Unlike local treatments, which focus on the area (or areas) where the invasive ductal carcinoma was found, systemic treatments involve the entire body. Treatments such as chemotherapy, hormonal therapy, and targeted therapies are used to destroy any cancer cells that may have left the original tumor, as well as to reduce the risk of the invasive ductal carcinoma coming back.

Chemotherapy

Chemotherapy involves taking anti-cancer medicines by injection directly into a vein or by mouth in the form of a pill. Two or more chemotherapy medications are often given in combination. The medicines travel through the bloodstream to all parts of the body. As chemotherapy damages the cancer cells, it also can damage some of the body’s healthy cells, which is why you may experience side effects.

If an invasive ductal carcinoma is larger than 1 centimeter in diameter and/or has spread to the lymph nodes, chemotherapy is usually recommended or, at the very least, seriously considered. When chemotherapy is given after surgery, it is called adjuvant therapy. In cases where the tumor is large, or breast cancer cells have traveled to many lymph nodes or other parts of the body, chemotherapy may be given before surgery to shrink the cancer. This approach is called neoadjuvant therapy. In either case, chemotherapy will be given in cycles, usually with a day (or days) of treatment followed by a period of “off” days. The exact schedule can vary depending on the medication or medications used. An entire course of chemotherapy usually takes about 3 to 6 months.

Just some examples of the many chemotherapies that may be used to treat invasive ductal carcinoma include:

• Adriamycin (chemical name: doxorubicin)
• Ellence (chemical name: epirubicin)
• Cytoxan (chemical name: cyclophosphamide)
• Taxotere (chemical name: docetaxel)
• Taxol (chemical name: paclitaxel)
• Xeloda (chemical name: capecitabine)
• Ixempra (chemical name: ixabepilone)
• methotrexate
• fluorouracil (also called 5-fluorouracil or 5-FU)

You and your doctor will work together to determine which chemotherapy treatments are best for your situation. This can depend on the features of the cancer and any other health conditions you may have. For example, if you have a history of heart disease or heart-related risk factors, you and your doctor will want to avoid medications that can affect the heart. Your decision will also be influenced by whether or not the tumor tested positive for HER2 receptors. Some chemotherapies, such as Taxol and Cytoxan, are more commonly used with Herceptin in treating HER2-positive breast cancers.

Tests to determine the need for chemotherapy

If you have a small, early-stage invasive ductal carcinoma that did not spread to the lymph nodes and you will be taking hormonal therapy (see below), you may wonder whether chemotherapy is truly necessary as well. You and your doctor can discuss whether or not chemotherapy is right for your situation. You also may be eligible for one of two new tests, called Oncotype DX and MammaPrint, which are being used to predict how likely the cancer is to recur (come back). Both tests, called genomic assays, look at certain genes in the tumor to assess the risk of recurrence. A “high-risk” result is typically seen as a good reason to go ahead and proceed with chemotherapy.

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