Breast Cancer (cont.)

Treatment

Women with breast cancer have many treatment options. The treatment that's best for one woman may not be best for another.

The options are surgery, radiation therapy, hormone therapy, chemotherapy, and targeted therapy. You may receive more than one type of treatment. The treatment options are described below.

Surgery and radiation therapy are types of local therapy. They remove or destroy cancer in the breast.

Hormone therapy, chemotherapy, and targeted therapy are types of systemic therapy. The drug enters the bloodstream and destroys or controls cancer throughout the body.

The treatment that's right for you depends mainly on the stage of the cancer, the results of the hormone receptor tests, the result of the HER2/neu test, and your general health.

You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for women at any stage of breast cancer.

Your doctor can describe your treatment choices, the expected results, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects, how to prevent or reduce these effects, and how treatment may change your normal activities.

You may want to know how you will look during and after treatment. You and your health care team can work together to develop a treatment plan that meets your medical and personal needs.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat breast cancer include surgeons, medical oncologists, and radiation oncologists. You also may be referred to a plastic surgeon or reconstructive surgeon. Your health care team may also include an oncology nurse and a registered dietitian.

At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. Information about such care is available on the NCI Web site at http://www.cancer.gov/cancertopics/coping and from the NCI Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) or at LiveHelp (http://www.cancer.gov/help).

You may want to ask your doctor these questions before you begin treatment:
  • What did the hormone receptor tests show? What did other lab tests show? Would genetic testing be helpful to me or my family?
  • Do any lymph nodes show signs of cancer?
  • What is the stage of the disease? Has the cancer spread?
  • What are my treatment choices? Which do you recommend for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • What are the risks and possible side effects of each treatment? How can side effects be managed?
  • What is the treatment likely to cost? Will my insurance cover it?
  • How will treatment affect my normal activities?
  • Would a research study (clinical trial) be appropriate for me?
  • Can you recommend other doctors who could give me a second opinion about my treatment options?
  • How often should I have checkups?

Surgery

Surgery is the most common treatment for breast cancer. Your doctor can explain each type, discuss and compare the benefits and risks, and describe how each will change the way you look:

  • Breast-sparing surgery: This is an operation to remove the cancer but not the breast. It's also called breast-conserving surgery. It can be a lumpectomy or a segmental mastectomy (also called a partial mastectomy). Sometimes an excisional biopsy is the only surgery a woman needs because the surgeon removed the whole lump.


  • Mastectomy: This is an operation to remove the entire breast (or as much of the breast tissue as possible). In some cases, a skin-sparing mastectomy may be an option. For this approach, the surgeon removes as little skin as possible.

The surgeon usually removes one or more lymph nodes from under the arm to check for cancer cells. If cancer cells are found in the lymph nodes, other cancer treatments will be needed.

You may choose to have breast reconstruction. This is plastic surgery to rebuild the shape of the breast. It may be done at the same time as the cancer surgery or later. If you're considering breast reconstruction, you may wish to talk with a plastic surgeon before having cancer surgery.

In breast-sparing surgery, the surgeon removes the cancer in the breast and some normal tissue around it. The surgeon may also remove lymph nodes under the arm. The surgeon sometimes removes some of the lining over the chest muscles below the tumor.

In total (simple) mastectomy, the surgeon removes the whole breast. Some lymph nodes under the arm may also be removed.

In modified radical mastectomy, the surgeon removes the whole breast and most or all of the lymph nodes under the arm. Often, the lining over the chest muscles is removed. A small chest muscle also may be taken out to make it easier to remove the lymph nodes.

The time it takes to heal after surgery is different for each woman. Surgery causes pain and tenderness. Medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more relief.

Any kind of surgery also carries a risk of infection, bleeding, or other problems. You should tell your health care team right away if you develop any problems.

You may feel off balance if you've had one or both breasts removed. You may feel more off balance if you have large breasts. This imbalance can cause discomfort in your neck and back.

Also, the skin where your breast was removed may feel tight. Your arm and shoulder muscles may feel stiff and weak. These problems usually go away. The doctor, nurse, or physical therapist can suggest exercises to help you regain movement and strength in your arm and shoulder. Exercise can also reduce stiffness and pain. You may be able to begin gentle exercise within days of surgery.

Because nerves may be injured or cut during surgery, you may have numbness and tingling in your chest, underarm, shoulder, and upper arm. These feelings usually go away within a few weeks or months. But for some women, numbness does not go away.

Removing the lymph nodes under the arm slows the flow of lymph fluid. The fluid may build up in your arm and hand and cause swelling. This swelling is called lymphedema. It can develop soon after surgery or months or even years later. You'll always need to protect the arm and hand on the treated side of your body from cuts, burns, or other injuries. Information about preventing and treating lymphedema is available on the NCI Web site at http://www.cancer.gov/cancertopics/coping and from Information Specialists at 1-800-4-CANCER (1-800-422-6237) or LiveHelp (http://www.cancer.gov/help).

You may want to ask your doctor these questions before having surgery:
  • What kinds of surgery can I consider? Is breast-sparing surgery an option for me? Is a skin-sparing mastectomy an option? Which operation do you recommend for me? Why?
  • Will any lymph nodes be removed? How many? Why?
  • How will I feel after the operation? Will I have to stay in the hospital?
  • Will I need to learn how to take care of myself or my incision when I get home? Where will the scars be? What will they look like?
  • If I decide to have plastic surgery to rebuild my breast, how and when can that be done? Can you suggest a plastic surgeon for me to contact?
  • Will I have to do special exercises to help regain motion and strength in my arm and shoulder? Will a physical therapist or nurse show me how to do the exercises?
  • Is there someone I can talk with who has had the same surgery I'll be having?
  • How often will I need checkups?


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