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 comes 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. Genomic (tumor genes) testing can tell if someone will benefit from chemotherapy. Other genomic testing can tell if radiation is needed. A medical oncologist and/or a radiation oncologist will be involved. In some cases chemotherapy (called neoadjuvant chemotherapy) is given before surgery. Others only the pill form of therapy is needed. There are also many surgical options including breast conservation, mastectomy, skin sparing mastectomy, nipple sparing mastectomy, etc. Breast cancer today has so many treatment options that rarely will two women have the same treatment. This is very good as treatment is as individual as the woman or man undergoing the therapy. It can also be very confusing.
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 might be scheduled for more information depending on age, breast density (and anxiety levels) or other factors. The MRI can find additional tumors that the mammogram might have missed. Sometimes other radiology tests (Bone scan, PET Scan or CT Scan) will be ordered as well. There are several genes that can cause breast cancer in a broad panel of cancer genes that includes BRCA and many others. This will be discussed and a sample taken if indicated by your age and family history. The surgical option will also be 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 in person meeting or televisit can be scheduled to discuss any test results. Sometimes the breast MRI uncovers an area that needs a second look sonogram or possibly a needle biopsy. The genetic testing results can possibly change surgery plans. A pre-op appointment is scheduled with Brittany Kovalix, PA-
STEP 4: Surgery.
Lumpectomy and sentinel lymph node biopsy is a day surgery (without overnight stay in the hospital) or drains. If the lumpectomy is performed on a 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. Dr Anglin has started an ERAS, or Enhanced Recovery after Surgery, program to lessen postoperative pain and nausea. This consists of oral medications pre-surgery, liquid drink pre-surgery and intraoperative injections of long acting pain medications during surgery. A stretchy support garment is provided that helps decrease pain by lessening swelling and bruising. A post op visit usually takes place one to two weeks later. The pathology results take 5 to 7 days and will determine the stage of breast cancer and further treatment. Brittany or Dr. Anglin will call you with these results as soon as received.
STEP 5: Medical or Radiation Oncologist.
Patients are referred to a Medical Oncologist to discuss 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. Another option is 3 to 5 day partial breast radiation. These treatments usually begin 2-4 weeks after surgery. A preference for a physician or location closer to home or work 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 2-3 weeks after surgery or at the completion of chemotherapy. Traditional whole breast radiation is given Monday through Friday and lasts 15 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 a specialized catheter inserted in the breast. View a demonstration of the Mammosite procedure. It is given twice a day for 3-5 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. A tissue expander, placed at mastectomy, is exchanged for the permanent implant. The nipple reconstruction will be completed or maybe a 3-D tattoo. Sometimes the opposite side needs a lift or reduction. Reconstruction using one’s own tissue or fat 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. Brittany or Dr. Anglin will see you every six months for a few years then yearly many more years until beginning a Survivorship Program. With a lumpectomy, a diagnostic mammogram is obtained every 6 months on the cancer side (and yearly for both) for a total of 2-3 years. Mammography then returns to a yearly screening study. No mammograms are needed after mastectomy. Physical exam is most important in this case. The opposite or remaining breast still requires yearly mammograms if a single mastectomy was performed. In some instances a MRI will be used with mammograms or sonograms, especially in the case of dense breasts.