Summary And Future Directions
While research into the etiology, course, and treatment of cancer-related fatigue is relatively new, much progress has been made in recent years however, considerable opportunities remain. While some well-powered studies have examined risk factors for fatigue in breast cancer patients and survivors, most studies examining underlying mechanisms have involved small to very small sample sizes. While a few studies employing repeated-assessments have been conducted, most have been cross-sectional in design. Thus, more longitudinal studies that involve assessment of cancer patients pre-/post-completion of initial treatment and into survivorship are needed. While multiple factors have been observed to be linked with cancer-related fatigue, it has yet to be determined which factors predispose, precipitate or exacerbate/maintain the patients experience of fatigue. For example, longitudinal studies examining and comparing the effects of chemotherapy- and radiation-induced inflammation on functioning during survivorship are warranted. Also, additional studies employing statistical analytic techniques that can evaluate hypotheses about causal pathways are needed. These will require multiple assessments of established or promising biomarkers of fatigue. Such studies should also assess fatigue using multidimensional scales normed on and/or tailored to breast cancer patients.
Grade Of Breast Cancer
The grade describes the appearance of the cancer cells.
- Low grade the cells, although abnormal, appear to be growing slowly.
- Medium grade the cells look more abnormal than low-grade cells.
- High grade the cells look even more abnormal and are more likely to grow quickly.
Want to know more?
- Breast Cancer Now: Secondary breast cancer
Treatment Of Fatigue In Breast Cancer Patients And Survivors
Clinical trials of treatment regimens for the alleviation and management of cancer-related fatigue have been limited compared with those focused on the alleviation of pain and suffering. Treatment of cancer-related fatigue can be complex because of the links observed between fatigue and various physical and psychological variables. Thus, a multidisciplinary approach to treatment and management of cancer-related fatigue is likely to be necessary for many cancer patients and survivors and treatments must be individualized based on underlying pathology.
To recap, in two large studies four and five years post-diagnosis or treatment of breast cancer, survivors fatigue was most strongly linked with depressive symptoms, pain and sleep disturbance and with worse physical health, less physical activity, and depressive symptoms. Depressed mood, cardiovascular problems, and cancer treatment modality were also linked with ongoing fatigue. Thus, several possible underlying factors have been implicated in cancer fatigue, many of which respond well to conventional treatments.
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What Do Lumps In My Breast Mean
Many conditions can cause lumps in the breast, including cancer. But most breast lumps are caused by other medical conditions. The two most common causes of breast lumps are fibrocystic breast condition and cysts. Fibrocystic condition causes noncancerous changes in the breast that can make them lumpy, tender, and sore. Cysts are small fluid-filled sacs that can develop in the breast.
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If Youre Getting Radiation Therapy To The Breast
If you have radiation to the breast, it can affect your heart or lungs as well causing other side effects.
Short-term side effects
Radiation to the breast can cause:
- Skin irritation, dryness, and color changes
- Breast soreness
- Breast swelling from fluid build-up
To avoid irritating the skin around the breast, women should try to go without wearing a bra whenever they can. If this isnt possible, wear a soft cotton bra without underwires.
If your shoulders feel stiff, ask your cancer care team about exercises to keep your shoulder moving freely.
Breast soreness, color changes, and fluid build-up will most likely go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem, ask your cancer care team what steps you can take. See Lymphedema for more information.
Long-term changes to the breast
Radiation therapy may cause long-term changes in the breast. Your skin may be slightly darker, and pores may be larger and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before treatment. Sometimes the size of your breast changes it may become larger because of fluid build-up or smaller because of scar tissue. These side effects may last long after treatment.
After about a year, you shouldnt have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, tell your cancer care team about them right away.
Less common side effects in nearby areas
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Why You’re So Tired After Radiation Therapy
When you are prescribed radiation therapy to treat cancer, your healthcare provider will provide you with a list of possible side effects of treatment. Things like nausea, diarrhea, and hair loss usually catch a person’s attention first because they seem to be the worst. While these are side effects that can be difficult to tolerate, it is actually fatigue that affects people the most. Lack of energy and excessive tiredness seem to plague all cancer patients, but those going through radiation therapy do experience it more frequently and often chronically. Learning how to manage and cope with fatigue is essential for your quality of life during radiation therapy treatment.
Blockage In The Bowel
Sometimes cancer in the abdominal area can cause the bowel to become blocked. This is called bowel obstruction. Because waste matter cannot pass through the bowel easily, symptoms may include feeling sick or vomiting. To relieve these symptoms, you may have a small, hollow tube put in that helps keep the bowel open. The stent is inserted through the rectum using a flexible tube called an endoscope.
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Acute And Delayed Nausea And Vomiting Are Common In Patients Being Treated With Chemotherapy
How often nausea and vomiting occur and how severe they are may be affected by the following:
- The specific drug being given.
- The dose of the drug or if it is given with other drugs.
- How often the drug is given.
- The way the drug is given.
- The individual patient.
The following may make acute or delayed nausea and vomiting with chemotherapy more likely if the patient:
- Had chemotherapy in the past.
- Had nausea and vomiting after previous chemotherapy sessions.
- Is younger than 50 years.
- Has a history of motion sickness.
- Has a history of morning sickness during pregnancy.
Patients who have acute nausea and vomiting with chemotherapy are more likely to have delayed nausea and vomiting as well.
Invasive Breast Cancer Symptoms
Most breast cancers start in the ducts, or the tubes that carry milk to the nipple, or in the lobules, the little clusters of sacs where breast milk is made. Invasive breast cancer refers to breast cancer that spreads from the original site to other areas of the breast, the lymph nodes or elsewhere in the body. In these cancers that form in the ducts or lobules, invasive ductal carcinoma or invasive lobular carcinoma , the cancer spreads from the ducts or lobules to other tissue. Depending on the stage, you may notice symptoms.
Invasive breast cancer symptoms may include:
- A lump or mass in the breast
- Swelling of all or part of the breast, even if no lump is felt
- Skin irritation or dimpling
- A lump or swelling in the underarm lymph nodes
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High Levels Of Calcium In The Blood
Feeling nauseous may be a symptom of high levels of calcium in your blood . If the cancer spreads to the bones, the cancer cells make the bone break down and release calcium into the blood. This can cause you to feel tired, thirsty and confused. Hypercalcaemia is more common in some types of advanced cancer. Drinking more water can help but you may also be given drugs to lower your calcium levels. These are called bisphosphonates, which are usually given through a drip into a vein.
‘i Felt A Pea On My Ribs’
I had done monthly self-breast exams since I was in my early 20s. I felt a tiny hard little bump the size of a small pea. I could only feel it because it was over my rib at the bottom of my left breast. In retrospect, my bra may have hurt a little in that area before I found the lump. I have had many lumps, bumps, and cysts biopsied, but this pea was definitely different. I scheduled my annual mammogram along with a biopsy. I received the breast cancer diagnosis within a week, just shy of my 55th birthday. Turns out, there was another in the other breast that didnt show up on a mammogram. I also discovered I was a BRCA 1 mutation carrier. I needed aggressive chemo followed by a double mastectomy. Had I not done the exam that evening, everything would be quite different.
Cynthia Bailey, MD, president and CEO of Advanced Skin Care and Dermatology, Inc., Sebastopol, California
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Many Factors Increase The Risk Of Nausea And Vomiting With Chemotherapy
- Is treated with certain chemotherapy drugs.
- Had severe or frequent periods of nausea and vomiting after past chemotherapy treatments.
- Is female.
- Is younger than 50 years.
- Had morning sickness or vomiting with a past pregnancy.
- Is receiving certain drugs, such as opioids .
- Has an infection, including an infection in the blood.
- Has kidney disease.
Patients who drank large amounts of alcohol over time have a lower risk of nausea and vomiting after being treated with chemotherapy.
If Youre Getting Radiation Therapy To The Brain
People with brain tumors often get stereotactic radiosurgery if the cancer is in only one or a few sites in the brain. Side effects depend on where the radiation is aimed. Some side effects might show up quickly, but others might not show up until 1 to 2 years after treatment. Talk with your radiation oncologist about what to watch for and when to call your doctor.
If the cancer is in many areas, sometimes the whole brain is treated with radiation. The side effects of whole brain radiation therapy may not be noticeable until a few weeks after treatment begins.
Radiation to the brain can cause these short-term side effects:
- Trouble with memory and speech
Some of these side effects can happen because radiation has caused the brain to swell. Medicines are usually given to prevent brain swelling, but its important to let your cancer care team know about headaches or any other symptoms. Treatment can affect each person differently, and you may not have these particular side effects.
Radiation to the brain can also have side effects that show up later usually from 6 months to many years after treatment ends. These delayed effects can include serious problems such as memory loss, stroke-like symptoms, and poor brain function. You may also have an increased risk of having another tumor in the area, although this is not common.
Talk with your cancer care team about what to expect from your specific treatment plan.
Possible Breast Implant Complications
Autoimmune disorders. Any foreign substance in the body can cause an autoimmune reaction, including breast implants. Sometimes removing the implants will relieve the symptoms, although the autoimmune reaction may persist after removal and require functional medicine management. This can trigger Hashimotos hypothyroidism in a genetically susceptible individual, exacerbate existing Hashimotos, or raise the risk of developing other autoimmune diseases in addition to Hashimotos.
Infection. Though leakage is less frequent with saline implants than with silicone implants, mold and bacteria can grow within the saline solution. It has been speculated that when the solution inevitably leaks out, it may cause illness and possibly even endanger a nursing baby, though this effect has not been conclusively studied or established.
Cancers. Breast implants may be linked with cancer in two ways. One is that the implants can obstruct early detection of breast cancer. The other is that silicone implants in particular are believed by some doctors to leak cancer-causing chemicals.
Raynauds Syndrome. This is a condition in which blood circulation is restricted by a narrowing of the small arteries, causing coldness and numbness in the hands and feet. It occurs more often in women who have had breast implants.
When To See Your Doctor
Its important to talk to your physician if you have breast pain from any cause. Even if its not due to cancer, many women find that breast pain decreases their quality of life. In one study,15% of the women experienced breast pain at some time in their life that interfered with work and family activities. So, make sure to talk to your doctor if you are experiencing any suspicious discomfort.
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When To Call Your Doctor
Although cancer-related fatigue is a common side effect of cancer and its treatments, you should mention any of your concerns to your doctor. There are times when fatigue may be a clue to an underlying medical problem. Other times, there may be things your doctor can do to help control fatigue.
Be sure to let your doctor or nurse know if you have:
- Shortness of breath
- Anxiety or nervousness
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The best way to cite this PDQ summary is:
PDQ® Supportive and Palliative Care Editorial Board. PDQ Nausea and Vomiting Related to Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .
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‘i Felt Something Like A Hard Round Piece Of Cheese’
After a shower one night, I did a self-breast check. I felt something like a round, hard piece of cheese about the size of a quarter. I had just had a mammogram six months earlier. I felt healthy, biked all the time, and wouldnt have guessed that something wasnt right in my body. But I didnt wait to see what was going on. I went to the doctor immediately and was referred for an ultrasound and needle biopsy. I was diagnosed at age 46 with stage 3 breast cancer, and soon after had a mastectomy. I would never recommend to anyone to ‘wait and see.’ While it was a very scary realization, youre only saving yourself if you take care of it aggressively.
Sandy Hanshaw, founder of Bike for Boobs, San Diego
‘my Breast Looked A Little Pink’
In the shower one day, I noticed a pale pinkness on my breast just below my nipple area, which looked more like a mild sunburn than a rash. I knew something was off. I had my ob-gyn take a look, and he said he wasnt concerned at all because it was barely noticeable. He suggested my bra fit too snugly, and I needed to go shopping for new bras. So I did just that.
“Over time, that pink area hardened slightly and was sore to the touch. My ob-gyn again said he wasnt concerned. Eventually the pain increased behind my breast in my back. My ob-gyn said that breast cancer does not hurt, so I didnt need to worry about it. He ordered a mammogram to put my mind at ease. The mammogram and all other tests came back normal.
“Weeks went by and my lower back began to hurt. Eventually, after my GP suggested I had arthritis and I went to physical therapy. I went to see a breast specialist. He told me I had mastitis and gave me antibiotics. That didnt help. Back at the breast surgeon, he sent a picture of my breast to the top surgeon who ordered a diagnostic mammogram, which includes a sonogram and a biopsy. I was diagnosed with Stage IV inflammatory breast cancer in my breast, bones, and liver.
Jennifer Cordts, stay-at-home mom, Dallas
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What Is A Normal Breast
No breast is typical. What is normal for you may not be normal for another woman. Most women say their breasts feel lumpy or uneven. The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. Breasts also tend to change as you age. For more information, see the National Cancer Institutes Breast Changes and Conditions.external icon