Breast Cancer

BREAST CANCER

Cancer can start any place in the body. Cancer that starts in the breast is called breast cancer. It starts when cells in the breast grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should.

Cancer cells can spread to other parts of the body. Cancer cells in the breast can sometimes travel to the bone and grow there. When cancer cells do this, it’s called metastasis (pronounced meh-TAS-tuh-sis). To doctors, the cancer cells in the new place look just like the ones from the breast.

Cancer is always named for the place where it starts. So when breast cancer spreads to the bone (or any other place), it’s still called breast cancer. It’s not called bone cancer unless it starts from cells in the bone.

There are many types of breast cancer. Some are very rare. Your doctor can tell you more about the type you have. Below are the medical names for the most common types of breast cancer. (Carcinoma is another name for cancer. It’s pronounced CAR-sin-O-muh.)

Ductal carcinoma in situ or DCIS
DCIS is very early breast cancer. In DCIS, the cancer cells are only found inside the ducts. (Ducts are the tiny tubes that carry milk to the nipple). The cancer cells have not spread through the walls of the ducts into the nearby breast tissue. Nearly all women with DCIS can be cured.

Lobular carcinoma in situ or LCIS
LCIS starts in the glands that make milk but does not grow through the walls of the glands. It’s not cancer, but women with LCIS have a higher chance of getting breast cancer. If you have LCIS, you should be sure to get mammograms the way your doctor tells you to.

Invasive ductal carcinoma
This is the most common type of breast cancer. It starts in a milk duct of the breast and grows through the wall of the duct into the nearby breast tissue. It can spread to other parts of the body, too.

Invasive lobular carcinoma
This breast cancer starts in the milk glands. These glands are called lobules (pronounced LOB-yules). It can spread to other parts of the body.

Inflammatory breast cancer or IBC
This is a rare type of breast cancer. Most often, there’s no lump or tumor. IBC makes the skin of the breast look red and feel warm. The skin can also look thick and pitted – kind of like an orange peel. The breast may get bigger, harder, tender, or itchy.

Because there’s no lump, IBC may not show up on a mammogram. This can make it harder to find IBC early. It’s more likely to spread and is harder to cure than invasive ductal or lobular cancer.

Questions to ask the doctor

• Why do you think I have cancer?
• Is there a chance I don’t have cancer?
• Would you please write down the kind of cancer you think I might have?
• What will happen next?
• How does the doctor know I have breast cancer?

Tests that may have been done
A change seen on your mammogram may be the first sign of breast cancer. Or you may have found a lump or other change in your breast.

The doctor asks you questions about your health and does a physical exam. A breast exam is done to look for changes in the nipples or the skin of your breasts. The doctor also checks the lymph (pronounced limf) nodes under your arm and above your collarbone. Swollen or hard lymph nodes might mean breast cancer has spread.

If signs are pointing to breast cancer, more tests will be done. Here are some of the tests you may need:

Mammogram (pronounced MAM-uh-gram): Mammograms are mostly used to find breast cancer early. But another mammogram may be done to look more closely at the breast problem you might have.

MRI MRIs use radio waves and strong magnets instead of x-rays to take pictures. MRIs can be used to learn more about the size of the cancer and look for other tumors in the breast.

Breast ultrasound For this test, a small wand is moved around on your skin. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture that you can see on a computer screen. Ultrasound can help the doctor see if a lump is a fluid-filled cyst (pronounced sist) or a tumor that could be cancer.

Ductogram (pronounced DUCK-tuh-gram): This test may be used to help find the cause of nipple discharge. To do the test, the doctor places a very thin plastic tube through the nipple and into the duct. A small amount of dye is put into the duct. It outlines the shape of the duct on an x-ray and shows if there’s a tumor in the duct.

Nipple discharge exam: If you have fluid coming from your nipple, some of it may be sent to a lab. There, it will be checked to see if there are cancer cells in it.

Questions to ask the doctor

• What tests will I need to have?
• Who will do these tests?
• Where will they be done?
• Who can explain them to me?
• How and when will I get the results?
• Who will explain the results to me?
• What do I need to do next?
• How serious is my cancer?

Breast Biopsy
In a biopsy (BY-op-see), the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have cancer.

There are many types of biopsies. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.

Sometimes, surgery is needed to take out all or part of the lump to find out if it’s cancer. This is often done in a hospital under local anesthesia (pronounced AN-es-THEE-zhuh). This means you’re awake but your breast is numb. You may also be given medicine to make you sleepy.

Grading breast cancer
The cancer cells in the biopsy sample will be graded. This helps doctors predict how fast the cancer is likely to grow and spread. Cancer cells are graded based on how much they look like normal cells. Grades 1, 2, and 3 are used. Cells that look very different from normal cells are given a higher grade (3) and tend to grow faster. Ask the doctor to explain the grade of your cancer. The grade helps the doctor decide which treatment is best for you.

If you have breast cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was “stage 1” or “stage 2.” Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the spread of the cancer through the breast. It also tells if the cancer has spread to other organs of your body that are close by or farther away.

Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the breast. Be sure to ask the doctor about the cancer stage and what it means for you.

Questions to ask the doctor

• Do you know the stage of the cancer?
• If not, how and when will you find out the stage of the cancer?
• Would you explain to me what the stage means in my case?
• Based on the stage of the cancer, how long do you think I’ll live?
• What will happen next?

What kind of treatment will I need?
There are many ways to treat breast cancer, but the main types of treatment are local or systemic.

Surgery and radiation are used to treat only the cancer. They do not affect the rest of the body. This is called local treatment.

Chemo and hormone treatment drugs go through the whole body. They can reach cancer cells anywhere in the body. They are called systemic (pronounced sis-TEM-ick) treatment.

Doctors often use both local and systemic treatments to treat breast cancer. The treatment plan that’s best for you will depend on:

• The stage and grade of the cancer
• The chance that a type of treatment will cure the cancer or help in some way
• Your age
• Other health problems you have
• Your feelings about the treatment and the side effects that come with it

Surgery of breast cancer
Most women with breast cancer have some type of surgery (SUR-jur-ee). Some types of surgery are lumpectomy (lump-ECK-tuh-me), mastectomy (mas-TEK-tuh-me), and taking out lymph nodes from the underarm. Women who have a mastectomy may also decide to have the breast shape rebuilt, either at the same time or later on.

Choosing between lumpectomy and mastectomy
Lumpectomy only takes out the lump and a little bit around it. It lets you keep most of your breast. The downside is that you’ll most likely need radiation treatment after surgery. But some women who have a mastectomy also need radiation afterward.

When choosing between a lumpectomy and mastectomy, be sure to get all the facts. At first you may think that a mastectomy is the best way to “get it all out.” Women tend to choose mastectomy because of this. But in most cases, lumpectomy is just as good as mastectomy. Talk to your cancer care team. Learn as much as you can to make the right choice for you.

Reconstructive surgery
If you have a mastectomy, you may want to think about having your breast shape rebuilt. This is called breast reconstruction. It’s not done to treat the cancer. It’s done to build a breast shape that looks a lot like your natural breast. If you’re going to have a mastectomy and are thinking about having reconstruction, you should talk to a plastic surgeon before the mastectomy is done. Your breast can be rebuilt at the same time the mastectomy is done or later on.

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat women with breast cancer should be able to help you with any problems that come up.

Radiation treatments
Radiation (pronounced RAY-dee-A-shun) uses high-energy rays (like x-rays) to kill cancer cells. This treatment may be used to kill any cancer cells that may be left in the breast, chest, or arm pit after surgery.

There are 2 main ways radiation can be given. It can be aimed at the breast from a machine outside the body. This is called external beam radiation. Or, radioactive seeds can be put right into the breast tissue near the cancer. This is called brachytherapy (pronounced BRAKE-ee-THER-uh-pee).

Side effects of radiation treatments
If your doctor suggests radiation treatment, talk about what side effects might happen. Side effects depend on the type of radiation that’s used. The most common side effects of radiation are:

• Skin changes where the radiation is given
• Feeling very tired (fatigue, which is pronounced fuh-TEEG)

Most side effects get better after treatment ends. Some might last longer. Talk to your cancer care team about what you can expect.

Chemo
Chemo (pronounced KEY-mo) is the short word for chemotherapy (pronounced KEY-mo-THER-uh-pee) – the use of drugs to fight cancer. The drugs may be given into a vein or taken as pills. These drugs go into the blood and spread through the body. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.

Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends. There are ways to treat most chemo side effects. If you have side effects, be sure to talk to your cancer care team so they can help.

Hormone treatment
Estrogen (pronounced ES-tro-jin) is the female hormone that your body makes until you go through the change of life (menopause). After that, the body still makes it but in much smaller amounts. Even these small amounts are enough to cause some breast cancers to grow. Drugs that block the effect of estrogen or cut down estrogen levels can be used to treat these breast cancers. Drugs like this are a type of hormone treatment.

Tamoxifen is the estrogen-blocking drug that’s most often used. It’s taken as a pill once a day, usually for 5 years after surgery. It helps lower the chances of the cancer coming back for some women. There are other drugs and other ways to lower estrogen to help fight breast cancer. Ask your doctor to tell you about any drugs you are given.

Clinical trials
Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.

Clinical trials are one way to get state-of-the art cancer treatment. They are the only way for doctors to find better ways to treat cancer. If your doctor can find one that’s looking at the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

What about other treatments that I hear about?
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor

• What treatment do you think is best for me?
• What’s the goal of this treatment? Do you think it could cure the cancer?
• Will treatment include surgery? If so, who will do the surgery?
• What will the surgery be like?
• Will I need other types of treatment, too?
• What’s the goal of these treatments?
• What side effects could I have from these treatments?
• What can I do about side effects that I might have?
• Is there a clinical trial that might be right for me?
• What about special vitamins or diets that friends tell me about? How will I know if they are safe?
• What should I do to be ready for treatment?
• Is there anything I can do to help the treatment work better?
• What’s the next step?
• What will happen after treatment?

What will happen after treatment?
You’ll be glad when treatment is over. But it’s hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back.

At first, your visits may be every 3 to 6 months. Then, the longer you’re cancer-free, the less often the visits are needed. After 5 years, they may be done once a year.

If you still have a breast (or part of one), you’ll need to get a mammogram every year.

If you’re taking tamoxifen, you should have a pelvic exam every year because this drug can raise your risk of uterus cancer. Be sure to tell your doctor right away if you have any vaginal bleeding that’s not normal. This is most often caused by something other than cancer, but it can be the first sign of cancer in the uterus.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us or talk to your cancer care team to find out what you can do to feel better.