Treatment Options

Once diagnosed with cancer, you will need a team of medical experts. No one doctor is able to provide all the services you may require. Here are some of the experts you may need to consult with regard to the right treatment for you and for other concerns:

Anesthesiologist – a doctor who gives medications that keep you comfortable during surgery

Oncologist – a doctor who uses chemotherapy or hormone therapy to treat cancer

Pathologist – a doctor who examines tissue and cells under a microscope to decide if they are normal or cancer

Physical Therapist – a medical professional who teaches exercises that help restore arm and shoulder movements after surgery

Radiation Oncologist – a doctor who uses radiation therapy to treat cancer

Radiologist – a doctor who reads mammograms and performs other tests, such as x-rays or ultrasound

Social Worker – a professional who can talk with you about your emotional or physical needs

Surgeon – a doctor who performs biopsies and other surgical procedures such as the removal of your lump (lumpectomy) or your breast (mastectomy)

Be sure to choose a team you trust and to seek a second opinion should you:

  • Want to confirm your diagnosis or treatment
  • Have concerns about your treatment plan
  • Feel uncomfortable with your doctor

Surgery

Due to decades of education on early detection, most women in developed countries who have breast cancer today are diagnosed with Stage 0, I, or II breast cancer. Many of these women will live a long life. Most of these women can choose to undergo lumpectomy with radiation therapy, or mastectomy.

Studies show that both options provide the same long-term survival rates. However, neither option gives you 100% guarantee that cancer will not return at the treated site. Whichever choice you make, you will still need medical follow-up and monthly breast self-exams for the rest of your life. Here is a closer look at today’s most common breast surgeries:

Lumpectomy

With a lumpectomy, a surgeon removes the breast cancer, a little normal breast tissue around the lump, and some lymph nodes under the arm. This procedure tries to totally remove the cancer while leaving you with a breast that looks much the same as it did before the surgery. Women who choose a lumpectomy almost always have radiation therapy as well. Radiation decreases the risk of cancer coming back in the remaining breast tissue.

Possible Problems: Infection, poor wound healing, bleeding, and a reaction to the drugs (anesthesia) used in surgery are the main risks of any kind of surgery, including lumpectomy. Women may have a change in the shape of the breast that was treated

Mastectomy

A mastectomy – the surgical removal of the breast – used to be the only treatment for breast cancer. Today a woman who has a mastectomy is likely to have either:

  • Total Mastectomy. This surgery removes as much breast tissue as possible, the nipple, and some of the overlying skin. The lymph nodes in the armpit are not removed.
  • Dodified Radical Mastectomy. This surgery removes as much breast tissue as possible,the nipple, some of the overlying skin, and some lymph nodes in the armpit.

A mastectomy is needed when:

  • The cancer is found in numerous areas in the breast.
  • The breast is small or shaped so that the removal of the entire cancer will leave little breast tissue or a deformed breast.
  • The woman does not want to have radiation therapy.

Possible Problems: Infection, poor wound healing, drug reactions, and a collection of fluid under the skin are possible complications.

Consult your doctor which surgery is best. Here are some questions you may consider asking as well:

  • How large will my scar be? Where will it be?
  • How much breast tissue will be removed?
  • Will I need radiation or chemotherapy? Why? When should it start?

Removal of Lymph Nodes

Whether you have a lumpectomy or mastectomy, your surgeon will usually remove some of the lymph nodes under your armpit. This procedure (an axillary node dissection) is most often done at the same time as the breast surgery. If cancer is found in the lymph nodes, your doctor will talk to you about additional treatments. These additional therapies are designed to control and kill cancer cells that could be in other parts of your body.

Possible Problems: Stiffness of the arm, numbness under your arm, and swelling of the arm (lymphedema). Physical therapy is often helpful to restore full motion of your arm.

The lymph nodes in your armpit filter lymph fluid from the breast and your arm. Both radiation therapy and surgery can change the normal drainage pattern. This can result in a swelling of the arm called lymphedema. The problem can develop right after surgery or months to years later.

Treatment of lymphedema will depend on how serious the problem is. Options include an elastic sleeve, an arm pump, arm massage, and bandaging of the arm. Exercise and diet also are important. Should this problem develop, talk to your doctor and see a physical therapist as soon as possible. In the Philippines, contact ICanServe Foundation (info@icanservefoundation.org or +632 636 5578) for a referral to a US-certified lymphedema therapist.

To avoid lymphedema or to protect your arm after treatment:

  • Avoid sunburns and burns to the arm or hand.
  • Have shots (including chemotherapy) and blood pressure tests done on the other arm.
  • Use an electric razor for shaving underarms.
  • Carry heavy packages or handbags on the other arm or shoulder.
  • Wash cuts promptly, apply antibacterial medication, cover with a bandage, and call your doctor if you think you have an infection.
  • Wear gloves to protect your hands when gardening and when using strong detergents.
  • Avoid wearing tight jewelry on your affected arm or elastic cuffs on blouses and nightgowns.

    Radiation Therapy

    In most cases, a lumpectomy is followed by radiation therapy. High-energy radiation is used to kill cancer cells that might still be present in the breast tissue.

    In standard therapy, a machine delivers radiation to the breast and in some cases to the lymph nodes in the armpit. The usual schedule for radiation therapy is 5 days a week for 5 to 6 weeks.

    Sometimes a “boost” or higher dose of radiation is given to the area where the cancer was found.

    During treatment planning, your chest area will be marked with ink or with a few long-lasting tattoos. These marks need to stay on your skin during the entire treatment period. They mark where the radiation is aimed.

    Possible Problems: Side effects may include feeling more tired than usual and skin irritations, such as itchiness, redness, soreness, peeling, darkening, or shininess of the breast. Radiation to the breast DOES NOT cause hair loss, vomiting, or diarrhea. Long-term changes may include changes in the shape and color of the treated breast, spider veins, and heaviness of the breast.

    Radiation after Mastectomy

    Radiation may be suggested after a mastectomy if:

    • The tumor is larger than five centimeters or 2 inches.
    • Cancer is in many lymph nodes in the armpit.
    • The tumor is close to the rib cage or chest wall muscles.

    Thoughts to Remember about Radiation Therapy

    • You often will be alone in a room, but your radiation therapist can hear you and see you on a television screen.
    • The treatment lasts a few minutes. You will not feel anything.
    • The radiation is only delivered to a small area for treatment.
    • You are NOT radioactive during or after your therapy.
    • You CAN hug, kiss, or make love as you did before your therapy.

    Chemotherapy & Hormone Therapy

    Research suggests that even when your lump is small, cancer cells may have spread beyond your breast. Most of these cells are killed naturally by your body’s immune system. When the growth of cancer cells is large enough to be detected, it means that your immune system is having difficulty fighting the cancer and needs additional help.

    Help in killing cancer cells comes from two other forms of therapy – chemotherapy and hormone therapy. Now, more than ever before, these treatments are chosen for your individual case: your age, whether you are still having your menstrual period and how willing and able you are to cope with the possible side effects.

    These therapies are used to:

    • Prevent cancer from coming back in women who are newly diagnosed with breast cancer, especially if they are at high risk for spread of the disease to other organs of the body
    • Control the disease when cancer is found in the lungs, bones, liver, brain, or other sites
    • Control the disease in women whose cancers have come back one or more time

    Chemotherapy

    Chemotherapy drugs are designed to travel throughout your body and slow the growth of cancer cells or kill them. Most often, the drugs are injected into the bloodstream through an intravenous (IV) needle that is inserted into a vein. Some are given as pills. Treatments can be as short as 4 months or as long as 2 years. The drugs you take will depend on the stage of the cancer at the time you are diagnosed, or if the cancer returns.

    Ask your doctor the following before considering chemotherapy:

    • Do I need chemotherapy? What drugs do you recommend?
    • What are the benefits and risks of chemotherapy?
    • How successful is this treatment for the type of cancer I have?
    • How long will I need chemotherapy?
    • Can I work while I’m having chemotherapy?
    • How can I manage side effects like nausea?

    Chemotherapy is usually given in cycles. You get one treatment and are given a few weeks to recover before your next treatment. The drugs are usually given in a doctor’s office or in an outpatient department of a hospital or clinic.

    Possible Problems: The most common side effects are fatigue, nausea, vomiting, diarrhea, constipation, weight change, mouth ulcers, and throat soreness. Some drugs cause short-term hair loss. Hair WILL grow back after or sometime during treatment.

    A. Preparing for Chemotherapy

    Before you start your therapy, you may want to have your hair cut short, buy a wig, hat, or scarves that you can wear while you are going through treatment. Be sure to finish necessary dental work as well. You cannot have any dental work during chemotherapy as you will be more prone to infections.

    B. Managing Nausea

    Feeling nauseous, or as though you have to vomit, is a common side effect of chemotherapy. The following suggestions may help:

    • Ask for new drugs that reduce nausea and vomiting.
    • Eat small meals often; do not eat 3 to 4 hours before your treatment.
    • Eat popsicles, gelatin desserts, cream of wheat, oatmeal, baked potatoes, and fruit juices mixed with water.
    • Chew your food thoroughly and relax during meals.
    • Learn stress reduction exercises.

    C. Fighting Infections

    Your body is less able to fight infections while you are on chemotherapy. The following steps can help you stay healthy:

    • Stay away from large crowds and from people with colds, infections, and contagious diseases.
    • Bathe daily, wash hands often, and follow good mouth care.
    • Wear work gloves to protect hands against cuts and burns.
    • If you cut yourself, keep the wound clean and covered.
    • Have a healthy diet and get plenty of rest.

    D. Pregnancy and Early Menopause

    During chemotherapy, you may stop having your period or enter into an early menopause. You can still get pregnant, however, so talk to your doctor about birth control. The effect of chemotherapy on an unborn baby is unknown. After your treatment has stopped, your ability to get pregnant will vary, depending on the drugs you received. If you plan to become pregnant after treatment, discuss it with your doctor even before beginning treatment.

    Hormone Therapy

    Tests are routinely done on breast cancer cells to decide if the cancer is “sensitive” to natural hormones (estrogen or progesterone) in the body. If the tests find that the cancer is “positive,” it means that cancer cells may grow when these hormones are present in a tumor. You may be given a hormone blocker (a drug called tamoxifen) that will prevent your body’s natural hormones from reaching the cancer. These drugs are taken daily in pill form.

    Possible Problems: Hot flashes, nausea and vaginal spotting are common. Other side effects may include depression, vaginal itching, bleeding or discharge, loss of appetite, headache,and weight gain. Studies show that there is a slightly increased risk of uterine cancer and blood clots for women on this drug. You should have an annual pelvic exam and notify your doctor if you are taking tamoxifen.

    Risk Factors for Recurrence

    Some women are at higher risk for the spread and return of breast cancer. Remember, the risk factors for recurrence are complex. They ARE NOT absolute forecasts of what your future will be.