Appledore Medical Group - October 16, 2018

I Have Breast Cancer - What Now?
Lauren Thompson, MD - Breast Surgeon

When Mary Thomas received a breast cancer diagnosis at the age of 56, it was the most terrifying moment of her life. “It was a shock,” she said. “My appointment was on a Friday and my surgery was scheduled for the following Wednesday. So I left the office knowing what I was dealing with. Even though it was bad news, I would rather know right away... I never dreamed that I would have breast cancer when I went in that day, but I was glad to know what I was facing when I left.” Unfortunately, more than 250,000 women in the United States face the same diagnosis as Mary did each year. Understanding your treatment options can help ease the burden.

Defining Breast Cancer

Before starting treatment, it is important to understand how breast cancer begins. Cancer is a disease in which cells grow in an abnormal way. Normally, the cells divide in a controlled manner to replace old or damaged cells. If cells keep dividing when new cells are not needed, a mass of tissue called a tumor forms.

A tumor can be benign or malignant. A benign tumor is not cancer and will not spread to other parts of the body. A malignant tumor is cancer. Cancer cells invade and damage tissue around them. The cancer cells also can enter the lymph and blood streams, spreading to other parts of the body. Breast cancer is the development of malignant cells in the breast tissue and is the most common form of cancer in women.

Cancers happen when cells grow and divide without control. Normally, there are many checkpoints in the cell growth cycle to stop cells from growing too much. It takes damaging several different checkpoints for cancer to develop. Checkpoints are damaged in one of two ways -- either from exposures (to radiation or harmful chemicals) over the course of a person’s life, or person can be born with a genetic mutation in one of the checkpoint genes. If a person inherits a genetic mutation in one of these important genes, they are more likely to get cancer, and at a younger age. Fewer than 10% of breast cancers are attributed to one of these inherited genetic mutations. BRCA 1 and BRCA 2 are examples of these cell growth genes called tumor suppressor genes. When someone says they have BRCA in their family, they are saying that a damaged copy of the BRCA 1 or 2 genes has been passed down from parent to child and is not working as a break to cells growing. Families with a high incidence of breast cancer may consider genetic testing to determine if known genetic factors are causing the increased risk.

Treatment Options for Breast Cancer

Most breast cancers are very treatable, especially those detected early and those that are still localized in the breast. There are two types of treatment for breast cancer – local and systemic. The goal of local treatment is to remove the entire cancer. That includes all the cancer that you can see and feel as well as microscopic cells that live nearby. The goal of systemic therapy is to kill off any cells which may have broken free and are circulating in the body. There is no one size fits all treatment plan – and a combination of both kinds of treatments will likely be offered based on a woman’s age, general health, the stage of the cancer, and her prognosis.

The healthcare team will be made up of a variety of health professionals including doctors, nurses, and pharmacists. It is important to maintain contact with your medical team, adhere to recommended treatment, and go to any recommended appointments for best outcomes possible.

Many women receive more than one type of treatment for their breast cancer, depending on the type of cancer, how advanced it is, and the patient’s overall health. Treatments may include:

Local Treatments

Localized treatments target cancer cells without impacting the rest of the body.

  • Surgery: According to the American Cancer Society®, surgery is critical for most women with breast cancer. There are two basic kinds of breast surgery. Lumpectomy is removing just the tumor with a rim of normal tissue. Mastectomy is removing the entire breast.
  • Radiation Therapy: Targets tumor cells with high-energy rays, similar to X-rays, that kill the cancer cells. There are many reasons your doctor may recommend radiation therapy. Very commonly though, there can be microscopic cancer cells which live near tumors. Your surgeon cannot see or feel them in the operating room. Radiation can be used to “mop up” these cells.

Systemic Treatments

Systemic treatments are typically drugs given either by mouth or IV. As a result, they are able to reach any part of the body. Systemic treatment can be used to kill any cancer cells which have broken free from the tumor and are circulating in the body, or to shrink the tumor if it is large. Different drugs may be used depending on the type and stage of the breast cancer.

  • Chemotherapy: Using special medicines to shrink the tumor and kill the cancer cells. The drugs can be pills, medicines given in your veins, or sometimes both.
  • Hormonal Therapy: Blocks cancer cells from getting the hormones they need to grow.
  • Biological Therapy: Works with your body’s immune system to help it fight cancer cells or to control side effects from other cancer treatments.

Clinical Trials

Existing treatment protocols have been established and continue to be modified through clinical trials. These research studies are essential to determine whether or not new treatments are both safe and effective. Since highly effective treatments for many cancers remain unknown, numerous clinical trials are always underway around the world. You may wish to ask your doctor if you should consider participating in a clinical trial. You can find out about clinical trials at the US National Institutes of Health.

Side Effects

Most women undergoing chemotherapy and/or radiation therapy have some side effects. While these treatments are aimed at killing cancer cells, they can also destroy some healthy cells in the process. Your doctor can help with ways to minimize the consequences of chemotherapy and radiation therapy as much as possible. Not all women will experience side effects but, if they do, they may include:

  • Loss of appetite
  • Nausea and vomiting
  • Weakness
  • Fatigue
  • Mouth sores
  • Hair loss
  • Weight gain
  • Early menopause
  • Bleeding
  • Diarrhea
  • Higher risk of infections

Your doctor will talk to you about the risks and benefits of targeted therapy treatment. A variety of treatments are available to help manage side effects including medication, lifestyle changes, and alternative treatments. The earlier the side effects are addressed, the more likely they will be controlled with a minimum of discomfort.

When asked what advice she would give women newly diagnosed with breast cancer, Mary said, “I would tell them to take one day at a time. Looking too far ahead could drive you crazy. I would encourage them to learn about breast cancer, but be careful about reading too much. It can get discouraging. I would also encourage them to take care of themselves. It's always there, but you can't let it take over.”

For more information regarding breast cancer or breast disease, contact Lauren Thompson, MD, of Atlantic Surgical Associates at (603) 431-5242.

Centers for Disease Control and Prevention (CDC)
American Cancer Society
National Cancer Institute
National Breast Cancer Foundation, Inc.®