There is this sense that there is an emergency. Most women probably should slow down.
A lot of women when they are first diagnosed, the sort of knee jerk reflex is Oh my gosh,get it out of me.And the truth is its been there for a while, and nothing is going to change drastically in coming days and weeks.
So they have time to make an informed decision about how to be treated. A reasonable time frame between diagnosis and surgery is usually within about a month. There can be a lot of work-up so even two months is perfectly fine for the vast majority of patients. But so many women feel, from an emotional perspective, that they want surgery faster than that. I feel like what I hear from patients very often is Why do I have to wait? And we as practitioners, want women to be informed.
We want them to understand their options and the ramifications of the decisions they make.And for them to realize that they really do have choices.We have several options for the surgical treatment of breast cancer. And in general were choosing between preserving the breast versus sacrificing the breast in the form of mastectomy with or without some form of reconstruction coordinated with that. Exactly what type of cancer is this? Is this a ductal cancer versus a lobular cancer, for example, which are two of the most common types of cancer we see.
Is this an invasive cancer otherwise known as infiltrating cancer? Or have we caught this before its an invasive cancer in which case we would typically call in situ cancer. In situ cancer is something that is typically limited with in the confines of the ductal elements of the breast, and it has not gained access to the bloodstream or to the lymphatics. Which means it has no risk virtually no risk of getting outside of the breast tissue.
The word invasive or infiltrating is a very scary word and it does mean that its a kind of cancer that has the potential to do that, but it does not mean it has done that at the time of diagnosis. And the vast majority of those women will not have any cancer outside of the breast when they get their initial diagnosis of invasive breast cancers.Were often not going to know the extent of the cancer until after surgery when we have the final surgical pathology available.
In breast cancer staging, there is often a number and a letter. And it has to do with the size of the tumor and the nodal involvement.Every stage is a combination of nodal size and tumor size. The only exception is stage 4 which is any metastatic site, gets you a stage 4 disease. And that is the only stage that is not curable unfortunately. But everything short of that is curable to different degrees.Grade is really about how the cells look under the microscope.
How ugly are they relative to normal cells? Or how close to normal cells do they appear? So the best way to explain that is really that word. Are they kind of ugly, do they look more aggressive or not?People often think that the type of surgery they have on their breast will often impact whether or not they need to have chemotherapy. And typically there is no relation one tothe next.
I cant really tell women very confidently whether or not they need chemo until surgery has happened, because so much of that decision-making is dependent on the pathology that the surgeon finds. No woman with non-invasive breast cancer, which is often called BCIS or breast cancer in situ is going to get chemo. And in fact, many women who have invasive breast cancer are not going to get chemotherapy either.
There is no question that chemotherapy is the hardest part of the treatment that we give to patients with cancer. There is no question that there can be long-term risks and long-term effects. Most patients eventually get back to a normal state of health. And that should be the main thing that they take home with them from an appointment, even though they may have months of not feeling as well as they would like to.
The goal is to prevent them from having a deadly illness.Radiation generally is a very easily tolerated procedure for breast radiation. Its long typical radiation is about 6 weeks. But the way they can deliver radiation these days, the side effects are so limited. Few women have much more than minor burning of the breast.
Its very rare to have any breakdown of the skin. And fatigue is usually very limited. Its actually rarely needed in women who have mastectomy. And that might be one of the things that goes into a woman's decision-making about lumpectomy or breast-preserving surgery versus mastectomy s their desire to avoid radiation or their comfort level with having radiation.Starting anti-estrogen therapy is always the last thing. I kind of think of breast cancer treatment as cassettes: surgery, chemo, radiation and anti-estrogen therapy. And some women need all 4, but many women need surgery and maybe nothing else. And if you don't nee done of those cassettes, you just sort of drop it out and everything else moves forward.
We have two tumor boards weekly at Swedish just for breast cancer where all of the experts who are involved in taking care of patients with breast cancer sit together and reviewcases. One of the best things about Swedish in delivering cancer care and the Swedish Cancer Institute network across the various campuses, is that women have full access to comprehensive, multidisciplinary care with all the right specialists, all the right know-how,all the right technology and they can get it delivered to them in their community.
There is absolutely no right answer for every woman. As a woman who has these choices tomake, you just need to be able to make them in a considered way. You just need to not be rushed into it and you need to be able to account for your own values in the context of doing the right thing for your cancer treatment.
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