes breast-conserving surgery (removal of the tumor, leaving as much of the breast intact as possible) with or without radiation therapy
Sometimes hormone-blocking drugs
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Lobular carcinoma in situ, classic (cancer confined to the milk-producing glands of the breast)
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Sometimes surgery to check for cancer
If no cancer is detected, observation plus regular examinations and mammograms
Tamoxifen or, for some postmenopausal women, raloxifene or an aromatase inhibitor (such as anastrozole, exemestane, or letrozole) to reduce the risk of invasive cancer
Rarely, bilateral mastectomy (removal of both breasts) to prevent invasive cancers
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Lobular carcinoma in situ, pleomorphic (which, unlike the classic type, leads to invasive cancer)
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Surgery to remove the abnormal area and some of the tissue around it
Sometimes tamoxifen or raloxifene to try to prevent cancer from developing
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Stages I and II (early-stage) cancer
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Chemotherapy before surgery to optimize the chances for breast-conserving surgery for some women whose tumor is stuck to the chest wall or is large in relation to the rest of the breast
Breast-conserving surgery to remove the tumor and some surrounding tissue, followed by radiation therapy
Mastectomy with or without breast reconstruction
After surgery, chemotherapy, hormone-blocking drugs, anti-HER2 drugs (such as trastuzumab), or a combination, except in some postmenopausal women with tumors smaller than 0.5 to 1.0 centimeter (about 0.2 to 0.4 inch) and no cancer in the lymph nodes
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Stage III (locally advanced) cancer (including inflammatory breast cancer)
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Chemotherapy or sometimes hormone-blocking drugs before surgery to reduce the tumor’s size
Breast-conserving surgery or mastectomy if the tumor is small enough to be completely removed
Usually, radiation therapy after surgery
Sometimes chemotherapy, hormone-blocking drugs, or both after surgery
For inflammatory breast cancer, mastectomy, chemotherapy, and radiation therapy
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Stage IV (metastatic) cancer
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If cancer causes symptoms and occurs in several sites, hormone-blocking drugs, ovarian ablation therapy,* or chemotherapy
If the cancer cells have too many HER2 receptors, trastuzumab, sometimes with pertuzumab
Radiation therapy for the following:
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Metastases that recur in the skin
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Metastases that occur in one area of bone and that cause symptoms
For metastases to bone, bisphosphonates (such as zoledronate or pamidronate) given intravenously to reduce bone pain and bone loss
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Paget disease of the nipple
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If breast cancer is also present, treatment based on that type of breast cancer
Occasionally, surgical removal of only the nipple with some surrounding normal tissue (local excision)
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Breast cancer that recurs in the breast or nearby structures
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Mastectomy sometimes preceded by chemotherapy or hormone-blocking drugs
Sometimes radiation therapy
Chemotherapy or hormone therapy
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Phyllodes tumors if cancerous
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Removal of the tumor and surrounding normal tissue (wide excision)
Mastectomy if the tumor is large or if analysis of the abnormal cells suggests cancer
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