CV Advance October 2018 Breast Cancer 201
Breast Cancer 201…..the details after diagnosis. We discussed how we develop breast cancer and how we might find it in Breast Cancer 101. How do we understand the label on our diagnosis and how do we begin to sleuth through treatment options? After we've been told we have cancer, we need to become an instant expert. We have to make decisions based on the information that we're presented at each medical visit. I'm hoping this information will help us all learn now…..perhaps for ourselves or perhaps to compassionately support a woman that we know and love. Numbers and Letters… Each breast cancer has a name and a number and letter to help us understand the type, nature and potential spread of the disease. Stage 0means that there are atypical cells, but no spread of the cancer into the ducts, lobules or surrounding tissues. It's early and non-invasive and accounts for around 20% of all breast cancer cases. Ductal or Lobular Carcinoma in Situ are in this category. Stage 1means that the tumour is under 2 cm. and has not spread into the lymph nodes or outside the breast tissue. Stage 2 (A and B)means the tumour is 2 - 5 cm. and may include up to 3 lymph nodes but has not spread further. Stage 3 (A and B)means that the tumour is larger that 2 cm. and may include up to 9 underarm lymph nodes and, with B, may have spread into the skin, chest wall, muscles and ribs. Inflammatorybreast cancer is an aggressive type of Stage 3B cancer, which also involves a reddened, inflamed breast. Stage 4tells us that the cancer has spread beyond the breast, chest and lymph nodes outwards to distant organs. Recurrentbreast cancer is the name used when it has returned; it may appear in the breast or elsewhere in the body. Now what? How do we go ahead? Most women will choose some type of surgery, their choice dependent on their type of cancer, impact on recovery and long term prognosis. Surgery a "local" treatment, used to remove tumour cells, to inspect/remove lymph nodes and to reconstruct the breast. Lumpectomyis a breast-conserving surgery and the least invasive procedure. The cancer is removed, along with some adjacent breast tissue and associated lymph nodes. Most women choosing this option will also need radiation. Total Mastectomyinvolves the surgical removal of the breast and lymph nodes as needed but the tissue beneath the breast is left intact. This is the most common surgery used to treat breast cancer. Radical Mastectomyis less common now, involving removal of the breast, pectoral/chest muscles and all of the lymph nodes. Reconstruction Surgerymay be begun during the initial surgery or it may be delayed. It may involve silicone or saline (salt water) implants or tissue flap surgery. The latter, tissue flaps, may mean taking some of a tummy muscle, buttock muscle or a back/shoulder muscle to be transplanted over to form breast tissue. More commonly now, your surgeon may recruit some tummy fat and blood vessels, called a DIEP Flap Reconstruction. This reconstruction has a natural feel and look, ages more naturally but takes time and multiple medical visits over some months. Radiation is a "regional" treatment, by directing high energy rays in order to destroy cancer cells. It can be given externally or internally (called brachytherapy). Most of the side effects of radiation (wait for the next article for more on this!) can be minimized and are not permanent. Chemotherapyis a whole-body or "systemic" treatment in which drugs are given through an IV or by mouth when they travel through the bloodstream and impact cancer cells. It may take some months to complete a series of treatments. Hormonal/Targeted Therapiesare a second form of systemic treatment. Hormonal therapy is used to reduce the risk of cancer returning or to treat cancer that has come back or spread. It changes the hormonal impact on the breast or simply reduces our hormonal load.
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