This Breast Cancer Awareness Month, we’re not only focusing on the importance of screening and early detection, but we also want to take an in-depth look at the diagnosis and treatment of breast cancer.
“There is no question, a breast cancer diagnosis is scary – for the patient and her loved ones,” says Dr. Anita Chow, a breast surgical oncologist in Fort Worth. “Just know that when you embark on a battle against breast cancer, you will not be alone. Your doctors and the rest of your health care team will be with you every step of the way. Your family and friends will rally to support you and be at your side during this journey.”
Possible Breast Cancer Symptoms
Breast cancer often produces no noticeable symptoms initially – that’s why breast self-awareness, clinical breast exams and mammography are so important to catch the disease early.
When breast cancer becomes symptomatic, those symptoms may include:
- A new lump in the breast or armpit area
- Thickening or swelling of part of the breast
- Irritation or dimpling of breast skin
- Redness or flaky skin in the nipple area of the breast
- Nipple discharge other than breast milk, including blood
- Any change in the breast’s size or shape
- A nipple that appears flattened or pulled in
Having one or more of these symptoms does not necessarily mean there is cancer; there could be another cause. However, you want to have it checked out by your doctor right away.
Breast Cancer Diagnosis
If a mammogram indicates an abnormality that may be cancerous, the patient will be referred to a breast specialist or surgeon. Additional imaging tests, such as an MRI or ultrasound may be conducted for a better look.
If a suspicious mass is detected, a biopsy will likely be performed to take a sample of tissue or fluid from the breast and test it for cancer. If the biopsy reveals cancer is present, your breast oncologist will devise a plan to help you treat the disease. The course of treatment will be informed by your medical history, how advanced the cancer is and the type of breast cancer.
Types of Breast Cancer
There are a few different types of breast cancer. The most common is invasive ductal carcinoma (IDC), which accounts for about 80% of all cases. This cancer begins in the breast ducts – the tubes that carry milk to the nipple – and then spreads to other parts of the breast. If not caught early, it can spread to the lymph nodes, the bloodstream and other parts of the body.
The second most common type of breast cancer is invasive lobular carcinoma (ILC). Ten to 15% of breast cancers are attributed to ILC. This type of breast cancer begins in the lobules, the part of the breast that produces milk and then spreads to other areas.
Less common types of breast cancer include inflammatory breast cancer. This is a form of IDC that spreads to the breast skin, causing it to turn red and swollen. Inflammatory breast cancer is especially dangerous, as it spreads faster than other types.
Breast Cancer Subtypes
Breast cancers are categorized by subtypes based on hormone receptors. Estrogen and progesterone receptors both play a role in determining subtype, as does the human epidermal growth factor (HER2) protein. Both receptors enable breast cancer cells to use the body’s hormones to grow and spread. Similarly, HER2 protein accelerates breast cancer growth.
Testing for these receptors and proteins is a key step in determining the best course of treatment. By targeting the receptors or protein, oncologists can slow or stop the spread of the disease. Breast cancer that lacks both receptors and does not make the HER2 protein is known as triple-negative.
Breast Cancer Treatment
The treatment of breast cancer continues to advance. Surgery, radiation and chemotherapy have traditionally been the main weapons against this disease. While those treatments still play a vitally important role in breast cancer treatment, newer therapies are also helping advance successful treatment.
Surgery
There are a few different surgical approaches to treating breast cancer.
Lumpectomy
In a lumpectomy, also called breast-conserving surgery, the cancerous tumor and surrounding tissue are removed from the breast.
Lumpectomies are often followed by radiation therapy. Radiation is directed at the breast tissue to kill remaining cancer cells.
Lumpectomies are usually done when the cancer is contained to one part of the breast and the cancer is relatively small compared to the overall size of the breast.
Mastectomy
In cases when the cancer is too large or is found in multiple areas of the breast, the entire breast must be removed, a procedure known as a total mastectomy or simple mastectomy. The surgeon may also remove lymph nodes under the arm.
Some women undergo a double mastectomy, the removal of both breasts. A double mastectomy may be called for if cancer is found in both breasts or the woman has tested positive for BRCA gene mutations, which increase the likelihood of cancer later occurring in the second breast.
Radiation may be used as a follow-up treatment but is not always necessary following a mastectomy.
There are several variations of the mastectomy, including:
Modified radical mastectomy
The breast is removed, as well as some of the lymph nodes under the arm.
Skin-sparing mastectomy
This procedure removes the breast but leaves most of the skin, which minimizes scarring and provides for a more natural look after reconstruction. This may not be an option if the tumor is close to the skin.
Nipple-sparing mastectomy
This procedure leaves the skin, areola and nipple intact. Again, it may not be an option in all cases.
Breast Reconstruction
Following a mastectomy, women have the option of breast reconstruction – the rebuilding of the breast. In some cases, women can undergo reconstruction at the same time as the mastectomy, with both procedures taking place in one surgery. This is known as immediate reconstruction.
The patient may also choose to recover from the mastectomy first and then have reconstruction surgery months or even years later – this is called delayed reconstruction.
Breast reconstruction is accomplished by using implants or tissue from elsewhere in the woman’s body. The surgeon removes a flap of tissue from the abdomen, back, buttocks or thigh to use to reconstruct the breast.
It’s not a requirement to undergo reconstructive surgery – some patients opt to forgo this option and elect to have a flat closure, where the skin and tissue are smoothed out.
Chemotherapy
Chemotherapy is often, but not always, used to treat breast cancer. One of the main benefits of chemotherapy following surgery is that it is often effective at killing cancer cells and can help reduce the likelihood of the cancer coming back.
This treatment can also be used before surgery. Sometimes chemotherapy is used to shrink a tumor before operating, making a lumpectomy possible where a mastectomy would have otherwise been necessary.
In general, doctors may recommend chemotherapy for patients who have:
- Aggressive, fast-growing cancer
- Triple-negative breast cancer
- Inflammatory breast cancer
- Cancer that has spread to the lymph nodes
While chemotherapy has been shown to be an effective breast cancer treatment, it is also very difficult on the patient. The common side effects of nausea, hair loss and extreme fatigue are tough physically and emotionally, making the continuous support of family and friends especially important.
Other Treatments
Additional breast cancer treatments include hormonal therapy, which blocks the cancer cells from getting the hormones they need to grow and spread. This treatment may be effective if the patient has one of the breast cancer receptors: estrogen or progesterone.
Immunotherapy helps the body’s immune system fight cancer cells and cope with side effects from chemotherapy and radiation treatment. Patients with triple-negative breast cancer may be candidates for immunotherapy.
Targeted therapy is designed to attack the proteins that help the cancer spread.
Complementary and Alternative Treatments
In the aftermath of a breast cancer diagnosis, it’s normal for a woman and her loved ones to try to learn everything they can about the disease and research the ways the cancer can be defeated.
“Your physicians are the best sources of information when it comes to treatment options and what to expect,” says Dr. Chow. “But you should also do your own research – just be sure to use reliable sources of information. If you read or hear about alternate therapies, just be sure to discuss them with your physician to see if it’s something that can work with your medical treatment.”
Alternative Treatments to Avoid
There are innocuous sounding “treatments” that patients should be wary of. A special diet might sound healthy, but if it is implemented in place of the cancer treatment recommended by the doctor, that’s not healthy – it’s dangerous.
Some alternative treatments are described as “all natural” – this is a term that does not have any medical significance. Any vitamins or supplements the patient takes need to be re-evaluated, as well.
The Role of Complementary Treatments
Complementary treatments, if used properly, will help a patient cope with the impact of the disease and treatments. Appropriate complementary treatments will work well in tandem with the patient’s medical treatment or, at the very least, not interfere with it. When approved by a doctor, a complementary treatment may provide value to the patient, but they must never replace medical treatment.
If you are considering complementary treatments, just remember, they are intended to help you cope with the physical or emotional impact of the disease and medical treatment; they are not in any way a treatment that kills the underlying cancer. Only medical treatment can accomplish that.
Complementary Treatments that May Help
The Mayo Clinic identifies 11 complementary treatments that are generally safe and may help cancer patients. However, even with these therapies, the patient must consult with her physician first to ensure that the treatment is safe for her. Every patient’s situation is different, so be sure to talk to your doctor.
Acupuncture
This ancient treatment may help some people with nausea caused by chemotherapy, as well as pain. Only see an acupuncturist who is recommended by your doctor.
Aromatherapy
This involves the use of fragrant oils that create a calming effect. There are professionals who provide this service, but many people just do it at home on their own.
Exercise
Exercise is good for you for many reasons. If you’re battling cancer, it can help with stress and pain.
Hypnosis
Some people find hypnosis to be helpful in easing stress, anxiety or even pain. It should only be performed by a certified therapist. A history of mental health disease may complicate hypnosis.
Massages
Massages can help relieve stress and pain. Only work with a massage therapist who is trained and experienced in working with cancer patients.
Meditation
Meditation is a healthy way to relax and relieve stress. An instructor can help you, or you can do it on your own. There are various apps you can download to help with meditation.
Music Therapy
This can involve listening to music, playing music, singing or writing songs. Many cancer treatment centers have music therapists available to patients.
Relaxation techniques
A therapist can help you learn to better relax your mind, as well as your body.
Tai chi
This is a type of exercise centered around gentle movements and deep breathing.
Yoga
Yoga is another popular exercise that involves deep breathing and stretching. There are yoga instructors who specialize in working with cancer patients.
Mindfulness-based interventions
Plenty of people engage in mindfulness to help relieve stress and feel unburdened. Essentially, mindfulness is about living in the moment and letting go of worry and anxiety.
Mindfulness can mean sitting still, breathing deeply and focusing on how your body feels, while shutting out other thoughts and distractions. It may involve going for a walk. Mindfulness interventions may help relieve anxiety and improve sleep.
Making Your Battle Plan
A breast cancer diagnosis marks the beginning of a battle – and like any fight, you need help and people on your side. Your family, your friends, your doctor and other health care professionals are in that fight with you.
“Every patient is unique, which is why your medical team will create a treatment plan tailored for your needs and to give you the best chance of beating breast cancer,” says Dr. Chow. “We do not want you to fight alone. Your physicians are there to help you win.”
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
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