Introduction
The Breasts
Important Facts
Treatment Descriptions
Surgery
Radiation Therapy
Chemotherapy
Hormone Therapy
Breast Cancer: The Disease
What is Cancer?
How Breast Cancer is Diagnosed
The Stages of Breast Cancer
Treatment
Planning Treatment
Extent of Disease and Treatment
Effects of Treatment
Non-Traditional Treatments
After Care
Follow-up Care
Coping with Breast Cancer
Support for Breast Cancer Patients
Other Helpful Information
Who is at Risk for Breast Cancer?
Importance of Early Detection
Symptoms of Breast Cancer
Definitions of Medical Terms
Resources
Questions to Ask Your Doctor
INTRODUCTION
Each year, more than 5,000 women in Michigan discover they have breast cancer. In fact, one out of every 10 women will develop breast cancer at some time in her life. After initial treatment, most of these women are able to continue living normal, productive lives. This booklet will help you better understand breast cancer.
Although breast cancer occurs in men, it is very uncommon, so the information contained in this booklet is directed primarily toward women. It may, however, be of some use to men who have been diagnosed with breast cancer. 'Throughout this booklet, words that may be new to readers are in italics. Definitions of these and other terms related to breast cancer begin on page 28. A brief description and diagram of your breasts is provided before beginning the discussion of the treatment of breast cancer.
The main function of female breasts is to produce milk. Each of your breasts has 15 to 20 sections, called lobes, that are arranged like the petals of a daisy. Each lobe has many smaller lobules, and each of these lobules ends in dozens of tiny milk-producing bulbs. The lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts carry milk from the lobes to your nipple, which is usually in the center of a dark area of skin on your breast called the areola. Fat fills the spaces between the other parts of your breast. Muscles cover your ribs and lie under your breasts, but they are not part of your breasts.
There are some simple facts that might help you understand what breast cancer is and what the possible treatments are. Understanding them and the other information in this booklet should help you face some of the decisions that lie ahead in your treatment.
First of all, remember that breast cancer is a treatable disease.
There are four kinds of treatment. One or more of these may be used for you depending upon what you need and want. The four ways of treating breast cancer are:
1. Surgery (Removing the cancer with an operation.)
2. Radiation therapy (Killing the cancer cells with special x-rays.)
3. Chemotherapy (Killing the cancer cells with drugs.)
4. Hormone therapy (Stopping the cells from growing with hormone drugs.)
Each of these four treatments is described in more detail later in this document.
Your doctor should tell you what kind of breast cancer you have and the stage it is in (that is, if it has spread and, if so, how far it has spread).
Some breast cancer can be treated in several different ways, and you may have a choice of treatments. If your doctor tells you that you do have a choice, you should take time to decide which treatment you would prefer.
Unfortunately, some breast cancer can only be treated in one, specific way, so not all persons have a choice of treatment. Before making any decision or starting any treatment, you may wish to talk with each doctor who may be giving you a particular type of treatment:
A surgeon removes breast cancer with an operation.
A radiation oncologist gives breast cancer patients special x-rays to kill their cancer cells.
A medical oncologist treats breast cancer patients, including selecting the drugs that can be used to kill their cancer cells or stop their cancer cells from growing.
A plastic surgeon rebuilds the breasts after an operation.
You have a right to get a second opinion from another doctor if you wish.
You also may wish to participate in a clinical trial of a new or potentially improved treatment, and you should ask your doctor about these options if you are interested.
TREATMENT DESCRIPTIONS
The type of treatment that will work best for you depends upon the stage of your cancer, the type of your cancer, the specific features of your cancer cells, your age, whether or not you still have monthly menstrual periods, and your general health. Once all these things have been determined, your team of physicians may decide you can have a CHOICE of treatments. This means that one way of treating you and your particular disease may be just as effective as another. You will be able to decide which of those treatments, or combination of treatments, you would rather have. Your physicians will discuss with you the risks of each type of treatment, as well as the advantages and the disadvantages of each type of treatment.
For some women, there may be only one way of treating their particular type of cancer. If you are one of these women, you probably will not have a choice among treatments. However, even if you do not have a choice, you can use the following information to help you understand what your particular treatment will be like.
This is the most common treatment for breast cancer. A surgeon performs an operation to remove the cancer from your breast and usually some of the lymph nodes under your arm. A number of different operations are used:
Lumpectomy: In this operation (also called a partial mastectomy, or a segmental mastectomy), just the lump is removed from the breast. The surgeon removes a little normal breast tissue all the way around the cancer to be sure that all of the cancer is removed. Lymph nodes are removed from under the arm. This type of operation usually is followed by radiation therapy and sometimes by chemotherapy or hormone therapy.
Advantages of a lumpectomy:
Your breast will not be removed.
Disadvantages of a lumpectomy:
You will need additional treatment with x-ray therapy. You may have arm swelling.
Modified Radical Mastectomy: In this operation, the entire breast is removed, along with some skin and some underarm lymph nodes.
Advantages of a modified radical mastectomy:
You probably will not need radiation therapy.
Disadvantages of a modified radical mastectomy:
Your entire breast and some of your skin will be removed. You may have arm swelling.
Total Mastectomy: In this operation, the entire breast is removed, but usually not the lymph nodes.
Advantages of a total mastectomy:
You probably will not need radiation therapy.
Disadvantages of a total mastectomy:
Your entire breast and some of your surrounding skin will be removed.
Breast Reconstruction: This is additional surgery done to rebuild (reconstruct) your breast. It may be done either at the same time as your breast is removed or at a later time. You may want to visit a plastic surgeon before making your final decision.
RADIATION THERAPY AS A "PRIMARY TREATMENT"
This treatment is done by a radiation oncologist who uses high doses of radiation to kill any cancer cells which might remain. 'Me radiation may come from a machine outside your body (external radiation) or it may actually be put into your breast through a small tube (implant radiation). For some women, both ways are used. An extra "boost" of radiation is usually given to the tumor site. The boost may be either external or internal (using an implant).
Advantages of radiation therapy:
Your breast will not have to be removed.
Disadvantages of radiation therapy:
The treatment is usually done 5 days a week for 5 to 8 weeks.
Radiation therapy is usually only available at large hospitals or medical centers, so you may have to travel outside your community for treatment.
There may be a temporary skin reaction similar to sunburn, and daily skin care will be required.
You can have arm swelling.
There may be long-term changes in the appearance and texture of your breast and the skin over your breast.
Another type of treatment for breast cancer is chemotherapy, in which drugs are given by an oncologist to kill the cancer cells anywhere they may be in your body. There are many different drugs which are used to kill cancer, and often, several drugs are given together during chemotherapy. Your doctor will help you decide which drugs are best for you and your type of cancer.
Advantages of chemotherapy:
This treatment can kill any unsuspected cancer cells which have spread to other areas of your body and cannot be treated with surgery or radiation therapy.
Disadvantages of chemotherapy:
Most cancer-killing drugs that are used in chemotherapy cause some unpleasant side effects, such as the temporary loss of all body hair, loss of appetite, sore mouth, upset stomach, vomiting, diarrhea, and tiredness. These side effects usually go away once your chemotherapy is over and you have stopped taking the drugs.
Chemotherapy may cause temporary or permanent sterility.
The cancer-killing drugs used in this treatment may harm unborn babies, so you should not be pregnant while on chemotherapy.
Hormones are substances which are produced normally in your body and which help some types of breast cancer to grow. With hormone therapy, your doctor will give you drugs to change the way these hormones work and stop your cancer from growing. Like chemotherapy, hormone therapy acts on any cancer cells that exist throughout your whole body. This type of treatment is only effective for certain kinds of breast cancers.
Advantages of hormone therapy:
Most hormone therapy drugs can be taken in the form of a pill.
Disadvantages of hormone therapy:
This type of treatment can cause infertility, hot flashes, vaginal dryness, and other symptoms of "change of life" (menopause), regardless of your age.
Cancer is the name for a group of diseases that all have one thing in common: abnormal cells grow and destroy body tissue. Normally, the healthy cells that make up your body's tissues grow, divide, and replace themselves in an orderly way. This process keeps your body in good repair. Sometimes, however, some cells lose the ability to control their growth. They grow too rapidly and without any order, making too much tissue and forming tumors. These tumors can be benign or malignant.
Benign tumors are not cancer. They will not spread to other parts of your body, and they are seldom a threat to life. Often, benign tumors can be taken out by surgery, and they are not likely to return.
Malignant tumors, on the other hand, are cancer. They can spread and kill nearby healthy tissues and organs. Cancer cells also can break away from a malignant tumor and enter the bloodstream and lymphatic system. This process of cancer spreading to other parts of your body is called metastasis. Even if a malignant cancer tumor is removed from your breast, the disease may return if the cancer cells had spread before the tumor was removed.
HOW BREAST CANCER IS DIAGNOSED
It is important to remember that four out of five breast lumps are not cancer. To diagnose breast cancer, a careful physical examination is done, including palpation of your breast, and you are asked about your personal and family history. One or more of these tests may also be done:
Aspiration: In this procedure, your doctor will use a thin needle to remove fluid or a small amount of tissue from your breast lump. This may show whether the lump is a fluid-filled cyst or a solid mass.
Mammography: In this examination, x-rays will be taken of your breast that can give both you and your doctor important information about your breast lump. A mammogram also can show any tumors you may have in your breast that are still too small to be felt. However, mammograms do not show all breast cancers.
Ultrasound: In this test, sometimes called a sonogram, high-frequency sound waves are sent into your breast. The pattern of echoes is shown on a monitor, like a TV screen. Ultrasound examination may be used to distinguish fluid-filled cysts from solid tumors.
Biopsy: A biopsy is surgery to take out part, or all, of a lump or suspicious area. After being removed, the tissue is examined under a microscope by a pathologist. A biopsy is the only sure way to know whether cancer is present. If you are going to have a biopsy, you have an important choice to make.
a. One-step procedure: You can decide that, if cancer is found, you will have surgery to treat your cancer at the same time as the biopsy (a one-step procedure).
b. Two-step procedure: Or, you can decide on only a biopsy and, if it shows cancer, have treatment at a later date. This gives you time to find out about your treatment choices, to get a second opinion, and to prepare for your stay in the hospital, but it does not reduce the chances for successful treatment. Many doctors and patients prefer the two-step procedure, and it is the most common approach.
Hormone receptor tests: If the biopsy shows that cancer is present, laboratory tests called estrogen and progesterone receptor tests are usually done on the tissue removed during the biopsy. These tests can tell whether these hormones help your particular kind of cancer to grow. This information helps your doctor decide whether hormone treatment is likely to be useful in your case.
If your biopsy shows that your lump is cancer, your doctor may order other special laboratory tests to learn more about the cancer. Your doctor may order chest x-rays, blood tests, and/or scans to determine whether or not the cancer has spread from your breast to other parts of your body. These tests help your doctor tell the extent, or stage, of the disease. Doctors use this staging system for breast cancer:
Carcinoma in situ is very early breast cancer. When this term is used, it means that the cancer has been found in a local area and in only a few layers of cells. Carcinoma in situ has not spread into, or beyond, the breast.
Stage I means the tumor is no larger than 2 centimeters-about an inch-and has not spread beyond the breast.
Stage II means the tumor is from 2 to 5 centimeters in size-about I to 2 inches-and may have spread to the lymph nodes under the arm.
Stage III means the cancer is larger than 5 centimeters-about 2 inches. At this stage, the cancer also may have spread to lymph nodes under the arm or to other tissues near the breast.
Stage IV means the cancer has spread to other organs of the body, most often the bones, liver, lungs, or brain.
TREATMENT
Treatment choices depend upon many things, including the type of breast cancer you have, whether it has spread, your age, your menopausal status, and your general health. Your doctor will discuss treatment plans to fit your individual needs.
Before starting treatment, you might want a second doctor to review your diagnosis and treatment plan. A short delay will not reduce the chances that your treatment will be successful. To get a second opinion, your doctor can discuss your case with other doctors who treat breast cancer or can refer you to another physician who is knowledgeable about breast cancer treatment.
Breast cancer may be treated with surgery, radiation therapy, chemotherapy, or hormone therapy, or a combination of the four treatments, depending upon your needs. In some cases, you may be referred to other doctors who specialize in different kinds of cancer treatment. New and old forms of breast cancer treatment are continually being tested, evaluated and improved through clinical trials. If your breast cancer has just been diagnosed, you may want to ask your physician(s) if participation in a clinical trial would be appropriate for you.
Extent of Disease and Treatment
Carcinoma in situ
If you have carcinoma in situ (non-invasive breast cancer), you may have a mastectomy or breast-sparing surgery. As with other breast cancers, the type of surgery that is best for you is based upon many factors. Also, depending upon the specific type of breast cancer involved, your doctor may need to remove some of your lymph nodes, and also may advise you to have radiation therapy.
Stage I and Stage II
If your breast cancer is diagnosed as early stage breast cancer (Stage I and H), your treatment choices may include a mastectomy or limited surgery (such as a lumpectomy or partial mastectomy), followed by radiation therapy. Some of the lymph nodes under your an-n also are removed. The type of surgery you will need depends upon the size and location of your tumor, the type of cancer you have, your age, your general health, and the size of your breast.
If you have early stage breast cancer, chemotherapy or hormone therapy may be considered after primary treatment. This additional treatment is called adjuvant therapy. It is used to help prevent the cancer from returning by killing undetectable cells that may remain in your body. The choice between chemotherapy or hormone therapy depends upon your age, your menopausal status, your hormone receptor status, and other factors.
Until recently, women whose underarm lymph nodes were free of cancer usually received no additional treatment because they had a good chance of survival. But, scientists now know that cancer may return in some of these women. Therefore, adjuvant therapy may be recommended in these cases.
Stage III
If you are diagnosed as having Stage IV breast cancer, you probably will have both local and systemic treatment. Your local treatment may be a mastectomy and/or radiation therapy. Your systemic therapy will be chemotherapy and/or hormone therapy.
Stage IV
Most women who have Stage IV breast cancer receive chemotherapy and/or hormone therapy. They also may have limited surgery or radiation therapy to control their breast tumor. If you have Stage IV breast cancer, your doctor also may want to use radiation to treat any cancer that has spread to other parts of your body.
Because it is hard to limit the effects of cancer treatments so that only cancer cells are destroyed, natural, healthy tissue also may be affected by the treatments. That's why treatment often causes significant and unpleasant side effects. The side effects you will experience will depend upon the type of treatment used on your cancer and upon the part of your body that is being treated.
If your treatment involves the removal of your breast, you may feel that your body is not balanced afterwards, especially if you have relatively large breasts. After a mastectomy, some women choose to wear a breast form, also called a prosthesis. Other women choose to have a plastic surgeon reconstruct their breast. Each choice has its advantages and disadvantages, and what is right for one woman may not be right for another. It may be helpful to talk with a plastic surgeon before your mastectomy is done, but remember: even if you decide not to have your breast reconstructed now, reconstruction is still possible years after the removal of your breast.
If your treatment involves surgery, you may find that your skin in the breast area feels tight and the muscles of your arm and shoulder feel stiff after the operation. If your breast is removed, you may find that your neck and back become uncomfortable afterwards.
Your doctor, nurse, or physical therapist can recommend exercises to help you regain movement and strength in your arm and shoulder and to help reduce the pain and stiffness in your neck and back. Carefully planned exercises should be started as soon as your surgeon says you are ready, often within a day or so after surgery. The first exercises you will do will be gentle and you will be able to do them in bed. Gradually, your exercises will become more active, and regular exercise should become a part of your normal activities.
If you have a mastectomy and immediate breast reconstruction, your exercise needs will be different than if you hadn't had the immediate breast reconstruction. Your surgeon will explain the best exercise approach for you.
Because nerves are cut during surgery, you may have numbness and tingling in your chest, under your arm, and in your shoulder and arm. These problems usually go away within a few weeks, but some numbness may be permanent. The numbness should not interfere with your normal daily activities.
If you have surgery that includes the removal of lymph nodes under your arm, the flow of lymph fluid in that arm will be slowed. In some women, this means that fluid builds up in the arm and hand and causes swelling (lymphedema). This fluid build-up after surgery can be reduced or prevented with exercises and by resting with your arm propped up on a pillow so that your arm is raised above the level of your heart. If lymphedema becomes a problem later on, you should tell your doctor, who may suggest other solutions.
The removal of lymph nodes also will mean that it will be harder for your body to fight infection, so you will need to protect your arm or hand on the treated side from injury for the rest of your life.
If your treatment involves radiation therapy, you may become very tired as treatment continues. Increased rest may be necessary. Skin reactions in the breast area, such as redness or dryness, are common. Skin care is important at this time. You should not use lotions or creams on the skin without your radiation oncologist's advice. Following radiation therapy, the appearance of your treated breast may be changed.
If your treatment involves chemotherapy, the side effects you experience will depend upon the drugs that you are given. In addition, each person reacts to each drug differently.
Chemotherapy affects rapidly growing cells, such as blood-forming cells and those that line your digestive tract. As a result, you may have side effects such as a lower resistance to infection, less energy, a loss of appetite, nausea, vomiting, diarrhea, or mouth sores. You also may lose your hair, both on your scalp and on the rest of your body. Women taking chemotherapy often have the symptoms of menopause (hot flashes, vaginal dryness, pain during intercourse, and irregular periods). These side effects should only be temporary during treatment. If they persist, your dose may need to be changed. However, in some instances, chemotherapy may result in permanent sterility.
Hormone therapy also can cause a number of side effects, depending upon the specific drug. When treatment interferes with your body's production or use of estrogen, you may have some of the symptoms of menopause, such as hot flashes, interrupted periods, and vaginal dryness. You also may experience a weight gain. Because the usual hormones given after menopause to prevent hot flashes and osteoporosis might help your breast cancer cells grow, if you have been diagnosed with breast cancer you should not take replacement estrogen or progesterone (hormone replacement therapy) without talking with an oncologist.
Well-meaning friends or other persons may suggest that you use treatments that have not been recommended by your doctors. Some of the non-traditional treatments being used may be harmless, but should not be used in place of the treatment your doctor recommends. Others, however, in addition to being ineffective, can injure you directly or indirectly. Please discuss any treatment, drug, vitamin, herb, or other remedy you would consider using with your doctor before starting the treatment.
AFTERCARE
Regular follow-up exams are very important after breast cancer treatment. Checkups usually include examinations of your chest, underarm, and neck. Periodically, you may have a complete physical exam, blood tests, a mammogram, scans, and other x-rays.
Once you have had breast cancer, you should check both the treated area and your other breast each month. You should be shown how to do this by your doctor or nurse. You should report any changes to your doctor right away.
Cancer that Returns
If your breast cancer returns, your treatment will depend upon the location and extent of your recurring cancer, your menopausal status and general health, and your response to your initial therapy. If your disease reappears in your breast area, your treatment usually will be
surgery and/or radiation. Also, some type of systemic therapy probably will be recommended. If cancer develops in other parts of your body, you are likely to have chemotherapy and/or hormone therapy; some patients also may be helped by radiation therapy or surgery.
The diagnosis of breast cancer can change your life and the lives of those close to you. It's natural for you and your family and friends to have many different and sometimes confusing emotions.
Concerns about what the future holds-as well as worries about tests, treatments, a hospital stay, and medical bills-are common. Talking with doctors, nurses, social workers, and other members of your health care team may help to calm fears and ease confusion.
You can take an active part in decisions about your medical care by asking questions about breast cancer and your treatment choices. You and your family members and friends may find it helpful to write down questions to ask your doctor as you think of them. Taking notes during your visits to your doctor will help you remember what was said.
You should ask your doctor to explain anything that is not clear. Most women ask about the extent of their cancer, how it can be treated, and how successful the treatment is likely to be. Many are concerned about the risk other women in the family, including their daughters and sisters, have of developing breast cancer. Sample questions you may want to ask your doctor are at the end of this document.
You and the people close to you may feel frightened, angry, or depressed after you are told about your cancer and during your treatment. These are normal reactions that people have when faced with a serious health problem. Sometimes, women who have had breast cancer are worried, especially after surgery, that the changes to their body will affect not only how they look, but how other people feel about them. They may worry about holding a job, caring for their family, or starting new relationships. Concerns about sex and "feeling like a woman" also can be upsetting.
Many women who have had breast cancer have found that they cope with their emotions better if they can talk openly about their illness and their feelings with those who love them. Sharing feelings with those people who are close to you can help everyone feel more at ease and can open the way for others to show their concern and offer their support to you. Not everyone in your family may be ready to talk about their feelings at the same time, however, and this may create additional stresses within your relationships.
Many patients feel that it helps to talk with others who have faced problems like theirs. You can meet other breast cancer patients through self-help and support groups. In addition, your health care providers often may be able to put you in touch with another woman who has undergone a similar experience with breast cancer. Your doctor is the best person to give advice about treatment, working, or limiting daily activities. If it is hard to talk with your doctor about your feelings or other very personal matters, it may be helpful to speak with a nurse, social worker, counselor, or member of the clergy.
Support for Breast Cancer Patients
Learning to live with the changes that are brought about by having breast cancer is easier for you and for those who love you when you have helpful information and support services. Often, a social worker at your hospital or clinic can suggest local and national groups that will help you with rehabilitation, emotional support, financial aid, transportation, or home care.
The American Cancer Society (ACS), for example, has many services for cancer patients and their families. Their "Reach to Recovery" program offers special help for mastectomy patients. Trained volunteers, who have had breast cancer themselves, will visit you at your doctor's request and lend emotional support to you before and after your treatment. They will talk with you and share their own experiences with breast cancer treatment, rehabilitation, and breast reconstruction or fitting of breast forms. Your social worker or nurse can make a formal referral for you to the "Reach to Recovery" program at the time of your surgery.
Another resource for women who have had breast cancer surgery is "ENCORE". Sponsored by the YWCA, this program includes exercise to music, water exercises, and a discussion period. You may join this group after surgery, with your doctor's approval.
Information about other programs and services for breast cancer patients and their families is available through both the Meyer L. Prentis Comprehensive Cancer Center (toll-free: 800-4-CANCER) and the American Cancer Society Cancer Response Service (toll-free: 800-227-2345). Your local American Cancer Society office will have information about local programs and services. Another resource that you may use to find out about breast cancer programs in your community is your local hospital Social Work Department.
OTHER HELPFUL INFORMATION
Who is at Risk for Breast Cancer?
Doctors cannot explain why one woman gets breast cancer and another one doesn't. It is clear, however, that breast cancer is not caused by bumping, bruising, or touching the breast. And, it is not contagious-no one can "catch" breast cancer from another person.
Although scientists do not know exactly why breast cancer develops, they do know some things increase a woman's chances of getting the disease:
Age: About 75 percent of all breast cancers are found in women over the age of 50. The disease is uncommon in women under the age of 30.
Family history: The risk of getting breast cancer increases for a woman whose mother, sister or daughter has had the disease before she reached menopause.
Personal history: About 15 percent of women treated for cancer in one breast are likely to get cancer in the other breast later on.
Other risk factors include: having your first menstrual period at an early age, having a late menopause, having your first child after the age of 30, or never having children. Most common types of fibrocystic changes of the breast do not increase the risk of breast cancer.
Breast cancer can be treated best before it has spread. Plus, the earlier breast cancer is found and treated, the better a woman's chances are for complete recovery. If cancer is found early, there may be choices for treatment. Women should take an active role in the early detection of breast cancer. Every woman should:
Practice monthly breast self-examination (BSE).
Get a screening mammogram at regular intervals starting at age 40.
Have a yearly breast exam by a health professional.
Screening Mammography
Mammograms (x-rays of the breast) can find many breast cancers before they can be felt. Mammography, together with a breast exam by a health professional, can reduce the number of deaths from breast cancer. Between the ages of 40 and 50, every woman should have a mammogram every I to 2 years. After the age of 50, every woman should have a mammogram every year.
Some breast cancers, however, may not be detected by mammography, especially in premenopausal women. Therefore, it also is necessary to have regular breast examinations in addition to regular mammograms.
Yearly breast examination
Every woman should have her breasts checked regularly by her doctor or other health care provider beginning at age 20. When she reaches age 40, this should be done every year. Together, the thorough breast examination and the screening mammogram can detect most breast cancers in the early stages of development.
Breast Self-Examination (BSE)
Women's breasts come in many sizes and shapes. In addition, each woman's breasts change during her life because of age, her monthly menstrual cycle, pregnancy, menopause, or the taking of birth control pills or other hormones. Therefore, women often are confused about what their breasts are supposed to feel like. It is normal for your breasts to feel lumpy and uneven. Sometimes, your breasts will be swollen and tender, especially right before your menstrual period.
By doing monthly breast self-examinations, you can learn what's normal for your own breasts, and you will be more likely to find anything unusual that might be a warning sign of cancer. You should learn how to perform breast self examination from your health care provider, and you should examine your breasts monthly. If you do find changes, they should be reported to your doctor immediately.
Breast cancer can cause one or more symptoms, or it can cause none at all. This is why early detection is so important. Some warning signs to watch for include:
A lump or thickening in your breast or under your arm.
A change in the size or shape of your breast.
Discharge from your nipple, especially if it contains blood.
A change in the color or feel of the skin of your breast or areola (such as dimpling, puckering, or scaliness).
Pain is usually not an early warning sign of breast cancer. However, you should see your doctor if you notice any changes in your breasts. The changes may be caused by cancer, or they may be caused by other, less serious problems.
In summary, it is important that you understand that breast cancer is a treatable disease and that there is more than one way of treating it. If you are diagnosed as having breast cancer, there are many different types of health care professionals available to help you decide which treatment might be best for you. These same professionals will help you maintain your desired lifestyle, roles, and relationships with the least disruption possible during the course of your treatment.
Thousands of women in Michigan who have undergone treatment for breast cancer will not die of breast cancer and will live well into old age. Many women who have had breast cancer are willing to help other women and their families who are just beginning the process of treatment and recovery.
This booklet should be just one of many sources of information for you about breast cancer. Since each woman's experience is different, it is important that you continue to seek additional information and assistance from your health care providers and the many other resources that are available.
Remember, you do not have to face the challenges ahead by yourself.
DEFINITIONS OF MEDICAL TERMS USED IN THIS DOCUMENT
Adjuvant therapy (AD-ju-vant THER-a-pee): Treatment given in addition to the primary treatment.
Areola (a-REE-o-la): The area of dark-colored skin around the nipple.
Aspiration (as-per-AY-shun): Removing fluid or tissue from a lump with a needle.
Axilla (ak-SIL-a): The underarm.
Axillary node dissection: Surgical removal of some of the lymph nodes from under the arm.
Benign tumor (bee-NINE): A growth that it is not cancer; it will not spread to other parts of the body.
Biopsy (BY-op-see): The removal of a sample of tissue so it can be looked at under a microscope to see if cancer cells are present.
An excisional biopsy is surgery that is done to remove an entire lump.
An incisional biopsy is surgery that is done to remove part of the tumor.
A needle biopsy or aspiration is the removal of tissue or fluid with a needle.
Breast Reconstruction: A surgical operation in which a plastic surgeon restores the form and appearance of a breast after it has been totally or partially removed through a mastectomy.
Cancer (CAN-sir): A term for more than 100 diseases that involve uncontrolled, abnormal growth of cells. Cancer cells can spread through the bloodstream and lymphatic system to other parts of the body.
carcinoma (car-si-NO-ma): Cancer that begins in the lining or covering tissues of an organ.
Carcinoma in situ (car-si-NO-ma in SY-too): Cancer that involves only the cells in which it began and has not spread to other tissues.
Lobular carcinoma in situ is found in the lobules of the breast.
Ductal carcinoma in situ (also called intraductal carcinoma) is found in the ducts of the breast.
Chemotherapy (kee-mo-THER-a-pee): Treatment with anti-cancer drugs.
Clinical trial: Studies of cancer treatments. Each study is designed to answer scientific questions and to find better ways to treat patients.
Cyst (sist): An abnormal sac within a tissue or organ, usually filled with fluid.
Duct: A tube in the breast through which milk passes from the lobes to the nipple.
Estrogen (ES-tro-jin): A female hormone.
Hormone replacement therapy: Hormones sometimes taken after menopause to relieve symptoms such as hot flashes and to prevent osteoporosis (thinning of the bone).
External radiation: Radiation therapy that uses a machine located outside the body to aim high-energy rays at the cancer.
Fibrocystic changes: Nodularity (lumpiness) of both breasts, often accompanied by tenderness, that gradually increases with age until menopause and which may increase and decrease with the beginning and end of the monthly menstrual cycle.
Gynecologist (guy-na-KOL-o-jist): A doctor who treats diseases of the female reproductive organs.
Hormones: Chemicals produced by certain glands in the body. Hormones control the way certain cells or organs act.
Hormone receptor tests.: Laboratory tests done on breast cancer tissue that has been removed during surgery to determine whether the growth of the cancer cells in that tissue is affected by the presence of estrogen or progesterone.
Hormone therapy: Cancer treatment that involves removing, blocking, or adding hormones.
Implant radiation: Radiation therapy that places materials that contain radiation into the breast through thin plastic tubes.
Lobe: A part of the breast; each breast contains 15 to 20 lobes, arranged like the petals on a daisy.
Lobule (LOB-yool): A subdivision of the lobes of the breast; each lobule ends in dozens of tiny milk-producing bulbs.
Local treatment: Radiation therapy or surgery that affects cells in the tumor and the area close to it.
Lumpectomy (lump-EK-to-mee): Surgery that removes the breast lump; usually followed by radiation therapy.
Lymph (limf) fluid: An almost colorless fluid that bathes body tissues and carries cells that help fight infection.
Lymph nodes: Small, bean-shaped organs located along the lymphatic system. Lymph nodes (also called lymph glands) filter bacteria or cancer cells that may travel through the lymphatic system. Lymph nodes are one of the first places where breast cancer may spread. They are present in the armpit.
Lymphatic system (lim-FAT-ik): The tissues and organs (including the bone marrow, spleen, thymus, and lymph nodes) that produce and store cells that fight infection; also the channels that carry lymph fluid.
Lymphedema (lim-fa-DEE-ma): Swelling of the hand or arm caused by extra fluid that may collect in tissues when lymph nodes are removed or blocked.
Malignant (ma-LIG-nant): Cancerous. (See cancer.)
Mammogram (MAM-o-gram): An x-ray of the breast. Usually, a woman has two mammograms of each breast, one taken from the side and one from the top.
Mammography (mam-OG-ra-fee): The x-ray procedure of taking a mammogram to detect breast tumors.
Mastectomy (mass-TEK-to-mee): Surgery to remove the breast.
Medical oncologist: A doctor whose specialty is treatment of cancer with medications (chemotherapy).
Menopause: The time of a woman's life when menstrual periods stop; also called "change of life".
Metastasis (me-TAS-ta-sis): The spread of cancer from one part of the body to another. Cells in the metastatic tumor (the second tumor) are generally like those in the original cancer.
Modified radical mastectomy: Surgery to remove the breast, some of the skin, and some underarm lymph nodes.
Oncologist (on-KOL-o-jist): A doctor who specializes in treating cancer.
Palpation (pal-PAY-shun): A simple technique in which a health care provider lightly presses with his/her hand(s) on the surface of the body to feel the organs or tissue underneath.
Pathologist (pah-THOL-o-jist): A doctor who identifies diseases by studying cells and tissues under a microscope.
Progesterone (pro-JES-ter-own): A female hormone.
Prosthesis (pros-THEE-sis): An artificial breast used to replace the appearance of one removed during surgery.
External prosthesis: A breast form worn under clothing.
Internal prosthesis: A breast form inserted under the skin in a surgical procedure.
Radiation oncologist: A doctor whose specialty is treating cancer with radiation (radiation therapy).
Radiation therapy (ray-dee-AY-shun THER-Apee): Treatment with high-energy rays from x-rays or other sources to kill cancer cells.
Scans: Imaging tests that allow physicians to visualize various parts of the body to help them determine if cancer is present.
Stage: The term used to describe how far the disease has spread within the body.
Staging: The process of learning whether cancer has spread from its original site to another part of the body.
Surgery: An operation.
Systemic therapy (sis-TEM-ik THER-a-pee): Treatment that reaches and affects cells all over the body.
Tumor: An abnormal mass of tissue.
Ultrasound (UL-tra-sound): A test that bounces sound waves off tissues and converts the echoes into pictures. Tissues with different densities reflect sound waves differently, making it possible to tell the difference between a fluid-filled cyst and a solid mass.
Xeroradiography (zee-ro-ray-dee-OG-ra-fee): A type of mammography that records the picture of the breast on paper, rather than on film.
X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer.
National Cancer Institute Office of Cancer Communications National Institutes of Health
U.S. Department of Health and Human Services Building 31, Room 1OA24 Bethesda, MD 20892 301-496-2351
Cancer Information: 800-4-CANCER
American Cancer Society - Michigan Division 1205 E. Saginaw Lansing, MI 48906 517-371-2920
Cancer Response Service: 800-227-2345
Michigan Cancer Foundation I 10 E. Warren Detroit, MI 48201 313-833-0710
What are my treatment choices?
What are the benefits of each type of treatment?
What are the risks and side effects of each type of treatment?
How will I look after treatment?
Will I need to change my normal activities?
For how long?
Can I keep working during treatment?
How often will I need to have checkups?
Can you put me in touch with any other women I can talk with who have had a similar type of breast cancer and treatment?
Now that I have developed breast cancer, are my sister, daughter, or mother at risk, too?
What should they be told? What should they do?
How do I decide whether a breast prosthesis or surgical reconstruction is best for me?
Should I make this decision at the same time you and I are deciding which treatment is best?
Will I need help with physical recovery and rehabilitation?
Can you refer me to a program that will help with this?
If I want to discuss problems my family and I have in coping with breast cancer, can you refer me to someone?