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How Is Breast Cancer Diagnosed
During your regular physical examination, your doctor will take a thorough personal and family medical history. He or she will also perform and/or order one or more of the following:
- Breast examination: During the breast exam, the doctor will carefully feel the lump and the tissue around it. Breast cancer usually feels different than benign lumps.
- Digital mammography: An X-ray test of the breast can give important information about a breast lump. This is an X-ray image of the breast and is digitally recorded into a computer rather than on a film. This is generally the standard of care .
- Ultrasonography: This test uses sound waves to detect the character of a breast lump whether it is a fluid-filled cyst or a solid mass . This may be performed along with the mammogram.
Based on the results of these tests, your doctor may or may not request a biopsy to get a sample of the breast mass cells or tissue. Biopsies are performed using surgery or needles.
After the sample is removed, it is sent to a lab for testing. A pathologist a doctor who specializes in diagnosing abnormal tissue changes views the sample under a microscope and looks for abnormal cell shapes or growth patterns. When cancer is present, the pathologist can tell what kind of cancer it is and whether it has spread beyond the ducts or lobules .
Talk To Your Doctor To Find Out What Your Breast Cancer Stage Is And How It Is Used To Plan The Best Treatment For You
After surgery, your doctor will receive a pathology report that describes the size and location of the primary tumor, the spread of cancer to nearby lymph nodes, tumor grade, and whether certain biomarkers are present. The pathology report and other test results are used to determine your breast cancer stage.
You are likely to have many questions. Ask your doctor to explain how staging is used to decide the best options to treat your cancer and whether there are clinical trials that might be right for you.
The treatment of breast cancer depends partly on the stage of the disease.
For treatment options for stage IIIB, inoperable stage IIIC, and inflammatory breast cancer, see Treatment of Locally Advanced Inflammatory Breast Cancer.
For treatment options for stage IV breast cancer or breast cancer that has recurred in distant parts of the body, see Treatment of Metastatic Breast Cancer.
Hormone Therapy For Postmenopausal Women
After menopause, hormone therapy for women with metastatic breast cancer can be an aromatase inhibitor, tamoxifen, fulvestrant or other hormone therapy drug.
If the first hormone therapy stops working and the cancer starts to grow again, a second hormone therapy can be used. If the second drug stops working, another can be tried.
Ovarian suppression isnt helpful for postmenopausal women because their ovaries have already stopped producing large amounts of estrogen.
Playing An Active Role
You play an active role in making treatment decisions by understanding your breast cancer diagnosis, your treatment options and possible side effects.
Together, you and your health care provider can choose treatments that fit your values and lifestyle.
The National Academy of Sciences released the report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis in 2013. Susan G. Komen® was one of 13 organizations that sponsored this study.
The report identified key ways to improve quality of care:
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Ovarian Ablation Or Suppression
In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.
Treatment Of Metastatic Disease
MSK physicians, nurses and other healthcare professionals are experts in breast cancer surgery, reconstruction, radiation oncology and more.
Women with metastatic breast cancer may receive various systemic therapies to control the disease. These include chemotherapy, hormonal therapy, biologics, immunotherapies, other targeted agents, or combinations of these.
The choice of treatments depends on certain characteristics of your breast cancer tumor type, such as hormone receptors, HER2/neu status, and the location of the disease.
ChemotherapyThere are a large number of chemotherapy drugs that work in many different ways. In a very general sense, these drugs can help you fight breast cancer by interrupting the growth and spread of cancer cells. Each of them works in a somewhat different fashion and their dose, schedule, and use, either alone or in combinations, can lead to different levels of effectiveness.
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Computer Tools To Help Choose Treatment
Specialised computer programmes can help doctors to decide which treatment might be best in your particular case. The programmes contain all the details of trial results for treatments after surgery for early stage breast cancer.
Doctors can type the details of your cancer into the computer database and then add in different types of treatment, such as chemotherapy or hormonal therapy.
The computer tells how much each treatment reduces the chance of the cancer coming back. The computer programmes also give information about the risk of side effects of each treatment. One commonly used programme is called Predict.
Do speak to your doctor if you want to find out more about this.
Types Of Available Breast Cancer Treatment Options
The most commonly available breast cancer treatment options include the following:
In addition to external-beam radiotherapy, there are others forms of radiotherapy. When radiation is given in the operating room by using a probe, it is called intra-operative radiation therapy. Brachytherapy is another type of radiotherapy in which radiation is given by placing radioactive substance in-between the tumor. Hypo-fractionated radiation therapy is the radiotherapy in which a higher daily dose of radiation is given to the whole breast so as to shorten the overall length of treatment.
Radiation therapy can be given before or after surgery depending upon the cancer stage. It is called neoadjuvant radiation therapy if radiation is given before surgery and adjuvant radiation therapy if it is given after surgery. It is given as a specific number of treatments over a decided period of time, for example, 5 days a week for 5 to 6 weeks
Systemic Therapy: Systemic therapy is the type of cancer treatment that is given either by mouth or through a vein. In this form of treatment, drugs enter the bloodstream and reach cancer cells to kill them. It is mainly of three types:
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Getting A Second Opinion
Treatment decisions can be complicated and confusing. You can ask for a second opinion if you would like to get another doctor’s view about your treatment. This means going to see another specialist. They will need to see all your test results and x-rays.
Having a second opinion doesn’t usually mean that the new doctor takes over your treatment and care. They discuss with you and your current doctor which is the best treatment approach to take.
If you want to get a second opinion, your doctor will usually be happy to arrange it for you. It can take time to arrange though and it might mean that your treatment is delayed for a while.
It is worth discussing your treatment again with your current specialist first. Once you have heard why they are suggesting particular treatments for you, you might feel that you don’t need a second opinion.
It is always a good idea to jot down a few questions before you go to the hospital for an appointment with your specialist. It can be difficult to remember everything you want to ask once you get there. Writing down your questions beforehand can help you to feel more confident during the discussion.
Treatment Of Early Localized Or Operable Breast Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
- A clinical trial of a new chemotherapy regimen.
- A clinical trial of monoclonal antibody therapy.
For patients with triple-negative or HER2-positive disease, the response to preoperative therapy may be used as a guide in choosing the best treatment after surgery.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
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Who Gets Breast Cancer
Breast cancer is the most common cancer among women other than skin cancer. Increasing age is the most common risk factor for developing breast cancer, with 66% of breast cancer patients being diagnosed after the age of 55.
In the US, breast cancer is the second-leading cause of cancer death in women after lung cancer, and it’s the leading cause of cancer death among women ages 35 to 54. Only 5 to 10% of breast cancers occur in women with a clearly defined genetic predisposition for the disease. The majority of breast cancer cases are “sporadic, meaning there is no definitive gene mutation.
A Family History Of Breast Cancer And Other Factors Increase The Risk Of Breast Cancer
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for breast cancer.
Risk factors for breast cancer include the following:
- A personal history of benign breast disease.
- A family history of breast cancer in a first-degree relative .
- Inherited changes in the BRCA1 or BRCA2 genes or in other genes that increase the risk of breast cancer.
- Breast tissue that is dense on a mammogram.
- Exposure of breast tissue to estrogen made by the body. This may be caused by:
- Menstruating at an early age.
- Older age at first birth or never having given birth.
- Starting menopause at a later age.
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
NCI’sBreast Cancer Risk Assessment Tool uses a woman’s risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a health care provider. For more information on breast cancer risk, call 1-800-4-CANCER.
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What Are The Options For Breast Cancer Treatment
If youve been diagnosed with breast cancer, your treatment will depend on your test results and type of cancer. Usually, you will have more than one type of treatment and the order will be personalised according to your diagnosis.
- How do oncologists work out the best treatments?
Your specialty team will do a variety of tests to determine what type of cancer you have and how likely it is to respond to various treatment options. Through mammogram, ultrasound, biopsy, microscopic examination, blood tests and other scans, they will work out the stage and the grade . They may understand whether the cancer is resistant to certain treatments, what cancer subtype it is and what its hormone receptor status is.
Genetic and biomarker testing will help determine whether there are any genetic mutations or cancer biomarkers that will show whether one treatment would work better than another. You may like to be involved in deciding on your treatment. Or you may prefer the doctor to advise the best way to go. You may also like to get a second opinion.
You can question your treatment options and make the best decision for you and your family.
Here are some treatment options you may have.
- Treatments for breast cancer
Can Cancer Form In Other Parts Of The Breast
Cancers can also form in other parts of the breast, but these types of cancer are less common. These can include:
- Angiosarcomas. This type of cancer begins in the cells that make up the lining of blood or lymph vessels. These cancers can start in breast tissue or breast skin. They are rare.
- Inflammatory breast cancer. This type of cancer is rare and different from other types of breast cancer. It is caused by obstructive cancer cells in the skins lymph vessels.
- Paget disease of the breast, also known as Paget disease of the nipple. This cancer affects the skin of the nipple and areola .
- Phyllodes tumors. These are rare, and most of these masses are not cancer. However, some are cancerous. These tumors begin in the breasts connective tissue, which is called the stroma.
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If Cancer Is Found Tests Are Done To Study The Cancer Cells
- how quickly the cancer may grow.
- how likely it is that the cancer will spread through the body.
- how well certain treatments might work.
- how likely the cancer is to recur .
Tests include the following:
Based on these tests, breast cancer is described as one of the following types:
This information helps the doctor decide which treatments will work best for your cancer.
Biomarker Testing Is Used To Find Out Whether Breast Cancer Cells Have Certain Receptors
Healthy breast cells, and some breast cancer cells, have receptors that attach to the hormonesestrogen and progesterone. These hormones are needed for healthy cells, and some breast cancer cells, to grow and divide. To check for these biomarkers, samples of tissue containing breast cancer cells are removed during a biopsy or surgery. The samples are tested in a laboratory to see whether the breast cancer cells have estrogen or progesterone receptors.
Another type of receptor that is found on the surface of all breast cancer cells is called HER2. HER2 receptors are needed for the breast cancer cells to grow and divide.
For breast cancer, biomarker testing includes the following:
- Triple negative. If the breast cancer cells do not have estrogen receptors, progesterone receptors, or a larger than normal amount of HER2 receptors, the cancer cells are called triple negative.
- Triple positive. If the breast cancer cells do have estrogen receptors, progesterone receptors, and a larger than normal amount of HER2 receptors, the cancer cells are called triple positive.
Abemaciclib Palbociclib And Ribociclib And Hormone Therapy
The CDK4/6 inhibitors FDA-approved for metastatic breast cancer treatment are:
CDK4 and CDK6 are enzymes important in cell division. CDK4/6 inhibitors are a class of drugs designed to interrupt the growth of cancer cells.
Although the CDK4/6 inhibitors abemaciclib, palbociclib and ribociclib have not been compared directly to one another, studies show similar results with each drug .
A CDK4/6 inhibitor in combination with hormone therapy can be used to treat hormone receptor-positive, HER2-negative metastatic breast cancers. Compared to treatment with hormone therapy alone, this combination can give people more time before the cancer spreads and increase overall survival .
The CDK4/6 inhibitor abemaciclib may also be used alone to treat hormone receptor-positive, HER2-negative cancers that have progressed during past hormone therapy and chemotherapy .
Abemaciclib, palbociclib and ribociclib are pills.
The table below lists some possible side effects for CDK4/6 inhibitors.
For a summary of research studies on the use of CDK4/6 inhibitors in treating metastatic breast cancer, visit the Breast Cancer Research Studies section.
Hormone Therapy For Breast Cancer
About 2 of every 3 breast cancer cases are hormone-receptor positive. This means the breast cancer cells grow by attaching to hormones like estrogen and progesterone. Hormone therapy, also called endocrine therapy, stops these hormones from attaching to cancer cells, thus stopping their spread.
There are different types of hormone therapy but most work by altering levels of estrogen and preventing estrogen from connecting to cancer cells.
Hormone therapy is most often used after surgery to reduce the risk of cancer returning but is sometimes used before surgery. Its a long-term treatment taken for at least 5 to 10 years.
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