Breast Cancer Guide
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Breast Cancer Guide A Journey Through Your Care If you have just been told that you have breast cancer, you are likely feeling overwhelmed with emotions, information, and decisions. Mount Carmel’s team of expert physicians and Breast Oncology Nurse Navigators are here for you from your diagnosis and treatment through your recovery and survivorship. Our Breast Cancer Guide contains information to help you better understand the different aspects of your care and the resources that are available to you through your journey in the coming weeks and months. Although you may not be a healthcare professional, you are an important part of your healthcare. As you go through your diagnosis and treatment, keep these suggestions in mind: Don’t be afraid to ask questions. Keep a written list of your questions to take with you to your doctor’s appointments. Bring someone with you to your appointments to help you listen, ask questions, and take notes. It is hard to absorb everything by yourself. Keep a log of your healthcare journey as you go along. Feel free to get a second opinion about what treatment options are best for you. Express your feelings — talk with friends and family members and seek support. For your continued health education, this booklet and others are available on mountcarmelhealth.com. 1 Table of Contents This Breast Cancer Guide is dedicated with love Breast Cancer ..........................................4 Survivorship — What Is Breast Cancer? ....................................4 New Beginnings ....................................35 to the many women diagnosed with breast cancer. Types of Breast Cancer .....................................5 Your Survivorship ...........................................35 Our hope is that by sharing the knowledge Understanding Your Pathology Report .........6 Fertility After Cancer Treatment ..................37 Your Healthcare Team .....................................9 Menopause .......................................................38 we have gained over the years from working Sexuality ............................................................40 Surgery .......................................................10 Finances ............................................................42 with women with breast cancer, we may ease the Types of Surgery ..............................................10 Helping Your Children Cope ........................43 way for all those to come. Your Surgical Experience ...............................13 Follow-up Care ................................................15 Support Resources ...........................45 Breast Reconstruction .....................................18 National Organizations ..................................45 THE MOUNT CARMEL BREAST ONCOLOGY NURSE NAVIGATORS Breast Prostheses .............................................21 Websites ............................................................45 Books .................................................................47 Treatments ..............................................22 Radiation Therapy ...........................................22 Glossary ......................................................48 Oncotype Dx Test ...........................................23 Chemotherapy .................................................23 Notes .............................................................52 Anti-hormone Therapy ..................................24 Clinical Trials ...................................................25 Family History .................................................26 Managing Side Effects ....................27 Fatigue...............................................................27 Hair Loss ...........................................................27 Lymphedema ...................................................28 Lymphedema Treatments ..............................30 Digestive Side Effects ......................................31 Nutrition, Exercise, and Weight Management ......................................32 Other Nutrition Issues ....................................33 2 3 Types of Breast Cancer Breast Cancer Ribs There are many different types of breast Pectoralis muscle cancer. The two most common types are: Fat Lobules What Is Breast Cancer? “Breast cancer is just a Ductal carcinoma — begins in the ducts of diagnosis. It does not limit me the breast and occurs in about 80% of all Duct Breast cancer begins when cells in the breast breast cancers. undergo certain changes. A normal cell or define me as a person.” Nipple Lobular carcinoma — occurs in 10% to becomes malignant, or cancerous, when it — TISH JOHNSON, Silver Linings 15% of breast cancers and begins in the grows and reproduces itself without normal Duct lobules or milk glands of the breast. control mechanisms. In most cases we do not opening know what causes these changes to occur. If lymph fluid is channeled back into the the abnormal cells are not eliminated, they bloodstream. Other types of breast cancer that are not as can continue to grow and eventually spread to common are: other areas of the body. The lymph nodes may play an important part in your treatment decisions. Lymph nodes Tubular — about 2% of breast cancers. Most breast cancers begin months to years are places where cancer cells may collect. For before they can be detected. Because of this, certain types of breast cancer, removing and Mucinous — about 2% of breast cancers. Ductal breast cancer is not usually a medical or carcinoma in studying some of the lymph nodes (most Inflammatory — about 1% of breast situ (DCIS) surgical emergency. It is often fine for you to often from under the arm near the affected cancers, and usually appears as a red and take the time you need to learn about your breast) helps to determine whether the breast warm area of the breast with “orange peel” breast cancer. Together with your doctors cancer has begun to spread outside of the appearance of the skin. and loved ones, you can make thoughtful breast. decisions about surgery and treatment. There are many different types of breast Breast cancers are either in situ or invasive: cancer. Each breast cancer has various In situ cancers begin within the walls of characteristics that affect how it may behave. the duct or lobule. They are very unlikely After studying the tissue specimens from to spread to other parts of the body any biopsies or surgeries, the pathologist (metastasize). will report the numerous characteristics of Invasive cancers have broken through the the breast cancer. Your surgeon and your walls of the duct or lobule and have the oncologist will look at all the factors about ability to spread to other parts of the body. you and your breast cancer in determining Invasive what treatment to recommend for you. ductal Having a basic knowledge of the lymphatic carcinoma system will help you understand certain aspects of your treatment for, and recovery from, breast cancer. The job of the lymphatic system is to keep the tissue around the cells of the body free from excess fluid, proteins, bacteria, viruses, and destroyed cells. Lymph nodes and lymph vessels act as filtering stations. They remove and destroy bacteria, viruses, and dead cells. The remaining cleaned 4 5 Understanding Your The last section is the microscopic Angiolymphatic HER2/neu Status diagnosis that states: Pathology Report Space Invasion This test is done to note the number of HER2/ • Size of tumor This tells whether your cancer has spread to neu receptors on the surface of the tumor Some women want to know the results of • Type of cancer the blood vessels or lymphatic system around cells. The amount of HER2/neu receptors their surgery on their pathology report. Other present may help your doctor know if your • Grade of cancer your tumor. It is best when no invasion is women prefer not to know the details. The seen. cancer will respond to certain treatments. following will help you to understand what • Angiolymphatic invasion you would like to know about your report. • ER/PR status Margin Status Lymphatic channel The tissue removed at the time of the • HER2/neu status The margins are the edges of the tissue that biopsy or surgery is sent to a pathologist. • Margin status Breast tissue Cancer cells was removed. The report will state if there is A pathologist is a doctor who has had cancer at these edges. The goal is to have a specialized training looking at tissue under • Lymph node status margin of healthy tissue that is free of cancer Blood vessel Normal duct cells a microscope. While you may not meet this • Staging cells removed from around the tumor. If the doctor, he or she plays a key role in your care. Wall of milk duct margins are not free of cancer cells, your At Mount Carmel, when a diagnosis of breast Grade surgeon may want to remove more tissue. cancer is made, two pathologists review the If the tissue is cancerous, it will be graded as tissue to ensure an accurate diagnosis. They A examine the tissue very closely and provide to the amount of change the cancerous cells A – cancer cells have from normal cells. The grade is based on B – normal tissue your doctor with a report of the findings. ER/PR Status B C – the edge The report with the diagnosis, including the a combination of growth pattern and tubule Tumors are tested for whether or not they C grade of the tumor, estrogen receptor status, formation, nuclear changes, and cellular depend on estrogen and progesterone to progesterone receptor status, HER2/neu proliferation (mitotic rate). grow: