Patients Risk For Breast Cancer example essay topic

Introduction, Signs and Symptoms, Terminology, Definitions ONE Patients diagnosed with breast cancer should obtain a second opinion as soon as possible. Chapter 2 ONE Breast cancer begins with a single glandular mutation in the breast. ONE Risks Previous breast cancer, age over 50 and strong history of family breast cancer increases a patients risk for breast cancer. ONE Risks Minor risk factors include menarche at 12 years or younger, onset of menopause after age 55, having no children or first child after age 30, and appearance of breast cysts or pre-cancerous breast disease.

ONE Risks Unproven but potential risk factors include high fat diet, obesity, alcohol, radiation exposure, pesticide, other environmental pollutants and estrogen replacement therapy in postmenopausal women with strong family history of breast cancer. ONE Signs and symptoms After five years, when tumor reaches one-half inch in diameter, cancer may begin to spread One terminology Most common forms of breast cancer are ductal- cancer of the breast duct (80%), lobular- cancer of the breast lobe (15%) and other types of cancers (5%). Chapter 6 One terminolgoyDCIS cancers (20%) are confirmed by calcification patterns on a mammogram. Chapter 3 One terminology Breast cancer cells may dislodge from primary breast masses and infiltrate into the bloodstream... A single doctor cannot diagnose and treat breast cancer alone. A team of doctors is needed.

- The team of doctors requires a leader, which doctor fulfills this role depends on the nature of the illness and shifts as need arises. Usually the surgeon is the initial team leader - The doctor who makes the initial discovery of something suspicious is usually your regular doctor or the radiologist who performs your annual mammograms. The radiologist performs all mammograms and x-rays. You will then be referred to a surgeon who will perform the biopsy. The biopsy is an essential early step in finding out whats wrong. - You may then need to return to the radiologist for additional mammograms and x-rays.

- An oncologist is a cancer specialist who treats you after diagnosis is confirmed and after surgery performed. If no surgery is needed then the oncologist treats you from the beginning. An oncologist treats the whole body with hormone therapy and / or chemotherapy to prevent recurrence. - You may need to see a radiotherapist.

The radiotherapist handles the radiation treatment. - A plastic surgeon may be required for breast reconstruction. The patients have time to find best quality doctors without the situation worsening. You can find a good cancer specialist in the following ways: -National Alliance of Breast Cancer Organization (NABCO) -National Cancer Institute (NCI) (800-4-CANCER) -American Cancer Society (800-ACS-2345) -American College of Surgeons (1-312-664-4050) -Breast cancer hotlines -Call best hospital in region -Local womens health groups -Call a clergyman or social worker at a mental health institution -Friends, relatives and colleagues are valuable sources of information in this regard. After compiling a list of doctors, it is important to verify their credentials.

- These include training, experience, hospital affiliation, peer recognition. - Credentials can be checked by consulting medical directories, public libraries, the county medical society, or medical libraries. - The Internet is also a valuable resource for checking credentials. Consult these organizations online-The National Library of Medicine, The National Cancer Institute PDQ - It is important to be treated in those hospitals that are especially excellent in treating breast cancer.

Here are some. -Dana-Faber cancer center in Boston -Memorial-Sloan-Kettering Cancer Center in NY -MD Anderson Cancer Center in Houston breast cancer is caused by a defect in the genes which permit uncontrolled growth of cells No one dies of breast cancer, only of cancers which have spread to other parts of the body Breast cancer is rare, though possible, in men. 1 out of 8 women develop breast cancer. Currently, there is an 85 percent survival rate (for which stage) for women with breast cancer.

Breast cancer is the most common cancer in women. A diagnosis of breast cancer does not mean immediate death. The breast contains the following elements: Except for the nipple, the breast contains no muscle but rests on its pectoral muscle. -Areola: pigmented skin around nipple. -Acini: sacks lined with cells that produce milk. -Lobules: clusters of acini.

-Ducts: drains lobules and carries milk to nipple. -Lobes: groups of lobules emptying into duct. -Fat, the majority of the breast, seldom less than one third, cushions this milk producing part of the breast. - connective tissue called fascia that enclose and support it -Blood vessels: arteries, veins, and capillaries. -Lymphatics and very few lymph nodes. Cancer is the abnormal and uncontrollable, multiplication and spread of cells in the body. Cancer is caused by genetic changes in the cell.

A benign tumor is a limited loss of cell control. A malignant tumor is the unrestrained growth of cells and has the ability to spread throughout the body. Cancers are divided into two categories: carcinomas and sarcomas. Cancers starting in bone, muscle, fat, or connective tissues are called sarcomas, and all other cancers are called carcinomas. Most breast cancer occurs in cells that line the lobules that make milk or in ducts that carry it to the nipple are called carcinomas. Those rare breast cancers that occur in breast fat or in other breast tissue are called sarcomas.

A tumor is not necessarily cancer. It is more likely to be cancer if it is firm or strangely shaped. Cancers originating in the ducts are called ductal carcinoma. Cancers originating in the lobules are called lobular carcinomas.

Some ductal or lobular cancers have a special appearance and pattern. These cancers are divided into subcategories of ductal or lobular cancer. They include tubular, medullary, mutinous, papillary, and adenocystic. These cancers are rare and the prognosis for women who have them is excellent. An in situ cancer is one that is confined to its site and shows no tendency of spreading. It can be detected only through a mammogram.

An in situ breast cancer appears in the ducts or lobules. An in situ cancer of the duct is often referred to as DCIS. DCIS cancers can be detected very early LCIS (lobular neoplasm) is most common in pre-menopausal women. If LCIS appears in one breast, it will likely appear in the other. Therefore the other breast must be closely watched An infiltrating, or invasive, cancer is one in which the cancer spreads to tissue surrounding the ducts or lobules. This type of cancer can be detected by physical exams.

An invasive cancer is not one that has spread to other parts of the body, but only to other breast tissue. Infiltrating cancer of the duct is the most common form of breast cancer. It produces a lump larger than that produced by cancer in the center of the breast, thus making detection easier. Warning signs include nipple retraction, nipple discharge, and skin changes. Infiltrating cancer of the lobules accounts for about fifteen percent of cases of breast cancer. It is harder to detect on a mammogram and so will be larger when detected.

The tumor itself is also softer, more a thickening than a lump. If present in one breast, might be present in other one as well. There is a condition called Pages Disease of the breast whose presence usually indicates underlying in situ or invasive ductal cancer. The symptoms are oozing from the nipple, scaliness, or skin hardening. This condition is very rare. There is a rare condition called Cystosarcoma phyllode which can be cancerous usually appears only in women in their 30's or 40's.

When cancerous, it usually does not spread to other parts of the body, but may spread to other parts of the breast and tends to recur. Removal of surrounding tissue is required to treat this condition, and sometimes even an entire mastectomy is required. Inflammatory cancer, which usually appears as an infection, is actually a very aggressive cancer. Breast cancer during pregnancy is usually detected late because of the changes caused by pregnancy. The spread of cancer is classified as: Local cancer is cancer that is confined to the breast, Regional cancer is cancer which has spread to the lymph nodes, Distant cancer is cancer which has spread to distant parts of the body. Not every lump is breast cancer some are cysts.

However, all lumps should be checked out. A cyst is a sac filled with liquid. One cyst is usually followed by other cysts. Cysts may change in size and location.

Repeated cyst occurrence may increase risk of breast cancer. Conditions Fibro cystic disease that is the presence of multiple cysts in the breast. However, if cysts contain too many irregular cells it may indicate an increased risk of breast cancer. Fibro adenomas - is the regular growth of cells resulting in lumps, which are usually removed. They should then be examined by biopsy in women over twenty. Various infections and disorders can simulate cancer.

Sometimes, dead cells can form small, flat, lumps called fat necrosis and are usually benign. However, a biopsy should be performed. A condition called intra ductal papilloma causes watery or bloody discharge from the nipple. It can also cause a lump, swelling, discharge, and inflammation. These are all possible signs of cancer, a biopsy should be performed. There is a condition called Mon dors Disease, which is an inflamed vein or phlebitis of the breast.

It can cause a lump but is not cancer, which usually disappears in weeks. Lumps are discovered: by yourself, by your doctors exam, by a mammogram, or by a sonograph. In order to perform effective self-exams, you must be intimately acquainted with the composition and regular feel of your breasts. A malignant breast tumor does not usually hurt, if a spot on your breast causes pain, it does not generally indicate cancer. However, should still be examined. A self-exam is an attempt to find irregular lumps in the breast.

If done correctly, it lowers the risk of cancer reaching an advanced stage. You should begin giving yourself self exams in your late teens or early twenties and continue for life. Self exams should be performed once a month. Do not perform self-exams before your period.

The correct time is ten days after your period or as soon after as possible. There are two aspects to performing a self-exam, visually observing the breast and feeling the breast, which is called Palpitation. A visual self exam should be performed as follows. First, visually observe the normal appearance of breast in order to establish a reference point. Then look for irregularities in size, shape, and skin color.

Palpitation should be performed as follows: Feel left breast with right hand with tips of three longest fingers. Note lumps or changes from last exam. Repeat process with right breast Lie back with pillow under right shoulder and right arm behind your head. Examine right breast with three longest fingers of left hand. Examine entire breast for lumps. Repeat process with left breast.

A lump in the armpit may sometimes warn of breast cancer and should be examined. Self- examinations should be supplemented by a doctors physical exam. A doctor has more experience and might find a lump youll miss. A mammogram is the single most effective way of finding cancer early.

Annual mammograms are suggested in the following cases. -if a lump is discovered through physical examination. -if you have a family history of breast cancer -for all women over 40 -for women with a previous breast cancer -for women who have had a high risk benign tumor You must carefully choose a reliable mammogram facility because some facilities can be of low quality. When choosing a mammogram facility consider these factors. -FDA certification -JCAHO Accreditation -DOH Inspection results -the quality of the equipment -the competence of the person taking the picture and the person interpreting the results -the technique used. -try to find a radiologist who specializes in mammography -do not have a mammogram done in the office of someone who uses general x-ray machine, xero mammography, or equipment other than film screen mammography, because film screen mammography is the most accurate method of all. Under no circumstances have a mammogram performed by a doctor who is not an expert but has a machine in his office. Mammograms are expensive. The costs can be covered in these ways -most health plans pay for them -some communities pay for them.

Inquire locally -some centers provide mammograms on the basis of what you can afford. For information call the ACS (800-ACS-2345) You are legally entitled to a summary of the mammogram in terms you can understand. It may be necessary to have multiple mammograms to arrive at a clear result. Also, mammograms sometimes miss cancer.

A mammogram is uncomfortable but not painful. In order to produce clear pictures your breast must be brought out as far as possible onto the platform and firmly compressed. This should only cause discomfort and not pain. If you feel pain you should ask the technologist to reposition you.

You can increase the accuracy of the mammogram in these ways. - If you think you know the location of the lump, telling this to the radiologist might ensure a more accurate mammogram - Having your doctor clearly mark the suspected area of the tumor before going for a mammogram might ensure a more accurate mammogram. If this is not possible, explain to the radiologist yourself where you think the tumor is - Try to make sure the suspected area of the breast is positioned on the plate. There is a slight risk associated with mammography radiation, however, the benefits far outweigh the risks. The breast tissue of women under 35 is more sensitive to radiation.

Therefore, it is advisable for women under 35 to not have annual mammograms unless there are suspicious circumstances. Annual mammograms combined with physical exams reduce mortality by one third. VERIFY Sonography, or ultrasound, uses sound waves to examine the breast. Sonography is not a good general screening tool, but is useful in the following circumstances. when lumps are felt but elude mammograms. to determine whether lumps are cysts or tumors to monitor multiple cysts to clarify a mammogram to search for cancer in women who have already had breast cancer. Thermography detects heat radiating off the breast on the premise that tumors emit more heat. This method has not been proven effective.

Trans illumination is a procedure which searches for the infrared radiation the breast. It is based on the premise that tumors emit more infrared radiation. This procedure has not been proven effective. It is unclear if cat scans are useful in detecting breast cancer. Cat scans pose greater risk than mammograms and are not widely used. MRIs may be useful in determining the extent of cancers found by a mammogram.

A biopsy is a tissue sample extracted for study. Final confirmation of cancer usually depends on the results of a biopsy. The following are types of biopsies: SHRAGA Fine-needle aspiration: done by a surgeon or radiologist, involves a thin needle extracting a sample. This is uncomfortable but not painful. This procedure has these drawbacks. If biopsy is negative, further investigation is still required to rule out cancer.

The needle might miss the lump altogether, it might be unable to extract sample, or only able to extract a uselessly small one. core biopsy: a large needle is used, which can cause pain despite anaesthetic. It is more effective than fine needle aspiration, but further investigation to rule out cancer might still be required. mammotome biopsy: a large needle is used and moved around after insertion. Can cause pain despite anaesthetic. This procedure is more effective than either fine needle aspiration or core biopsy but still cannot rule out the need for further investigation if biopsy is negative. Stereotaxis biopsy- one of the three other biopsies performed under the guidance of a computer.

It is highly accurate, though in some cases still cannot yield a conclusion. It is usually used when a lump is seen on a mammogram but cannot be felt. Surgical biopsies, or open biopsies, is a type of invasive surgery. An incision is made and a part or the entire tumor is removed.

If only a piece is taken, it is called an incision al or sectional biopsy, and if the entire tumor is removed then it is called an excision al biopsy. Needle localization - Small tumors only locatable by sonograph must be properly marked before a biopsy can be done. A needle with a hook is inserted and the surgeon performing the biopsy follows the needle to the tumor and completes the biopsy. Microcalcification - tiny flecks of calcium, which can be an early sign of cancer and must be biopsied. Specimen radiography- the excised segment from the needle localization biopsy is x-rayed before surgery is complete to ensure that all tissue containing calcification is removed. Specimen radiography is used when microcalcification are picked up by a mammogram but are not visible during surgery.

This can lead to overlarge samples being taken during biopsy. To avoid this specimen radiography is used. You should not feel serious pain during a biopsy. If you do, immediately tell your doctor so he can alleviate it The pathologist provides this information about the tumor. - whether the tumor is malignant or not - how advanced, or what stage it is in, which affects treatment - if currently benign, whether it reveals a high risk of developing a malignancy in the future - if it has spread to other parts of the body -whether it is hormone receptive, something that affects whether hormone treatment is given The risk of recurrence generally depends on the stage of the original cancer. - Recurrence can occur either in the breast or in another part of the body - The risk of recurrence for an in situ cancer after mastectomy is almost zero. CONTRA - With infiltrating cancers, chances of recurrence are determined by tumor size and pattern of infiltration.

- The larger the tumor, the higher the risk of recurrence. - If the tumor was less than one centimeter (three eighth of an inch), the chances the patient will be cancer free after 5 years is more than ninety percent. - If the cancer was up to two centimeters (three fourth of an inch), the chances the patient will be cancer free after five years is seventy five percent - If the cancer was two to five centimeters (three fourth of an inch to two inches), the chances the patient will be cancer free after five years is thirty to forty percent. - If the cancer was five centimeters (2 inches) or larger, the chances the patient will be cancer free after five years is twenty five percent.

- Cancers which infiltrated to the lymphatics of the skin or to the chest muscle greatly increase the chances of spread to other parts of the body, regardless of tumor size. There is some correlation between tumor size and lymph node involvement. - approximately twenty percent of patients with tumors smaller than one centimeter had cancerous lymph nodes. - Sixty percent of patients with tumors larger than five centimeters had cancerous lymph nodes The following pattern of lymph node involvement affects risk of recurrence. - the more lymph nodes are cancerous, the higher the risk of recurrence. - The highest risk of recurrence exists among patients with ten or more cancerous nodes - The larger a specific tumor in the node, the greater the risk of recurrence - If the tumor breaks through the capsule of the node and they (node and tumor) adhere together, the risk of recurrence increases. - In one study in which people only had surgery, five year survival rate for people with level one lymph lymph node involvement was sixty five percent, forty five percent for people with level two involvement, and twenty percent for those with level three involvement.

(SOURCE & LEVEL) Women whose tumors have hormone receptors have a slightly lower risk of recurrence. Hormone receptors, however, are less significant than tumor size or lymph node involvement when evaluating chances of recurrence. The genetic material of cells affects chances of recurrence. Cells which duplicate normally, producing two chromosomes, are called diploid. Those which produce less or more are called aneuploid. The higher the number of diploid cells, the lower the chance of recurrence.

The S phase is the period in which the cell is synthesizing DNA in preparation for dividing. The higher the number of cells in the S phase, the higher the chance of recurrence. SHRAGA It is possible the cancer has spread to other parts of the body even though there is no evidence of this Even after surgery, the risk remains that cancer will spread to other parts of the body. Cancer may recur at the site where the breast used to be, even after a mastectomy. Cancer may also recur after a lumpectomy in tissue near the site of the original cancer. Cancer may also spread to other parts of the body.

For these reasons it is important to have regular follow up exams to search for recurrence. It is more difficult to cure a recurrence than the initial cancer Breast cancer cells are most likely to produce a recurrence in the bone Any part of the skeleton may be affected, but the spine, ribs, pelvis, and upper arms and legs are the most frequent sites Bones below the elbow or the knee are seldom affected. If breast cancer occurs in the treated breast after a lumpectomy, it indicates either a new cancer or a recurrence in that spot. It does not mean the cancer has spread. You should also continue self examination of the breasts after surgery.

This should be done once a month The risk of recurrence of breast cancer has gone down in recent years. Search for a qualified and capable doctor who will provide thorough medical care while taking into account your expressed wishes. The following exams should be performed to search for a recurrence - every six months a physical exam is necessary - a blood count should be performed every six months - a mammogram should be given at least once a year - if the patient had a mastectomy, the remaining breast should be x-rayed. - if the patient had a lumpectomy, both breast should be x-rayed - a chest x-ray, to detect cancer spread to the lung, should be performed once a year - if the initial cancer was invasive, a bone scan is necessary to establish whether any cancer has spread to the bone - back, joint, or other bone pains are symptoms which require an immediate bone scan most local occurrences, as well as most cancer spread, occur in the first two top three years after surgery Women who have advanced cases of cancer, ten years without a recurrence suggest, although does not guarantee, there will be none. These women can scale back their follow up exams to an annual basis only after ten years the risk factors that played a role in the original cancer may still be present after treatment a woman is at risk of breast cancer recurrence her entire life. Thus it is necessary to have regular follow up exams. The frequency and intensity of the follow up exams depend on the extent of the original cancer Breast cancer has a tendency to recur locally and spread to other parts of the body Searching for a recurrence is especially important the first five years Even after a mastectomy, cancer can recur where the breast used to be.

It can also recur in the lymph nodes in the underarm and neck. distant recurrence is the term used to describe cancer which has spread to other parts of the body. Following a lumpectomy with radiation treatment, there still remains the chance cancer remains in nearby healthy tissue The most common occurrence site after a lumpectomy is in the original area of the tumor If cancer recurs on the chest wall at the site of the mastectomy, this indicates the original cancer has regrown and carries a high risk of spread to other parts of the body. Chapter fourteen: Prevention Chapter fifteen: New Directions BRCA 1 and BRCA 2 are genes which are directly related to breast cancer Women with defective BRCA 1 genes have a 56 percent risk of developing breast cancer by age seventy Half of those cases attributable to genetics are linked to BRCA 1 It is expected that BRCA 2 will be proven to account for forty percent of hereditary cases Tests for both breast cancer genes are widely available testing positive for a breast cancer gene implies a higher risk for other family members as well currently, intensive research is being conducted to develop drugs which inhibit or prevent uncontrolled growth of cells Medications, Treatments, and Pain management There is no treatment which guarantees you will survive breast cancer A radical mastectomy is a surgery once used to treat breast cancer. Of all possible surgeries, it disfigures most, but fortunately is no longer needed. A modified radical mastectomy is a surgery in which the breast is removed but the muscles left intact. This permits breast reconstruction to be done more easily and successfully.

Most women are treated with a lumpectomy, often called a wide excision. In this procedure, only the tumor, some healthy tissue, and nearby lymph nodes are taken, without removing the entire breast. The remainder of the breast is then treated with radiation. Breast reconstruction surgery is a form of plastic surgery. (ELEVEN) A single doctor cannot diagnose and treat breast cancer alone. Here are some.

-Dana-Faber cancer center in Boston -Memorial-Sloan-Kettering Cancer Center in NY -MD Anderson Cancer Center in Houston When you make your decision of treatment, consider these factors: - Survival should be your primary concern, but can be balanced with other considerations. - Breast preservation, - Leading a normal life - Survival at all costs without consideration of other factors. You make your own decisions from the options presented from your doctor. Precise identification is required to determine risk and decide on best treatment. The following factors must be determined before treatment; The type of the tumor - its size, whether the skin around the tumor site is broken, red, or swollen, whether the nipple has retracted into the breast, and whether the tumor is attached to the pectoral muscle or chest wall. Spread to the lymph nodes - whether there is no cancer present or if it has spread to the nodes above the collarbone.

The degree of spread (metastasis) to other parts of the body must be established. These factors determine the stage of the cancer. The stage of the cancer affects risk assessment and treatment choice. Chapter Four: Diagnosis. It is common for biopsy and surgical procedures to be performed in separate stages. In the following cases it is best to perform the biopsy and any attendant surgery in one stage: If mastectomy or other surgery is agreed upon in the event that a malignancy is found.

If the cancer is discovered to be at a stage which does not permit breast reconstruction Chapter five: pathology Chapter six: After the Diagnosis The doctors demeanor plays an important role in the patients overall emotional reaction. He must be sympathetic and compassionate. People react differently to cancer: some delay acceptance and some seem to accept it only to break down later. Your insurance plan may require a second opinion. You should begin treatment of breast cancer within the first three to four weeks.

VERIFY It is not dangerous to wait this long, as cancer does not grow measurably in so short a period -it is worth waiting a short time for an excellent surgeon You should avoid surgeons who can receive you immediately since they are unlikely to be good. Good surgeons are busy. Surgery is the primary treatment for breast cancer Cancers detected early do not necessitate breast removal. Treatments evolve.

Find a doctor open to new ideas or you will be limiting your options There are two general surgical categories: -Lumpectomy - the cancer is removed without removing the entire breast -Mastectomy - the entire breast is removed. Breast cancer usually requires only local anesthesia. Anesthesia can numb locally or induce total unconsciousness. Stop taking aspirin a week or two before surgery. Aspirin is a blood thinner and therefore may interfere with blood clotting Prepare a precise list of all the medications and dosages you are taking and inform the nurse, also inform the nurse of all over the counter medicines and allergies you may have. The use of monoamine oxidase inhibitors (MAO Is) such as Nardi l or Par nate should be stopped at least two weeks before surgery.

A mastectomy is the surgical removal of the breast. There are several general categories of mastectomy: modified radical, radical, total, and partial. Modified radical mastectomy: - most common procedure for breast cancer - has the best long-term results with the fewest complications - the effectiveness of all other techniques are measured against it - consists of the following elements: removal of the portion of the breast that visually protrudes, removal of the breast tissue that extends towards the breast bone, the collarbone, the lowest ribs, and the latissimus dorsi, and the removal of the lymph nodes in the armpit. - The minor pectoral muscle is removed only if it interferes with the removal of the lymph nodes, but its absence is hardly noticed - The major pectoral muscle is never removed Care is taken to ensure that general appearance harmed. - the cut is in the shape of an ellipse, avoiding a vertical line.

- The cut is slightly removed from the breastbone, so the scar wont be visible in low cut clothing - An effort is made to avoid unsightly folds - Nevertheless, such folds sometimes do occur in heavier women Surgery to remove armpit lymph nodes creates a risk of future arm swelling, or lymphedema. Sentinel Node biopsy. - seeks to lessen the risk of developing lymphedema - this has not been proven effective Total (or simple) mastectomy - the breast is removed - the lymph nodes are not removed - used to treat ductal carcinoma in situ radical mastectomy. - rarely used today - most disfiguring and traumatic of all breast cancer surgeries - it involves the removal of the breast, all muscles of the chestwall (minor and major pectorals), and sometimes, so much skin that skin grafting may be necessary - the natural contours of the chest wall is lost, arm mobility may be temporarily reduced, and breast reconstruction is more difficult - this technique is used only in those rare cases of breast cancer which have not been detected early and have already invaded the muscles of the chestwall Partial mastectomy - Three types: lumpectomy, wide excision, or a quadrantectomy - If the tumor is small in relation to the whole breast, then it and about two centimeters of surrounding tissue is removed. This is called a lumpectomy or wide excision - If approximately a quarter of the breast is removed the procedure is called a quadrantectomy. This reduces the size of the breast. - Followed by radiation treatment and usually by hormone therapy and chemotherapy - The purpose of a partial mastectomy is to remove the tumor while preserving the breast - It is a new procedure and the techniques are still developing. - Its cosmetic results are not always excellent.

Skin sparing mastectomy - the breast is removed leaving the skin intact. Most of the skin is preserved and ready for an immediate breast reconstruction. - The breast removal can be a total mastectomy or a modified radical mastectomy - This method creates the most normal looking breast with minimal scars Neither partial nor modified radical mastectomies cause great pain. Permanent or temporary numbness can occur in the underarm if lymph nodes were removed.

Modified radical mastectomy - general numbness of chest within area of incision will occur. - Numbness usually disappears within months or sometimes within years - The area may never feel completely normal Removal of the lymph nodes in the arm has these effects - leaves the arm more vulnerable to infection - does not impair the general immune system - may cause phlebitis a clot developing in the vein of the arm after an incision. This condition is uncomfortable though not serious and usually disappears in four to six weeks - may cause lymphedema, or swelling of the arm In deciding on the correct surgical procedure, two factors should be considered. - the nature of the tumor, its characteristics and stage - your individual preference. How much risk is acceptable for you and your priorities tumors are classified in five stages. - stage 0: cancers which remain in their site of origin, without spread - stages 1 and 2: small cancers which show a tendency to spread - stage 3 cancers: large (two inches or more), may have spread to the skin, may be inflammatory, may have spread extensively to the lymph nodes.

- Stage 4 cancers: cancers which have spread to other parts of the body Stage 0 cancers consist of lobular neoplasm or ductal carcinoma in situ. Lobular neoplasm - Does not need be operated on - must be closely watched because having this condition greatly increases the risk of later developing more serious infiltrating cancer - 20 percent of women with this condition develop infiltrating cancer with ten years - recent evidence suggests the risk of developing infiltrating cancer greatly reduced with hormone treatment Ductal carcinoma in situ must be treated with surgery. Two procedures: total mastectomy without removal of armpit nodes or a lumpectomy a total mastectomy eliminates the chances of recurrence but a lumpectomy leaves a one percent chance per year of recurrence. VERIFY of those having a recurrence, half will have an in situ recurrence and be treatable with a total mastectomy, while the other half will have an infiltrating recurrence, and some of these will die.

Thus opting for a lumpectomy poses a very small, though potentially grave, risk. - Nevertheless, over the past five years a lumpectomy has become the treatment of choice for most surgeons when dealing with small tumors. - However, a mastectomy is usually done in the following cases: a large tumor, a spread out tumor, multiple tumors, and tumors involving the central ducts near the nipple When a mastectomy is not done, radiation therapy is effective in reducing the risk of a recurrence. Stage 1 and 2 cancers are small infiltrating cancers which can usually be treated with a lumpectomy, armpit lymph node removal, and radiation therapy. A mastectomy for stage 1 and 2 cancers is advised in the following cases. - multiple tumors - multiple areas of microcalcification - a large tumor in a small breast - a tumor in or near the center of the breast - if there is extensive armpit lymph node involvement stage 3 cancers are treated first with chemotherapy followed by surgery, usually a modified radical mastectomy. Stage 4 cancers are treated primarily with chemotherapy.

Surgery or radiation therapy can sometimes be used to help combat local tumors. Breast cancer in pregnant women is treated as follows. - with a mastectomy if the woman is in the second or third trimester or later - if breast cancer develops in the first trimester the woman usually aborts the baby and seeks the most appropriate treatment - radiation therapy is not used on pregnant women as it risks the well-being of the baby - chemotherapy may be started in the later half of pregnancy Two treatment factorsA combination of prognostic factors is used to determine statistical risk of relapse for patients. Chapter 9 TwoTreatmentChemotherapy drugs are powerful chemicals that arrest specific cancer cell cycle stages, and aim to destroy as many malignant cells as possible. Two Selection of the best chemotherapy drugs and dosage with minimal side effects is critical. TwoWhile some patients will respond favorably to any one or combination of chemotherapy drugs or radiation doses, no prediction of final patient outcome can be made. TwoMajor chemotherapy side effects include bone marrow damage, infections and increased gastrointestinal tract sensitivity.

Some women experience permanent menopause. TwoMinor chemotherapy side effects include nausea and vomiting, sensitivity in the mouth, hair loss, finger and toe numbness, temporary memory changes. Chapter 8 Radiation therapy TwoRadiation therapy uses a high-energy radiation beam directed to specific areas of the body. Radiation treatments consist of a string (25-30 sessions) of short treatments (lasting seconds to minutes) TwoR Cancer cells, dividing faster than normal cells, are affected more by radiation therapy. Cancer cells enter a cell death cell (apotosis) Normal cells have an abiltity to repair themselves, even after high dose radiation. TwoRAn oncologist may recommend giving boosts or implantation of small iridium seeds, when radiation therapy is not proceeding as expected.

TwoRRadiation therapy side effects include breast shrinkage, reduced skin elasticity and sensitivity. Some women experience temporary fatigue, decreased blood cell counts, and mild weight gain. TwoRWhen women require both chemotherapy and radiation therapy, chemotherapy is given first. TwoRMany patients do not understand the importance radiation therapy plays in their overall treatment planespecially after mastectomy treatment. Two treatment factorsA combination of prognostic factors is used to determine statistical risk of relapse for patients. Chapter 8 TwoRadiation therapy uses a high-energy radiation beam directed to specific areas of the body.

Two R Clinical studies demonstrate that for older women 60 years, radiation therapy may not increase their success rate of recovery. almost all women who have had lumpectomies are now treated with radiation SHRAGA Although the cancer was removed by a lumpectomy, there is a high risk of recurrence in the affected breast. Radiation therapy is given to lessen this risk. radiation therapy consists of x-rays being trained on specific areas of the body. These rays destroy malignant cells though also healthy cells. The healthy cells are able to regenerate and in the treatment of breast cancer the damage is local, not body wide.

When the tumor is large or has spread to the lymph nodes, radiation therapy is sometimes used with a mastectomy. It is not normally used with a mastectomy. Radiation is sometimes used to treat the lymph nodes behind the breast bone or above the collarbone Extremely large tumors are sometimes combated partially with radiation A radiotherapist or radiation oncologist is a physician trained in the administration of radiation for medical purposes. Some radiation specialists are particularly expert in the treatment of breast cancer, and should be sought out.

A proper treatment facility must contain the following: a radiation physicist, a radiation technologist, and radiation therapy nurses. Radiation therapy has the following effects. - radiation therapy does not cause pain - does cause swelling, redness of skin, and fatigue - radiation can cause a malignancy of blood vessels, bone, or connective tissue at the site of treatment. This is called a hemangioma and is a serious malignancy. It requires a mastectomy.

- Occasionally, radiation can cause a hairline fracture of the ribs. - Radiation therapy can sometimes injure lungs. (neither of the last two conditions are likely to occur if radiation therapy is properly planned and administered.) - Some women experience episodes of discomfort and report their breasts are more sensitive. - Slight skin discoloration or thickening may occur. - Radiation does not affect the immune system response - Sometimes radiation can cause cancer. This depends on age and dosage.

- People age nineteen and younger are at the highest risk of radiation induced cancer. After thirty five, the risk is tiny. - The risk of radiation induced-induced malignancy increases with dosage, but only from 300 to 1000 rads of radiation. The risk decreases as dose increases after 1000 rads - With dosage close to 4,500 rads, the risk is negligible Radiation therapy cannot be used on a recurrence in the breast that has already been treated this way. Most women who have had breast cancer now receive chemotherapy or hormone therapy to prevent recurrence. Systematic treatment, treatment with drugs that circulate throughout the body, are needed to reduce the risk of cancer spreading to other parts of the body.

Systematic treatment reduces the risk of recurrence by one third / Systematic treatment must begin immediately after surgery, to reduces likelihood of recurrence and to combat cancer spread. Systematic treatment also combats cancers which have already spread but are too subtle to be detected yet. Chemotherapy and hormone treatment are the two most common methods of systematic treatment. Which patients should receive chemotherapy is generally determined by these factors. - the size of the tumor - whether the tumor was in situ or invasive - whether the tumor has hormone receptors - whether the tumor has spread to the lymph nodes - whether you are pre-menopausal or post-menopausal at the time the tumor appeared chemotherapy works best in pre-menopausal women hormone therapy works best in post-menopausal women, especially if their tumors had hormone receptors however, chemotherapy is useful in post-menopausal women as well, together with hormone therapy.

Hormone therapy can benefit premenopausal women together with chemotherapy For infiltrating cancers, chemotherapy with or without hormone therapy is most common For in situ cancers, hormone therapy is most common Drugs used for chemotherapy are cytotoxic they act by destroying cells. Cancer cells are much more sensitive to their effects than regular cells, although some normal cells die as well. Dosage is tailored for minimizing side effects and maximizing curative effects. Most chemotherapy is completed within three to six months. Hormone treatment can last up to five years. A combination of drugs is required, no single drug is effective.

There are four types of drugs: alkyl ating agents, anti metabolites, natural products, and hormones Chapter 11 TwoHTamoxifen, a hormone-like substance of the SERM family, binds to estrogen receptors on cancer cells, interferes with cellular functions and eventually destroys them. TwoHConflicting opinions exist over the optimal length of time a patient should continue tamoxifen treatment. TwoHMost patients with breast tumors who are estrogen and progesterone receptor positive will respond to tamoxifen therapy. Twomajor tamoxifen side effects include cancer in the uterus and higher risks of stomach and colon cancer development. Tamoxifen causes greater bone loss in pre-menopausal women as well as the development of early on-set menopause. Twominor tamoxifen side effects include vaginal dryness, hot flashes, mild weight gain, and depression.

TwoHEvista, a newly released hormone-like substance of the SERM family is being reviewed for its breast cancer treatment potential. Hormone therapy may produce increased sweating, chilliness, and hot flashes. The side effects of chemotherapy - are usually transitory - some side effects are acute right after treatment, but soon go away - There is no way to avoid the side effects of chemotherapy completely, though they can be alleviated - There is no pain resulting from chemotherapy - Nausea - most drugs do not cause immediate nausea. Some nausea can result from acid secretion, but are easily treated with standard anti-nausea medicine - Serious nausea may occur, requiring prescription drugs to be taken before each treatment session. - Hair loss may occur as a result of treatment, but will fully grow back after treatment is complete - With certain drugs, it may be possible to eliminate or reduce hair loss by use of a tourniquet - Treatment does cause some initial fatigue which subsides in a day or two - Weight gain is a common side effect of treatment - Menstruation may stop during treatment, but will likely resume if patient is young enough - it is possible to experience several or none of these side effects - individual drugs can have side effects particular to the drug in question.

- Phlebitis occurs frequently in the legs and must be treated promptly - Some people develop arthritis when chemotherapy is discontinued. This usually disappears a year after its onset - Some women report problems with memory. It is unclear if this is caused by the chemotherapy or just stress. Memory usually returns to normal. Most chemotherapy drugs are given intravenously, directly into a vein. Some, however, can be taken orally.

In some situations plastic tubing is inserted under the skin and connected to one of the larger veins leading to the heart and chemotherapy administered. Tamoxifen is one of the most common hormone related drugs used. Tamoxifen should be given for a period of five years. Taking tamoxifen for more than five years provides no additional benefit Tamoxifen should begin four weeks after surgery or after radiation therapy is complete Most programs of chemotherapy and hormone treatment last for three to six months. Some programs last a year, but this is rare. Tamoxifen occasionally causes nausea or weight gain, and younger women sometime have menopausal symptoms.

Rarely, some facial hair occurs. Chemotherapy programs must be tailored for each patient. These factors help determine which program each patient will be put on: the level of risk of recurrence, whether patient is pre- or postmenopausal, level of invasion, size of tumor, lymph node involvement The following are general guidelines for tailoring chemotherapy and hormone treatment: - cancers which are in situ and are noninvasive have a very low risk of spreading to other body parts and chemotherapy is not used. However, tamoxifen might be used. - If the cancer was primarily in situ but shows some evidence of spread, there is debate about whether chemotherapy or hormone therapy is used.

- If the tumor is more invasive but restricted to the breast and less than one centimeter in size, many doctors do give adjuvant treatment but some dont. - If the tumor was invasive and one centimeter or more in size, hormone and chemotherapy are generally advised, whether or not there is lymph node involvement. - If there is lymph node involvement, chemotherapy or hormone therapy should always be used, even if the tumor was less than one centimeter. Chapter eleven: Breast Reconstruction Breast reconstruction is an elective surgery whose purpose is entirely cosmetic. There is no compelling medical reason to have it. Instead of breast reconstruction, an artificial breast form, a prosthesis, can be worn According to the American Society of Plastic Reconstructive Surgeons, in 1998 close to 70,000 women had breast reconstruction Federal law requires insurance plans to pay for breast reconstruction Two types of breast reconstruction exist: one in which tissue from elsewhere is used to form a mound in the shape of the breast and another in which a foreign body, a prosthesis, is used.

Nipple reconstruction is also possible to further enhance the appearance of the breast Breast implants can cause some discomfort. The appearance of the reconstructed breast is not identical to the original breast Breast reconstruction is now mostly done at the time of the mastectomy, when the surgeon has finished his work. In those cases where breast reconstruction is not done at the time of the mastectomy, it is recommended that you allow a three month period for the surgery site to heal. Scar tissue forms around the implant.

This may result in the breast hardening. The TRAM flap - a type of breast reconstruction that uses tissue from the stomach, may result in a loss of muscle tone in the stomach. If cancer recurs after a lumpectomy in the treated breast, the breast now has to be removed. This is often referred to as a salvage mastectomy.

This must be followed by chemotherapy and hormone therapy. Rarely, a new cancer can grow in the remaining breast tissue after a mastectomy. This carries a lower risk of spread Treatment should begin with removal of tumor and some surrounding healthy tissue. This might mean some bone and muscle. Radiation should then be given and the entire region operated on followed by chemotherapy and hormone treatment. If the cancer recurs in a distant site, or other parts of the body, then palliation is the method most often adopted by doctors.

Palliation means to relieve or lessen without curing. Many doctors seek only to relieve symptoms and not cure the illness when treating distant site recurrence. There are several procedures which sometimes manage to achieve a cur, in combination or separately. They are: surgery, radiation, hormone therapy, and chemotherapy The following are general guidelines for treating distant site recurrence - Surgery is used to remove an isolated tumor that gets in the way of functioning, if the disease has spread - If there is an isolated tumor, it can sometimes be cured by removing it - Radiation can reach hard to get at locations.

It can destroy tumors in parts of the body where it is not advisable to perform surgery. It is particularly useful in relieving pain in bones where cancer has metastasized. - Hormone therapy can be used for women who have hormone positive receptors - For some patients, high dose chemotherapy followed by bone and / or stem cell transplant offers a chance of cure. Women with recurrent tumors that are both estrogen and progesterone receptor positive respond to hormone treatment in seventy five percent of cases. Women with only one type of hormone receptor present respond to treatment in only forty percent of cases. Women whose tumors are not hormone receptive at all respond to hormone therapy in only ten percent of cases.

Hormone drugs are effective only for a limited time span, so several drugs must be used in succession, with each new drug being given only when the previous one stops working. Chemotherapy is used to supplement hormone therapy even for those patients who respond well to hormone therapy, as this even further increases the benefits to your health. If the original tumor has no hormone receptors, chemotherapy is the primary method of treatment and given from the beginning. Chemotherapy drugs are only effective for a limited time span.

Chemotherapy drugs are given in various combinations. The first combination is called first-line treatment, when it ceases being effective a new combination called second-line treatment is given, and following that another combination called third-line treatment is given. Drug combinations are always in development and advances are made constantly. Combinations of drugs are generally more effective than single drugs in treating breast cancer. It is important to overcome or minimize side effects when giving chemotherapy. Bone marrow or stem cell transplant- this procedure is sometimes used to treat cancer that has spread to other parts of the body. - it sometimes produces infection in the lungs, liver damage, and other painful side effects.

- It is often used to supplement high dose chemotherapy - The most promising use of this procedure is in women with a small number of me tastic sites - This treatment is not given to women who have previously had multiple treatments. Studies have shown that bisophonates, drugs that disrupt the normal process of bone building and destruction, are able to delay or prevent the spread of breast cancer to bone. During treatment, it is important to carefully monitor for side effects and complications. Best results are obtained with the most powerful and early response to recurrence.

Surgery, radiation, hormone therapy, and chemotherapy, should be used in sequence or in combination. If cancer still recurs it may have become resistant to the drugs being used. It might be possible to prevent this by alternating different forms of chemotherapy. In nearly every case of recurring breast cancer, it is possible to prolong life. Chemotherapy is not incompatible with a high quality of life and does not necessarily cause suffering. Breast cancer spreads least often to the spleen, kidney, or skeletal muscle Alternative Medicine, Prevention, Diets Alternative medicines are not a substitute for conventional medicine.

- Relying on alternative medicine before seeking regular medical attention can allow an otherwise treatable tumor to grow to unmanageable size. - vitamin supplements, high carbohydrate diets are not harmful, unless they interfere with prompt or proper treatment - imaging, enemas, macrobiotic diets, relaxation technique, deep massage, group healing, Chapter 13 ( ) Three Diet Some suggest cancer can be prevented (even cured) by diet and lifestyle changes. Three Diet Physicians suggest a diet low in fat, high in carbohydrates and soy-based protein and eating as many organically grown meats, vegetables and fruits, for their cancer patients. Three Diet Supplements suggested for cancer patients include vitamin C plus bioflavonoids, beta-carotene, selenium (taken with vitamin E) and co-enzyme Q 10. Soy products include soybeans, soy sprouts, soy nuts and textured vegetable protein.

Tofu, soy flour, milk, protein powder as well as tempeh and miso are other soy sources. Soy sauce, however, is not a recommended soy source because of its high sodium content. The soy plant contains genistein, which has the ability to bind to unwanted estrogen in the breast and in other parts of the body. Cruciferous vegetables contain certain important enzymes. A combination of vegetables and fruit contain Vitamin A and beta-carotene. Eating organically grown food is recommended since, the soil has been sprayed with pesticides.

Cancer patients should avoid junk and processed refined foods, foods with caffeine, salt, sugar, white flour, carbonated drinks, and alcohol. Supplements such as vitamins, minerals, and other nutrients are necessary to provide additional support for the body during and after chemotherapy and / or radiation. Studies have revealed that reduction in cancer incidence is associated with a diet high in vitamin C. Foods rich in vitamin C are potatoes, peppers, peas, tomatoes, broccoli, brussels sprouts, cabbage, cauliflower, kale and parsley, in addition to most fruits and melons. Bioflavonoids are crystalline compounds, essential for vitamin C absorption. Flavonoids in food and herbs have additional anti-inflammatory and anti-allergic effects due to their anti-oxidant properties. Fat consumption may be lowered by using olive and canola oils only, eliminating red meat from ones diet, increasing fish varieties, and eating fewer sweets.

Complex carbohydrates containing dietary fiber include grains, nuts, seeds, and unpolished rice. are high in dietary fiber, which is said to bind to excess estrogen in the intestine and is then excreted. Cruciferous vegetables such as broccoli, brussels sprouts, cabbage, radishes, cauliflower and kale are important because they contain an enzyme, indole-3-carbinol, which changes the way estrogen is metabolized. In addition, broccoli contains a second chemical that synthesizes enzymes which detoxifying cancer substances in the body. A combination of yellow, orange-red and dark green vegetables and fruit containing Vitamin A and beta-carotene protect the body against oxidative damage which may lead to additional mutations Eating organically grown food is recommended since most of the soil has been sprayed with pesticides. A Hebrew University study revealed a drop of 30% in breast cancer, once DDT pesticides were outlawed in Israel.

Studies by Dr. Davis at the Strang Cancer Research Laboratory in New York demonstrated that DDT-like pesticides cause the body to produce a carcinoma-linked type of estrogen (16 alpha hydroxyestone). instead of natural estrogen. A study of Japanese women living in Japan, who regularly ate soy based-protein had a lower cancer level than their American counterparts. Genistein, found exclusively in soy products. have been shown to reduce hot flashes and night sweats and hormonal fluctuations in older women. Soy proteins play a role similar to the SERM family of hormone like drugs that compete with estradiol for receptor sites. By blocking estradiol from binding to cell receptors, cell growth is not stimulated. Estrogen stimulation may cause painful, swollen breast sensations before menstruation.

Continued breast stimulation by estrogen on a monthly basis may increase the risk of breast cancer, especially as women age. Even though soy-based proteins are the most recommended protein source for cancer patients, it is essential that cancer patients have protein in their diet. Other forms of protein include nuts, beans, fish, organic meats and eggs. Junk and processed foods must be avoided. When sugar is refined, all the vitamins, minerals and enzymes needed for sugar metabolism by the body, are eliminated. Sugar- refined foods have been.