Next Steps For Breast Cancer Survivors
Following a diagnosis of breast cancer, I always tell my patients to pace themselves. The journey after treatment can be long and challenging. The late, great Maya Angelou gave sage advice when she stated, My mission in life is not merely to survive, but to thrive, and to do so with some passion, some compassion, some humor, and some style.
These 5 steps can help you thrive in your overall health and cancer survivorship:
Take care of yourself emotionally. Seeking social support, developing strong personal relationships, accessing mental health services, and having a solid spiritual foundation are effective steps to manage lifes stressors and especially those unique to cancer survivorship.
Eat a healthy diet. Good nutrition supports overall health, such as eating a diet rich in fresh fruits, vegetables, and lean meats.
Maintain a healthy weight. Research shows that maintaining a healthy weight through a healthy diet and moderate physical activity lowers the risk of developing diabetes, high blood pressure, and other cancers and chronic diseases.
Stick with your follow-up care and other health screenings. Your routine oncology appointmentis a good time to talk about any concerns. If you notice any changes or new symptoms before your scheduled appointment, be sure to alert your health care provider. Also, take care of your entire body, including other recommended health screenings, such as Pap tests, general blood tests, blood pressure checks, and colonoscopy.
Side Effects Of A Double Mastectomy
The side effects you may experience after a double mastectomy depend a lot on how complex the surgery is.
You may have:
- Pain in and near the surgical area, such as soreness in your arm, shoulder or chest
- Swelling in the surgical area, as well as in the hands, arms, fingers or back
- Numbness that can affect your upper arm and chest
- Limited movement in your arms or shoulders
Your breasts will likely look different than they did before surgery, including having new scars or being a different size or shape.
If you have pain that persists over time and includes numbness, burning, tingling and/or itching, it could be related to postmastectomy pain syndrome, or PMPS.
Rashes arent a common side effect of double mastectomies, but some people may have skin irritation due to bandages, medical tape, dry skin or radiation therapy. If you notice a rash, inform your care team right away. In some cases, it may be a sign of cancer recurrence.
How Do Surgeons Use Tissue From A Womans Own Body To Reconstruct The Breast
In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a womans body and used to rebuild the breast. This piece of tissue is called a flap.
Different sites in the body can provide flaps for breast reconstruction. Flaps used for breast reconstruction most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.
Depending on their source, flaps can be pedicled or free.
- With a pedicled flap, the tissue and attached blood vessels are moved together through the body to the breast area. Because the blood supply to the tissue used for reconstruction is left intact, blood vessels do not need to be reconnected once the tissue is moved.
- With free flaps, the tissue is cut free from its blood supply. It must be attached to new blood vessels in the breast area, using a technique called microsurgery. This gives the reconstructed breast a blood supply.
Abdominal and back flaps include:
Flaps taken from the thigh or buttocks are used for women who have had previous major abdominal surgery or who dont have enough abdominal tissue to reconstruct a breast. These types of flaps are free flaps. With these flaps an implant is often used as well to provide sufficient breast volume.
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Understanding Breast Cancer Recurrence
Australia has one of the best survival rates of breast cancer in the world, with 91% of women surviving at least five years past their diagnosis. New Zealand is not far behind with 88% of women surviving five years past their first diagnosis.
This information may come as a relief for those diagnosed with early stages of the disease, as many recurrences appear within five years after the initial treatment, the exception being ER positive breast cancer, as many recurrences will occur after the first five years as within the first five years. But the fear of recurrence , is a common issue faced by women who have had early stage breast cancer. The chance of recurrence is not the same for all breast cancer patients. Understanding the risk of recurrence for your type of breast cancer may help to ease some anxiety.
How Can You Decide What’s Right For You
Be sure to give yourself time to think through both the medical facts and how you feel about your choices. This is a very personal decision. Your feelings are as important as any other factor.
No one else can tell you what’s right for you. But it may help to discuss your choices with people who know you well.
If you’re thinking about breast reconstruction, it’s a good idea to meet with a plastic surgeon. You can ask to see photos and talk to women who have had the surgery.
It might also help to ask yourself some questions, such as:
- Can I take time for a longer recovery? Or do I need to get back to my life as soon as possible?
- Can I accept the small chance of a new cancer in my healthy breast? Or would I rather give up my breast to help make this risk as low as possible?
- Do I want to keep the natural look and feel of my healthy breast? Or is it more important that my breasts match as well as possible?
- Do I have the information I need to make this decision? Or do I need to know more before I can make up my mind?
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What Is The Breast Cancer Recurrence Rate After A Total Mastectomy
While being told you are in remission following your total mastectomy is undoubtedly a reason to celebrate, chances are theres still one thing on your mind recurrence. Its frustrating and scary to think that even if youve had your entire breast removed, your cancer might still come back. So, how likely is it that your breast cancer will recur? The truth is that its impossible to know, but experts believe there are some factors that put a woman at a higher risk of breast cancer recurrence. One indicator is lymph node involvement. The more lymph nodes that had cancer at the time of the mastectomy, the greater the chance of recurrence. Experts also believe that those who were initially diagnosed before the age of 35, those who had inflammatory breast cancer or those whose breast cancer did not respond to hormone therapy may also be at a higher risk for recurrence. However, having one or more of these risk factors isnt a reason to panic. Just like there was no way to know that you would develop breast cancer in the first place, theres also no way to tell if you will have a recurrence, and many survivors never experience a relapse.
Local And Regional Recurrence
Breast cancer that comes back in the treated breast, chest or scar is called a local recurrence. Having a local recurrence does not mean the cancer has spread.
Breast cancer that comes back in the lymph nodes in the armpit, close to the breast bone, or lower neck, is called a regional recurrence. If cancer cells are blocking the lymph nodes in the armpit, fluid can build up in the arm and cause lymphoedema.
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Can Genetic Tests Detect Breast Cancer Risks Accurately
Humans have more than 20,000 genes. When just one amino acid in these genes is swapped out for another, thats called a mutation, or variation.
Genetic variation is extremely common in the human species, , medical oncologist and Chief of the Breast Cancer Medicine Center at Memorial Sloan Kettering Cancer Center.
When studying genetic variants that may be linked to cancer, scientists rate them on a five-point scale, from “benign” to “pathogenic.” Robson said that with more research, scientists might find that most VUS are likely noncancerous.
Due to the uncertainty about their role in breast cancer, VUS are not usually considered actionable,” according to the American College of Medical Genetics and Genomics. That means clinicians should not take preventive actions, like recommending a mastectomy, based solely on the detection of a VUS.
Some clinical lab tests have the capacity to detect as many as 84 different variants implicated in breast and ovarian cancer. Sharing a positive test result may give just enough information to worry patients, but not enough for clinicians to feel confident taking drastic action, Robson said.
Robson said he falls on the conservative end of the spectrum of cancer geneticists. Although hes not opposed to encouraging a patient with a VUS to receive more frequent screening, recommending a preventive surgery based on an uncertain risk factor could have severe consequences.
Cancer Beyond The Breast Area
A locally advanced recurrence means that the breast cancer has spread beyond the breast and the lymph nodes under the arm . This includes areas near to or around the breast but has not spread to other parts of the body.
A locally advanced cancer might come back in one or more of the following:
- lymph nodes under the breastbone or between the ribs
- the nodes above the collarbone
- lymph nodes around the neck
Symptoms can include, changes in the breast, and swelling in the lymph nodes above and below the collarbone, the neck, and around the breast bone.
The tests you might have are usually the same as for checking for a local recurrence.
Do speak to your nurse or doctor if you notice any of these changes.
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What Are My Options For Breast Cancer Surgery
For women who choose prophylactic mastectomy, several new and important surgical options have become available.
It is now possible to remove breast tissue using skin-sparing techniques in which the underlying breast tissue is removed from just under the skin, down to the chest wall. This technique removes the vast majority of the glands where breast cancer may be likely to develop. The nipple and surrounding tissue, called the areola, are removed, because the ducts converge toward the nipple, creating a concentrated area of duct tissue. However, the skin of the breast is spared, preserving the breast skin envelope.
When skin-sparing mastectomy is combined with immediate breast reconstruction, the results can be excellent. Many women who choose prophylactic mastectomy, often combined with immediate reconstruction, are very pleased, not only with their choice but also the reconstruction.
While surgery is not an approach that should be advocated for all high-risk individuals, it can be very important for some women.
It is important that you talk to your doctor to learn about all your options.
After Surviving Breast Cancer What Are My Chances Of Getting Cancer In The Other Breast
There are a number of a large studies with ten-year follow up or more that have estimated that the risk of getting cancer in the other breast increases 0.2 to 0.4% per year. Therefore if a cancer survivor lives another 20 years after her diagnosis, her risk of developing a breast cancer on the opposite side ranges from 4 to 8%. The risk is lower if she has chemotherapy or hormone therapy as part of her original treatment , which translates to a 2 to 4% 20-year risk. These figures represent the average risk of developing contralateral breast cancer in the future. Some women are at higher risk based on their age or the characteristics of their tumor.
Those at higher risk include:
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What Are The Breast Cancer Recurrence Statistics
Most of the time, local recurrences of breast cancer happen within the first five years after being diagnosed. After a mastectomy, when the lymph nodes have not been affected by cancer, the chance of local recurrence within the five-year period is only about six percent. If there was cancer in the lymph nodes at the time of the mastectomy, the risk increases to approximately 23% without radiation therapy after the surgery. Radiation can help decrease the risk to about 17%. It has also been shown that women that have tumors of 5cm have a 25% higher risk of having a recurrence after mastectomy.
For over 20 years, our team at Causenta has been using the latest, cutting-edge, non-toxic therapies to work with patients that have been diagnosed with breast cancer or breast cancer recurrence after mastectomy. Our oncologists work closely with naturopaths and physical therapists to provide an individualized cancer treatment plan for each patient. Patients from all over the world are finding relief as they work with our experienced team at Causenta. Is Causenta is right for you? Contact us today to schedule a free 30-minute consultation.
How Is A Local Breast Cancer Recurrence Or Metastasis Found
Breast cancer that recurs at the original site is called a local recurrence. Breast cancer that returns and spreads to other parts of the body is called a distant recurrence . This is metastatic breast cancer and may also be called stage IV or advanced breast cancer.
A local recurrence is usually found on a mammogram, during a physical exam by a health care provider or when you notice a change in or around the breast or underarm.
Metastasis is usually found when new and persistent symptoms are reported to a health care provider and follow-up tests are done.
If you have a local recurrence or metastasis, its not your fault. You did nothing to cause it.
Learn about follow-up care after breast cancer treatment.
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Doing My Homework Before Deciding To Go Flat
In preparing for my surgical appointment, I did lots of research online about both flat closure and breast reconstruction. I reached out to others who had undergone flat closure. I found pictures of nice flat closures to show my surgeon so she knew what I expected. I also wrote down a long list of questions to ask. I even saw a plastic surgeon to make sure I understood all my reconstructive surgical options.
On the day of my appointment, my breast surgeon described all my surgical options in detail without pressuring me one way or the other. She listened to my concerns and provided unbiased, non-judgmental answers to my questions. She showed me photos of other people that she had done flat closures on to reassure me of her skill level. She supported me throughout the decision-making process, even when I knew some of my questions might seem silly or trivial.
Adipose Derived Stem Cells In Grafted Fat
CAL has been shown in vivo to elicit regenerative effects via vascularization of the fat graft in a situation of radiation therapy . Studies have shown that ASCs in fat have the ability to withstand the initial hypoxic environment of the graft, and remain viable to recruit new vasculature. This is critical in avoiding necrosis of tissue and involution of grafted fat, both of which would defy the purpose of fat grafting . However, it is the same mechanism for which CAL earns skepticism in planning cancer reconstruction. A more recent study examined the paracrine impact of ASCs on co-grafted breast cancer cells in vivo. Tumors were artificially created in mice by co-injection of breast cancer cells with ASCs, the latter of which had been harvested from human fat and passaged in vitro . Cancer cell to ASC ratios ranged from 1:1 to 1:3, with larger tumors resulting from the increasing ratio. Tumors excised and lysed for chemokine analysis showed tumors had high levels of CXCL1 and CXCL8. The mechanism was elucidated further using shRNA to knock out CXCL1/8 in the supplied ASCs a co-injection which resulted in a smaller, less vascularized tumor . This type of targeted research is a step in the right direction when considering the safety of CAL in cancer patients.
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Can Breast Cancer Return After A Double Mastectomy
During the course of breast cancer treatment, a woman may decide, after discussion with her doctors, to have both of her breasts removed.
She might choose to have a double mastectomy in the hope that it will reduce the risk of breast cancer recurring in the remaining tissue or a new cancer developing in the opposite, unaffected breast.
A woman who has had breast cancer does not inherently or automatically face an increased risk of being diagnosed with another type of cancer, says Ellis Levine, MD, Chief of Breast Medicine at Roswell Park Comprehensive Cancer Center.
Unless they have an underlying hereditary genetic mutation, I do not consider them at exquisite risk to develop another type of cancer, he says. The cancer that is most often genetically linked to breast cancer is ovarian, due to mutations in the BRCA 1 or BRCA 2 genes.
When mastectomies are performed, surgeons will remove as much of the cancerous tissue as possible. If a woman, in consultation with her doctors, decides to have a skin-sparing or nipple-sparing mastectomy, a small amount of healthy breast tissue may be left behind on the skin to allow for reconstruction of her breasts.
Even if the full breast is removed, surgeons will not have removed 100% of the breast cells, explains Jessica Young, MD, a breast surgeon at Roswell Park. The risk of cancer recurring is lower if the whole breast is removed, but it is not zero percent.
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