Summary: In Part 1 Questions for Your Doctor about Breast Cancer, we focus on the top asked questions of our doctor. This is usually the doctor who first finds your cancer, whether through a blood test, biopsy or physical palpitation. Here you can read and learn about the questions you may need to ask your own doctor about your breast cancer.
Next to skin cancer, breast cancer is the most common form of cancer found in American women today. Statistics show that breast cancer accounts for every one out of three cancers diagnosed. If you, your friend, or your loved one is diagnosed with cancer, the best thing that you can do is educate yourself and immerse yourself in knowledge and facts about your specific type of cancer, treatment, and expected bumps along the road. Here are some of the top asked questions reported by numerous oncologists across the country.
What causes breast cancer?
Breast cancer is the term used to describe a cancerous, malignant tumor that starts in the cells that line the ducts and lobes of the breast. Breast cancer is not simply one disease, but several that all act and react differently. The exact cause for breast cancer is not clear, but studies have identified many risk factors for this cancer. Hormonal changes, lifestyle and environmental factors may all increase and affect your risk for this type of cancer. Other factors may include:
- Increasing age
- Personal history of breast cancer
- Early menstruation
- Late menopause
- A first pregnancy after age thirty or no prior pregnancies
- Use of oral contraceptives
- Family history of breast cancer
- Presence of certain inherited genetic changes
- History of radiation therapy to the chest
- Long-term use of combined hormone therapy
- Alcohol use
- Obesity after menopause
While risk factors do increase your overall risk, they do not determine if you will or will not get cancer.
When should I begin my screenings for breast cancer?
The American Cancer Society recommends the following early-detection screenings for women at average risk for breast cancer:
- Optional mammograms beginning at age forty
- Annual mammograms for women ages forty-five to fifty-four
- Mammograms every two years for women fifty-five and older, unless they choose to stick with yearly screenings
- MRIs and mammograms for some women at high risk of breast cancer
The ACS also recommends that women know the benefits and potential harms associated with breast cancer screening, as well as how their breasts normally look and feel and report any changes to their doctor right away.
If I have breast cancer, what kind of doctor will I see?
If you think you have breast cancer, you should talk to your primary care physician or OB/GYN. A number of doctors may play a role in your breast cancer treatment. The following is a list of doctors who may be involved in your care:
- Medical oncologist: A physician who has special training in diagnosing and treating cancer using chemotherapy, hormonal therapy and targeted therapy
- Surgical oncologist: A doctor who uses surgery to diagnose, stage and treat cancer and manage certain cancer-related symptoms, and who may perform biopsies and other surgical procedures such as removing a lump or a breast
- Radiation oncologist: A physician trained in cancer treatment using radiation to shrink tumors and destroy cancer cells
I was told I have inflammatory breast cancer. What does this mean?
This type of breast cancer is considered a rare disease that forms in the soft tissues, blocking lymph vessels in the breast skin. This can cause the breast to become extremely firm, tender, itchy, red and warm, which is caused by the increase and build-up of blood flow. This form differs from other forms of breast cancer, the planned treatment and overall outcomes.
What are the most common treatments done for breast cancer?
The treatment you receive will depend on the type of breast cancer you have, the stage it is at the time of diagnosis, and your overall health. There are two main goals when it comes to dealing with breast cancer. One is to destroy as many of the cancer cells as possible, and the other is to prevent tumors from returning. Certain treatments remove or kill the disease within the breast and close tissues, like lymph nodes. Some of these common treatments could include:
Surgery: Surgical options include a mastectomy, which removes the whole breast, and a lumpectomy, or breast-conserving surgery that removes only the tumor and the tissues around it. A sentinel node biopsy is a surgical diagnostic technique that removes one or a few of the first draining lymph nodes to determine whether cancer cells have spread beyond the breast. Women who have surgery as part of their breast cancer treatment may choose oncoplastic and breast reconstruction surgery to rebuild the shape and look of the breast.
Radiation therapy: This conventional technique uses targeted, high-energy radioactive waves to destroy tumors. Because these treatments often affect the lymph nodes, lymphedema is a common treatment-related side effect for breast cancer patients who receive surgery or radiation therapy. Lymphedema is the buildup of lymphatic fluid under the skin, which often leads to swelling.
The goal of other treatments is to destroy or control cancer cells all over the body. These include:
- Chemotherapy which delivers anti-cancer drugs throughout the body to kill cancer cells
- Hormone therapy which uses drugs to prevent hormones from fueling the growth of breast cancer cells
- Targeted therapy which prompts the body’s immune system to destroy cancer
Your doctor may recommend a combination of therapies like chemotherapy, hormone therapy or targeted therapy treatment along with surgery or radiation in order to kill cancer cells that were left behind by other treatments.
People tell me that treatment side effects are unbearable. What are the side effects like for each treatment?
During your cancer treatment, you are sure to experience some form of side effect. These are usually temporary side effects that occur while treatment is happening and immediately after. Some treatments do create side effects that become a new part of life, which then last for years after treatment ends. Here are the common side effects associated with each specific type of treatment.
Surgery. Surgical procedures for breast cancer may cause short-term pain or discomfort in the treated area. Also, the muscles of the arm may feel weak, and the skin in the breast area may feel tight. Surgery involving the lymph nodes may also cause swelling in the arm, a condition known as lymphedema.
Radiation therapy. Many breast cancer patients who undergo radiation therapy experience skin irritation and breast pain. These conditions usually begin within a few weeks of starting treatment and go away on their own within six months after treatment ends. For some patients, these symptoms may not develop until several months or years after treatment. Another common radiation-related side effect is fatigue, especially in the later weeks of treatment and for some time afterward.
Chemotherapy. Certain chemotherapy drugs may cause potential side effects like nausea, vomiting, fatigue, nerve damage, sore mouth, diarrhea, constipation and decreased blood counts.
Hormone therapy. Some hormone therapies for breast cancer may cause a wide range of side effects, such as hot flashes, vaginal discharge, dryness and irritation, irregular periods, decreased sex drive, and mood changes. Aromatase inhibitors may also cause joint and muscle pain, as well as an increased risk of bone thinning, called osteoporosis.
Targeted therapy. Side effects for HER2-positive targeted therapy drugs are typically mild, but serious side effects are possible and may include nausea, vomiting, diarrhea, fatigue, mouth sores and rashes, or a combination of all of the above.
Are there any special ways to help ease and control my side effects?
Side effects of cancer treatment can be managed in a multitude of ways. The idea is to help you to maintain and build your strength and stamina so that you can better handle your treatments, stay on the schedule created for your care, and focus on your life without much interruption. Natural and holistic support, nutrition therapy, pain management and rehabilitation are just a few examples of the care that is available to help ease these effects. Many cancer services also offer mental health support, which is vital in whole-being healing.
I was diagnosed with breast cancer five weeks ago but cannot decide which treatment path to follow. How fast do I need to make this decision? Do I have time?
Generally, you should always start some form of treatment immediately after diagnosis. In most cases that are not considered severe or life-threatening, it will not hurt to wait a few weeks to digest the news and changes and get your life in line for the rough road ahead. Be sure that you are aware of all of your treatment options, how they work, and the possible side effects and possible outcomes for your case.
After hearing my diagnosis and prognosis, I have decided that I do not want cancer treatment. Can anyone force me to have treatment?
As an adult, no one can force you into any treatment that you do not want to take part in. Breast cancer patients may refuse their doctors treatment plans in whole, or in parts. Many patients work with their doctors to ensure their treatment plan has what they want, too. No treatment comes without risks of some varying level. Palliative care is designed to help control severe side effects like pain, nausea and other heavy symptoms, which may be something you are more interested in. Hospice care, or end of life care, is also available for severe cases.
If I have breast cancer treatment, will I ever be able to conceive and carry a child?
While there is no set answer to this question as everybody handles the chemotherapy and radiation load differently, it is possible to become pregnant and carry a successful, healthy pregnancy to term after cancer treatment. Women of childbearing years who are being treated for breast cancer or any other type of cancer should be concerned about the possible impact on their fertility. Chemotherapy may affect the functioning of the ovaries and reduce the overall number and quality of eggs. Cancer treatment drugs can also cause infertility in women who have not yet gone through menopause and are pre-menopausal. The chances of infertility occurring depends on the medications used and patient’s overall health.
This is not only true for women, as cancer treatments like radiation can affect men, too. Radiation therapy kills these cancer cells by ceasing and reducing their ability to grow and divide. Radiation has the ability to pass through healthy tissues and organs around the cancer, which can cause permanent damage, and infertility if in that area of the body and pelvic region.
You may want to consider your options for preserving fertility before starting treatment and discuss your questions and concerns with your oncologist.