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Wednesday, November 5, 2014

58 WORDS YOU SHOULD KNOW: BREAST CANCER


Being diagnosed with breast cancer is devastating, and processing the news and coming to accept your diagnosis will take time. When you’re finally ready to move forward, you’re faced with learning a whole new vocabulary to understand the disease. Don’t worry: We’re here to help. Hover over the words to define and decode breast cancer terms around diagnosis, treatment, and recovery, and take back control of your health.

DIAGNOSIS
If you or your doctor finds a lump in your breast, it doesn’t necessarily mean you have cancer. In fact, most breast lumps turn out to be noncancerous. But you’ll want to know for sure because it’s easier to treat early-stage breast cancer before it has the chance to spread. The only way to rule out breast cancer is diagnostic testing.

TESTING
Diagnosing a breast lump usually begins with imaging tests that can help your doctor get a better look at the lump. Even if you already had a mammogram, your doctor may want to do another. Mammograms can sometimes identify cysts, precancerous changes in the breast, or tumors that are too small to feel. Sometimes it’s hard to tell, so your doctor may order an ultrasound or magnetic resonance imaging (MRI) to get a more detailed look at the lump.
After examining the images, your doctor will probably want to perform a biopsy of the lump. A biopsy is a procedure in which small tissue samples are removed from the breast for examination under a microscope. You might feel anxious at the thought, but don’t panic. According to the National Breast Cancer Foundation, 80 percent of breast biopsy results come back negative for cancer.


Your doctor will use a needle to remove tissue samples from the abnormal area. A fine needle biopsy uses a very tiny needle to get the sample. Sometimes, a slightly larger, hollow needle (core needle) is necessary. A vacuum-assisted biopsy uses a probe to remove tissue samples. Any one of these outpatient procedures can be performed under local anesthetic. Usually, a small marker is placed inside the breast at the site of the biopsy. That way, if you need surgery later on, it will be easier to find.
It doesn’t take long to perform a biopsy, but you won’t get results right away. After the procedure, the tissue sample will be sent to a pathologist, a doctor who is trained to analyze cells for signs of disease. They’ll perform a thorough examination of the cells under a microscope and create a pathology report for your doctor. It may take a few days or a few weeks to get the results, which will tell you whether or not you have cancer.
If the report says the cells are benign, you don’t have cancer. Examples of benign lumps are cysts, fibrocystic changes, and fat necrosis. You may still need to receive treatment for these causes, but you can rest easy.
If the report indicates that the tumor is malignant, that means it’s cancerous, and has the ability to spread throughout and beyond the breast.

TYPES OF BREAST CANCER
You may think that all breast cancer is the same, but there are many types. Each has specific characteristics and corresponding potential treatments.
If your pathology report indicates DCIS, you have ductal carcinoma in situ, a non-invasive, pre-cancerous condition. That means cells lining the ducts appear like cancer cells, but they haven’t spread through the duct. You’ll need some treatment because they have the potential to invade, but it’s almost always curable.
Cancer that begins in the milk ducts is called invasive or infiltrating ductal carcinoma (IDC). This is the most common type of breast cancer. When it begins in the milk glands, it’s called invasive lobular carcinoma (ILC). Both types have the ability to spread to the rest of the breast and beyond, so treatment is necessary.
Your breast pathology report will also include information about hormone receptors, which are proteins found in and on normal breast cells. The proteins tell cells what to do. Certain hormones trigger activity in the cells. Normal breast cells have estrogen and progesterone receptors, and cancer cells can also have them.
When cancer cells test positive for estrogen receptors, it means the cancer may be fueled by estrogen. This type of cancer is called ER-positive. When cancer tests positive for progesterone receptors, it’s said to be PR-positive. If you have HER2 or HER2/neu-positive breast cancer, your cells have too much of this growth-promoting protein. Each of these hormone-positive types respond to targeted hormone therapy.
If your breast cancer is negative for all these receptors, you have triple-negative breast cancer (TNBC). TNBC tends to strike younger women and African-Americans in higher numbers than other groups. It’s likely to spread faster than hormone-positive breast cancers, and has a higher rate of recurrence in the first five years. TNBC accounts for about 10 to 20 percent of breast cancers, according to Johns Hopkins Medicine. There are no targeted hormone therapies.
Inflammatory breast cancer (IBC) is even more rare. According to the American Cancer Society, only 3 percent of breast cancers fall into this category. Symptoms are different than those of other breast cancers and include warm, red skin and an orange peel appearance. It can easily be mistaken for some type of infection, especially since there’s usually no lump. A delayed diagnosis can allow IBC to spread and complicate treatment.
Your pathology report will also identify the grade of the tumor. Tumors are graded on a scale of one to three, depending on how fast they’re likely to grow and spread. The higher the grade, the more aggressive the tumor. Knowing the grade will help your doctors decide on the best course of action.
By now, you’re probably anxious to know about staging. Staging tells you how advanced the cancer is—that is, how far it has spread. You usually can’t get this information from a biopsy report. In fact, your doctor may not be able to stage your cancer until after surgery. Even then, it may require additional imaging tests to confirm.         

STAGES OF BREAST CANCER
After a lumpectomy or mastectomy, your doctor will have a better idea of how far the cancer has advanced beyond the original tumor.
Lymph nodes are the part of the immune system charged with collecting fluid and filtering waste products. They’re located throughout our bodies, including around the breasts and underarms. Breast cancer is most likely to spread to the sentinel nodes of the underarm or the internal mammary lymph nodes located near the breastbone. That’s why lymph nodes are checked when you have a cancerous breast tumor.
Non-invasive cancer is stage 0. The other stages of breast cancer are:
stage 1A: The tumor is 2 centimeters or smaller, and cancer hasn’t spread beyond the breast.
stage 1B: Tiny groups of breast cancer cells are located in the lymph nodes, but there’s either no tumor in the breast, or it’s smaller than 2 centimeters.
stage 2A: There’s no breast tumor, or it’s smaller than 2 centimeters and there’s cancer in lymph nodes. Or, the tumor is between 2 and 5 centimeters, but it hasn’t spread to lymph nodes.
stage 2B: The tumor is between 2 and 5 centimeters and some breast cancer cells are in the lymph nodes. Or, the tumor is over 5 centimeters and the lymph nodes are clear.
stage 3A: There may or may not be a breast tumor, but cancer is discovered in four to nine lymph nodes. Or, the tumor is bigger than 5 centimeters and breast cancer cells are found in lymph nodes. Or, the tumor is over 5 centimeters and there are cancer cells in lymph nodes.
stage 3B: There’s a breast tumor, and cancer has invaded the chest wall or spread to breast skin, lymph nodes near the breastbone, or up to nine axillary lymph nodes.
stage 3C: There may or may not be a tumor in the breast, and cancer has spread to breast skin or the chest wall in addition to lymph nodes.
stage 4: Breast cancer is found in other organs of the body (metastasis). Breast cancer is most likely to metastasize to the bones, lungs, liver, or brain.
Sometimes, a post-surgery pathology report includes letters with stages. The meaning behind them is as follows:
T describes the stage of the tumor.
N indicates the lymph node involvement.
M explains whether the cancer has metastasized.
We can learn a lot about cancer from biomarkers. Biomarkers are cellular or molecular markers that can show inherited traits or a link between something in the environment and health. A genetic mutation is a permanent change in your DNA. You can inherit genetic mutations from your parents, or they can develop spontaneously. Certain genetic mutations can increase your risk of developing breast cancer.
You’ve probably heard about BRCA1 and BRCA2 gene mutations. Carriers of these mutated genes are more likely to develop breast cancer. If you have a family history of breast cancer, it’s worth genetic testing to find out if you carry these genes, and if you’re likely to pass them along to your children.
Oncotype DX is a genomic test. Using a sample of breast tissue, this test can help estimate how cancer will grow and spread. This is especially useful when planning treatment for estrogen-positive, early-stage breast cancer.
Once you receive a diagnosis, you’ll probably be asking your doctor about your outlook, the likely course of your disease. To arrive at a prognosis, your doctor will take into account the type and stage of breast cancer, along with general statistics. Keep in mind that it’s only a wide-range estimate. Your personal prognosis depends on many specific factors, including your general health and treatment choices.

TREATMENT
If you’ve been diagnosed with breast cancer, you’ll be referred to a breast surgeon or oncologist to determine your treatment options. An oncologist is a doctor who specializes in treating cancer. Based on the information in your pathology report, your doctor will talk to you about which treatments might be best for you. Besides the type of cancer you have, they’ll take your age and overall health into consideration.
There are many treatments for breast cancer. In most cases, your oncologist will recommend a combination of therapies.
Systemic Treatment
Systemic treatment is something that treats the body as a whole. Chemotherapy is a systemic treatment because it affects cells throughout the whole body. Powerful chemotherapy drugs can kill cancer cells, shrink tumors, and prevent cancer from spreading. Your oncologist will determine how many rounds of treatment you should have. When chemotherapy is used to try to shrink the tumor before surgery, it’s called neoadjuvant therapy.
A common breast cancer drug is Adriamycin, the brand name for doxorubicin. This powerful cancer killer is delivered intravenously under a doctor’s care. Its bright red color has earned it the nickname, “the red devil.” It’s used for treatment of many types of cancer, including all types of breast cancer. Taxol, the brand name for paclitaxel, is often used for aggressive or advanced breast cancer. These are just a couple of the many drugs available.
Chemotherapy drugs are often combined. Your doctor may recommend several rounds of a drug, then switch you to another. As you progress through treatment, it’s very likely that some adjustments will be made based on side effects and how well your body responds.
Chemotherapy has a lot of potential side effects, but everyone is different. There’s no way to predict how your body will react until you’re in treatment. You’ve probably heard someone use the term “chemo brain” or “chemo fog.” It describes an overall foggy feeling caused by the drugs. Chemo treatment may cause you problems with your memory and concentration, making everyday tasks difficult. The extent of chemo brain—and how long it lasts—is different for everyone.
A bald head is probably one of the most visible signs of someone in chemotherapy. Because chemo drugs kill fast-growing cells, alopecia (hair loss) can occur. It’s only temporary, though. Your hair will grow back when chemotherapy ends.
If you’re in your childbearing years, chemotherapy can affect your fertility. If you have a type of hormone-positive breast cancer, hormone-blocking therapy you receive may interfere with your ability to conceive. Chemo can also trigger early menopause.

TARGETED TREATMENT
Targeted therapies are designed to treat specific types of breast cancer. For example, hormone-positive breast cancers can be treated with medications that lower or block those hormones. Herceptin, the brand name for trastuzumab, is effective in treating HER-2-positive breast cancer. Tamoxifen is an oral chemotherapy used to lower the risk of spreading or recurring ER-positive breast cancer.
Radiation therapy is another type of targeted treatment. High-energy rays are aimed at a specific area of the chest. Before getting radiation treatment, you’ll need to get “marked.” That is, your doctor will use precise measurements to strategically tattoo tiny, permanent marks on your chest. They’ll be used to help position your treatment.
When a surgeon removes a lump, but spares the rest of the breast, it’s called a lumpectomy. Lumpectomy is a great option for women who have a small tumor and no evidence that the cancer has spread.
A mastectomy is surgical removal of the breast. It’s called a partial mastectomy when only the tumor and some surrounding tissue are removed. Removing the entire breast is called a simple or total mastectomy. When lymph nodes are also removed, it’s called a modified radical mastectomy. A radical mastectomy also involves removal of muscles from the chest wall.
A mastectomy performed as a preventive measure is called a prophylactic mastectomy. You might opt to do this if you carry a genetic predisposition to aggressive breast cancer. Some people having a mastectomy for breast cancer on one side decide to remove both breasts. Ask your doctor to go over all the pros and cons of a prophylactic mastectomy with you if you’re considering this procedure.

ALTERNATIVE OPTIONS
Complementary therapies are those used in addition to standard medical treatment. Many therapies fall into this category, including acupuncture, massage, and herbal treatments. It’s important to choose a qualified practitioner and let your oncologist know what other treatments you’re receiving. These therapies are called alternative therapy when they’re used in place of standard medical treatment.
Your oncologist may talk to you about research studies called clinical trials. They’re a way for researchers to test new treatments and compare them to other treatments, or to no treatment at all. If you’re in a clinical trial, you won’t necessarily know what medication you’re taking. Clinical trials generally have very strict criteria on who can participate and how they’re carried out. They’re often offered to those with advanced cancer who aren’t benefitting from current treatment.

RECOVERY
Cancer and cancer treatment are hard on the body. It will take time to heal and feel physically strong again. Much will depend on the treatment you received and how long it took. Keep in mind that the recovery process is different for everyone. Don’t compare your recovery time with anybody else’s, and don’t get discouraged if it’s slow going. Respect your body’s unique timetable.
In the weeks and months that follow chemotherapy, your hair will begin to regrow. Your taste buds will return to normal, and your appetite will start to improve. Some side effects, like chemo brain, may continue indefinitely. If you had chemotherapy, radiation, or both, you probably experienced extreme fatigue. That won’t change overnight. Your body is using an enormous amount of energy in its quest to make repairs and heal.
Adjuvant systemic therapy is treatment started after the initial treatment is over. It’s used to prevent recurrence and increase the chances for long-term survival. This will probably include ongoing hormone treatment (oral therapy) for hormone-positive breast cancers, which will continue to affect your body.
It’s impossible to estimate recovery time after a mastectomy. Pain and discomfort should ease within a few weeks to a few months if you don’t have reconstructive surgery or complications. Instead of reconstruction, some women prefer a prosthesis. Prosthetic breasts are made of silicone, gels, or other materials, and they’re weighted for balance. They can fit directly on your skin, or inside the fitted pocket of a mastectomy bra.

You’ll need additional procedures over a longer period of time if you choose reconstruction.
Usually, an inflatable implant called a tissue expander is inserted under the skin and muscle following removal of the breast. A saltwater solution is injected over several months, causing the skin to slowly expand. When the skin reaches the correct size, the expander can be removed in preparation for reconstruction.
Some types of reconstruction include:
DIEP flap: The deep inferior epigastric artery perforator (DIEP) flap is a breast reconstruction technique. Skin and tissue are cut from the abdomen and reattached to the chest to create a new breast mound.
TRAM flap: In a transverse rectus abdominis myocutaneous (TRAM) flap procedure, a flap of skin, fat, and muscle from the abdomen remains attached to its blood supply. The flap is pushed underneath the skin and up into the chest. The new mound may or may not need an additional implant.
latissimus dorsi muscle flap: On your back and below your shoulder is a muscle called the latissimus dorsi. In this reconstructive procedure, the flap of skin, fat, muscle, and blood vessels can be moved under the skin to your chest to create a new breast mound. The blood vessels remain attached to their original position.
If you had lymph nodes removed, you’re at increased risk of lymphedema, a condition in which the lymphatic system becomes blocked and causes swelling. Notify your doctor at the first sign of swelling. There’s no cure for lymphedema, but it can be effectively managed.

You’ll need to keep regular appointments with your team of cancer doctors even if there’s no evidence of disease (NED). This will probably involve routine blood work and examination of the breast area. Be sure to tell your doctor about any concerns or unexplained symptoms. They’ll be on the alert for signs of recurrence.

You’re considered a “survivor” as soon as you’re diagnosed with breast cancer. Surviving breast cancer involves more than simply reaching a state of remission. You may start out longing for a return to “normal,” but with all the physical and emotional issues that come about, you may find yourself redefining what that means, on your own terms.

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