Breast Cancer Information

Breast Cancer Biology - A Helpful Primer

What is Cancer? Cancer occurs when, for largely unknown reasons, cells become abnormal and divide without control or order. All parts of the body are made up of cells that normally divide and multiply only when the body needs them. A tumor occurs when some cells keep dividing uncontrollably and clump together into a mass. Most breast tumors are benign, which means they do not invade or damage the surrounding tissue. However, some breast tumors are malignant and can destroy nearby tissues and eventually spread or “metastasize” to other parts of the body either through the blood stream or, more commonly, through the lymph nodes.

Two kinds of cells can lead to breast cancer: ductal cancers arise from the cells lining the canals that carry milk to the nipple, and lobular cancers arise from cells lining the glands that make the milk, as depicted in this figure of the female breast. Roughly 85% of the cancers found in women are of the ductal variety. The process of growth from a single cluster of cells to a malignant tumor is slow, perhaps as long as several years, although the exact growth period varies from one patient to the next.

The change from normal duct cells to cancer requires several steps (see diagram below).

• Hyperplasia: The cells lining the duct start to divide at an abnormally fast rate. At this point, the cells still look normal under the microscope. This tumor still represents a benign process, such as fibrocystic disease of the breast.
• Atypia: The cells start to look different, ‘atypical’. Although this is still a benign condition, these changes are believed to be pre-cancerous and put the patient at a higher risk of getting a cancer in the future.
• In-Situ Cancer: Also called Ductal Carcinoma In Situ (DCIS). The cells look very abnormal, and grow at such a rate that they clump together. At this stage, the cells are still contained within the lining of the duct.
• Invasive Cancer: Also called Infiltrating Carcinoma. The abnormal cells now eat through the lining of the duct and invade the surrounding normal breast tissue, the lymphatics and the blood stream.

Why should women have regular mammograms and exams?

As malignant cells multiply, they eventually form a clump of tissue, commonly referred to as a lump or mass or tumor. Because the smaller tumors are less likely to spread and are easier to treat than larger ones, finding lumps early can make a big difference. Mammograms are special X-rays than can do just that, finds tumors in the breast before they grow too large. Since mammograms can miss up to 20% of cancers, regular exams by the woman and her doctor can also be used to find the smaller tumors.

The only way to find out for sure if a breast lump or suspicious mass on mammogram is a cancer is by having a biopsy. A pathologist who makes the diagnosis examines the tissue under a microscope after a surgeon or radiologist removes a sample of it during a biopsy. If your biopsy result is positive, it means that the tumor or tissue from the suspicious area contains cancer and you will need treatment.

How Cancer Spreads

A malignant tumor can invade and destroy the surrounding normal tissue. The larger it grows, the more likely it is to invade blood vessels and lymphatics. Once the cancer cells are able to enter the bloodstream or lymph nodes, they can travel to the lungs, liver, brain and bones. When breast cancer spreads, it is called metastatic breast cancer even though it is found in another part of the body. For example, breast cancer that has spread to the bones is still called breast cancer, not bone cancer.

Breast cancer cells usually can get trapped in the lymph nodes under the arm, called axillary lymph nodes, before they spread to the rest of the body. Although it is not common, some patients whose axillary lymph nodes are clear may still have spread. The faster the tumor invades the surrounding tissue and reaches the lymph nodes, the more ‘aggressive’ it is. More importantly though, the larger the tumor, the more likel;y it is to metastasize (see “Stages” below.)

What Are The Stages Of Breast Cancer?

Breast cancer is a complex disease. All cases are not the same. Once breast cancer has been found, more tests will be done to find out the specific pattern of your disease. This important step is called staging. Knowing the exact Stage of your disease will help your doctor plan your treatment. Staging is often confused with the Grade of the cancer, which is a description of the cells when seen under a microscope.

• Stage 0 breast cancer is reserved to Carcinoma-In-Situ (CIS). Regardless of size, CIS rarely metastasizes to lymph nodes or other areas.
• Stage I breast cancer: The cancer is smaller than 1 inch across and it hasn't spread anywhere.
• Stage II breast cancer is one of the following: the tumor is less than an inch across but has spread to the underarm lymph nodes (IIA); or the tumor is between 1-2 inches (with or without spread to the lymph nodes); or the tumor is larger than 2 inches and not has spread to the lymph nodes under the arm (both IIB).
• Stage IIIA breast cancer is also called locally advanced breast cancer. The tumor is larger than 2 inches and has spread to the lymph nodes under the arm, or a tumor that is any size with cancerous lymph nodes that adhere to one another or surrounding tissue (IIIA).
• Stage IIIB breast cancer is a tumor of any size that has spread to the skin, chest wall or internal mammary lymph nodes (located beneath the breast and inside the chest).
• Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to places far away from the breast, such as bones, lungs or lymph nodes.

Your team of doctor needs to know the stage of the breast cancer in order to plan the most appropriate therapeutic combination to treat it. That is why the surgeon often recommends removing the tumor as well as the axillary lymph nodes. Listed below are the surgical alternatives most often offered to patients with breast cancer.

SURGICAL PROCEDURES

Lumpectomy / Partial or Segmental Mastectomy

The surgeon removes the lump containing the cancer without removing the entire breast. This procedure usually results in removing all the cancer, while leaving you with much of the remaining breast tissue, and is usually recommended for a smaller cancers.  Depending on the size and location of the cancer, this surgery can conserve most of the breast.  In addition, this procedure is usually coupled with a Sentinel Lymph Node biopsy (see below).  Women who have lumpectomies almost always have radiation therapy as well. Radiation therapy is used to destroy any cancer cells that may not have been removed by surgery. 

Lumpectomy/ Partial Mastectomy with Axillary Lymph Node Dissection (Removal of Lymph Nodes)

In addition to the Partial Mastectomy described above, the surgeon may also remove the lymph nodes under the armpit, usually through a separate incision.  This additional dissection of the lymph nodes is carried out if the cancer has already spread to the lymph nodes as confirmed on physical examination or Sentinel Node Biopsy.  In most cases, radiation therapy follows.  

Total (or Simple) Mastectomy

The surgeon removes the entire breast. Some lymph nodes under the arm may be removed also, because it is hard to separate the breast tissue from the lymph nodes in the armpit. This option is usually recommended for cancers that are too large or are suspected of being in more than one part of the breast. Some women with smaller cancers that can be treated with lumpectomy alone choose to have a mastectomy instead.  The two primary reasons for that are avoiding radiation and decreasing the recurrence rate (the chance of cancer returning to the breast months to years after lumpectomy).  In addition, this procedure is usually coupled with a Sentinel Lymph Node biopsy (see below).

Modified Radical Mastectomy

The surgeon removes the breast, some of the lymph nodes under the arm including the Sentinel Lymph nodes (see below), along with the lining over the chest muscles and sometimes part of the chest muscles.  This option is usually recommended for large invasive cancers. It can also be recommended for smaller invasive cancers instead of lumpectomy with axillary node dissection.

Lumpectomy or Mastectomy? What’s right for you.

Most cancers that are still small and unlikely to have spread out of the breast can be treated with lumpectomy or partial mastectomy.  This option is commonly referred to as 'breast conserving therapy', because most of the normal breast tissue remains intact.

Given the choice, the decision of whether a woman undergoes a mastectomy or breast conserving therapy is entirely up to her.  You should discuss the pros and cons of each method with your surgeon.  However, several important points need to be emphasized when contemplating this decision:

• Lumpectomy offers the best cosmetic outcome available for the treatment of breast cancer. In most cases, the scar from surgery can be easily hidden in a bra, and the bust remains full. The nipple and the sensation around it will also remain. Finally, the woman does not go through the shock of losing her breast.
• After a lumpectomy, most women will have to undergo radiation therapy. Radiation is designed to ‘kill’ cancer cells that may be remaining in the breast, and thus decrease the likelihood that the cancer would come back in the breast after treatment (so-called local recurrence).
• Radiation does not completely eliminate the risk that the cancer would come back. In fact, the risk of local recurrence after breast conserving therapy even with radiation remains higher than the risk of recurrence after mastectomy.
• Radiation will increase the time required to treat the cancer, and is not without its risks.
• Mastectomy offers the smallest chance that the cancer would come back in the breast but it does not completely eliminate this risk.
• Women who undergo a mastectomy rarely require radiation therapy.
• Some women with a very large cancer or many axillary lymph nodes that are positive may need to have radiation therapy after a mastectomy.

However, a mastectomy is strongly recommended when: The cancer is large or found in more than one part of the breast, so-called multicentric disease. The breast is small or shaped so that a lumpectomy would leave little breast tissue or a very deformed breast. A woman chooses not to have radiation therapy. A woman prefers a mastectomy.

The Sentinel Lymph Node Procedure

This information provides you with an understanding of the procedures you will experience with the removal of your sentinel lymph nodes (SLN). The SLN is defined as the first lymph node the breast cancer would spread to and is believed to be the msot likely to contain cancer in the event of spread. The nodes are found during your surgery by means of a special technique that typically uses radioactive and blue-colored dyes which help the surgeon identify them. Usually, one to four SLN’s are found.  Sentinel lymph node biopsy has been developed to decrease the potential complications of removing multiple lymph nodes in your armpit.

Who is a candidate for this procedure?

If your invasive tumor is 3 cm or less, and your surgeon does not feel cancer in your lymph glands, then you can have this procedure.

Intra-operative "Radioactive" Mapping:

Your surgeon injects a small amount of radioactive material (called technetium sulfur colloid) into the skin or tissue around the site of the breast cancer. The amount of radiation exposure with this procedure will be less than that of a routine chest xray. The material moves through the breast’s lymphatic channels, and a special hand-held probe determines the location of the ‘Hot’ lymph nodes in your armpit. Your surgeon will then make a small incision over this area, and find the sentinel node.

Intra-operative "Blue Dye" Mapping:

Your surgeon injects the second blue dye (isosulfan blue) into the tissue around the breast cancer. The dye is picked up by the lymphatic vessels and then travels to the sentinel nodes. The SLN turns blue and can be identified more easily. The blue dye may discolor the injected skin, the lymphatic channels, and the urine. The blue color in the skin can remain for several weeks (sometimes months). The urine will return to normal color in 2-3 days. There is a possibility of allergic reaction to the blue dye at the time of injection, although this is rare.

All sentinel lymph nodes removed will be sent to the pathology department where they will be more closely examined.  All of the information about your lymph nodes will be reported in your pathology report within one week after your surgery.

Instructions Before Surgery

The following information will help you to prepare for your upcoming surgery. We hope this information may help to make this experience more comfortable for you. If you have any questions regarding the instructions, please contact Carolina Breast & Oncologic Surgery.

Carolina Breast & Oncologic Surgery - 413-0036

SurgiCenter Services Information - 847-7700

Pitt County Memorial Hospital Admissions- 847-4540

Always have the following information handy:

• Insurance Information
• List of Medications you are taking
• List of Allergies to medications

NOTHING TO EAT OR DRINK AFTER MIDNIGHT on the night prior to your surgery.

ANY MEDICATIONS THAT YOU TAKE SHOULD BE TAKEN AT THE USUAL TIME WITH A SIP OF WATER. People with diabetes, heart disease, and other illnesses should contact their primary care physicians for directions.

YOU WILL NEED TO HAVE A RESPONSIBLE ADULT WITH YOU TO DRIVE YOU HOME if you will be going home the same day as your surgery. It is unsafe and against hospital policy to permit you to drive home after surgery when you would have received  medications that might slow your responses (anesthesia, pain medication, or any medication to relieve anxiety).

INFORM US IF YOU ARE TAKING ASPIRIN, PLAVIX®, COUMADIN® OR OTHER BLOOD THINNING MEDICATION. You should not take aspirin or aspirin-containing products for 7 days prior to your surgery. Tylenol® is okay.

Wear comfortable clothing: a two-piece, loose outfit with a zipper or buttons in front is the easiest to put on. Some women prefer a loose dress with zipper or buttons in front. Wear a supportive non-wire bra (such as a bra that fastens in the front). The bra will provide comfort and support after your procedure.

Recommended items to bring with you if you plan to stay overnight in the hospital:

• Personal items (toothbrush, toiletries, pillow, earplugs)
• Slippers, extra socks
• Tape player and headphones, favorite music, books on tape
• Bathrobe open in front, button or zipper sweater
• Light reading material
• Important telephone numbers
• DO NOT BRING VALUABLES, or give them to family/friends

Instructions After Surgery

Pain Management

People experience different types and amount of pain or discomfort after surgery. You will be given a prescription for Percocet® or Vicodin® pain medication. It is recommended that you take these medications as needed before your pain is severe during the first 24-48 hours after your surgery. Ibuprofen (Advil® or Motrin®) or Tylenol® can be added to or replace Vicodin®

PLEASE NOTIFY US OF ANY DRUG ALLERGIES, REACTIONS OR MEDICAL PROBLEMS THAT WOULD PREVENT YOU FROM TAKING THESE DRUGS. PERCOCET® AND VICODIN® ARE NARCOTICS AND SHOULD NOT BE TAKEN WITH ALCOHOLIC DRINKS. DO NOT USE NARCOTICS WHILE DRIVING.

Healing and recovery are improved with good pain control. Narcotics can also cause or worsen constipation, so increase fluids, eat high fiber foods (like prunes and bran); Also make sure you are up, out of bed, taking small walks. An ice pack may be helpful to decrease discomfort and swelling, particularly to the armpit after a lymph node dissection. A small pillow positioned in the armpit may also decrease discomfort. You will have a breathing tube inserted into your throat during the surgery. This can often cause a sore throat for a few days following your surgery.

PLEASE WEAR A BRA FOR 5-7 DAYS FOLLOWING SURGERY, EVEN WHILE YOU SLEEP. This minimizes post-operative bleeding and will make you more comfortable.

Incision (Scar) and Dressing Care

Your incision has both stitches and Steristrips (thin white strips of tape placed over the incision) and is covered by a gauze dressing and tape. You can remove the gauze dressing over your incision in 2-3 days, but do not remove the Steristrips. If they fall off, do not attempt to replace them. Most of the time, the stitches placed under the strips are absorbable and do not need to be removed. NOTE: Bruising and some swelling are common after surgery. A lowgrade fever (under 100oF) is normal the day after surgery.

Sometimes, the incision is closed with steel clips. We will remove these clips in ten days to two weeks. You should keep a dry dressing over these clips until they are removed.

You may have a JACKSON-PRATT (JP) drain after your surgery. This drain is a plastic tube from under the skin to outside your body with a bulb attached to it. A nurse will teach you how to empty your drain prior to going home from the hospital. Empty the drain 2-3 times per day or when the bulb is full. Write down the amount drained on a sheet of paper. An information sheet on the JP drain is included in this pamphlet.

Showering and Bathing Instructions

IF YOU HAVE A DRAIN IN PLACE, or if you have steel clips on your incision, you cannot shower until 24 hours after the drain and the clips are removed.  We recommend sponge bathing until then.

IF YOU DO NOT HAVE A DRAIN, you may shower 2-3 days after the surgery. Remove the gauze and paper tape that cover your incision before you shower. Pat dry your incision thoroughly after showering with a clean towel and BE CAREFUL NOT TO REMOVE THE STERI-STRIPS OR SUTURES. You can cover them with a dry dressing afterwards. Activity after Surgery Avoid strenuous activity, heavy lifting, and vigorous exercise until the stitches are removed. Walking is a normal activity that can be restarted right away. You may restart driving when you are no longer on narcotics, all drains are out and you feel safe turning the wheel and stopping quickly.

THINGS YOU CAN DO...	THINGS YOU CAN NOT DO...
Cooking	Vacuuming
Washing dishes and clothes	Sweeping
Riding in a car	Heavy cleaning
Climbing stairs	Lifting heavy objects
	Heavy yard work
FOLLOWING A LYMPH NODE DISSECTION, YOU SHOULD MINIMIZE THE ACTIVITY OF THE AFFECTED ARM AS MUCH AS POSSIBLE UNTIL YOUR DOCTOR REMOVES THE JP DRAIN
Note, you must not avoid using your arm altogether and should move all joints on a regular basis. After all the drains have been removed, you can start exercises to regain movement and flexibility.

Return to Work

Most people return to work within 3 to 6 weeks. If you will be undergoing radiation and/or chemotherapy, that may be longer. Return to work also varies with your type of work, your overall health and personal preferences. Discuss returning to work with your physician or nurse.

Follow-Up After Surgery

The pathology results from your surgery should be available within one week after your surgery. Follow-up appointments to discuss the pathology results and examine the operative site are generally made by your nurse before you leave the hospital or surgery center. Call the Carolina Breast & Oncologic Surgery office to confirm your appointment or if you do not have one or do not remember it.

THE PATHOLOGY RESULTS ARE USUALLY NOT DISCUSSED OVER THE TELEPHONE.

Contact us for the following problems or any unanswered questions. Ask to speak with a nurse during the day or the answering service in the evening to reach your doctor or the doctor on call.

• Pain that is not relieved by medication
• Fever more than 101o F or chills
• Excessive bleeding (a very bloody dressing)
• Redness outside the dressing
• Excessive and painful swelling
• Discharge or bad odor from the wound
• Allergic or other reactions to medication(s)

Jackson-Pratt Drain Care

After surgery, you may have a drain(s) called a Jackson-Pratt (JP) drain. This device suctions and collects body fluids and blood from your surgical area. The drain promotes healing and recovery, and reduces the chance of infection. The drain will be in place until the drainage slows enough for your body to reabsorb fluid on its own. While you are hospitalized the nursing staff will care for the drain and teach you to continue to do so at home. The drainage usually starts as bloody, but turns to yellow after a few days. Do not be alarmed if the drainage remains blood-tinged.

Wash your hands thoroughly before emptying your drain(s). Have the plastic measuring cup from the hospital ready to collect and measure the drainage. Unpin the drain from your clothing. Open the top of the drain. Turn the drain upside down and squeeze the contents of the bulb into the measuring cup. Be sure to empty the bulb as completely as possible.
	Use the chart to record the amount of drainage twice a day or any time the bulb is full. Record the total for 24 hours. If you have more than one drain, remember to record the drainage from each drain separately. To prevent infection, do not let the stopper or top of the bottle touch the measuring cup or any other surface.
Use one hand to squeeze all of the air from the drain. With the drain still squeezed, use your other hand to replace the top. This creates the suction necessary to remove the fluids from your body. Pin the drain back on your clothing to avoid pulling it out accidentally. Wash your hands again. Remember to wash your hands before and after the procedure to reduce the risk of infection.

Activities and Helpful Exercises after Surgery

If you have had a lumpectomy only without an axillary dissection, you can resume your regular exercises as soon as wish. IF YOU HAVE HAD AN AXILLARY DISSECTION OR MASTECTOMY, YOU WILL NEED TO MINIMIZE THE ACTIVITY OF THE ARM ON THE SIDE YOU WERE OPERATED UNTIL THE DRAINS ARE REMOVED. It is best that you avoid even regular light-duty work on the side that has the drain. You can start the exercises shown below after all drains are removed.

If you exercise slowly, you will notice relief of stiffness, pain or heaviness in your shoulder. You do not have to work through the pain. Move your arm to the point where you feel discomfort. Stop, and try again. By the end of one month, your range of motion should be back to normal.

Before returning to more vigorous upper extremity exercise (for example, tennis or weightlifting,) check with your surgeon. If you were involved in a lower extremity exercise program such as walking prior to surgery, you may resume that activity as your endurance allows.

Plan to exercise after your drains are removed. Proper exercise will ensure the quick return of range of motion and strength of the shoulder. The exercises that follow will hasten your recovery and can be performed twice daily, in the morning and before bedtime.

Exercise 1: CLASP AND REACH
While either sitting or standing, clasp your hands together and slowly raise them toward your forehead. When this is comfortable, proceed by slipping your clasped hands down behind your neck with your elbows bent. Gradually begin to bring your elbows together in front of you and breathe out. Then spread them apart breathing in. Return to starting position. Repeat this exercise five times.
Exercise 2: WALL CLIMBING
Stand facing the wall with your arms straight and your fingertips touching the wall. Keeping your arms parallel, slowly climb the wall stepping closer to the wall, in an itsybitsy- spider fashion. Progress to bringing your toes as close to the wall as possible. When your arms are straight overhead bring them in toward your ears. If pulling or discomfort occurs, stop and lower your arms back down the wall. Your goal is to get your arms to equal height up the wall. You will find that you are able to reach higher up the wall by exercising each day. Repeat this exercise five times. Now turn to the side so that your body is at a right angle with the wall. Slowly let your fingers on your affected arm climb the wall as you side step to the wall. Keep your arm straight and in line with your ear. Repeat this exercise five times.
Exercise 3: SIDE REACH
While either sitting or standing extend your arms out to the side. Slowly raise your extended arms up over your head. Your goal is to hold your arms straight over your head with you hands touching. Now lower your arms to the side by reversing the path they traveled. Repeat this exercise five times.
Exercise 4:OVERHEAD REACH
Laying flat on the floor, knees bent slightly, grab a rod with both hands. First, extend your arms straight above your head. Slowly lift them in unison over your head towards your knees, keeping your arms straight. Return to original position and try again.

Nutrition and Lifestyle

Eating healthy, exercising and learning stress-reducing strategies help most people to feel healthier. Integrating healthier habits into your life is important, but can be difficult. Some people are more successful if they make small changes over a long time period. Others find that a major change in how they live is more effective. Lifestyle change begins with a personal commitment to be healthier. The following is a brief list of items that can help you feel better and healthier.

• Stop smoking cigarettes.
• Do not drink alcohol in excessive amounts.
• Look at what you are eating and its nutritional content.  Try to drink enough water.
• Find an exercise program that works for you and stick to it. Any kind of physical activity will help.
• Adjust your sleep habits to make sure you get a comfortable night’s rest. Avoid any interruptions in your sleep cycle.
• Identify the stressors in your life and learn how to avoid or change them. If it is work, take a leave of absence until you are ready to go back. If it is family, confront them head-on and talk about what it is that is making you stressed.
• Ask yourself what advice would I give if I were my best friend, sister, or daughter.
• Avoid doing the things you don’t like, and do the things that you love. Find a new hobby or resurrect an old one.

Diet and Nutrition

You may resume your regular diet as soon as you can take fluids after recovering from anesthesia. We encourage 8-10 glasses of water and non-caffeinated beverages per day, plenty of fruits and vegetables, and lower fat foods. The goal is to create a lifestyle change, not to temporarily lose weight on a "crash diet." DON’T FORGET TO READ THE FOOD LABELS.

RECOMMENDATIONS	EXAMPLES
Lower dietary fat to between 10% and 20% of calories	Low or nonfat foods that have less than 3 grams of fat per serving
Eat more plant based protein and eat less animal based protein	More beans and soy
	Less turkey and lean meats
Minimum daily servings of:
grains: 6 per day	Whole grains
vegetables: 3-5 per day	Cauliflower-like vegetables
fruits: 2-4 per day	Fresh fruits in season
beans and soy: 1-2 per day	Pinto and kidney beans, Tofu and soy milk
Limit caffeine to no more than 1-2 cups per day	Try Herbal teas instead
Drink alcohol in moderation	No more than 3 servings per week
Limit nitrates and cured foods	Avoid hot dogs, processed meats, prepared frozen foods
Decrease food additives	Avoid artificial flavors, colors, preservatives

Chemotherapy and Radiation Therapy: What comes after surgery?

Treatments for breast cancer are grouped into two major categories - local and systemic. Local therapies, meaning those therapies that treat the breast only, include surgery and radiation therapy. Systemic therapies, meaning those therapies that treat the entire body, include chemotherapy and/or hormonal therapy.

Radiation Oncology

Radiation therapy uses radiation particles, like X-Rays, to treat cancer. Radiation therapy is most commonly used in the local treatment of primary breast cancer following breast-conserving surgery. It is also a good method to control metastatic disease and alleviate symptoms (eg. radiation of the spine in the setting of bone metastasis may stop or slow growth of disease preventing damage to the spinal cord and decreasing pain).

Radiation treatments are usually given at CAROLINA RADIATION MEDICINE, a division of 21st Century Oncology, where the emphasis and concern is that you receive personal attention from your very first visit. A specialist in radiation cancer therapy will review all your records and discuss with you the available treatment options after a thorough physical exam.

Medical Oncology

Medical oncology is the study of and use of chemotherapy (drugs to treat cancer) and/or hormone therapy (drugs that interfere with the body's hormonal stimulation of tumor growth). Chemotherapy may be given for primary breast cancer either before or after surgery. Chemotherapy may also be used as treatment for metastatic breast cancer that has spread to other organs of the body. Hormonal therapy (see below) can be given for primary or metastatic breast cancer. A medical oncologist has expertise in managing these treatments and treatment side effects and problems encountered over the course of the illness.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given by mouth as pills or by injection through an intravenous (IV) needle. Either way, chemotherapy is a systemic therapy because the drugs enter the bloodstream and travel throughout the body to slow the growth of cancer cells or kill them. The oncologists at Physicians East ® division of Hematology and Oncology will recommend a treatment plan according to your individual case. The treatment will depend on your age, whether or not you are still having your periods, the stage of your cancer, the risk for spread or recurrence, and your general health.

Chemotherapy is used decrease the chances that cancer will come back after your breast cancer surgery. Sometimes, it is given before surgery (called neoadjuvant) in order to shrink a very large or advanced breast cancer. It can control breast cancer that has metastasized to the lungs, bones, liver, brain, or other parts of the body.

Treatment can be as short as a few months or as long as 2 years. Chemotherapy is usually given in cycles during which you have treatment for a period of time, and then you have a few weeks to recover before your next treatment. Depending on the drugs you take, you may have your chemotherapy at home, in your doctor's office, in a clinic, in a hospital's outpatient department, or in a hospital. How often and how long you have chemotherapy will depend on the type and stage of breast cancer, the drugs that are used and how your body responds to them, and the goals of the treatment.

Throughout chemotherapy, your oncologist and nurse will watch how you respond to the therapy. You will have frequent physical exams and blood tests. You should check with your doctor before taking any other medications during your treatment.

Chemotherapy can cause short-term and long-term side effects that are different for each patient, depending on the drugs used. The most common short-term side effects that may appear during chemotherapy include: loss of appetite, nausea, vomiting, diarrhea, constipation, fatigue, infections, bleeding, weight change, mouth sores, and throat soreness. Some of these problems may continue for some time after chemotherapy ends. Some drugs cause short-term hair loss. Hair will grow back either during treatment or after treatment is completed. Before you start chemotherapy, you may want to have your hair cut short, or buy a wig, hat, or scarves that you can wear while you are going through treatment. Serious long-term side effects may include weakening of your heart, damages to your ovaries, infertility, early menopause, or second cancers such as leukemia (cancer of the blood). These side effects may not appear until later, some time after chemotherapy is completed.

Hormonal Therapy

The female hormone estrogen is known to stimulate the growth and development of breast cancer. It does so through special receptors found on the breast cancer cells called estrogen receptor (ER) or progesterone receptor (PR). Hormonal therapy can useful if a particular person's breast cancer makes these hormone receptors, usually designated as ER+ or PR+. It works by blocking the hormones from their receptor, thus inhibiting their growth effects on cancer cells. The most common estrogen blocker used in the treatment of breast cancer is Tamoxifen (Nolvadex®), although newer agents such as Arimidex ® and Aromasyn ® are increasingly being used.

Glossary of Helpful Terms

American College of Radiology (ACR) Accreditation - Equipment, professional expertise and quality control for mammography services which meet standards set by the ACR.

Baseline Mammogram - A first mammogram which includes two views of each breast and is used for comparison with future mammograms.

Bereavement - The experience of losing a loved one.

Biopsy - Surgical removal, using a large-gauge needle, of a small portion of tissue for diagnosis.

Breast Cancer Support Group - Peer or professionally-guided meetings for breast cancer survivors, people undergoing treatment for breast cancer and/or their families.

Breast Prosthesis - Artificial substitute for an absent breast.

Breast Reconstruction - Surgical reconstruction of a breast after removal of breast tissue.

Breast Self-Examination (BSE) - A technique to examine one’s own breasts by looking and feeling for changes.

Chemotherapy - Treatment of cancer with certain drugs that are poisonous to cancer cells.

Clinical Breast Exam - Examination by a trained health professional of the breasts and surrounding areas, conducted by touch and sight.

Clinical Trials - Carefully designed and monitored studies of new methods of treating or preventing cancer.

Complementary Therapies - Treatments such as acupuncture, chiropractic, homeopathy, massage, meditation, art, dance or nutrition which may reduce stress and/or boost the immune system. Often used along with traditional medical treatment.

Computerized Tomography (CT) - Cross-sectional x-rays which detect or monitor tissue abnormalities.

Counseling - Treatment of emotional discomfort through the use of psychological techniques which encourage communication of conflict, insight into problems and personal growth.

Detection - Finding abnormalities or disease.

Family Support Services - Counseling and/or support groups for the families or caregivers of cancer patients.

Financial Assistance - Direct assistance or referral to appropriate sources which may provide financial counseling or direct monetary support for medical procedures and treatments.

Genetic Risk Counseling - Education, information and discussion of genetic factors which may put certain family members at risk for inheriting the potential to develop breast cancer.

Hormone Therapy - Treatment of some cancers that are known to stabilize or shrink if certain hormones are administered, removed or blocked.

Hospice - A philosophy and delivery of care emphasizing comfort, peace of mind and control of symptoms, usually invoked when life expectancy is short. Available to cancer patients, families and friends.

Hotline - Telephone service staffed by knowledgeable individuals to deliver specialized referral information.

Internet - A worldwide network of computers that can communicate with each other.

Lumpectomy - Surgical removal of a cancerous lump and surrounding tissue without removing the entire breast.

Lymphedema - Swelling of arms and legs caused by bulky tumors, surgery or radiation. It can be seen after an axillary node dissection.

Magnetic Resonance Imaging (MRI) - A method of creating three-dimensional images of the body using a magnet and radio waves, instead of x-rays.

Mammography - A low-dose x-ray, which usually includes two views of each breast, used to detect abnormalities.

Mastectomy - Surgical removal of all of the breast and sometimes underlying muscles and lymph nodes.

Medicaid - A federal program that reimburses hospitals and doctors for providing health care to qualifying people who cannot afford medical expenses.

Medicare - A program under the U.S. Social Security Administration that reimburses doctors and hospitals for health care provided to qualified patients over 65 years of age or qualified disabled.

Metastasis - The spread of cancer out of the primary site into far-away organs such as bone, liver, lung and brain.

Nutritional Support - Medically-developed and supervised diets for use by cancer patients during treatment.

Oncology/Oncologist - Oncology is the study, diagnosis and treatment of cancer; an oncologist is a physician who specializes in the treatment of cancer.

Patient Information and Education - Brochures, pamphlets, videos, posters, classes or workshops to educate cancer patients on disease, treatment options, stress-reduction and/or recovery plans.

Physical Therapy - Treatment by physical methods such as massage and exercise after surgery, treatment or injury to restore strength and range of motion.

Post-Operative Apparel - Swimsuits, bras and lingerie specially designed for use after breast surgery.

Primary Care Provider - The physician or other health care provider whom a patient identifies as the main source of her general medical care.

Radiation Therapy - Treatment by x-ray machines delivering high-energy beams directed at the breast. It is commonly used to reduce the size of tumors or the risk that the tumor would come back in the breast.

Reach to Recovery - A free American Cancer Society program in which specially-trained breast cancer survivors visit recently-diagnosed breast cancer patients.

Referral - Directing individuals to service providers, such as specialists or support groups.

Road to Recovery- A free American Cancer Society service provided by local volunteers to assist in the transportation needs of cancer patients to and from medical appointments.

Second Opinion- Examination of a patient or a patient's records by another physician for treatment recommendations.

Spiritual Counseling- A system of support that focuses on the individual's soul and spirit.

Stereotactic Biopsy- Removal of small samples of breast tissue for microscopic evaluation using a hollow needle which is precisely guided to the correct location via x-rays and computer coordinates.

Tumor Board- A panel of experts in radiology, oncology, surgery and/ or pathology that makes treatment recommendations.

Tumor Registry- A system designed for the collection, management and analysis of information about patients with a diagnosis of cancer.

Ultrasound- Non-invasive medical imaging that uses high-frequency sound waves to generate images of the body.

Web Site- A specific address or location on the Internet.

Helpful Numbers

Carolina Breast & Oncologic Surgery - 413-0036

Surgicenter Services of Pitt Information - 847-7700

Pitt County Memorial Hospital - 847-4504

Physicians East, PA - 752-6101

Carolina Radiation Medicine, PA - 329-0025

Helpful Internet WebSites

NOTE: CAROLINA BREAST & ONCOLOGIC SURGERY DOES NOT ENDORSE ALL OF THE FOLLOWING WEBSITES. THE LISTING IS PROVIDED MERELY AS AN EDUCATIONAL RESOURCE.

www.carolinabreast.com

Main website for Carolina Breast & Oncologic Surgery. Providing comprehensive breast care to the community.

www.carolinaradiation.com

Website of Carolina Radiation Medicine, PA. It provides very helpful information regarding radiation therapy.

http://cancernet.nci.nih.gov

CancerNet is the National Cancer Institute’s website delivering information on the latest research activities and clinical trials relating to all cancers.

www.peoplelivingwithcancer.org

People Living With Cancer, the patient information website of the American Society of Clinical Oncology (ASCO), provides live chats, message boards, a drug database, and links to patient support organizations.

www.komen.org

Susan G. Komen Foundation is the world's largest grassroots network of breast cancer survivors and activists.

www.breastcancer.net

Provides up-to-date news information on breast cancer.

www.cancer.org

Provides up-to-date news information on breast cancer.

 

OUR PARTNERS IN CARE...