Summary Of Surgery Timing
Though we don’t have a solid answer on how soon surgery should be done after a diagnosis of breast cancer , it would seem earlier surgery is ideal .
Delaying for a lengthy period of time can be dangerous, with studies finding that those who delay over six months are twice as likely to die from the disease. This is important to keep in mind for those who have breast lumps they are “observing” without a clear diagnosis. Any breast lump needs to be explained.
What Happens During A Mastectomy
A mastectomy typically requires a hospital stay. Procedures may varydepending on your condition and your doctor’s practices.
Generally, a mastectomy follows this process:
Will I Need Radiation After A Mastectomy
The answer is most likely, no. Post Mastectomy Radiation Therapy is the term for applying radiation to the area of the chest wall after a mastectomy, usually performed about 4 weeks after surgery or after both surgery and chemotherapy are completed. PMRT is generally recommended for those with a high risk of local recurrence.
If you or your surgeon. before surgery, think you might need PMRT it is essential to see your radiation oncologistbefore you have mastectomy surgery. This way, your radiation oncologist will better understand the size, shape, and extent of your breast tumor before it is removed by surgery or has shrunk away with Neoadjuvant Chemotherapy. Radiation oncologists have a unique insight into breast cancer treatment options that can assist your surgeon in planning the direction of your cancer care.
The decision to undergo Post Mastectomy Radiation Therapy is complicated. Patients should insist on a multidisciplinary team approach to get the best treatment recommendations for high risk breast cancer situations. When your breast surgeon works closely with your radiation oncologist and medical oncologist, you will be offered the best treatment options. Below is a general outline to help you understand when radiation after a mastectomy is needed.
Time To Chemotherapy After Surgery
After surgery for early-stage breast cancer, many women also have adjuvant chemotherapy .
The period of time between surgery and chemotherapy depends somewhat on how well someone does with surgery since the surgical site needs to be relatively well-healed before chemotherapy begins. But once the incision are healed, what is the optimal time to begin this treatment?
Types Of Breast Cancer
There are several types of breast cancer, and theyre broken into two main categories: invasive and noninvasive, or in situ.
While invasive cancer has spread from the breast ducts or glands to other parts of the breast, noninvasive cancer has not spread from the original tissue.
These two categories are used to describe the most common types of breast cancer, which include:
- Ductal carcinoma in situ. Ductal carcinoma in situ is a noninvasive condition. With DCIS, the cancer cells are confined to the ducts in your breast and havent invaded the surrounding breast tissue.
- Lobular carcinoma in situ. Lobular carcinoma in situ is cancer that grows in the milk-producing glands of your breast. Like DCIS, the cancer cells havent invaded the surrounding tissue.
- Invasive ductal carcinoma. Invasive ductal carcinoma is the most common type of breast cancer. This type of breast cancer begins in your breasts milk ducts and then invades nearby tissue in the breast. Once the breast cancer has spread to the tissue outside your milk ducts, it can begin to spread to other nearby organs and tissue.
- Invasive lobular carcinoma. Invasive lobular carcinoma first develops in your breasts lobules and has invaded nearby tissue.
Other, less common types of breast cancer include:
The type of cancer you have determines your treatment options, as well as your likely long-term outcome.
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Nerve Damage Around The Treatment Area
Scaring from radiotherapy may cause nerve damage in the arm on the treated side. This can develop many years after your treatment. Symptoms include tingling, numbness, pain, and weakness. In some people, it may cause some loss of movement in the arm and shoulder.
Speak to your doctor if you notice any of these symptoms.
Diagnosis Of A Breast Hematoma
Hematomas are usually very obvious because they are visible. They tend to be a dark red/purple color that fades to greens, grey and yellows. In other words, they look like a typical bruise. In addition, hematomas are often palpable. That is, you can feel them under the skin as a lump.
In the breast, a small hematoma might be the size of a cherry. A medium sized breast hematoma could be the size of a plum. A large breast hematoma might grow to the size of a grapefruit, except they tend to elongate to the shape of a banana.
Sometimes, a hematoma can occur without any obvious symptoms, but still show up on a mammogram. For example, see the mammogram on the right for example.
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How Long Does Radiation Therapy Typically Last
With breast cancer, radiation therapy usually begins about 3 to 4 weeks after breast-conserving therapy or a mastectomy, according to the National Breast Cancer Foundation.
External beam radiation is typically given once a day, 5 days a week, for anywhere from 2 to 10 weeks on an outpatient basis. This means you can go home after the treatment.
Sometimes the schedule for external radiation can differ from the standard schedule. Some examples of this include the following:
- Accelerated fractionation. Treatment is given in larger daily or weekly doses, reducing the duration of the treatment.
- Hyperfractionation. Smaller doses of radiation are given more than once a day.
- Hypofractionation. Larger doses of radiation are given once daily to reduce the number of treatments.
For brachytherapy , treatments are usually given twice a day for 5 days in a row as outpatient procedures. Your specific treatment schedule will depend on what your oncologist has ordered.
A less common treatment option is to leave the radiation in your body for hours or days. With this type of treatment, youll stay in the hospital to protect others from the radiation.
Common side effects of external beam radiation therapy for breast cancer include:
- sunburn-like skin irritation in the treatment area
- dry, itchy, tender skin
- swelling or heaviness in your breast
Skin changes and changes to your breast tissue usually go away within a few months to a year.
Who Cannot Have Radiation Therapy
Sometimes a woman may be eligible for a lumpectomy, but not for radiation, thus requiring a mastectomy. Not everyone can have radiation therapy. Being pregnant or having certain health conditions can make radiation therapy harmful.
- Pregnancy. Radiation can harm the foetus, so is not given during pregnancy. Depending however on the timing of the pregnancy and the breast cancer diagnosis, a woman may be able to have a lumpectomy and put off radiation therapy until after delivery.
- Scleroderma or systemic lupus. Certain serious connective tissue diseases such as scleroderma or lupus, may make you especially sensitive to the side effects of radiation therapy
- Past radiation therapy to the same breast or to the same side of the chest. In general, radiation therapy to the breast can only be given once.
If you have a choice, take time to study your options. In the vast majority of cases there is absolutely no rush to come to a decision, and it is more important that you take your time to come to a decision with which you are comfortable, than to rush into a decision that you may later regret. A short delay before surgery will have no adverse impact on prognosis, and if you feel that your breast surgeon is unduly pressuring you into making a hasty decision, particularly if they indicate that a short delay may influence your prognosis, you may wish to consider a second opinion. See Delay between Diagnosis and Surgery
Reproduced from breastadvocateapp.com
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This Consequence Can Affect The Breast And Other Parts Of The Body
Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.
In breast cancer treatment, radiation fibrosisscar tissue that forms as a result of damage caused by radiation therapycan occur in the breast and chest wall. It can also strike the lungs and bones. It often begins with inflammation during radiation therapy and is most common in the first two years post-treatment, though it can occur up to 10 years after therapy is completed.
Fibrosis is a potentially painful, life-long condition, as the tissue changes are permanent. However, you have a lot of options for treating it, including medications, physical therapy, and more.
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What Are Clinical Trials
Cancer specialists regularly conduct studies to test new treatments. These studies are called clinical trials. Clinical trials are available through cancer doctors everywhere- not just in major cities or in large hospitals.
Some clinical studies try to determine if a therapeutic approach is safe and potentially effective. Many large clinical trials compare the more commonly used treatment with a treatment that cancer experts think might be better. Patients who participate in clinical trials help doctors and future cancer patients find out whether a promising treatment is safe and effective. All patients who participate in clinical trials are carefully monitored to make sure they are getting quality care. It is important to remember that clinical trials are completely voluntary. Patients can leave a trial at any time. Clinical trials testing new treatments are carried out in phases:
Only you can make the decision about whether or not to participate in a clinical trial. Before making your decision, it is important to learn as much as possible about your cancer and the clinical trials that may be available to you. Your radiation oncologist can answer many of your questions if you are considering taking part in a trial or contact the National Cancer Institute at 1-800-4-CANCER or www.cancer.gov.
What Is Stage 3 Breast Cancer
Also known as locally advanced breast cancer, the tumor in this stage of breast cancer is more than 2 inches in diameter across and the cancer is extensive in the underarm lymph nodes or has spread to other lymph nodes or tissues near the breast. Stage 3 breast cancer is a more advanced form of invasive breast cancer. At this stage, the cancer cells have usually not spread to more distant sites in the body, but they are present in several axillary lymph nodes. The tumor may also be quite large at this stage, possibly extending to the chest wall or the skin of the breast.
Stage 3 breast cancer is divided into three categories:
Stage 3A: One of the following is true:
- No tumor is found in the breast, but cancer is present in axillary lymph nodes that are attached to either other or other structures, or cancer may be found in the lymph nodes near the breast bone, or
- The tumor is 2 cm or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or other structures, or cancer may have spread to lymph nodes near the breastbone, or
- The tumor is 2 cm to 4 cm in size. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breast bone, or
- The tumor is larger than 5 cm. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
What Are The Cancer Risk Reduction Options For Women Who Are At Increased Risk Of Breast Cancer But Not At The Highest Risk
Risk-reducing surgery is not considered an appropriate cancer prevention option for women who are not at the highest risk of breast cancer . However, some women who are not at very high risk of breast cancer but are, nonetheless, considered as being at increased risk of the disease may choose to use drugs to reduce their risk.
Health care providers use several types of tools, called risk assessment models, to estimate the risk of breast cancer for women who do not have a deleterious mutation in BRCA1, BRCA2, or another gene associated with breast cancer risk. One widely used tool is the Breast Cancer Risk Assessment Tool , a computer model that takes a number of factors into account in estimating the risks of breast cancer over the next 5 years and up to age 90 years . Women who have an estimated 5-year risk of 1.67 percent or higher are classified as “high-risk,” which means that they have a higher than average risk of developing breast cancer. This high-risk cutoff is widely used in research studies and in clinical counseling.
Drug Treatment Before Surgery
You might have chemotherapy as a first treatment to shrink the cancer down.
You might have hormone therapy first if your cancer cells have hormone receptors. But you usually only have this if chemotherapy isnt suitable.
If your cancer cells have particular proteins called HER2 receptors you might also have a targeted cancer drug called trastuzumab .
These treatments might shrink the tumour enough to allow your surgeon to remove just the area of cancer. This is called breast conserving surgery or a wide local excision.
If the cancer doesnt shrink enough, you need to have the whole breast removed . You may be able to have a new breast made . Do speak to your surgeon about this.
Before your surgery the lymph nodes in the armpit are checked for cancer cells.
You usually have radiotherapy to the breast after surgery.
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Helping You To Make The Choice
Patients often get a lot of different information from a lot of different sources around the time of diagnosis, some of which may be unsolicited, and its a hard time processing whats going to be valuable. Its very difficult when youre given a cancer diagnosis, Okay, well whats going to happen 5, and 10 and 15 years from now? And how do I make a decision that Im going to be happy with at that time because right now the only thing that most women are thinking about is that they want to be cured. In addition, it comes at a time that is emotionally charged.
For the undecided patient, some will choose BCT if educated about their choices and given proper time for decision-making. Conversely, some women once presented the data and given time to make an informed decision prefer mastectomy. A prospective study of patients eligible for BCT who were provided with a standardized decision support identified 3 treatment outcomes that discriminated between those choosing BCT versus mastectomy. The 3 discriminants were remove breast for peace of mind,avoid radiation, and keep breast.
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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.
Timing Of Chemotherapy Matters
The next study, Chavez-MacGregor et al, asked basically the same question, except that the authors looked at time to adjuvant chemotherapy after definitive surgery. Adjuvant chemotherapy is chemotherapy given after surgery with the intent of decreasing the chance of tumor recurrence. It is standard of care for many kinds of breast cancer. For instance, in two of the kinds of breast cancer with poorer prognosis, triple negative breast cancer and HER2 breast cancer, except in the case of very small node-negative tumors, nearly every patient who is healthy enough to handle it will be recommended adjuvant chemotherapy.
Not surprisingly, the authors found a correlation between prolonged time to chemotherapy and Hispanic ethnicity, non-Hispanic black race, lower socioeconomic status, and nonprivate insurance. This is similar to what Bleicher et al found with respect to time-to-surgery, namely that the proportion of patients with black race or Hispanic ethnicity increased with each interval delay. This is by no means a new finding disparities in health care of this sort have been documented in many previous studies. Indeed, these sorts of disparities are likely one reason why minorities and people of lower socioeconomic status experience worse outcomes in many cancers. Indeed, there are a lot of potential confounders, many of which couldnt be accounted for in either study, as Chavez-MacGregor et al note:
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