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Frequently asked Questions about Breast Cancer


 

 

 

 

 

 

I found a lump in my breast ... does that mean ...you have breast cancer? ?

Not necessarily. Lumps can be due to a variety of causes (e.g., hormonal imbalances) apart from cancer. And as a matter of fact, the majority of breast lumps are not cancerous. However, a lump should never be ignored. You should visit a doctor and have it checked out without any delay. For that matter, you should get ANY change inthe breast, like a lump or thickening, nipple discharge, skin dimpling or puckering, color change, pain or irritation to the breast or nipple area checked by a medical professional.

What kind of doctor do I go to?

A gynaecologist

What exactly will happen?

The doctor will take your personal and family medical history and palpate (feel) the lump. After this, you might be asked to get some investigations done. These could be any of the following:

Mammogram,ie breast x-ray

FNAC, I e fine needle aspiration.

Core Needle Biopsy

Based on the results of these tests, you might then be advised to get investigative surgery done.
What's that?

An operation done under general anesthesia. The surgeon will remove the lump and send it for a histo-pathological examination. A technician will observe the lump under a microscope and determine whether it is malignant or not. This report will come in about 20 minutes, while you are still under anesthesia. If the report indicates the lump is benign, that's the end of it.

If the lump is malignant, the surgeon will proceed to remove some lymph nodes from your armpit, to try to establish if, and how much, the disease might have spread.

The final report comes in a few days later, after a detailed analysis of the tissue taken from the lump and lymph nodes.

So that means I don't necessarily have to lose my breast?

Absolutely not. Mastectomy, ie removal of the breast, was the default course of action 20 years ago, but breast cancer treatment has changed a lot since then. Today, doctors prefer to take a less drastic route of lumpectomy (removal of the lump), followed by adjuvant (ie additional) therapy in the form of radiation, chemotherapy or hormonal medication, as the case may be. Mastectomy is now recommended only in the following cases: the lump is large, the breast is small, the tumour is almost attached to the chest wall or the results of the surgery will be cosmetically unacceptable.

But won't a lumpectomy instead of mastectomy mean a higher risk of recurrence?

No. There are studies, which show that the majority of women with early stage disease - stage I and II, treated by breast conservation procedures and radiation have the same survival as women treated with mastectomy.

What's Stage I and II?

Stages are a way to classify the spread of the disease.
Stage I Tumor is confined to breast, tumor is less than or equal to 2 centimeters in greatest dimension.
Stage II Tumor less than 5 centimeters with positive underarm lymph nodes or tumor is more than 2 centimeters with negative underarm lymph nodes.
Stage III Tumor is more than 5 centimeters with positive underarm lymph nodes or tumor with extension to chest wall or skin or lymph nodes fixed to one another or internal mammary lymph nodes.
Stage IV Tumor has spread to other parts of the body.

Would they do the mastectomy right away?

Not without taking your permission first. But with cancer, it is always advisable not to delay.

Will I need to be admitted to hospital for a lumpectomy?

Yes. The operation is performed under general anesthesia.

How long will I need to be in hospital?

That varies according to the patient and hospital. Typically the stay ranges from 3 to 5 days. You will have to go back afterwards for the lymph to be drained away.

If things are taken out of my armpit, will it affect my arm movements?

No. Provided you do the exercises, which will be shown to you by the physiotherapist before you leave hospital. However, since the nerve is cut during surgery, a feeling of numbness in the upper arm is normal.

What is this TNM thing the doctor wrote on my report?

T-N-M is a system of classification of the tumor. T refers to the size of the tumor. N stands for the nodes that tested positive. M refers to metastasis, ie whether the tumor is spread.

And what's Grade II? Does it mean things are very bad?

No. Grade is a way of classifying the kind of tumor. It has nothing to do with the Stage of the illness.

OK, now that the final report has come, what next?

Based on the findings, as well as the doctor's qualitative reading, a course of treatment will be prescribed. This would typically be a combination of the following:

OK, now that the final report has come, what next?

Based on the findings, as well as the doctor's qualitative reading, a course of treatment will be prescribed. This would typically be a combination of the following:

Radiation, the use of high energy x-rays to destroy cancer cells in the area being treated.

Chemotherapy, the use of chemicals (drugs) to kill cancer cells or stop them from growing.

Hormonal Therapy, the use of drugs that block the action of hormones like estrogen which promote the growth of some cancers.

Will I have to stop working?

Not necessarily. In fact, doctors prefer that patients keep themselves busy as it prevents them from brooding over their illness. Just be careful not to overexert yourself. Avoid rush hours while traveling and ask your employer if you can do some work from home.

Chemotherapy ... that means my hair will fall out?

Once again, not necessarily. Individual constitutions react in very different ways, and different treatment protocols lead to
varying amounts of hair loss.
What actually happens is this: the chemicals are designed to attack and kill any fast growing cells that might be in the body. Besides the cancer cells they are targeted for, normal cells also get affected. Hair follicles are among the first to get affected, and so hair falls.

Mind you, the loss is temporary. When you stop chemotherapy, your hair will grow back. In fact, many patients have reported their hair growing back thicker and glossier.

What about side effects of radiation?

Side effects from radiation depend on the dose and the area being treated. Common side effects include the following: Local skin reactions including itching, redness, or dryness and scaling of the skin.
This will continue for approximately 2 weeks following the end of treatment.

Fatigue. This will gradually go away following treatment.

How could this have happened ?

No one in my family has breast cancer ...

Only 5 - 10% of women who develop breast cancer have a family history of the disease.

According to the American Cancer Society, the following factors have been shown to be related to increased risk of breast cancer:

First menstruation at an early age

Pregnancy after age 35 or not at all

Late onset of menopause

Obesity

Excessive use of alcohol

Excessive amount of fat in diet

Even so, seventy-five percent of breast cancers occur in women with no known risk factors.

All women are at risk for breast cancer. The two most significant risk factors are being female and getting older.

As a woman ages, her risk increases. What else should I know?

Until we know more about preventing breast cancer, early detection of the disease while the tumor is small, provides more treatment options and the best chance of survival. And that is why Breast Self Examination is so important.

 



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