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If you’ve just been diagnosed with breast cancer, or are close to someone who has, you probably have a lot of questions. Breast cancer surgeon Dr. Kristi Funk, also the director of the Pink Lotus Breast Center in Beverly Hills, spells out what you need to ask the doctor.
What did the doctor just say? You’ve been diagnosed with breast cancer? Your worst fears scream through your mind. This can’t be happening — and yet, it is happening. Take a deep breath. Exhale, and think, “I will survive.” Most women with breast cancer do survive, you know — so why not you? I’m not minimizing the strength and endurance it takes to get from here to cure — but you must believe that you will get there!Two words: “It’s cancer.”
Let’s talk about what you can expect between now and the day this journey becomes history. What follows are the answers to the top eight questions I hear — questions you need to ask your doctor to make sure you get the care you deserve.
1. What exactly is breast cancer?
I always use pictures to explain how breast cancer starts — even a cursory understanding of this process takes away some of the mystery cancer holds. Stripped of its mystery, cancer looks a little less daunting.
breastcancer.org
About 80 percent of breast cancer starts in ducts, 15 percent in lobules (broccoli-like bunches in the picture), and 5 percent is more unusual (but not necessarily more aggressive).
The majority of breast tissue is made up of milk-producing glands, called lobules (broccoli-like bunches in the picture), and the tubes that carry milk down and out the nipple, called ducts. About 80 percent of breast cancer starts in ducts, 15 percent in lobules, and 5 percent is more unusual (but not necessarily more aggressive).
Normal ducts and lobules are lined by a single layer of cells that all look similar to each other. When those cells proliferate for whatever reason (genetic mutations, estrogen stimulation ... no one knows exactly why), this is called hyperplasia, and we really don’t care about that common, benign finding. However, when those new cells become disorganized, creating multiple layers and changing their look, this is atypical hyperplasia and needs to be removed when identified. Once those atypical cells bridge across a duct or lobule, and nearly fill up the central spaces, it becomes carcinoma in situ (CIS) ductal DCIS, or lobular LCIS, depending on where it is located. When left unchecked, some CIS will break through the duct or lobule walls, invading the surrounding breast tissue. Once cancer becomes invasive, it has the potential to enter the lymphatics or bloodstream and travel to other organs (metastasize).
2. What stage is my cancer?
STAGE 0: This stage is called DCIS (ductal carcinoma in situ) or LCIS (lobular carcinoma in situ). The cancer cells are still within the intact ducts or lobules of the breast, and therefore Stage 0 cancers have no ability to spread. Stage 0 is the most curable type of cancer, although DCIS generally requires more treatment than LCIS.
STAGE 1: In this stage, cancer cells have invaded the walls of the duct or lobule, but the total size is less than 2.0 cm, and cells have not yet spread to lymph nodes or anywhere else in the body.
STAGE 2: Cancers less than 5 cm in size that have spread to one to three axillary (armpit) lymph nodes, and cancers over 2 cm that have not spread to nodes and have not invaded the chest muscles or skin
are all Stage II.
are all Stage II.
STAGE 3: Cancers of any size that have spread to four or more axillary (armpit) lymph nodes, the nodes around the clavicle (collarbone), and/or the nodes near the sternum (internal mammary nodes); cancers over 5 cm that spread to any number of nodes; and tumors that have grown into the chest wall or skin are all Stage III.
STAGE 4: This stage cancer has spread beyond the breast and nearby nodes, and has metastasized to other organs or distant nodes. The most commonly involved areas are liver, lung, brain, and bone.
3. What kind of operation is best for me?
A lumpectomy removes the cancer with a rim of healthy breast tissue surrounding it. A mastectomy removes all of the breast tissue. Remember this: Your chances of survival, and your chances of cancer recurrence (with a single cancer site in your breast) are identical whether you choose to have a lumpectomy followed by radiation, or a mastectomy. Shocking, right? You can keep your breast and not sacrifice your chance of cure! Make sure your surgeon is offering you options tailored to you.
Here are six reasons why you might choose mastectomy, even though at first it might seem like a drastic measure:
1. Small breast/large cancer. Lumpectomy will be significantly deforming, whereas mastectomy with reconstruction actually looks much better.
2. More than one cancer in different parts of the breast.
3. Not interested in radiation after lumpectomy, for whatever reason.
4. Already had radiation for a previous breast cancer in the same breast.
5. BRCA genetic mutation, or strong family history of breast cancer — you might consider removing the other breast as well.
6. Personal preference: “It’s my breast and I just don’t want it.”
4. Do I have a choice about radiation?
Well, yes and no. Lumpectomy without radiation leads to a cancer recurrence rate in the breast tissue of about 40 percent. If you add radiation to “sterilize” the breast after lumpectomy, recurrence drops to 4-8 percent. So if you choose lumpectomy, you really need radiation. However (here’s your choice!), you might be a great candidate for APBI, accelerated partial breast irradiation. Standard radiation is Monday through Friday, every day for about 33 treatments, taking 6.5 weeks. APBI takes 5 minutes, twice a day for 5 days, and you’re done!
Video: Your breast cancer concerns addressed (on this page)
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