When you’re first diagnosed with breast cancer, it’s normal to feel bombarded by information. But even with all this new information coming at you, you’re likely going to have some of your own questions. The following nine questions are some of the things you’re probably wondering right now.
Now that I’ve been diagnosed with breast cancer, are there other tests I will need?
If you received a diagnosis of breast cancer, you probably already had mammography, ultrasound, and a biopsy. Other imaging tests may include an MRI of the breast or CT scan that uses X-rays of the breast, chest, or abdomen, or a PET scan that measures how much of a radioactive tracer the cancer cells in the body absorb. These imaging tests can help determine the tumor size, where in the breast the tumor is located, and whether or not the tumor has spread to lymph nodes, other parts of the chest, the abdomen, or other parts of the body. In addition, bone scans can determine whether or not the tumor has spread to the bone.
A biopsy can tell what type of tumor cell is present, what grade or degree of aggressiveness the cells have, and whether the cancer cells have receptors on their surface that can bind to hormones or other proteins in the body, which can stimulate the tumor to grow. The American Cancer Society recommends that all patients with invasive breast cancer be tested to see if the surface of their cells contain high levels of the tumor receptor HER2 and/or estrogen and progesterone receptors. These receptors on the surface of cells help your oncology team plan the most effective treatment for you.
After treatment, your oncologist will monitor the effectiveness of treatment with more imaging tests, as well as making sure that your blood cell counts, heart, liver, and kidney function stay at acceptable levels.
What stage of breast cancer do I have?
The stage of breast cancer is based mainly on the size of the tumor and whether or not the tumor has spread to lymph nodes or other areas of the body. Cellular characteristics, such as the type of breast cancer and the degree of aggressiveness of the tumor, can affect the initial stage at the time of diagnosis. Usually, physical exams, imaging tests, biopsies, and analysis of surgical specimens of the tumor are used to determine the stage of breast cancer.
Different classification systems for stages of breast cancer exist. A common, simple staging system is by number:
- Stage 0: Called carcinoma in situ, this stage is a precancerous condition of the breast that hasn’t invaded the breast tissue or spread to lymph nodes or distant sites in the body.
- Stage 1: The tumor is less than or equal to 2 centimeters (cm) in diameter and hasn’t spread to distant sites.
- Stage 2: The tumor is between less than 2 cm in diameter and larger than 5 cm in diameter and hasn’t invaded the chest wall or skin or to distant sites.
- Stage 3: The tumor can be of any size, has invaded into the chest wall or skin, may have spread to lymph nodes, but has not spread to distant sites.
- Stage 4: The tumor can be of any size, may have spread to lymph nodes, and has spread or metastasized to distant sites of the body like the bone, liver, or lungs.
More detailed stages for the numerical system use letters to further describe the degree of spread. These stages are derived from a staging system, called the TMN system, which uses the size of the tumor (T), whether or not the tumor has spread to the lymph nodes (N), and whether or not the tumor has metastasized to distant sites in the body (M).
What symptoms of breast cancer might I experience?
Symptoms of breast cancer vary from one person to another. If you already have a diagnosis of breast cancer, you might experience none or only some of the following possible symptoms:
- a lump or mass that that you can feel within the breast
- swelling of the breast
- pain in the nipple or the rest of the breast
- irritation, redness, scaling, or thickening of the skin of the breast
- a dimpling (folding) of the skin of the breast
- nipple redness, scaling, or thickening
- discharge (that is not breast milk) coming from the nipple
- swollen lymph nodes or a lump in the lymph nodes under an arm or surrounding the collar bone
What are my treatment options?
Your treatment options will depend on your medical history, your age, the type of breast cancer you have, the grade of your tumor, the types of receptors on the surface of your tumor, your recurrence score, and the stage of your cancer.
Possible treatment options include the following, as well as combinations of treatments:
- surgery to remove the tumor (a lumpectomy), a part of the breast, all of the breast (a mastectomy), and/or affected lymph nodes
- hormone therapy to block the effects of the natural hormones in the body on cell growth
- monoclonal antibodies that bind to HER2 receptors on the surface of the tumors
- radiation therapy
Therapy performed to shrink the tumor before surgery is called neoadjuvant therapy. Therapy performed after surgery to reduce the chance of recurrence of the tumor or spread of the tumor is called adjuvant therapy.
Also, you may want to consider participating in a clinical trial, which is a study of new types of therapies. See www.clinicaltrials.gov for information on clinical trials.
What medications for breast cancer will my doctor recommend for me?
Again, the medications your doctor or healthcare team recommends will depend on your medical history, your age, the type of breast cancer you have, the grade of your tumor, the types of receptors on the surface of your tumor, and the stage of your cancer.
A variety of different chemotherapies, hormone therapies, and HER2-targeted monoclonal antibodies are available to treat breast cancer. Other medications your oncologist may recommend are for reducing the side effects of your treatment.
Will I lose my hair because I am being treated for breast cancer?
Most but not all chemotherapy medicines used to treat breast cancer cause loss of hair, or alopecia. Fortunately, hair loss due to chemo usually is temporary. Ask your oncologist whether the medications recommended have the side effect of causing alopecia.
What other side effects of treatment might I experience?
Other side effects of treatment that you may experience depend upon the type of therapy you receive. Surgery can result in post-surgical pain, scarring, and lymphedema or swelling of the arm. Radiation therapy can result in pain, irritation of the skin, lymphedema, and fatigue. Hormone therapy may affect menstruation, fertility, and sexual function.
Possible side effects of chemotherapy, which depend on the particular medications you receive, may result in dryness and irritation of the mouth (called mucositis), nausea and vomiting, anemia, lowering of levels of white blood cells leading to infections, fatigue, effects on your heart and liver function, and a condition called chemo brain, which affects memory and thinking. Monoclonal antibodies may cause fever, chills, fatigue, headache, nausea, vomiting, diarrhea, low blood pressure, effects on the heart, damage to the nerves in the limbs, and rash.
Consult your oncologist regarding side effects and how to manage them during and after treatment. For example, some women may want to consider surgical reconstruction of the affected breast.
What is my outlook after treatment?
It’s important to remember that early diagnosis and treatment is the most important factor in surviving breast cancer. The earlier your stage of breast cancer is at the time of diagnosis and treatment, the greater the likelihood of curative treatment. Goals of treatment are to shrink or destroy the tumor, reduce the risk of recurrence, relieve symptoms, improve quality of life, prolong your life, and, whenever possible, to cure your cancer. Your oncologist will discuss your outlook specifics with you and monitor the effectiveness and side effects of treatment.