Breast Cancer Treatment, Part 3

by National Cancer Institute

(Page 3 of 9)

To be sure that you have a correct diagnosis if breast cancer in situ is detected, an experienced pathologist should examine your biopsy slides. You may want to have yourslides examined also by a second pathologist at a university hospital, cancer center, or breast clinic. This is important because it is sometimes difficult to make an accurate diagnosis. The pathologist needs to determine the types of cells that are present in the tissue sample, how fast the cells are changing, and whether it is likely to become invasive cancer. The diagnosis will help your doctor decide on the appropriate treatment from a wide range of choices. The decision could be to have frequent followup exams to watch the suspicious area, or surgery to remove only the affected tissue, or surgery to remove one or both breasts. Surgery removing only the affected area is sometimes followed by radiation therapy to the breast.

Prognosis (Chance of Recovery)

Most women who are treated for early breast cancer go on to live healthy, active lives. You may have more choices of treatment if your breast cancer is found early.

Treatments have changed over time. Today, many women who are diagnosed with breast cancer do not have to lose a breast. Because there are improved ways to treat breast cancer, it is more important than ever for you to learn all you can. Working with your team of medical specialists, you can play a key role in choosing the treatment that is best for you.

Once your doctor has determined your specific type and stage of breast cancer, you can begin to plan for your treatment and recovery. Your chance of recovery will depend on many factors, including:

• The type and stage of your cancer (what kind of cancer; the size of the tumor; and whether it is only in your breast, or has spread to any lymph nodes or to other parts of your body).

• How fast the cancer is growing. Special lab tests on the tissue can measure how fast the cancer cells are dividing and how different they are compared to normal breast cells.

• How much the breast cancer cells depend on female hormones (estrogen and progesterone) for growth which can be measured by hormone receptor tests. Patients whose tumors are found to be dependent on hormones (described as estrogen-positive or progesterone-positive) can be treated by hormonal therapy to prevent further growth or recurrence of breast cancer.

• Your age and menopausal status (whether or not you still have monthly menstrual periods).

• Your general state of health.

Risk Factors for Recurrence

Your chance of surviving breast cancer will also depend upon your risk for return of cancer after treatment is completed. Some women are at higher risk for the spread or return of breast cancer. In many cases, doctors can't explain why one patient stays well and another does not. Remember, the risk factors for recurrence are complex. They are not absolute predictions of your future health. Some factors that affect the spread or the recurrence of breast cancer are:

• Tumor size: The smaller your tumor, the lower the risk.
• Lymph nodes: The fewer underarm lymph nodes that have cancer, the lower your risk.
• Cell growth: Cancer cells that grow slowly are linked to a lower risk.
• Hormones: If a tumor depends on hormones for growth, hormonal therapy can lower the risk of cancer spread or recurrence.

QUESTIONS TO ASK YOUR DOCTOR AFTER A BIOPSY Please explain what is on the pathology report. What type of breast cancer do I have? What stage of breast cancer do I have? Did a pathologist who is experienced in diagnosing breast cancer examine my biopsy slides? Should my biopsy slides be examined again? Why or why not? What are the chances that the cancer has spread within or outside my breast? Were lab tests done on the tumor tissue? What do the results mean for me? Were estrogen and progesterone receptor tests done? What do the results mean for me? What other tests do I need? (Chest x-ray, bone scan, etc.) What are my treatment choices? How can I get more information about them? What benefit can I expect from each kind of treatment? What are the risks and possible side effects of each treatment? Short-term? Long-term? What are the risks if I don't get treatment? What are my chances for recurrence? How can I get another opinion? Did you check NCI's PDQ database 4 for physicians to get the latest information about my type and stage of breast cancer? Is there any research being done on my kind of cancer? Did you check NCI's Web site for clinical trials?

Your Treatment Team

Once your doctor has all the specific information about your breast cancer, you will talk about all the treatments considered appropriate for your case. No one doctor is able to provide all the care and services you may need, and you will quickly learn about new people who will be on your treatment team. Some of the medical experts who may be part of your treatment team are:

Anesthesiologist: a doctor who gives drugs or gases that keep you comfortable during surgery.

Gynecologist: A doctor who specializes in the care and treatment of women's reproductive systems. This doctor or your primary care doctor can serve as the manager and main source of information among your treatment team members and you.

Nutritionist or dietitian: a health professional with specialized training in nutrition who can offer help and choices about the foods you eat.

Oncologist, medical oncologist, or cancer specialist: a doctor who uses chemotherapy or hormonal therapy to treat cancer. This specialist can put together all the information about your case and can discuss your treatment choices with you.

Oncology nurse: a nurse with special training in caring for cancer patients. You may also receive care from a clinical nurse specialist or nurse practitioner.

Oncology pharmacy specialist: a person who prepares anticancer drugs in consultation with the oncologist and can answer your questions about chemotherapy.

Pathologist: a doctor who examines tissues and cells under a microscope to determine if they are normal or abnormal.

Physical therapist: a health professional who teaches exercises that help restore arm and shoulder movement and build back strength after breast cancer surgery.

Plastic surgeon or reconstructive surgeon: a doctor who can surgically rebuild (reconstruct) your breast.

About the Author

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