I have breast cancer, what do I need to know?

Non-invasive cancer

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer (cancer has not spread into nearby breast tissue). It’s also called stage 0. In situ [in SY-too] means “in place.” The abnormal cells are contained within the milk ducts (the canals that carry breast milk to the nipple during breastfeeding).
DCIS is a non-invasive condition, but if left untreated, the abnormal cells could eventually develop into invasive breast cancer. However, with appropriate treatment, the outlook for those with DCIS is quite positive.

Invasive cancer

Invasive breast cancer occurs when cancer cells move from the milk ducts or lobules, which are the milk-producing sacs in the breast, into the surrounding breast tissue. These cancer cells can also spread to lymph nodes or other areas of the body. The outlook for someone with invasive breast cancer varies based on the stage of the disease and several other factors.

Lymph nodes are tiny groups of immune cells that serve as filters in the lymphatic system. When breast cancer spreads, the underarm lymph nodes are usually the first to be affected. Therefore, it's crucial to determine if any lymph nodes have cancer, as this can influence the cancer's stage and the available treatment options.

Lymph node status shows if the breast cancer has spread to the lymph nodes or not

• Lymph node-negative. This means no cancer is found in the sentinel nodes. It’s unlikely other lymph nodes contain cancer. Surgery to remove more lymph nodes won’t be needed.
• Lymph node-positive. This means the cancer is found in the sentinel nodes. More lymph nodes may be removed.

The lymph node status helps determine the breast cancer stage and guides treatment options. The chances of survival are better when breast cancer is lymph node-negative.

Once the tumor is excised, the pathologist will assess its size. Generally, a smaller tumor is associated with a more favorable prognosis.

Tumor grade indicates how closely tumor cells resemble normal cells when viewed under a microscope. If the cells look more unusual, the tumor grade is higher. Typically, a lower tumor grade suggests a more favorable outlook for the patient, with Grade 1 representing the most positive prognosis.

Hormone receptor status

Certain types of breast cancer rely on the body's natural hormones, estrogen and progesterone, to grow and multiply. To determine this, breast cancer cells are examined for hormone receptors. These receptors promote cancer growth by binding to estrogen and progesterone. When a tumor has a high number of these receptors, it is classified as ER-positive or PR-positive breast cancer. Hormone therapy is used to treat these cancers, leading to better survival rates.

HER2 status

Breast cancer cells undergo testing for a protein known as HER2, which plays a crucial role in cell growth and survival. Certain breast cancers exhibit high levels of HER2 protein on their cell surfaces, categorizing them as HER2-positive tumors. These tumors benefit from HER2-targeted therapy, which enhances survival rates for affected individuals.
Tumors that display minimal or no HER2 protein on their surfaces do not receive HER2-targeted treatment.

Tumor profiling

Tumor profiling tests provide insights into the genetic makeup of cancer cells. This type of profiling is particularly useful for guiding treatment choices for individuals with ER-positive breast cancer. It can assist in determining the necessity of chemotherapy alongside hormone therapy. Additionally, it helps assess the likelihood of metastasis, which is when cancer spreads to other parts of the body.

This may also be referred to as genomic testing or molecular profiling.

Types of Surgery may be:

• Lumpectomy, also known as breast-conserving surgery, involves the removal of the tumor along with a small amount of surrounding healthy tissue. This procedure aims to preserve the breast's appearance, keeping it as similar as possible to its original state before the operation.

• Mastectomy involves the complete removal of the breast. During this procedure, some lymph nodes located in the underarm, known as axillary nodes, may also be taken out to check for cancer presence. For those who can choose, studies show that survival rates after a lumpectomy followed by radiation are comparable to those after a mastectomy. The choice of surgery does not influence the necessity for additional treatments, as drug therapies are determined by the characteristics of the tumor rather than the surgical method used.

After either type of surgery, you may experience numbness and soreness. If lymph nodes are removed or treated with radiation, there is a possibility of developing lymphedema, which is swelling in the arm, hand, or other areas, typically occurring within three years post-surgery. It’s important to take an active role in your health by understanding your diagnosis, treatment options, and potential side effects. Once you receive a treatment plan from your doctor, take the time to explore your choices to make an informed decision, keeping in mind that each option has its own risks and benefits. Reflect on your personal values and lifestyle, and consider seeking a second opinion if needed.

Radiation therapy employs X-rays to eliminate cancer cells. Its primary aim is to eradicate any remaining cancer cells in or around the breast and nearby lymph nodes following surgery, thereby reducing the chance of cancer returning. This treatment is typically administered after a lumpectomy and, in some instances, after a mastectomy. Common short-term side effects include fatigue, and the breast may feel rough, appear red like a sunburn, and experience swelling and tenderness.

Chemotherapy targets cancer cells that might have spread from the breast to other areas of the body. This treatment is usually given over a period of 3 to 6 months, with breaks of days or weeks in between sessions.

Short-term side effects may consist of:

• Hair loss
• Nausea and vomiting
• Weakened fingernails and toenails
• Mouth sores
• Fatigue
• A decrease in red and/or white blood cell counts

Long-term side effects can include:

• Early menopause
• Weight gain
• Difficulties with memory and concentration, often referred to as "chemo-brain."

Some types of breast cancer rely on hormones like estrogen and progesterone for their growth. When these hormones bind to specific proteins known as hormone receptors on cancer cells, it stimulates their growth. Hormone therapy medications work by hindering the growth of hormone receptor-positive tumors by preventing the cancer cells from accessing these hormones.

Tamoxifen and aromatase inhibitors (AIs) are examples of daily pills taken for a duration of 5 to 10 years. Another approach to hormone therapy is ovarian suppression, which stops the ovaries from producing estrogen, achievable through medication or surgical methods.

Common side effects often resemble menopausal symptoms, including:

• Hot flashes
• Night sweats
• Aches in the joints and muscles.

Certain types of breast cancer exhibit elevated levels of a protein known as HER2 on the cancer cell surface, which is referred to as HER2-positive breast cancer. Treatments specifically designed for HER2-positive breast cancer include targeted therapies. Notable examples of these drugs are trastuzumab (Herceptin) and pertuzumab (Perjeta), which are administered intravenously or via subcutaneous injection. Patients may experience side effects, including potential heart issues, so heart function will be monitored before and throughout the treatment process. Additionally, fatigue and other side effects may occur.