Timeline After Breast Cancer Diagnosis
Receiving a breast cancer diagnosis can create many feelings and emotions. Since some breast cancer diagnoses come with a bleak outlook, its common to want to start a treatment plan as soon as possible.
This article is designed to give you a comprehensive understanding of which factors play a role in your prognosis and what you should expect in the coming days, weeks and months following your diagnosis.
Other Treatments Your Doctor May Consider
In addition to chemo, your doctor may consider other cancer treatments such as:
- Targeted therapies target specific cancer proteins and receptors to destroy the cancer cells and prevent them from spreading.
- Immunotherapy uses drugs that boost your immune system, so its able to destroy cancer cells before they grow.
- Hormone therapy stops certain cancers from using hormones needed to grow, such as in the case of breast, uterine, and prostate cancers.
The goal is to target cancer cells when they may be most active while also allowing your body recovery time to build healthy ones.
Still, your exact treatment plan depends on the:
- type of cancer you have
- stage of cancer
- types of chemo drugs used, and whether youre taking other drugs, such as targeted therapies
- primary reason youre taking chemo for example, to prevent tumor spread or to alleviate pain.
- how your cancer responds to the treatment
- how you tolerate the treatment
- other possible health conditions you may have, such as diabetes or heart conditions
With all of these factors in mind, its difficult to predict an exact timeline for when chemotherapy will start working. This treatment may work immediately for some people, while it may take several rounds over the course of many months for others.
Combination Drug Therapy For Early
Combination drug therapy means that you receive more than one type of drug at a time.
Combining drug therapies allows your care team to increase the chances that your treatment will be effective against the breast cancer. If a tumor becomes resistant to one drug, your treatment may still be effective because the tumor responds to the second or third drug in the combination you receive.
Combination therapy can be given before or after breast surgery. Most women receive a combination of two or three drugs at the same time. Some of these drugs are breast cancer targeted therapies. These drugs work by targeting specific molecules involved in breast cancer development.
Here are some of the drug combinations that MSKs medical oncologists commonly prescribe:
Dose-Dense AC-T
- Doxorubicin and cyclophosphamide, followed by paclitaxel
- Used to treat early-stage breast cancer, particularly in younger women or women with aggressive disease
- Given intravenously before or after surgery
Dose-Dense AC-TH
- Doxorubicin and cyclophosphamide, followed by paclitaxel and trastuzumab
- Used to treat early-stage HER2-positive breast cancer
- Given intravenously before or after surgery
Dose-Dense AC-THP
- Doxorubicin and cyclophosphamide, followed by paclitaxel, trastuzumab, and pertuzumab
- Used to treat early-stage breast cancer
- Given intravenously before or after surgery
- Used to treat early-stage breast cancer
- Given intravenously or by pill after surgery, depending on what your doctor recommends
TCHP
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How Soon After A Breast Cancer Diagnosis Should You Have Surgery
Breast cancer surgery is often the first course of treatment. In some cases, your doctor may recommend chemotherapy first to help shrink larger cancer cells.
Surgery should come within a few weeks of diagnosis. Research shows the sooner you receive surgery, the better the overall prognosis. For example, a study showed women ages 15 to 39 who had surgery within two weeks had a 84 percent five-year survival rate compared to a 78 percent five-year survival rate for women who waited six weeks or more until surgery. Overall, the optional time for surgery after diagnosis is less than 90 days.
Lumpectomy, mastectomy and lymph node removal are three common surgical procedures to treat breast cancer. A lumpectomy is a breast-conserving procedure in which only a part of the breast that contains cancer cells is removed. A mastectomy removes the entire breast. Some women also undergo a double mastectomy to remove both breasts.
How Is The Risk Of Recurrence Determined
Doctors determine a womans risk of recurrence after breast cancer surgery based on various clinical criteria:
- Involvement of lymph nodes: Has the cancer spread to lymph nodes? If so, how many lymph nodes?
- Hormone sensitivity: Does the tumor have receptors for hormones such as estrogen and progesterone ?
- Grade of differentiation: How different are the tumor cells to normal breast cells?
- Size of the tumor: How big is the tumor?
- Speed of tumor growth: How fast did the tumor cells grow ?
- Growth factors: Does the tumor have a lot of receptors for certain growth factors ?
- Age: How old is the woman? Has she already reached menopause?
A lot of these clinical criteria are determined based on a tissue sample taken from the tumor during surgery.
Doctors use special tables to help them estimate the risk of recurrence.
The risk of recurrence is a measure of how likely it is that a woman will get cancer again. Its not possible to predict whether the cancer will return in a particular woman.
In some women it also makes sense to do an oncotype DX test. This involves looking at other biological characteristics of the tumor in a laboratory.
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External Beam Breast Cancer Radiation
External beam radiation is the most common kind of radiation treatment for breast cancer. Its a painless treatment, like getting an X-ray. A doctor will place a machine on the outside of your body and aim the radiation beams at the area of the cancer. Your doctor will figure out where to aim the rays and how much radiation to use before each treatment. They will mark the area with temporary or permanent ink.
Each treatment only lasts a few minutes. The session setup will take longer. External radiation treatment happens five days a week for about five to seven weeks. Its the longest type of radiation treatment available.
Short-term side effects of external radiation include:
- fatigue
- swelling and pain in the arm or chest
- weakened and fractured ribs
- future cancer in the inner lining of your blood vessels
External radiation does not leave radiation in your body. You will not be radioactive during or after treatment.
What Are The Types Of Targeted Therapy
Most targeted therapies are either small-molecule drugs or monoclonal antibodies.
Small-molecule drugs are small enough to enter cells easily, so they are used for targets that are inside cells.
Monoclonal antibodies, also known as therapeutic antibodies, are proteins produced in the lab. These proteins are designed to attach to specific targets found on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Other monoclonal antibodies directly stop cancer cells from growing or cause them to self-destruct. Still others carry toxins to cancer cells.
How Monoclonal Antibodies Treat Cancer
Learn how monoclonal antibodies such as trastuzumab, pembrolizumab, and rituximab are used to treat cancer.
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Why Are People Offered Chemotherapy
Chemotherapy is given to reduce the risk of breast cancer coming back in the future. It uses anti-cancer drugs to destroy cancer cells.
It is most commonly given after surgery.
Some people wonder why they need chemotherapy if theyve already had surgery to remove their cancer. Whether someone is offered chemotherapy depends on a number of features of their cancer. These include the size and grade of the cancer whether it has spread to any of the lymph nodes under the arm and whether the cancer is hormone receptor and HER2 positive or negative.
For some people the benefit is clear, but for others its less certain. This is why cancer specialists may use a test, like the one described above, to help estimate the benefit.
Because it affects cells throughout the body, chemotherapy can cause side effects including sickness, hair loss and an increased risk of infection.
Fear Of Cancer Coming Back
After treatment, many people might be afraid that their cancer will come back . You may become concerned about new symptoms youre having and wonder if theyre related to breast cancer.
Its important to talk with your healthcare provider about any new symptoms you notice. Many of these issues are normal parts of healing and your body returning to a new normal after breast cancer treatment. Your healthcare team is always available to discuss your concerns or fears with you.
You can call or send messages to your doctor or nurse through MyMSK . It may also be helpful to talk with a social worker, therapist, or chaplain. You can also join a support group. For more information, read MSK Support Services.
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Time To Treatment With Metastatic Breast Cancer
There is little research looking at the optimal time until treatment for metastatic breast cancer, though it appears that waiting more than 12 weeks has been linked with lower survival. In general, however, the goal of treatment with MBC is different than early stage disease. For most people, treatment for early-stage disease is aggressive, with the goal to reduce the risk of recurrence. With MBC, the goal is often to use the least amount of treatment necessary to control the disease.
How Often Does Stage 1 Breast Cancer Come Back After Treatment
If stage 1 cancer is treated comprehensively, it rarely comes back. A new, unrelated breast cancer is more likely to emerge after stage 1 breast cancer is treated than a recurrence. Your healthcare provider will recommend a surveillance schedule for you so that new breast cancer or a recurrence can be identified and treated as quickly as possible.
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How Long Will I Have Chemotherapy For
Chemotherapy is commonly given as a series of treatments with a break between each treatment to give your body time to recover from any short-term side effects. The treatment and period of time before the next one starts is called a cycle.
You may have treatment weekly or every two or three weeks.
You may have one drug or a combination of two or three drugs. The exact type and dose of chemotherapy will be tailored to your individual situation. The drugs used, the dose, how often theyre given and the number of cycles may be called your chemotherapy regime or regimen.
The length of time that you have chemotherapy will depend on your individual situation. Your treatment team will discuss this with you.
Youve Been Diagnosed With Breast Cancer How Soon Do You Need Treatment
Timely surgery for breast cancer is obviously better than delaying surgery, but how long can a patient safely wait for surgery once diagnosed. Because a randomized controlled clinical trial to answer this question would be unethical, this has been a difficult question to answer. Fortunately, a new study provides an estimate of how much of a delay it takes before outcomes start to suffer.
A new year is upon us yet again, and Science-Based Medicine has been in existence for eight years now. It seems only yesterday that Steve Novella approached me to ask me to be a contributor. Our part-serious, part-facetious predictions for 2016 notwithstanding, one thing about 2016 is certain: I will almost certainly encounter some form of cancer quackery or other and deconstruct it, probably multiple forms. In any case, a topic Ive been meaning to write about is based on a couple of studies that came out three weeks ago that illustrate why, even if a patient ultimately comes around to science-based treatment of his cancer, the delay due to seeking out unscientific treatments can have real consequences.
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Is Chemotherapy Necessary Before Or After Breast Cancer Surgery Or At All
A recent study found that breast cancer has been highly over treated with chemotherapy and doctors can now confidently provide an alternative treatment known as Endocrine Therapy.
However, each patient is different with a unique set of circumstances. Chemotherapy is necessary in advanced stages, as well as early stages when specific characteristics are present, such as spreading to the lymph nodes or other body parts.
Treating Stage Iii Breast Cancer
In stage III breast cancer, the tumor is large or growing into nearby tissues , or the cancer has spread to many nearby lymph nodes.
If you have inflammatory breast cancer: Stage III cancers also include some inflammatory breast cancers that have not spread beyond nearby lymph nodes. These cancers are treated slightly different from other stage III breast cancers. You can find more details in Treatment of Inflammatory Breast Cancer.
There are two main approaches to treating stage III breast cancer:
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How Chemotherapy Drugs Are Given
Most chemotherapy drugs for breast cancer are given by vein in an outpatient setting at a hospital or clinic. Often, a combination of 2 or 3 chemotherapy drugs is used.
At each visit, an IV is inserted into your arm, allowing the drugs to drip into the bloodstream.
A few chemotherapy drugs are pills.
What Happens During Chemotherapy Treatment
There are different ways you can receive chemotherapy. The most common way that chemotherapy drugs are given is through a needle into a vein. This is called intravenous or IV chemotherapy. Chemotherapy can also be taken as a pill, capsule, or liquid by mouth, as an injection or shot, or as a cream that is put directly on your skin. Learn more about the different kinds of chemotherapy.
During your first IV chemotherapy appointment, you should bring a friend or family member. They can support you and help you remember information. Sometimes you will be given medication before your chemotherapy treatment that can make you tired, so you may need someone who can drive you home.
You may also bring items that make your treatment time easier. For instance, considering bringing your phone, a tablet, books, or a blanket.
Before your treatment starts, you will:
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Have a blood sample taken
-
Meet with your oncologist so they can check your health and blood test results
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Meet the nurse or other health professionals who will give your treatment
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Have your blood pressure, pulse, breathing, and temperature taken before starting treatment
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Have your height and weight measured to find the right dose of chemotherapy
-
May have an IV tube, also called a catheter, put in your arm
To get the full benefit of chemotherapy, it is important to follow the schedule of treatments recommended by your doctor and manage other medications you’re taking.
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Keeping Personal Health Records
You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed. At the conclusion of active treatment, ask your doctor to provide you with a treatment summary and a survivorship care plan.
This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor, another health care professional, or a specialized survivorship clinic. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.
The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.
How You Have Chemotherapy
You usually have treatment into your bloodstream .
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
- portacath
If you don’t have a central line you might have treatment through a thin short tube . The cannula goes into a vein in your arm each time you have treatment.
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Take Advantage Of Patient Navigators
Though intuition would tell us that people who are insured would experience shorter delays before surgery, that doesn’t appear to be true. A large 2019 study in PLoS One looked at over 1.3 million people to see how time to initial treatment affected survival. In this study, they found that with early stage breast cancer, waiting more than 35 days between diagnosis and surgery reduced survival rates. Surprisingly, uninsured people had faster times to initiation of treatment.
While the reasons weren’t certain, it was thought that perhaps those who were insured lost precious time going through prior authorization procedures for diagnostic tests and treatment. Difficulty navigating the maze of large treatment centers may also be at play, and the authors made mention of recent clinical trials showing patient navigation could have a beneficial effect on assuring timely cancer care.