Understanding Breast Cancer

Staging

To plan your treatment, your doctor needs to know the extent (stage) of the disease. The stage is based on the size of the tumor and whether the cancer has spread. Staging may involve x-rays and lab tests. These tests can show whether the cancer has spread and, if so, to what parts of your body. When breast cancer spreads, cancer cells are often found in lymph nodes under the arm (axillary lymph nodes). The stage often is not known until after surgery to remove the tumor in your breast and the lymph nodes under your arm.

These are the stages of breast cancer:

•     Stage 0 is carcinoma in situ.
  •           Lobular carcinoma in situ (LCIS): Abnormal cells are in the lining of a lobule. (See picture of lobule on page 3.) LCIS seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of cancer for both breasts.
  •           Ductal carcinoma in situ (DCIS): Abnormal cells are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread outside the duct. They have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated.
•     Stage I is an early stage of invasive breast cancer. The tumor is no more than 2 centimeters (three-quarters of an inch) across. Cancer cells have not spread beyond the breast.
•     Stage II is one of the following:
  •           The tumor is no more than 2 centimeters (three-quarters of an inch) across. The cancer has spread to the lymph nodes under the arm.
  •           The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has not spread to the lymph nodes under the arm.
  •           The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has spread to the lymph nodes under the arm
  •           The tumor is larger than 5 centimeters (2 inches). The cancer has not spread to the lymph nodes under the arm.
•     Stage III is locally advanced cancer. It is divided into Stage IIIA, IIIB, and IIIC.
  • Stage IIIA is one of the following:
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    • The tumor is no more than 5 centimeters (2 inches) across. The cancer has spread to underarm lymph nodes that are attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone.
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    • The tumor is more than 5 centimeters across. The cancer has spread to underarm lymph nodes that are either alone or attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone.
  • Stage IIIB is a tumor of any size that has grown into the chest wall or the skin of the breast. It may be associated with swelling of the breast or with nodules (lumps) in the breast skin.
  •  
    • The cancer may have spread to lymph nodes under the arm.
  •  
    • The cancer may have spread to underarm lymph nodes that are attached to each other or other structures. Or the cancer may have spread to lymph nodes behind the breastbone.
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    • Inflammatory breast cancer is a rare type of breast cancer. The breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast. When a doctor diagnoses inflammatory breast cancer, it is at least Stage IIIB, but it could be more advanced.
  • Stage IIIC is a tumor of any size. It has spread in one of the following ways:
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    • The cancer has spread to the lymph nodes behind the breastbone and under the arm.
  •  
    • The cancer has spread to the lymph nodes above or below the collarbone.
•     Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body.
•     Recurrent cancer is cancer that has come back (recurred) after a period of time when it could not be detected. It may recur locally in the breast or chest wall. Or it may recur in any other part of the body, such as the bone, liver, or lungs.

Many women with breast cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. Knowing more about breast cancer helps many women cope.

Shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor - to take part in the discussion, to take notes, or just to listen. You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat breast cancer include surgeons, medical oncologists, and radiation oncologists. You also may be referred to a plastic surgeon.

Treatment Methods

Women with breast cancer have many treatment options. These include surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy. These options are described below. Many women receive more than one type of treatment.

The choice of treatment depends mainly on the stage of the disease. Treatment options by stage are described below.

Your doctor can describe your treatment choices and the expected results. You may want to know how treatment may change your normal activities. You may want to know how you will look during and after treatment. You and your doctor can work together to develop a treatment plan that reflects your medical needs and personal values.

Cancer treatment is either local therapy or systemic therapy:

•     Local therapy: Surgery and radiation therapy are local treatments. They remove or destroy cancer in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
•     Systemic therapy: Chemotherapy, hormone therapy, and biological therapy are systemic treatments. They enter the bloodstream and destroy or control cancer throughout the body. Some women with breast cancer have systemic therapy to shrink the tumor before surgery or radiation. Others have systemic therapy after surgery and/or radiation to prevent the cancer from coming back. Systemic treatments also are used for cancer that has spread.

Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next.

Dosimetry

We use 3-D conformed radiation therapy technique at the
Tidwell Cancer Treatment Center. Utilizing computed
tomography (CT) planning to image and reconstruct the
tumor on tumor bed and surrounding breast tissue in
3-D multiple radiation beam can be shaped exactly to the
contour of the treatment area. So not only are you looking
at the area of breast tissue at the center of the field of
tissue, but also up stream at the most upper and downstream
lower part of tissue beam typed and everything in
between. Because the radiation beam are precisely
focused, nearby normal tissue is usually spared. The
treatment usually includes the whole breast and spending
on the size and extent of the cancer, may include the
chest wall and underarm area as well.
Before the patient starts, the radiation team carefully
takes measurements to determine the correct angles for
aiming the radiation beams and the proper dose of
radiation. There will be some ink marks on the patients
skin that the therapist will use later as a guide to focus
the radiation on the right area.
Most radiotherapy machines will be able to rotate around
the patients body to give the treatment from several
different directions.
For more information on breast cancer treatment, call the
Tidwell Cancer Treatment Center.