Cancer Alters Your Life And It Never Really Leaves You
For those beginning their cancer journey, Carol has two bits of advice. “Definitely don’t put off getting anything suspicious checked.” She doubts she would have found the cancer early if she weren’t seeing Dr. Khoo regularly. “Lastly, know that cancer never leaves you. Post-cancer PTSD and anxiety is real, even after treatment ends, and that’s OK.”
Because El Camino Health knows that the emotional toll may continue long after cancer treatment ends, they’ve developed the Survivorship Program to support patients like Carol who may have questions or fears about what’s happening with their mind, body or emotions.
Now at age 33, Carol’s life is basically back to normal, although she still struggles with the possibility that she may not be able to have more children through natural means.
“As much as cancer sucked,” states Carol, “I truly appreciate the many new perspectives it gave me: A glimpse of the lives of the doctors and nurses providing care. The depths of empathy of everyone on a cancer journey. And it forced me to jump off the never-ending achievement treadmill with no regrets. Life is such a gift!”
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the breast.
- Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.
What Is Invasive Lobular Carcinoma
Invasive lobular carcinoma is a cancer that starts in the breasts lobules and invades surrounding tissue. ILC is the second most common form of invasive breast cancer, accounting for 10 to 15% of breast cancer cases. ILC doesnt always form a lump, but women who have it may notice a thick or full area that doesnt feel like the rest of the breast.
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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.
Hormone Therapies Slow Or Stop Cancers Growth By Changing The Hormonal Milieu
Tamoxifen is an oral treatment. It is a selective estrogen receptor modulator , meaning it blocks estrogen from getting into breast cells. But although tamoxifen is anti-estrogenic in the breast, it is estrogenic in others parts of the body, such as the uterus and the bones. This is good for the bones, but not good for the uterus, and this is the reason why tamoxifen slightly increases a womans risk of developing uterine cancer
The aromatase inhibitors reduce estrogen by blocking an enzyme called aromatase and keeping it from converting androgens into estrogen. Both premenopausal and postmenopausal women can use tamoxifen as hormonal therapy. But for a woman to take an aromatase inhibitor, she must be postmenopausal. Thats because postmenopausal women get most of their estrogen from the conversion of androgens into estrogen by the aromatase enzyme, while premenopausal women get most of their estrogen directly from their ovaries. There are drugs that a premenopausal woman can take to put her into menopause that are used as breast cancer treatments. These include goserelin and leuprolide .
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Do I Need Genetic Counseling And Testing
Your doctor may recommend that you see a genetic counselor. Thats someone who talks to you about any history of cancer in your family to find out if you have a higher risk for getting breast cancer. For example, people of Ashkenazi Jewish heritage have a higher risk of inherited genetic changes that may cause breast cancers, including triple-negative breast cancer. The counselor may recommend that you get a genetic test.
If you have a higher risk of getting breast cancer, your doctor may talk about ways to manage your risk. You may also have a higher risk of getting other cancers such as ovarian cancer, and your family may have a higher risk. Thats something you would talk with the genetic counselor about.
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The Signs Of Triple Negative Breast Cancer
Symptoms of triple negative breast cancer arent different from other types of breast cancer, Dr. Mayer says. According to the ACS, these symptoms include:
- A new breast lump that may be hard, soft, painful, or painless
- Swelling of the breast
- Skin peeling, thickening, or redness
- Skin that resembles an orange peel
- Nipple discharge
- Swollen lymph nodes
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Estrogen Receptor And Progesterone Receptor Positive Breast Cancer
Breast tumors are tested to see if they are estrogen receptor and/or progesterone receptor positive or negative. Hormone receptor tests are both prognostic and predictive. In general, tumors that are ER+ and/or PR+ are slightly slower growing and have a slightly better prognosis than tumors that arent. Hormone receptors also provide information about treatment options. If your tumor is ER+ and/or PR+, then your cancer can be treated with a hormone therapy. For this reason, these tumors are also sometimes referred to as hormone sensitive.
Hormone therapies slow or stop cancers growth by changing the hormonal milieu. For early stage cancer, these treatments include tamoxifen and a class of drugs called aromatase inhibitors or AIs. Currently three aromatase inhibitors are approved for use by the U.S. Food and Drug Administration : anastrozole , letrozole , and exemestane . Studies suggest that all three are equally effective. Women with metastatic breast cancer also have other hormone therapy options, including fulvesrant , megestrol acetate , and tormifene .
How Does Staging Relate To Types Of Breast Cancer
In addition to cancer stage, doctors will determine the tumor grade and subtype.
Tumors are graded on a scale of 1 to 3, based on how abnormal the cells appear compared to normal cells. The higher the grade, the more aggressive the cancer, meaning that it tends to be growing quickly.
The subtype is important because treatment and outlook will vary depending on which subtype of breast cancer that you have. Subtypes include:
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Triple Negative Breast Cancer Risk Factors
As with so many complicated health conditions, experts arent quite sure what causes triple negative breast cancer. Doctors dont understand for certain what causes breast cancer in general, Dr. Mayer says, much less the complex triple negative kind. They have some ideas about risk factors involved, though.
Much of the conversation about breast cancer risk factors revolves around hormone exposure since most breast cancers grow in response to hormones. But thats not an issue with triple negative breast cancer, so other factors take center stage.
In general, breast cancer risk rises as you get older, according to the Mayo Clinic. But triple negative breast cancer is actually more common in premenopausal people than in older ones, Dr. Nanda says. This could be because of triple negative breast cancers link with BRCA gene mutations, which are often implicated in cases of people developing breast cancer before age 50.
Mutations in the BRCA1 and BRCA2 genes can raise your risk of breast and ovarian cancers, according to the CDC. When these genes function normally, they help to suppress tumor growth, the National Cancer Institute explains. When they have mutations, however, your cells may divide and change too quickly, leading to cancerous tumors. Theres a lot of scientific interest surrounding a possible association between these mutations and triple negative breast cancer, though experts dont yet know how exactly they might be connected.
What Is A Breast Papilloma And Is It Cancer
Also called intraductal papilloma, a breast papilloma is a small, wartlike growth in the breasts milk ducts. This benign condition may cause a clear or bloody discharge from the nipple, or you may feel a small lump behind or next to the nipple. Having one papilloma does not raise your breast cancer risk, though having several of these growths has been linked to higher risk.
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Stage Iia & Iib Treatment Options
Stage II is divided into subcategories known as IIA and IIB.
In general, stage IIA describes invasive breast cancer in which:
- no tumor can be found in the breast, but cancer is found in 1 to 3 axillary lymph nodes or in the lymph nodes near the breast bone or
- the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes or
- the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the axillary lymph nodes
Still, if the cancer tumor measures between 2 and 5 cm and:
- has not spread to the lymph nodes or parts of the body away from the breast
it will likely be classified as stage IB.
Similarly, if the cancer tumor measures between 2 and 5 cm and:
- has not spread to the lymph nodes
- has an Oncotype DX Recurrence Score of 9
it will likely be classified as stage IA.
In general, stage IIB describes invasive breast cancer in which:
- the tumor is larger than 2 cm but no larger than 5 cm small groups of breast cancer cells larger than 0.2 mm but not larger than 2 mm are found in the lymph nodes or
- the tumor is larger than 2 cm but no larger than 5 cm cancer has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the breastbone or
- the tumor is larger than 5 cm but has not spread to the axillary lymph nodes
Still, if the cancer tumor measures between 2 and 5 cm and:
- cancer is found in 1 to 3 axillary lymph nodes
What Does Estrogen Receptor Positive Mean
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Talking To Your Family
People who carry inherited BRCA mutations also face the issue of how to inform relatives about the results of their BRCA testing. These relatives may also have a BRCA mutation, potentially increasing their own or their childrens risk of breast, ovarian, or other cancers. Genetic counselors help patients understand the implications of genetic testing and genetic results and how to approach discussion with family members.
About Inflammatory Breast Cancer
Cancer begins when healthy cells in the breast change and grow out of control, forming a mass or sheet of cells called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Breast cancer spreads when the cancer grows into other parts of the body or when breast cancer cells move to other parts of the body through the blood vessels and/or lymph vessels. This is called metastasis.
Inflammatory breast cancer is a less common form of breast cancer. The cancer gets its name because it causes symptoms that are similar to a breast infection. These symptoms include redness, tenderness, swelling, and pain in the breast. However, unlike an infection, inflammatory breast cancer does not improve with antibiotic treatment.
Clinicopathologic Characteristics Of Single Hormone Receptor
The median follow-up duration for the 6,980 patients included in this analysis was 45 months . In this study, 4,651 cases were double HR+ tumors, 1,758 were double HR- tumors, and 571 cases were single hormone-receptor positive tumors, of which 90 cases were ER-PR+ tumors and 481 were ER + PR- tumors. The clinicopathological characteristics of the four subtypes are summarized in Table . Overall, ER+/PR- tumors were found more frequently in postmenopausal women than other subtypes . Compared with ER + PR+ tumor, ER + PR- tumors were not significantly different in staging , but ER+PR- tumors exhibited higher nuclear grade , higher Ki-67 level , and higher EGFR and HER2 expression . However, compared with ER-PR- tumors, ER + PR- tumors showed lower stage , lower NG , lower Ki-67 level , lower p53 expression and lower EGFR expression , but there was no difference in HER2 overexpression .
Table 1 Clinicopathologic characteristics of patients with ER + PR+, ER + PR-, ER-PR+ and ER-PR- tumors
ER-PR+ tumors had higher NG , higher Ki-67 level , and higher expression of p53 and EGFR than ER + PR+ tumors. However, compared with ER-PR- tumors, there was no difference in stage or NG . Also, there was no difference in expression of Ki-67 , p53 , EGFR or HER2 .
Common Types Of Breast Cancer
There are many types of breast cancer, but the most common ones are:
- Ductal carcinoma in situ
- Invasive ductal carcinoma
- Invasive lobular carcinoma
Lobular or ductal describes whether the cancer originated in the lobules or the ducts of the breast. An in situ cancer is located within the ducts or lobules and has not invaded into the breast tissue. An invasive cancer has invaded normal tissue within or beyond the breast.
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What Are Lobular Carcinoma In Situ And Atypical Lobular Hyperplasia
Lobular carcinoma in situ is not considered breast cancer or a precancer because it doesnt turn into invasive cancer if untreated. LCIS and atypical lobular hyperplasia , a similar noncancerous condition, are subtypes of lobular neoplasia, a disorder marked by abnormal cells in the breasts lobules . Since LCIS and ALH raise your risk for breast cancer in the future, if youve been diagnosed with either of them, talk to your doctor about how often you should be screened for breast cancer and whether you should have any additional screening tests.
What Is Triple Negative Breast Cancer
A diagnosis of triple negative breast cancer means that the three most common types of receptors known to fuel most breast cancer growthestrogen, progesterone, and the HER-2/neu gene are not present in the cancer tumor. This means that the breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 , estrogen receptors , and progesterone receptors .
Since the tumor cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen, progesterone, and HER-2 are ineffective. Using chemotherapy to treat triple negative breast cancer is still an effective option. In fact, triple negative breast cancer may respond even better to chemotherapy in the earlier stages than many other forms of cancer.
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We Will Look At Several Factors Including:
- Where the cancer cells originated
- How the breast cancer cells look under the microscope
- Whether the breast cancer cells react to hormones
- The genetic makeup of the cancer cells
We will then use that information to chart a treatment course that reflects your goals, personal desires, and unique nature of your particular type of breast cancer.
Recently Diagnosed With Triple Positive Breast Cancer
Thanks Lorraine, there’s a sort of strange comfort in hearing someone has had a similar diagnosis and treatment and has been ok. I know that’s daft because we all respond differently..but hey, my emotions and feelings haven’t been too rational since I had the “news”
I’ve had a bit of a setback this morning though, as my gp has told me I have shingles so my chemo is delayed until it clears, which is usually 3-4weeks, so my fear has now ramped up a notch, knowing I wont start my fight back for possibly another month!!
Your tips on coping with the fears about cancer and living in the now are all really helpful and I was so ready to tackle this head on, but the delay in treatment has really scared me…that this could now spread…
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