Term paper on Breast Cancer
Breast Cancer Essays
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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 patient’s 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 terminologyMost 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 terminologyBreast 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 what’s 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 women’s 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, mucinous, 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 Pagets 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 30s or 40s. 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
¨ Fibrocystic 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.
¨ Fibroadenomas - 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 intraductal 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 Mondors 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 doctor’s 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 doctor’s physical exam. A doctor has more experience and might find a lump you’ll 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, xeromammography, 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.
¨ Transillumination 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.
¨ MRI’s 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.
¨ Stereotaxic 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 incisional or sectional biopsy, and if the entire tumor is removed then it is called an excisional 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 microcalcifications 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 radiogrophy 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
¨ BRCA1 and BRCA2 are genes which are directly related to breast cancer
¨ Women with defective BRCA1 genes have a 56 percent risk of developing breast cancer by age seventy
¨ Half of those cases attributable to genetics are linked to BRCA1
¨ It is expected that BRCA2 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 sujrgery.
¨ (ELEVEN) 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 what’s 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 women’s 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
¨ 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;
Ø 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.
Ø Spread to the lymph nodes - whether there is no cancer present or if it has spread to the nodes above the collarbone.
Ø 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.
§...
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