Breast Cancer Information
Breast Cancer Information and Statistics – 8 Steps . . .
Breast cancer is being diagnosed at earlier stages and the treatment is much easier than just 10 years ago. There are usually no symptoms with breast cancer in most cases. That is why it is so difficult to believe you need surgery or other treatments. Sometimes a mass is felt, but more often it is diagnosed at mammogram. If faced with a cancer diagnosis, the first person one usually sees is the breast surgeon. The information needed to make decisions about chemotherapy come with the pathology report after surgical removal of the cancer. This information includes tumor size or lymph node involvement which gives the stage of the cancer. A medical oncologist and/or a radiation oncologist will be involved. In some cases chemotherapy is given before surgery. Others only the pill form of chemotherapy is needed. There are also many surgical options. Breast cancer today has so many treatment options that rarely will two women have the same treatment. This is good as treatment is individualized but can be confusing as well.
Inflammatory breast cancer (IBC) is very rare (approximately 1% of breast cancers diagnosed). It is characterized by a red, swollen breast with skin dimpling or nipple changes. Sometimes antibiotics are given as this can mimic a breast infection. IBC usually covers the entire breast whereas, infection is usually more localized. Even though rare, one should see their physician if this is expected.
In an attempt to make the journey easier, here are the usual 8 steps through the Breast Cancer maze.
STEP 1: Mammogram, sonogram and needle biopsy for diagnosis.
STEP 2: Visit to the surgeon for discussion of surgical options.
A breast exam will be performed and mammogram films reviewed. A breast MRI or PET mammogram (PEM) will be scheduled on for most women with a new cancer diagnosis. The MRI or PEM can find additional tumors that the mammogram might have missed especially if one has dense breasts. Sometimes other radiology tests (Bone scan, PET Scan or CT Scan) will be ordered. Genetic testing for the BRCA gene will be discussed and blood drawn a sample taken if indicated by your family history. The surgical option will be discussed explained. Briefly, the choices are lumpectomy with radiation or mastectomy with or without reconstruction. Reconstruction can be done at the same time as the mastectomy. A plastic surgeon will be consulted for reconstruction if desired.
STEP 3: Discussion of the results.
A separate meeting can be scheduled to discuss any unexpected test results. Sometimes the breast MRI or PEM uncovers an area that needs a second look sonogram or possibly a needle biopsy. A pre-op appointment is scheduled with Debbie to go over all the details and do a baseline L-Dex or lymphedema screen (see lymphedema etc., link to Impedimed site or our info)
STEP 4: Surgery.
Lumpectomy and lymph node biopsy is a day surgery without overnight stay in the hospital and drains are not needed. If the lumpectomy is performed on Thursday or Friday, one goes back to work on Monday in most cases. Mastectomy is a one or, less often, two night stay in the hospital. Usually the discomfort is not as bad as expected. I use an injection of long acting pain medicine during surgery. Occasionally a pain reducing pump will be used. A stretchy support garment is provided that helps decrease pain by lessening swelling and bruising. A post op visit usually takes place one week later. The pathology results take one to three days and will determine the stage of breast cancer and further treatment. Debbie or I will call you with these results as soon as we receive them.
STEP 5: Medical or Radiation Oncologist.
A visit will be scheduled to a Medical Oncologist who will discuss any further treatment such as chemotherapy or anti-estrogen pills. I refer all cancer patients to an oncologist for this important visit. A Radiation Oncologist gives radiation treatment if a lumpectomy was performed or in certain cases after mastectomy. These treatments usually begin 3-4 weeks after surgery. If you have a preference for a physician or location closer to home or work, this can be arranged. Second opinions can also be arranged.
STEP 6: Breast cancer treatment begins.
Chemotherapy can last anywhere from 3 to 18 months. Some women need a drug called Herceptin that is given once a month for one year. Radiation begins 3 weeks after surgery or at the completion of chemotherapy. Traditional whole breast radiation is given Monday through Friday and lasts 20 minutes from entering the office to leaving. It truly takes more time to changing clothes than the actual treatment. Whole breast radiation lasts 6 ½ weeks with minimal side effects. Mammosite or partial breast radiation is advanced radiation directed to the site of the prior tumor. through specialized balloon catheter inserted in the breast. View a demonstration of the Mammosite procedure. It is given twice a day for 5 days. The type of radiation treatment is determined by the size and location of your tumor, your age and your comfort levels with the risks and benefits of each treatment. Anti-estrogen pills are given after chemo and radiation if indicated.
STEP 7: Reconstruction.
If chemotherapy was needed, reconstructive breast surgery is completed after chemo. The tissue expander is exchanged for the permanent implant. The nipple reconstruction will be completed. Sometimes the opposite side needs a lift or reduction. Reconstruction using ones own tissue or fat alone is also available.
STEP 8: Follow-up process begins.
The oncologist will begin follow-up every 3 to 6 months. The radiation oncologist might see you one or two times after radiation is completed. Debbie or I will see you every six months for a few years then yearly for ever many more years. With a lumpectomy, a diagnostic mammogram is obtained every 6 months on the cancer side (and yearly for both) for a total of five years. Mammography then becomes yearly. No mammograms are needed on the mastectomy side. Physical exam is most important in this case. The opposite remaining breast still needs yearly mammograms. In some instances an MRI or PEM will be used with mammograms or sonograms, especially in the case of dense breasts.