Your team of doctors will make treatment recommendations based on the stage of your cancer. Your standard treatment options may include surgery, chemotherapy, radiation, and hormone therapy. If you have been diagnosed with DCIS or LCIS, your stage is the lowest and the road you will travel will be easier. For DCIS, your options may include breast-conserving surgery or mastectomy with or without radiation and hormone therapy.
LCIS treatments options are a bit different. They include observation to determine changes, hormone therapy to prevent cancer from developing, or bilateral prophylactic (preventive) mastectomies.
Things get more complicated when your cancer spreads beyond the ducts or lobes/lobules. Once your cancer has been staged, you can visit www.cancer.gov to determine your treatment options. They will typically include: surgery, chemotherapy, radiation, and/or hormone therapy. For IBC, treatment options are similar to the other types of breast cancer, but they will always include chemotherapy because of its aggressiveness.
• Surgery: Breast surgery can be either a lumpectomy, where the tumor is removed, or a partial or modified radical mastectomy. With a lumpectomy, it is typically followed by radiation. This way, you get to keep your breast and studies have shown no difference in survival rates between lumpectomy/radiation and mastectomy.
Note: Not too long ago, they used to perform radical mastectomies where the breast, all the lymph nodes, and the underlying muscle were cut away. Thankfully, medicine has discovered that’s not necessary. Now, a partial or modified radical mastectomy is performed, where either part of the breast tissue, or the entire breast, and possibly a portion of the lymph nodes, are removed. On the whole, a mastectomy isn’t too bad a surgery, although everyone is different. I found both of mine to be quite easy, but you will wake up with drain tubes, which you’ll typically have for at least a week.
• Chemotherapy: Chemotherapy is defined by Wikipedia as “the use of chemical substances to treat disease. In its modern-day use, it refers primarily to cytotoxic drugs used to treat cancer.” This can be a frightening prospect for anyone. We’ve all heard horror stories about how very debilitating chemotherapy can be. However, much progress has been made in the management of chemo’s side effects, to the point that, once you have the right management tools, you can continue to enjoy the activities you typically do. Chemo is a means of treating your cancer systemically and is typically recommended for those whose tumor is larger than a certain size and/or the cancer has spread to your lymph nodes. The thinking is that if your cancer has had the opportunity to access the rest of your body, your treatment should be systemic as well.
• Radiation: Radiation therapy is typically a localized treatment option, where rapidly dividing cells are damaged. Cancer cells are very rapid dividers, so radiation is an effective option. Typically, radiation therapy is given for about six weeks, five days a week. It’s very much like lying still for an x-ray, only instead of lasting a second or two, it lasts a couple of minutes. It can cause fatigue, toward the end and slightly after, and can cause a sunburn effect on your skin.
• Hormone Therapy: Many breast cancers are hormone-dependent. In these cancers, there are receptors on the tumor that can be filled with estrogen. The thinking is that when estrogen fills these receptors, it causes the tumor to grow. This is called estrogen-receptor positive (ER). These cancers respond well to hormone therapy and the hormone therapy drug that will be recommended for you will depend on your menopausal status. These drugs are in pill form and you take them once a day. The most popular of these drugs, for pre-menopausal women, is Tamoxifen and, for post-menopausal women Femara or Arimidex. There is new evidence that suggests that taking Femara, after taking Tamoxifen for five years, increases survival rates.
• Immunotherapy: There is a fourth modality of treatment on the horizon and it’s called Immunotherapy. This involves getting your immune system to fight your cancer and there is, and will be, a lot of research being done in this area.
Chemotherapy is a word that strikes fear into most of our hearts. We’ve seen the movies and heard such horrible stories about undergoing this difficult treatment for a disease that could very well kill us. I underwent chemo for breast cancer and know that, in some cases, the cancer isn’t hard … it isn’t painful … it doesn’t make us sick. That’s the case for most of us who have breast cancer, but don’t have distant metastases. But then, they say we need to do chemo and we know we’ll feel that.
Although chemo drugs haven’t changed that much, and they’re still terribly hard on our bodies, the management drugs have changed a lot. Chemotherapy, for many of us, isn’t the show-stopper we thought it would be. Of course, each of us is different and the chemo drugs affect each of us in different ways, but, for the most part, chemo is definitely doable.
My breast cancer was Stage IIIa, with a 5.8 cm tumor, 8 of 10 lymph nodes positive, and I was only 39 years old. That bought me a ticket for the chemo ride. And I was scared out of my wits. But, I found an online breast cancer support group, at WebMD, and those women told me everything to expect and more. I went through four rounds of adriamycin and cytoxan. Both of them are some pretty stout breast cancer chemo drugs. After that, I did a controversial treatment that involved extremely high doses of cytoxan, taxol, and cisplatin, so I learned quite a bit about surviving chemotherapy.
First of all, I would highly recommend getting a port. This is a line that goes into a vein in your chest, the entrance to which sits just under your skin, right below your collarbone. It requires a quick surgery to put it in but, if you’re having a mastectomy for your breast cancer, you can get the chemo port put in at the same time. If you choose not to do that, you’ll have to get your chemo treatments through your veins and chemo is really hard on your veins. This means that you will, most likely, have to endure multiple attempts for them to find a vein, as time goes by. With the port, it’s already in a vein, so all they have to do is stick the needle into the port to access it. If you find this uncomfortable, there is a cream they can give you called Emla cream. One of the first things I learned was to tell them the moment I was uncomfortable. It’s all fixable. You’ll put the Emla cream on a bit before you have to have your port accessed and it’ll numb your skin.
Most breast cancer chemotherapy drugs will cause your hair to fall out. This is because chemo kills the rapidly dividing cells in your body. Your mucous areas and hair follicles are affected for this reason. That’s why you may have nausea or develop mouth or throat sores. Again, all this sounds scary, but is totally manageable. Since you will probably be losing your hair, which can be quite traumatic, I would advise going wig or hat shopping before you even get your first chemo. Take a girlfriend with you and be adventurous. Try on different styles, and even colors. If you’ve always wanted to be a blonde, now’s your chance! Make a day of it and have fun with it. Goodness knows, you have to look for that silver lining every chance you get. Also, make sure to have your nausea med prescription filled before you go so you’ll have it waiting for you if you need it at home. You may be pretty tired, afterward, so don’t wait till then to get those meds.
On your first chemo day, they will probably give you some steroids, intravenously or through your port, to help with the nausea. This may make you hungry; it sure did for me! But, I would recommend you don’t eat your favorite food on chemo day. Chemo is manageable, but after you’re all done, you may find that you have associations. For example, I used to love the cucumber melon fragrance when I was going through chemo. I had cucumber melon everything! But, to this day, the smell of cucumber melon makes my stomach do a little somersault because it reminds me of such an unpleasant time in my life. The same can happen with food. I still can’t look a chicken burrito in the eye! But, I’m sure glad I didn’t eat a taco because I would’ve hated for that to be ruined for me!
Many breast cancer chemo drugs are hard on your bladder, so be sure to drink, drink, drink. If you don’t feel like drinking water, then broth, jello, or even popsicles will help. Since you’ve gotten your nausea meds all filled in advance, be sure to take them as prescribed, whether you think you need them or not. Chemo nausea isn’t just any kind of nausea and it’s much easier to stay ahead of it than to try to fix it once it occurs. If you do happen to get nauseated, and I can’t stress this enough, call your doctor!!! There are many, many nausea meds and you do not have to feel sick just because you’re doing chemo. Once they find the right drug for you, it will be so much easier. So, do not suffer this in silence! The same applies for if you get sores in your mouth or throat.
You will be tired from this treatment. Most of us get more tired as the treatments progress because they make our white blood cell counts drop really low. Because of this, it’s a good idea to keep some Purell, or something similar, with you all the time for use when you’ve had to touch, for example, public restroom door handles. Your risk of infection will be much higher during this time.
If you lose your hair, it will typically happen in 10-14 days after your first chemo treatment. If you have long hair, you might want to cut it short in preparation. I know I felt so out of control of everything, during that time. When your hair comes out, it lets go quickly and in large clumps, getting all over your pillow and clogging your drain. For many women, that is more traumatic than even losing a breast. So, I figured that was the one thing I could control about this whole breast cancer thing … when my hair came out. I cut it really short, beforehand and, when it started to let go, I had my husband get the clippers and shave my head. My daughter helped and we did a little Mohawk and stripe action first!
That was my way of shaking my fist at this cancer … it might take my breasts, and it might take my hair for a while, but I beat it to the punch! It was my way of saying, “You cannot take my spirit!” You can do the same thing. Your breast cancer does not define you. It is but a speed bump in the course of your life. Strap on your gloves and step into the ring. This chemo is your biggest punch. Your spirit is your own and that breast cancer can’t touch it!
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