Questions To Ask Your Radiation Oncologist Breast Cancer

Will I Need Radiation

Most oncologists generally recommend radiation treatment for all breast cancer patients who undergo only removal of the tumor .

For women who undergo whole-breast removal, radiation may be recommended for those who are considered high-risk, especially those with tumors larger than 5 centimeters and with more than four cancerous lymph nodes.

What If I Dont Want Cancer Treatment

All treatments carry some sort of risk. A decision to decline treatment has its own risks, too. Breast cancer patients may refuse their doctors treatment recommendations in whole or in part. Palliative care, designed to help control severe side effects such as pain, nausea or other symptoms, may help you manage your quality of life in the meantime.

After My Breast Cancer Surgery Will I Need Radiation Or Chemotherapy Or Both

The stage of breast cancer helps determine which treatment regimen your oncologist will recommend. After breast-sparing surgery, radiation treatments may be used to help destroy remaining breast cancer cells. Radiation therapy for breast cancer is typically given after surgery to lower the chance of a cancer recurrence. Adjuvant breast cancer chemotherapy may be used after surgery to destroy remaining cancer cells not killed during surgery.

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What Type Of Doctor Should I See If I Think I Have Breast Cancer

If you think you have breast cancer, you should talk to your primary care physician or OB/GYN. A number of doctors may play a role in your breast cancer treatment. The following is a list of doctors who may be involved in your care:

• Medical oncologist: A physician who has special training in diagnosing and treating cancer using chemotherapy, hormonal therapy and targeted therapy
• Surgical oncologist: A doctor who uses surgery to diagnose, stage and treat cancer and manage certain cancer-related symptoms, and who may perform biopsies and other surgical procedures such as removing a breast lump or the entire breast
• Radiation oncologist: A physician trained in cancer treatment using radiation to shrink tumors and destroy cancer cells

How Big Is My Tumor

Tumor size is another factor that will determine your course of treatment. Your doctor uses the size of your tumor to stage, or further categorize your cancer .

The tumors dimensions are estimated by a physical exam, a mammogram, an ultrasound or an MRI of the breast. The precise size wont be known until a pathologist studies the tumor after surgical removal.

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What Size Is My Tumor And Why Does That Matter

Treatment options for breast cancer partly depend on how small or large your tumor is, if the cancer has spread to the lymph nodes and if the cancer is found in other parts of your body. The larger the tumor, the more likely it is that the breast cancer is lymph node-positive, meaning the axillary lymph nodes contain cancer. Sentinel node biopsy is the most common way to determine whether cancer cells have spread beyond the breast.

Questions For Family Or Caregivers To Ask The Doctor

• How will this treatment impact the way they live their life?
• Will they be able to maintain their regular schedule?Will they need to take time away from work?
• Will they need someone to drive them to and home from their appointments?
• What can I do to help?
• Are there special meals or preparations I should make?
• Is there a support group for families you would recommend?
• Who should we call in case of an emergency?

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How Much Experience Do You Have Treating My Type And Stage Of Breast Cancer

Oncologists who are experienced in not only treating breast cancer but in your specific type of breast cancer are typically better equipped to explain and deliver the full range of treatment options. You should feel comfortable asking your doctor about his or her experience. Doctors and the hospitals they may work for are not required by law to publish the survival rates of the patients they treat, but some choose to do so. Others may be willing to provide these statistics upon request.

Is My Cancer Invasive Or Noninvasive

A tumor is an abnormal growth that may be benign or malignant. Benign breast tumors are not life-threatening and do not spread to other parts of the body. Malignant breast tumors are cancers that impact your health and may spread to other parts of the body. A malignant tumor that grows into surrounding tissue is considered invasive. Invasive tumors are more likely to spread to other parts of the body than non-invasive tumors. Non-invasive breast cancer cells remain in a particular area of the breast without spreading to surrounding tissue, lobules or ducts.

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Is The Cancer In My Lymph Nodes

Whether your breast cancer has spread to your lymph nodes the filtering mechanisms in your armpits and elsewhere in the body that are part of the immune system is one of the most important predictors of the severity of your disease.

Involvement of the lymph nodes changes the treatment plan, says Dr. Abraham. When breast cancer cells have spread to the lymph nodes, we tend to discuss more aggressive treatment options, such as chemotherapy.

What Emotional Responses Might I Expect

You may or may not experience anxiety or fear when you begin your treatment. Most people tell us that their concerns lessen as they adapt to the new environment and treatment.

Please speak to the staff if you feel that you need either emotional or practical support. There is a social worker on staff in the Radiation Oncology department. This may be a time when you think again about support groups or one-to-one consultation for the feelings that arise or to support your coping. For information about support services, please call the Breast Care Center at 353-7070.

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Questions To Ask Your Breast Surgeon After Your First Surgery

• What type of breast cancer do I have?

• What is the size of the tumor?

• What is the grade and stage of this disease? What are my biomarkers? What do these mean?

• What are the chances that the breast cancer will return?

• Can you explain my pathology report to me?

• Can I get a copy of my pathology report? How and when can I get these results?

• Was all of the cancer removed during the surgery?

• Will I need to take further medication after surgery even if all of the cancer was removed? If so, why?

• How many lymph nodes were removed?

• Has the cancer spread to any of the lymph nodes? If so, how many? Has the cancer spread to anywhere else in my body?

• Do I need additional surgery?

• If I have a mastectomy without reconstruction, where can I get a prosthesis? Is this covered by my insurance?

• Will my arm be affected by surgery? For how long? Will I need physical therapy for my arm?

• When will I be able to work and/or return to my normal routine? Are there any activities I should avoid?

• Who should I contact about any side effects I experience? And how soon?

• Will my surgeon communicate with my medical oncologist or radiation oncologist?

• Do you recommend any genetic testing of the tumor?

What Course Of Treatment Do You Recommendshould I Pursue Complementary Therapies

Breast cancer treatment options include surgery, radiation, chemotherapy, hormone therapy, and any number of combinations thereof. Your specific treatment plan can vary and will likely be unique to your own individual needs depending on the type and stage of your breast cancer. Dr. Halaharviherself a breast cancer survivorknows how important it is to tailor your treatment to you.

“Breast cancer treatment is no longer a one-size-fits-all approach,” Dr. Halaharvi told Parade. “As not all patients and tumors are the same, these are important questions to ask your doctor to enable personalized treatment decisions. Personalized medicine, or tailoring treatment to the biology of each patients individual tumor, can potentially spare some women the time, expense and harmful side effects that can be associated with chemotherapy.”

Also ask your doctor whether complementary therapies, like acupuncture, may be beneficial to your care, Dr. Bajia advises. Different doctors will have different opinions based on your specific case and diagnosis, so it’s important to consult with your care team before pursuing any of these avenues on your own.

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What Is The Difference Between Radiation And Chemotherapy

Chemotherapy involves medications delivered by injections or taken in pill form. This type of treatment is circulated throughout the entire body and is generally prescribed by a medical oncologist. Radiation therapy, delivered by a radiation oncologist, uses radiotherapy beams focused on a very specific area of the body in order to deliver high doses of the treatment while reducing the risk of radiation exposure to healthy tissue.

Questions To Ask At Diagnosis

• What type of cancer do I have?
• What stage is my cancer, and what does that mean?
• How will the stage affect my prognosis and treatment?
• Where is the cancer located?Has my cancer spread from where it was initially?
• Can I have a copy of my pathology report?
• What is the long-term prognosis?
• Is my cancer curable?
• What is the survival rate of this kind of cancer?
• Are there other tests I should take before considering treatment?
• How do I get a second opinion?
• What can I do to stay healthy throughout this experience?
• Are there any trusted websites or books you would recommend for learning more about my diagnosis?

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What Treatment Options Are Typically Available

Breast cancer treatments have two main goals: to destroy as much of the cancer as possible, and to prevent tumors from returning.

Some treatments remove or destroy the disease within the breast and nearby tissues, such as lymph nodes. These treatments include:

Surgery: Surgical options include a mastectomy, which removes the whole breast, and a lumpectomy, or breast-conserving surgery that removes only the tumor and the tissues around it. Sentinel node biopsy is a surgical diagnostic technique that removes one or a few of the first draining lymph nodes to determine whether cancer cells have spread beyond the breast. Women who have surgery as part of their breast cancer treatment may choose oncoplastic and breast reconstruction surgery to rebuild the shape and look of the breast.

Radiation therapy: This conventional technique uses targeted, high-energy radioactive waves to destroy tumors.

Because these treatments often affect the lymph nodes, lymphedema is a common treatment-related side effect for breast cancer patients who receive surgery or radiation therapy. Lymphedema is the buildup of lymphatic fluid under the skin, which often leads to swelling.

The goal of other treatments is to destroy or control cancer cells all over the body. These include:

Your doctor may recommend chemotherapy, hormone therapy or targeted therapy treatment along with surgery or radiation in order to kill cancer cells that were left behind by other treatments.

What Can I Expect From My Treatment

When you arrive, please check in at the desk. Each treatment should only last 10 to 15 minutes. You can change your clothes in the dressing room and then wait in the lounge to be called.

During each treatment session, you will lay on a table while the technician uses the marks on your skin to locate and treat the field. It is important to be still while getting the radiation, although you should continue to breathe normally.

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Questions To Ask After Treatment

• What warning signs should I watch for that might indicate my cancer has returned?
• Who should I call if I notice these symptoms?
• Is there any follow-up treatment I will need?
• How often will we run follow-up tests and exams?
• Do I need to maintain a special diet?Are there any activities I should avoid?
• How long will it take me to feel like myself again?
• What records should I keep regarding my treatment?
• What do I do if the cancer returns?

How Much Does Radiation Therapy Cost

If you receive radiation therapy as an outpatient in a public hospital, Medicare pays for your treatment. Medicare also covers some of the cost of radiation therapy in private clinics, but you may have to pay the difference between the cost of treatment and the Medicare rebate .

Private health insurance does not usually cover radiation therapy, as its considered an outpatient treatment.

Before treatment starts, ask your provider for a written quote that shows what you will have to pay.

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What Are The Possible Side Effects Of Each Treatment Option

Breast cancer treatments may cause temporary side effects that go away soon after treatment is completed, as well as longer-term side effects that last months or years. Below is a list of the side effects associated with each treatment option.

Surgery: Surgical procedures for breast cancer may cause short-term pain or discomfort in the treated area. Also, the muscles of the arm may feel weak, and the skin in the breast area may feel tight. Surgery involving the lymph nodes may also cause swelling in the arm, a condition known as lymphedema.

Radiation therapy: Many breast cancer patients who undergo radiation therapy experience skin irritation and breast pain. These conditions usually begin within a few weeks of starting treatment and go away on their own within six months after treatment ends. For some patients, however, these symptoms may not develop until several months or years after treatment. Another common radiation-related side effect is fatigue, especially in the later weeks of treatment and for some time afterward.

Chemotherapy: Certain chemotherapy drugs may cause potential side effects like nausea, vomiting, fatigue, nerve damage, sore mouth, diarrhea, constipation and decreased blood counts.

Targeted therapy: Side effects for HER2-positive targeted therapy drugs are typically mild, but serious side effects are possible and may include nausea, vomiting, diarrhea, fatigue, mouth sores and rashes.

What Is My Estrogen Receptor And Progesterone Receptor Status

Your bodys hormones such as estrogen and progesterone may play a role in how your breast cancer progresses.

Normal cells are equipped with receptors that allow them to receive information from circulating hormones, similar to the way your phone picks up satellite signals. Cancer cells may also have hormone receptors, letting them tap into your bodys normal cell growth-regulating system.

Your ER/PR status is determined by testing a sample of breast cancer cells removed during a biopsy. If your breast cancer cells have estrogen and progesterone receptors if theyre ER/PR-positive then theyre capable of detecting estrogens signal and using it to fuel growth. If the cancer cells lack these receptors meaning theyre ER-/PR-negative they cant hear the growth-signaling message.

About 70% of breast cancer patients have positive ER/PR hormone status.

While being ER/PR-positive sounds bad, theres actually a benefit. Doctors can take advantage of the receptors presence. They can use an anti-estrogen drug that blocks the receptors and blocks estrogens growth signal. Or they can use other drugs like aromatase inhibitors that lower your bodys estrogen levels to deprive the cancer cells of fuel.

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When Deciding On A Treatment Plan

• How much experience do you have treating this type of cancer?
• Should I get a second opinion? How do I do that? Will getting a second opinion delay my treatment and can that affect my outcome?
• What are my treatment choices?
• What treatment do you recommend and why?
• Should I think about taking part in a clinical trial?
• What would the goal of the treatment be?
• How soon do I need to start treatment?
• How long will treatment last? What will it be like? Where will it be done?
• Should my biopsy tissue be sent for a gene expression test to help decide if chemotherapy might be helpful for me?
• Are there other molecular or protein tests that need to be done on my cancer tissue to help decide my treatment options?
• What should I do to get ready for treatment?
• What risks or side effects are there to the treatments you suggest? Are there things I can do to reduce these side effects?
• How will treatment affect my daily activities? Can I still work fulltime?
• Will I lose my hair? If so, what can I do about it?
• Will I go through menopause as a result of the treatment? Will I be able to have children after treatment? Would I be able to breastfeed?
• Do I have time to freeze my eggs before starting treatment? What are my options?
• What are the chances the cancer will come back after this treatment?
• What would we do if the treatment doesnt work or if the cancer comes back?
• What if I have transportation problems getting to and from treatment?

Questions To Ask Before Radiation Therapy

• What is the goal of the radiation for my cancer? Is this a cure or a short term solution?
• What will your proposed treatment do to my cancer stem cells?
• How will you support my immune system during treatment?
• How will you protect my heart, lungs, and/or other organs from the radiation?
• How will this treatment change the cancer environment: will it only kill some of the cancer cells and leave me vulnerable when the cancer stem cells go
• on to create more cancer?
• What is your opinion on taking antioxidants and other supplements during treatment?
• How will radiation affect my risk of distant relapse, which has a much higher rate of recurrence than the 10-15 percent of patients with stage I or
• II who will develop a local recurrence? In light of the risk of the radiation creating more cancer, how will this radiation treatment benefit me?
• What lifestyle changes will I need to make to improve the outcome of the radiation treatment and protect my body during treatments?
• Will a planning CT be required to determine the area to be treated? Will I require more than one of these scans which inherently subject me to
• even more radiation?
• Would you give this same treatment to your wife or children, and if not, what would you recommend for them? Would you do it yourself?

BEFORE

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