Updated 1/10/22

Updated Visitation Policy (1/22)

Effective January 10, 2022, we have updated both hospitals' Visitation Policy: Non-COVID Pediatric patients will now be allowed one non-rotating visitor. Read the full policy for details here.

Diagnosed with Breast Cancer: The Next Steps

Every 2 minutes a woman is diagnosed with breast cancer and around 2,650 cases are men will be diagnosed in a year. After a woman has had a mammogram and/or breast MRI and an abnormality is found a biopsy will be done of the breast tissue. From there a doctor will determine if it is breast cancer. 

After receiving a diagnosis

Your doctor will be determining how far the cancer has spread, and a team of doctors will plan a path of treatment for you. “There are about 5 different specialists,” Dr. Paul of RMC Radiation/Oncology says, “the radiologist who does the mammogram, the pathologist who looks at the sample to see if it’s cancer, the surgeon who does the surgery, then the radiation oncologist, which is myself, and then the chemotherapy team.” 

All of these specialists come together for what is called a tumor board. This is where each specialist gather each week at RMC to discuss your cancer case “to ensure nothing is missed,” Dr. Paul explains.

What kind of treatment will I need for my breast cancer?

There are several different cancer treatments as well as several different factors to what treatment your physician may recommend. Some factors include: age, cancer stage, and other health problems. Your overall feelings about the treatment are also taken into account when your doctor comes up with your treatment plan. Some treatments include:

  • Chemotherapy
  • Hormone Treatment
  • Surgery (mastectomy and lumpectomy)
  • Radiation Treatment
  • Targeted therapy

Dr. Paul, spoke on the history of these treatments and says “30 years ago we would have just done a mastectomy. Which is a very aggressive, very effective surgery where we remove the entire breast.” Dr. Paul further explains a study that involved 3 different sets of breast cancer patients; those who received a full mastectomy, those who received a lumpectomy, and those who received both a lumpectomy and radiation. “The group that received the lumpectomy, the tiny surgery, had the cancer return.” However, those who received a lumpectomy plus radiation and those who received a mastectomy had virtually the same results. Though some may still need a mastectomy, there is always a range of options to consider based on your specific conditions. 

What side effects will I get from my treatments?

This varies greatly by what treatment you receive along with other factors like age, cancer stage, other health conditions, etc. Several treatments are also used in tandem with others; chemotherapy can be used before and after surgery or is not needed at all. 

Chemotherapy

Loss of appetite, nausea, vomiting, diarrhea, mouth sores, hair loss, changes in nails, easy bruising or bleeding, fatigue, changes in menstrual cycle, and increased chance of infections.

Hormone Therapy

It is important to know there are several different drugs and therapies that can be used during hormone therapy. Always speak with your physician about the side effects of your prescribed medication.

  • Selective estrogen receptor modular (SERM) side effects can include hot flashes and vaginal dryness. More rare side effects are uterine cancer, blood clots, and stroke.
  • Selective estrogen receptor degrader (SERD) side effects can include hot flashes, headache, mild nausea, bone pain, and injection site pain.
  • Aromatase inhibitors can cause muscle pain, join pain, joint stiffness, and bone thinning.
  • Ovarian suppression can involve surgery or prescription drugs which all have the possible symptoms of hot flashes, night sweats, vaginal dryness, and mood swings.

Surgery

Along with the mastectomy and lumpectomy, there are some surgeries such as removing nearby lymph nodes that may produce soreness. 

Radiation

 External radiation and intracavity radiation brachytherapy are two types of radiation that can produce side effects such as redness, bruising, breast pain, infection, damage to fatty tissue in breast, fatigue, fluid collecting in the breast, and in rare cases weakness of the ribs, and fracture of the ribs.

Targeted Drug Therapy

There are several different types of drugs that researchers have developed to fight cancer cells. Because each individual drug has their own side effects, you should consult each medication’s website for a list of side effects, and as always speak with your physician about the expectations of your treatment.

What kind of questions should I ask my physician?

Treatment plans, life expectancy, side effects, and more can leave cancer patients reeling for answers. Limited time with a physician and the emotional toll that it takes to receive life altering news can make it impossible to remember everything you would like to ask your treatment team when you come in for an appointment. “Write it down.” Says Dr. Paul when talking about how patients and caretakers can manage all the questions that will come when they are not around someone you can ask.

What is the stage of my cancer? 

Stage 1 to 4 of breast cancer means different things for different patients. “There are some breast cancers that have spread which cannot be cured.” Dr. Paul when speaking about Stage 4 breast cancer. Thankfully, the most common stage of breast cancer is the localized stage where a Breast MRI or mammogram will show cancer cell growth in the milk ducts. This is why getting regular screenings is incredibly important.

What type of breast cancer do I have?

Types of cancer that have remained in the milk duct and not spread to the breast tissue is called non-invasive cancer or Ductal carcinoma. Invasive breast cancer has special types of cancer like triple-negative breast cancer and inflammatory breast cancer. Less common types of breast cancer include paget disease of the breast, angiosarcoma, and phyllodes. Each one of these cancers will need their own unique approach to treatment, and you should ask about what your cancer diagnosis entails.

What does my treatment involve?

“When talking about radiation, you will come in 5 days a week for 4 to 6 weeks.” Dr. Paul says. So asking the question of how often you need to come in for treatment is essential. Having a support person at your appointment as well that can help remember all this information to relay to your support team at home will make it easier to plan transportation to treatment visits. Dr. Paul reiterates the importance of the family during treatment, “The family can change the environment, where the patient is living, to be more biologically effective and at the same time more emotionally effective.”

Is this treatment safe/effective?

A common question that Dr. Paul says gets from patients is, “Would you treat your mother or someone in your family with this?” A cancer diagnosis can be scary and not knowing what a treatment will do to your body can be equally as terrifying. “You can always ask, ‘Where is the data?’” There are wonderful resources like the American Cancer Society and the National Cancer Care Network that have factual information on cancer and cancer treatments, so you never have to be in the dark about your health.

Listen to a Radiation Oncologist talk about Breast Cancer

Mentioned throughout this blog, Dr. Arun Paul sat down with Kristin Fillingim from RMC Marketing to speak on the full picture of breast cancer as a part of RMC’s Weekly Check-Up series. This series allows the community to ask a physician of the week questions related to their specialty. Click below to hear Dr. Paul’s answers to COVID vaccination in breast cancer patient questions, what a healthy environment for a cancer patient looks like, and how far breast cancer treatments have come in the last 30 years.