EDUCATE. CHEMOTHERAPY.

Let’s walk side by side through this journey.

Oncologists: Their Role in Your Journey
Your Biopsy Results
The Difference Between Staging and Grading
Medication-Endocrine Therapy
Medication-Chemotherapy
Immunotherapy
Our Long Term Connection
Chemo-From a Patient’s Perspective
Oncologists: Their Role in Your Journey
Oncology is the study of cancer. An oncologist is a doctor who treats cancer and provides medical care for a person diagnosed with cancer. An oncologist may also be called a cancer specialist. The field of oncology has 3 major areas based on treatments: medical oncology, radiation oncology, and surgical oncology.

Medical oncologists treat cancer using medication, including chemotherapy, immunotherapy, and targeted therapy.
Radiation oncologists treat cancer using radiation therapy, which is the use of high-energy x-rays or other particles to destroy cancer cells.
Surgical oncologists treat cancer using surgery, including removing the tumor and nearby tissue during a operation. This type of surgeon can also perform certain types of biopsies to help diagnose cancer.

There are also medical terms for oncologists who specialize in caring for specific groups of patients or groups of cancers. Learn more

As oncologist we help manage you through the diagnosis and make sure the right parties are involved in your care. Our main tool is the medication aspect of your treatment. An analogy I like to use, albeit sports related, we are the “quarterback” of your team.

An oncologist manages a patient’s care throughout the course of the disease. This starts with the diagnosis. Their role includes:

  • Recommending tests to determine whether a person has cancer.
  • Explaining a cancer diagnosis, including the type and stage of the cancer.
  • Talking about all treatment options and your treatment choice.
  • Delivering quality and compassionate care.
  • Helping you manage symptoms and side effects of cancer and its treatment.
    Learn more

We are instrumental in the process of diagnosing cancer and determining if treatment in the method of medications are needed. Learn more

Oncology is the study of cancer. An oncologist is a doctor who treats cancer and provides medical care for a person diagnosed with cancer. An oncologist may also be called a cancer specialist. The field of oncology has 3 major areas based on treatments: medical oncology, radiation oncology, and surgical oncology.

Medical oncologists treat cancer using medication, including chemotherapy, immunotherapy, and targeted therapy.
Radiation oncologists treat cancer using radiation therapy, which is the use of high-energy x-rays or other particles to destroy cancer cells.
Surgical oncologists treat cancer using surgery, including removing the tumor and nearby tissue during a operation. This type of surgeon can also perform certain types of biopsies to help diagnose cancer.

There are also medical terms for oncologists who specialize in caring for specific groups of patients or groups of cancers. Learn more

As oncologist we help manage you through the diagnosis and make sure the right parties are involved in your care. Our main tool is the medication aspect of your treatment. An analogy I like to use, albeit sports related, we are the “quarterback” of your team.

An oncologist manages a patient’s care throughout the course of the disease. This starts with the diagnosis. Their role includes:

  • Recommending tests to determine whether a person has cancer.
  • Explaining a cancer diagnosis, including the type and stage of the cancer.
  • Talking about all treatment options and your treatment choice.
  • Delivering quality and compassionate care.
  • Helping you manage symptoms and side effects of cancer and its treatment.
    Learn more

We are instrumental in the process of diagnosing cancer and determining if treatment in the method of medications are needed. Learn more

Your Biopsy Results

Unless we are able to determine the exact cause of the suspicious lesion noted in your breast we cannot determine what the next step would be in management. A phrase we oncologist like to use: “Tissue is the Issue.”

A breast biopsy is a procedure to remove a sample of breast tissue for testing. The tissue sample is sent to a lab, where doctors who specialize in analyzing blood and body tissue (pathologists) examine the tissue sample and provide a diagnosis.

A breast biopsy might be recommended if you have a suspicious area in your breast, such as a breast lump or other signs and symptoms of breast cancer. It can also be used to investigate unusual findings on a mammogram, ultrasound or other breast exam.

The results of a breast biopsy can show whether the area in question is breast cancer or if it’s not cancerous. The pathology report from the breast biopsy can help your doctor determine whether you need additional surgery or other treatment. Learn more

Not all women with breast cancer will need chemo, but there are several situations in which chemo may be recommended:

After surgery (adjuvant chemotherapy): Adjuvant chemo might be given to try to kill any cancer cells that might have been left behind or have spread but can’t be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. Adjuvant chemo can lower the risk of breast cancer coming back.

Before surgery (neoadjuvant chemotherapy): Neoadjuvant chemo might be given to try to shrink the tumor so it can be removed with less extensive surgery. Because of this, neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery when first diagnosed (called locally advanced cancers). Also, by giving chemo before the tumor is removed, doctors can see how the cancer
responds to it. If the first set of chemo drugs doesn’t shrink the tumor, your doctor will know that other drugs are needed. It should also kill  any cancer cells that have spread but can’t be seen. Just like adjuvant chemo, neoadjuvant chemo can lower the risk of breast cancer coming back.

For certain types of breast cancer, if there are tumor cells still found at the time of surgery (also called residual disease), you may be offered more chemotherapy after surgery to reduce the chances of the cancer coming back (recurrence).

For advanced breast cancer: Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area, either when it is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it. Learn more

There are many types of breast cancer, and many different ways to describe them. It’s easy to get confused over a breast cancer diagnosis.

The type of breast cancer is determined by the specific cells in the breast that are affected. Most breast cancers are carcinomas, which are tumors that start in the epithelial cells that line organs and tissues throughout the body. When carcinomas form in the breast, they are usually a more specific type called adenocarcinoma, which starts in cells in the ducts (the milk ducts) or the lobules (milk-producing glands).

In situ vs. invasive breast cancers
The type of breast cancer can also refer to whether the cancer has spread or not. In situ breast cancer (ductal carcinoma in situ or DCIS) is a cancer that starts in a milk duct and has not grown into the rest of the breast tissue. The term invasive (or infiltrating) breast cancer is used to describe any type of breast cancer that has spread (invaded) into the surrounding breast tissue.

Ductal carcinoma in situ (DCIS)
Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is a non-invasive or pre-invasive breast cancer.

Invasive breast cancer (ILC or IDC)
Invasive (or infiltrating) breast cancer has spread into surrounding breast tissue. The most common types are invasive ductal carcinoma and invasive lobular carcinoma. Invasive ductal carcinoma makes up about 70-80% of all breast cancers.

Special types of invasive breast cancers
Some invasive breast cancers have special features or develop in different ways that affect their treatment and outlook. These cancers are less common but can be more serious than other types of breast cancer.

Triple-negative breast cancer
Triple-negative breast cancer is an aggressive type of invasive breast cancer that accounts for about 15% of all breast cancers. It is a difficult cancer to treat.

Inflammatory breast cancer
Inflammatory breast cancer is an uncommon type of invasive breast cancer. It accounts for about 1% to 5% of all breast cancers.

Less common types of breast cancer There are other types of breast cancers that affect other types of cells in the breast. These cancers are much less common, and sometimes need different types of treatment.

Paget disease of the breast
Paget disease of the breast starts in the breast ducts and spreads to the skin of the nipple and then to the areola (the dark circle around the nipple). It is rare, accounting for only about 1-3% of all cases of breast cancer.

Phyllodes tumor
Phyllodes tumors are rare breast tumors. They develop in the connective tissue (stroma) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Most are benign, but there are others that are malignant (cancer).

Angiosarcoma
Sarcomas of the breast are rare making up less than 1% of all breast cancers. Angiosarcoma starts in cells that line blood vessels or lymph vessels. It can involve the breast tissue or the skin of the breast. Some may be related to prior radiation therapy in that area. Learn more

Breast cancer cells express the hormones estrogen (ER-positive) and/or progesterone (PR-positive) which drives the cancer cells to grow and spread. Just needs to be 1% positive to qualify. 

Triple-negative breast cancer is a kind of breast cancer that does not have any of the receptors that are commonly found in breast cancer. Think of cancer cells as a house. The front door may have three kinds of locks, called receptors—

One is for the female hormone estrogen.external icon
One is for the female hormone progesterone.external icon
One is a protein called human epidermal growth factor (HER2external icon).

If your cancer has any of these three locks, doctors have a few keys (like hormone therapy or other drugs) they can use to help destroy the cancer cells. But if you have triple-negative breast cancer, it means those three locks aren’t there. So doctors have fewer keys for treatment. Fortunately, chemotherapy is still an effective option. Learn more

Involved lymph nodes means the cancer has jumped outside the the primary breast site, which can affect the type of treatment required. Different scans can help us determine if there is cancer anywhere else in the body.

Biopsy results can take up to a week or longer depending on certain molecular tests. The biopsy is reviewed by a physician called a pathologist and interpreted as well by your oncologist/surgeon.

It is one the major parts of the story as it begins the path of determining what is involving your breast and how to move forward for management.

In certain situations, such as high risk genetics we need to also treat the other breast, but in most cases we are focused only on the breast involved.

Unless we are able to determine the exact cause of the suspicious lesion noted in your breast we cannot determine what the next step would be in management. A phrase we oncologist like to use: “Tissue is the Issue.”

A breast biopsy is a procedure to remove a sample of breast tissue for testing. The tissue sample is sent to a lab, where doctors who specialize in analyzing blood and body tissue (pathologists) examine the tissue sample and provide a diagnosis.

A breast biopsy might be recommended if you have a suspicious area in your breast, such as a breast lump or other signs and symptoms of breast cancer. It can also be used to investigate unusual findings on a mammogram, ultrasound or other breast exam.

The results of a breast biopsy can show whether the area in question is breast cancer or if it’s not cancerous. The pathology report from the breast biopsy can help your doctor determine whether you need additional surgery or other treatment. Learn more

Not all women with breast cancer will need chemo, but there are several situations in which chemo may be recommended:

After surgery (adjuvant chemotherapy): Adjuvant chemo might be given to try to kill any cancer cells that might have been left behind or have spread but can’t be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. Adjuvant chemo can lower the risk of breast cancer coming back.

Before surgery (neoadjuvant chemotherapy): Neoadjuvant chemo might be given to try to shrink the tumor so it can be removed with less extensive surgery. Because of this, neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery when first diagnosed (called locally advanced cancers). Also, by giving chemo before the tumor is removed, doctors can see how the cancer
responds to it. If the first set of chemo drugs doesn’t shrink the tumor, your doctor will know that other drugs are needed. It should also kill  any cancer cells that have spread but can’t be seen. Just like adjuvant chemo, neoadjuvant chemo can lower the risk of breast cancer coming back.

For certain types of breast cancer, if there are tumor cells still found at the time of surgery (also called residual disease), you may be offered more chemotherapy after surgery to reduce the chances of the cancer coming back (recurrence).

For advanced breast cancer: Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area, either when it is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it. Learn more

There are many types of breast cancer, and many different ways to describe them. It’s easy to get confused over a breast cancer diagnosis.

The type of breast cancer is determined by the specific cells in the breast that are affected. Most breast cancers are carcinomas, which are tumors that start in the epithelial cells that line organs and tissues throughout the body. When carcinomas form in the breast, they are usually a more specific type called adenocarcinoma, which starts in cells in the ducts (the milk ducts) or the lobules (milk-producing glands).

In situ vs. invasive breast cancers
The type of breast cancer can also refer to whether the cancer has spread or not. In situ breast cancer (ductal carcinoma in situ or DCIS) is a cancer that starts in a milk duct and has not grown into the rest of the breast tissue. The term invasive (or infiltrating) breast cancer is used to describe any type of breast cancer that has spread (invaded) into the surrounding breast tissue.

Ductal carcinoma in situ (DCIS)
Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is a non-invasive or pre-invasive breast cancer.

Invasive breast cancer (ILC or IDC)
Invasive (or infiltrating) breast cancer has spread into surrounding breast tissue. The most common types are invasive ductal carcinoma and invasive lobular carcinoma. Invasive ductal carcinoma makes up about 70-80% of all breast cancers.

Special types of invasive breast cancers
Some invasive breast cancers have special features or develop in different ways that affect their treatment and outlook. These cancers are less common but can be more serious than other types of breast cancer.

Triple-negative breast cancer
Triple-negative breast cancer is an aggressive type of invasive breast cancer that accounts for about 15% of all breast cancers. It is a difficult cancer to treat.

Inflammatory breast cancer
Inflammatory breast cancer is an uncommon type of invasive breast cancer. It accounts for about 1% to 5% of all breast cancers.

Less common types of breast cancer There are other types of breast cancers that affect other types of cells in the breast. These cancers are much less common, and sometimes need different types of treatment.

Paget disease of the breast
Paget disease of the breast starts in the breast ducts and spreads to the skin of the nipple and then to the areola (the dark circle around the nipple). It is rare, accounting for only about 1-3% of all cases of breast cancer.

Phyllodes tumor
Phyllodes tumors are rare breast tumors. They develop in the connective tissue (stroma) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Most are benign, but there are others that are malignant (cancer).

Angiosarcoma
Sarcomas of the breast are rare making up less than 1% of all breast cancers. Angiosarcoma starts in cells that line blood vessels or lymph vessels. It can involve the breast tissue or the skin of the breast. Some may be related to prior radiation therapy in that area. Learn more

Breast cancer cells express the hormones estrogen (ER-positive) and/or progesterone (PR-positive) which drives the cancer cells to grow and spread. Just needs to be 1% positive to qualify. 

Triple-negative breast cancer is a kind of breast cancer that does not have any of the receptors that are commonly found in breast cancer. Think of cancer cells as a house. The front door may have three kinds of locks, called receptors—

One is for the female hormone estrogen.external icon
One is for the female hormone progesterone.external icon
One is a protein called human epidermal growth factor (HER2external icon).

If your cancer has any of these three locks, doctors have a few keys (like hormone therapy or other drugs) they can use to help destroy the cancer cells. But if you have triple-negative breast cancer, it means those three locks aren’t there. So doctors have fewer keys for treatment. Fortunately, chemotherapy is still an effective option. Learn more

Involved lymph nodes means the cancer has jumped outside the the primary breast site, which can affect the type of treatment required. Different scans can help us determine if there is cancer anywhere else in the body.

Biopsy results can take up to a week or longer depending on certain molecular tests. The biopsy is reviewed by a physician called a pathologist and interpreted as well by your oncologist/surgeon.

It is one the major parts of the story as it begins the path of determining what is involving your breast and how to move forward for management.

In certain situations, such as high risk genetics we need to also treat the other breast, but in most cases we are focused only on the breast involved.

The Difference Between Staging and Grading
Staging:
Staging is the process of finding out how much cancer is in a person’s body and where it’s located. The cancer stage is also a way for doctors to describe the extent of the cancer when they talk with each other about a person’s cancer. A cancer’s stage can also be used to help predict the course it will likely take, as well as how likely it is that treatment will be successful.

Grade:
Grade is a measure of how abnormal the cancer cells look under the microscope. This is also called differentiation. Grade can be important because cancers with more abnormal-looking cells tend to grow and spread faster. www.americancancersociety.com

For most cancers, the stage is a Roman numeral from I (1) to IV (4).

Stage 0, which is often called carcinoma in situ or CIS, (CIS is not cancer, but it may become cancer) means the cancer is still only in the layer of cells where it first started, and it has not spread any farther.

Stage I II & III– Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues.

Stage IV – The cancer has spread to distant parts of the body. Most common areas include the brain, bones and lungs.

Sometimes stages are subdivided as well, using capital letters (for example, stage III might be subdivided into stages IIIA and IIIB).

The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) maintain the TNM classification system as a way for doctors to stage many different types of cancer based on certain common standards.

In the TNM system, the overall stage is determined after the cancer is assigned a letter or number to describe the tumor (T), node (N), and metastasis (M) categories.
T describes the original (primary) tumor.
N tells whether the cancer has spread to the nearby lymph nodes.
M tells whether the cancer has spread (metastasized) to distant parts of the body.

Grade is determined on the biopsy and stage is dependent on the size, lymph nodes involved, and if disease is found outside of the breast on scans. Staging of breast cancer is how we determine the extent of involvement by the disease.

For Hormone positive, Her-2/neu negative breast cancers that are local, we use a 21-gene recurrence score to determine if someone needs chemotherapy or not after primary treatment.

Staging:
Staging is the process of finding out how much cancer is in a person’s body and where it’s located. The cancer stage is also a way for doctors to describe the extent of the cancer when they talk with each other about a person’s cancer. A cancer’s stage can also be used to help predict the course it will likely take, as well as how likely it is that treatment will be successful.

Grade:
Grade is a measure of how abnormal the cancer cells look under the microscope. This is also called differentiation. Grade can be important because cancers with more abnormal-looking cells tend to grow and spread faster. www.americancancersociety.com

For most cancers, the stage is a Roman numeral from I (1) to IV (4).

Stage 0, which is often called carcinoma in situ or CIS, (CIS is not cancer, but it may become cancer) means the cancer is still only in the layer of cells where it first started, and it has not spread any farther.

Stage I II & III– Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues.

Stage IV – The cancer has spread to distant parts of the body. Most common areas include the brain, bones and lungs.

Sometimes stages are subdivided as well, using capital letters (for example, stage III might be subdivided into stages IIIA and IIIB).

The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) maintain the TNM classification system as a way for doctors to stage many different types of cancer based on certain common standards.

In the TNM system, the overall stage is determined after the cancer is assigned a letter or number to describe the tumor (T), node (N), and metastasis (M) categories.
T describes the original (primary) tumor.
N tells whether the cancer has spread to the nearby lymph nodes.
M tells whether the cancer has spread (metastasized) to distant parts of the body.

Grade is determined on the biopsy and stage is dependent on the size, lymph nodes involved, and if disease is found outside of the breast on scans. Staging of breast cancer is how we determine the extent of involvement by the disease.

For Hormone positive, Her-2/neu negative breast cancers that are local, we use a 21-gene recurrence score to determine if someone needs chemotherapy or not after primary treatment.

Medication-Endocrine Therapy
Some types of breast cancer are affected by hormones, like estrogen and progesterone. The breast cancer cells have receptors (proteins) that attach to estrogen and progesterone, which helps them grow. Treatments that stop these hormones from attaching to these receptors are called hormone or endocrine therapy.

Hormone therapy can reach cancer cells almost anywhere in the body and not just in the breast. It’s recommended for women with tumors that are hormone receptor-positive. It does not help women whose tumors don’t have hormone receptors.

When is hormone therapy used?
Hormone therapy is often used after surgery (as adjuvant therapy) to help reduce the risk of the cancer coming back. Sometimes it is started before surgery (as neoadjuvant therapy). It is usually taken for at least 5 to 10 years. Hormone therapy can also be used to treat cancer that has come back after treatment or that has spread to other parts of the body.

How does hormone therapy work?
About 2 out of 3 breast cancers are hormone receptor-positive. Their cells have receptors (proteins) for the hormones estrogen (ER-positive cancers) and/or progesterone (PR-positive cancers) which help the cancer cells grow and spread.

There are several types of hormone therapy for breast cancer. Most types of hormone therapy either lower estrogen levels or stop estrogen from acting on breast cancer cells. Learn more

If cancer is driven by hormones, then simply blocking it will cause the cancer to die.

In certain situations is just effective alone in preventing recurrence of cancer.

Two Major Types:

1. Tamoxifen
Tamoxifen – This drug blocks estrogen receptors on breast cancer cells. It stops estrogen from connecting to the cancer cells and telling them to grow and divide. While tamoxifen acts like an anti-estrogen in breast cells, it acts like an estrogen in other tissues, like the uterus and the bones. Because of this, it is called a selective estrogen receptor modulator (SERM). It can be used to treat women with breast cancer who have or have not gone through menopause.

2. Aromatase Inhibitors
Aromatase inhibitors (AIs)- Aromatase inhibitors (AIs) are drugs that stop estrogen production. Before menopause, most estrogen is made by the ovaries. But for women whose ovaries aren’t working, either due to menopause or certain treatments, a small amount of estrogen is still made in the fat tissue by an enzyme (called aromatase). AIs work by blocking aromatase from making estrogen.

These drugs are useful in women who are past menopause, although they can also be used in premenopausal women in combination with ovarian suppression.

Aromatase inhibitors (AIs) are drugs that stop estrogen production. Before menopause, most estrogen is made by the ovaries. But for women whose ovaries aren’t working, either due to menopause or certain treatments, a small amount of estrogen is still made in the fat tissue by an enzyme (called aromatase). AIs work by blocking aromatase from making estrogen. Learn more

It is common to switch from one medication to another if you experience side effects.

Depending on the stage of your disease it can range from 5-10 years.

Aromatase Inhibitors:
1. Muscle and Joint Aches; worsening of arthritis symptoms.
2. Bone loss (osteoporosis/osteopenia)
3. Sexual Dysfunction
4. Hair Thinning
5. Forgetfulness

Tamoxifen:
1. Hot Flashes
2. Vaginal Dryness or discharge.
3. Increased risk of uterine cancer ( less than 1% chance per year).
4. Blood clots

Increased chance of recurrence of your breast cancer, tend to be seen later with hormone positive breast cancer.

Some types of breast cancer are affected by hormones, like estrogen and progesterone. The breast cancer cells have receptors (proteins) that attach to estrogen and progesterone, which helps them grow. Treatments that stop these hormones from attaching to these receptors are called hormone or endocrine therapy.

Hormone therapy can reach cancer cells almost anywhere in the body and not just in the breast. It’s recommended for women with tumors that are hormone receptor-positive. It does not help women whose tumors don’t have hormone receptors.

When is hormone therapy used?
Hormone therapy is often used after surgery (as adjuvant therapy) to help reduce the risk of the cancer coming back. Sometimes it is started before surgery (as neoadjuvant therapy). It is usually taken for at least 5 to 10 years. Hormone therapy can also be used to treat cancer that has come back after treatment or that has spread to other parts of the body.

How does hormone therapy work?
About 2 out of 3 breast cancers are hormone receptor-positive. Their cells have receptors (proteins) for the hormones estrogen (ER-positive cancers) and/or progesterone (PR-positive cancers) which help the cancer cells grow and spread.

There are several types of hormone therapy for breast cancer. Most types of hormone therapy either lower estrogen levels or stop estrogen from acting on breast cancer cells. Learn more

If cancer is driven by hormones, then simply blocking it will cause the cancer to die.

In certain situations is just effective alone in preventing recurrence of cancer.

Two Major Types:

1. Tamoxifen
Tamoxifen – This drug blocks estrogen receptors on breast cancer cells. It stops estrogen from connecting to the cancer cells and telling them to grow and divide. While tamoxifen acts like an anti-estrogen in breast cells, it acts like an estrogen in other tissues, like the uterus and the bones. Because of this, it is called a selective estrogen receptor modulator (SERM). It can be used to treat women with breast cancer who have or have not gone through menopause.

2. Aromatase Inhibitors
Aromatase inhibitors (AIs)- Aromatase inhibitors (AIs) are drugs that stop estrogen production. Before menopause, most estrogen is made by the ovaries. But for women whose ovaries aren’t working, either due to menopause or certain treatments, a small amount of estrogen is still made in the fat tissue by an enzyme (called aromatase). AIs work by blocking aromatase from making estrogen.

These drugs are useful in women who are past menopause, although they can also be used in premenopausal women in combination with ovarian suppression.

Aromatase inhibitors (AIs) are drugs that stop estrogen production. Before menopause, most estrogen is made by the ovaries. But for women whose ovaries aren’t working, either due to menopause or certain treatments, a small amount of estrogen is still made in the fat tissue by an enzyme (called aromatase). AIs work by blocking aromatase from making estrogen. Learn more

It is common to switch from one medication to another if you experience side effects.

Depending on the stage of your disease it can range from 5-10 years.

Aromatase Inhibitors:
1. Muscle and Joint Aches; worsening of arthritis symptoms.
2. Bone loss (osteoporosis/osteopenia)
3. Sexual Dysfunction
4. Hair Thinning
5. Forgetfulness

Tamoxifen:
1. Hot Flashes
2. Vaginal Dryness or discharge.
3. Increased risk of uterine cancer ( less than 1% chance per year).
4. Blood clots

Increased chance of recurrence of your breast cancer, tend to be seen later with hormone positive breast cancer.

Medication-Chemotherapy

Chemotherapy refers to the use of any drug to treat any disease. But to most people, the word chemotherapy (or “chemo”) means drugs used for cancer treatment. Chemo is considered a systemic treatment because the drugs travels throughout the body, and can kill cancer cells that have spread (metastasized) to parts of the body far away from the original tumor. This makes it different from treatments like surgery and radiation. Learn more

Chemotherapy medicines prevent cancer cells from growing and spreading by destroying the cells or stopping them from dividing. Cancer cells tend to grow and divide very quickly with no order or control. Because they’re growing so fast, sometimes cancer cells break away from the original tumor and travel to other places in the body. Chemotherapy weakens and destroys cancer cells at the original tumor site AND throughout the body.

Goals of Chemotherapy:
-To shrink a tumor before surgery or radiation therapy. Chemo used in this way is called neoadjuvant therapy.
-After surgery or radiation therapy to help kill any remaining cancer cells in the body. Chemo used in this way is called adjuvant therapy.
-With other types of drugs to help kill cancer cells, such as targeted therapy drugs that act on certain targets of cancer cells or immunotherapy drugs that help the immune system fight cancer.
-With other treatments if cancer comes back or doesn’t completely go away.
Learn more

In many situations this is the only option of treatment as we are either unable to target a specific mutation or the cancer is too aggressive.

How many types are there?
-Oral
-IV
Many different types but the commonly administered chemotherapies are:
1. Paclitaxel (Taxol)
2. Adriamycin (Red Devil)
3. Carboplatin (Carbo)

Wide range which includes but is not limited to drop in blood counts, loss of hair, neuropathy, fatigue, weakness, lethargy, change in heart function, diarrhea, nausea/vomiting.

How often you get chemo and how long your treatment lasts depend on the kind of cancer you have, the goals of the treatment, the drugs being used, and how your body responds to them.

You may get treatments daily, weekly, or monthly, but they’re usually given in on-and-off cycles. This means, for example, that you may get chemo the first 2 weeks and then have a week off, making it a cycle that will start over every 3 weeks. The time off lets your body build healthy new cells and regain its strength.

Your cancer care team can tell you how many cycles are planned and how long they expect your treatment to last.

www.americancancersociety.com

IV – Many types of chemo are given as an infusion or injection. With chemo infusions, chemotherapy drugs are put into your body through a thin tube called a catheter that’s placed in a vein, artery, body cavity, or body part. In some cases, a chemo drug may be injected quickly with a syringe.

Intravenous drugs are given in these ways:

IV push: the drugs can be given quickly through the catheter right from a syringe over a few minutes.
IV infusion: a typical infusion can last from a few minutes to a few hours. A mixed drug solution flows from a plastic bag through tubing that’s attached to the catheter. The flow is usually controlled by a machine called an IV pump.
Continuous infusion: These infusions can last anywhere from 1 to several days and are controlled by electronic IV pumps.
Oral – If chemo is taken by mouth, you swallow the pill, capsule, or liquid just like other medicines. Like other types of chemo, sometimes chemo is given in rounds or cycles. This cuts down on the harm to healthy cells and allows the chemo to kill more cancer cells. Oral chemo is usually taken at home. Because of this, it’s very important to make sure you know exactly how it should be taken
Topical – Topical chemo is put right on the skin in an area where certain cancers are. Topical chemo can be a cream, gel, or ointment. Chemo drugs you use on your skin are as strong as other forms of chemo. Many are also considered hazardous. If you are using topical chemo, be sure you know the precautions you need to take when storing, handling, and disposing of the tube or container it comes in. www.americancancersociety.com

Many side effects go away fairly quickly, but some might take months or even years to go away completely. These are called late effects. Sometimes the side effects can last a lifetime, such as when chemo causes long-term damage to the heart, lungs, kidneys, or reproductive organs. Certain types of chemo sometimes cause delayed effects, such as a second cancer that may show up many years later.

www.americansociety.com

Chemotherapy refers to the use of any drug to treat any disease. But to most people, the word chemotherapy (or “chemo”) means drugs used for cancer treatment. Chemo is considered a systemic treatment because the drugs travels throughout the body, and can kill cancer cells that have spread (metastasized) to parts of the body far away from the original tumor. This makes it different from treatments like surgery and radiation. Learn more

Chemotherapy medicines prevent cancer cells from growing and spreading by destroying the cells or stopping them from dividing. Cancer cells tend to grow and divide very quickly with no order or control. Because they’re growing so fast, sometimes cancer cells break away from the original tumor and travel to other places in the body. Chemotherapy weakens and destroys cancer cells at the original tumor site AND throughout the body.

Goals of Chemotherapy:
-To shrink a tumor before surgery or radiation therapy. Chemo used in this way is called neoadjuvant therapy.
-After surgery or radiation therapy to help kill any remaining cancer cells in the body. Chemo used in this way is called adjuvant therapy.
-With other types of drugs to help kill cancer cells, such as targeted therapy drugs that act on certain targets of cancer cells or immunotherapy drugs that help the immune system fight cancer.
-With other treatments if cancer comes back or doesn’t completely go away.
Learn more

In many situations this is the only option of treatment as we are either unable to target a specific mutation or the cancer is too aggressive.

How many types are there?
-Oral
-IV
Many different types but the commonly administered chemotherapies are:
1. Paclitaxel (Taxol)
2. Adriamycin (Red Devil)
3. Carboplatin (Carbo)

Wide range which includes but is not limited to drop in blood counts, loss of hair, neuropathy, fatigue, weakness, lethargy, change in heart function, diarrhea, nausea/vomiting.

How often you get chemo and how long your treatment lasts depend on the kind of cancer you have, the goals of the treatment, the drugs being used, and how your body responds to them.

You may get treatments daily, weekly, or monthly, but they’re usually given in on-and-off cycles. This means, for example, that you may get chemo the first 2 weeks and then have a week off, making it a cycle that will start over every 3 weeks. The time off lets your body build healthy new cells and regain its strength.

Your cancer care team can tell you how many cycles are planned and how long they expect your treatment to last.

www.americancancersociety.com

IV – Many types of chemo are given as an infusion or injection. With chemo infusions, chemotherapy drugs are put into your body through a thin tube called a catheter that’s placed in a vein, artery, body cavity, or body part. In some cases, a chemo drug may be injected quickly with a syringe.

Intravenous drugs are given in these ways:

IV push: the drugs can be given quickly through the catheter right from a syringe over a few minutes.
IV infusion: a typical infusion can last from a few minutes to a few hours. A mixed drug solution flows from a plastic bag through tubing that’s attached to the catheter. The flow is usually controlled by a machine called an IV pump.
Continuous infusion: These infusions can last anywhere from 1 to several days and are controlled by electronic IV pumps.
Oral – If chemo is taken by mouth, you swallow the pill, capsule, or liquid just like other medicines. Like other types of chemo, sometimes chemo is given in rounds or cycles. This cuts down on the harm to healthy cells and allows the chemo to kill more cancer cells. Oral chemo is usually taken at home. Because of this, it’s very important to make sure you know exactly how it should be taken
Topical – Topical chemo is put right on the skin in an area where certain cancers are. Topical chemo can be a cream, gel, or ointment. Chemo drugs you use on your skin are as strong as other forms of chemo. Many are also considered hazardous. If you are using topical chemo, be sure you know the precautions you need to take when storing, handling, and disposing of the tube or container it comes in. www.americancancersociety.com

Many side effects go away fairly quickly, but some might take months or even years to go away completely. These are called late effects. Sometimes the side effects can last a lifetime, such as when chemo causes long-term damage to the heart, lungs, kidneys, or reproductive organs. Certain types of chemo sometimes cause delayed effects, such as a second cancer that may show up many years later.

www.americansociety.com

Immunotherapy

These are medications which stimulate your immune system to attack the cancer.

Pembrolizumab (Keytruda) for breast cancer

Pembrolizumab (Keytruda) is a drug that targets PD-1, a protein on immune system cells called T cells that normally help keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against breast cancer cells. This can often shrink tumors.

It can be used with chemotherapy before surgery to treat early-stage triple-negative breast cancer that is at high risk of coming back, and then
given by itself after surgery.

For triple negative breast cancer that makes the PD-L1 protein, pembrolizumab can be given with chemotherapy if the cancer:

  • has come back (recurred) locally but can’t be removed by surgery OR
  • has spread to other parts of the body.

This drug is given as an intravenous (IV) infusion, typically every 3 or 6 weeks.

Learn more

Uncommon but auto-immune disorders such as thyroid disease can be seen, along with diarrhea, cough, drop in blood pressure, among others.

These are medications which stimulate your immune system to attack the cancer.

Pembrolizumab (Keytruda) for breast cancer

Pembrolizumab (Keytruda) is a drug that targets PD-1, a protein on immune system cells called T cells that normally help keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against breast cancer cells. This can often shrink tumors.

It can be used with chemotherapy before surgery to treat early-stage triple-negative breast cancer that is at high risk of coming back, and then
given by itself after surgery.

For triple negative breast cancer that makes the PD-L1 protein, pembrolizumab can be given with chemotherapy if the cancer:

  • has come back (recurred) locally but can’t be removed by surgery OR
  • has spread to other parts of the body.

This drug is given as an intravenous (IV) infusion, typically every 3 or 6 weeks.

Learn more

Uncommon but auto-immune disorders such as thyroid disease can be seen, along with diarrhea, cough, drop in blood pressure, among others.

Our Long Term Connection

Depending on the stage of breast cancer, it can range from every 3-4 months to every 6 months.

Depending on the stage of breast cancer we can gather a lot of information from blood work which could include monitoring the cancer, assessing tolerance to treatment, and evaluating for recurrence of disease.

Once completed with definitive treatment (surgery, radiation, and/or chemotherapy/hormone/targeted therapy) we consider patients to be in remission which can be considered as cancer free.

Remission means there is no identifiably evidence of cancer “NED” stands for No Evidence of Disease,

If your doctor suspects you may have recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, he or she may recommend additional tests to confirm the diagnosis.

Tests and procedures may include:
  • Imaging tests. What imaging tests you’ll undergo will depend on your specific situation. Imaging tests may include magnetic resonance imaging (MRI), computerized tomography (CT), X-ray, bone scan or positron emission tomography (PET).

    Not every person needs every test. Your doctor will determine which tests are most helpful in your particular situation.
  • Removing a sample of tissue for lab testing (biopsy). Your doctor may recommend a biopsy procedure to collect suspicious cells for testing, as this is the only way to confirm whether your cancer has returned. Working in a laboratory, a pathologist examines the cells and determines the types of cells involved.

    A pathologist can determine if the cancer is a recurrence of cancer or a new type of cancer. Tests also show whether the cancer is sensitive to hormone treatment or targeted therapy, since these may have changed since your original cancer diagnosis. Learn more

Symptoms of local recurrence could include noticing a firm, non-painful, fixed spot, or skin dimpling, discoloration and changes in your breast.

Should you notice any of this on a self-breast exam, recommend notifying your oncologist or surgeon to have this evaluated immediately.

Depending on the stage of breast cancer, it can range from every 3-4 months to every 6 months.

Depending on the stage of breast cancer we can gather a lot of information from blood work which could include monitoring the cancer, assessing tolerance to treatment, and evaluating for recurrence of disease.

Once completed with definitive treatment (surgery, radiation, and/or chemotherapy/hormone/targeted therapy) we consider patients to be in remission which can be considered as cancer free.

Remission means there is no identifiably evidence of cancer “NED” stands for No Evidence of Disease,

If your doctor suspects you may have recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, he or she may recommend additional tests to confirm the diagnosis.

Tests and procedures may include:
  • Imaging tests. What imaging tests you’ll undergo will depend on your specific situation. Imaging tests may include magnetic resonance imaging (MRI), computerized tomography (CT), X-ray, bone scan or positron emission tomography (PET).

    Not every person needs every test. Your doctor will determine which tests are most helpful in your particular situation.
  • Removing a sample of tissue for lab testing (biopsy). Your doctor may recommend a biopsy procedure to collect suspicious cells for testing, as this is the only way to confirm whether your cancer has returned. Working in a laboratory, a pathologist examines the cells and determines the types of cells involved.

    A pathologist can determine if the cancer is a recurrence of cancer or a new type of cancer. Tests also show whether the cancer is sensitive to hormone treatment or targeted therapy, since these may have changed since your original cancer diagnosis. Learn more

Symptoms of local recurrence could include noticing a firm, non-painful, fixed spot, or skin dimpling, discoloration and changes in your breast.

Should you notice any of this on a self-breast exam, recommend notifying your oncologist or surgeon to have this evaluated immediately.

Chemo-From a Patient’s Perspective.
Sammie, Emotional Contributor

Chemo dries your skin out, so make sure you have lotion on hand.

A lot of chemo side effects can cause you to become dehydrated. Not only can this cause you to be nauseous and have low energy, but it can also cause other health issues. Also, the more you drink, the faster it flushes the chemo out of your system so you can begin to recover sooner.

Although chemo might make you nauseous or cause a loss of appetite, it is important to eat when you can to avoid malnourishment.

Exercising during chemo can help ease side effects, such as fatigue and nausea, and can help boost your immune system. So even on days you don’t want to get out of bed, going for a walk will do you wonders.

It is important to track your symptoms so you can discuss them later with your health care team and talk about how to alleviate them. Believe it or not, your team does not want to torture you.

If you are tired, sleep! Your body is going through a war and needs all the rest it can get.

Whether it is family, friends, a Facebook group or what, it is so important to have support during your journey. It often helps to talk to other survivors who know what you are going through and can offer advice and tips on how they coped.

A lot of patients find that if they are on a schedule it gives them a sense of normalcy, and keeps sleeping patterns consistent to combat fatigue.

Maintaining a positive attitude and talking about your feelings to a therapist or cancer coach can help you process your emotions and deal with the emotional trauma.

There are so many assistant programs and resources available to breast cancer patients now that it would be foolish not to utilize them. Check out what your local hospitals, cancer centers or nonprofits are offering.

People are always asking how they can help…here is how! Make a list of all the items you will need, whether it be for chemo, your mastectomy, radiation, etc. Then send the list out to all your friends and family and have them sign up for items they want to purchase and send to you.

Cancer is tough. Go easy on yourself. Have a spa day, use bath bombs, get a massage, try reiki or acupuncture, do yoga, practice meditating…do something just for you each and every day. It is important to have things to look forward to, so maybe schedule an outing with friends, or a day at the beach; things to get you out of the house and into the world. Remember, you are sick, not dead. Life is for the living.

Chemo dries your skin out, so make sure you have lotion on hand.

A lot of chemo side effects can cause you to become dehydrated. Not only can this cause you to be nauseous and have low energy, but it can also cause other health issues. Also, the more you drink, the faster it flushes the chemo out of your system so you can begin to recover sooner.

Although chemo might make you nauseous or cause a loss of appetite, it is important to eat when you can to avoid malnourishment.

Exercising during chemo can help ease side effects, such as fatigue and nausea, and can help boost your immune system. So even on days you don’t want to get out of bed, going for a walk will do you wonders.

It is important to track your systems so you can discuss them later with your health care team and talk about how to alleviate them. Believe it or not, your team does not want to torture you.

If you are tired, sleep! Your body is going through a war and needs all the rest it can get.

Whether it is family, friends, a Facebook group or what, it is so important to have support during your journey. It often helps to talk to other survivors who know what you are going through and can offer advice and tips on how they coped.

A lot of patients find that if they are on a schedule it gives them a sense of normalcy, and keeps sleeping patterns consistent to combat fatigue.

Maintaining a positive attitude and talking about your feelings to a therapist or cancer coach can help you process your emotions and deal with the emotional trauma.

There are so many assistant programs and resources available to breast cancer patients now that it would be foolish not to utilize them. Check out what your local hospitals, cancer centers or nonprofits are offering.

People are always asking how they can help…here is how! Make a list of all the items you will need, whether it be for chemo, your mastectomy, radiation, etc. Then send the list out to all your friends and family and have them sign up for items they want to purchase and send to you.

Cancer is tough. Go easy on yourself. Have a spa day, use bath bombs, get a massage, try reiki or acupuncture, do yoga, practice meditating…do something just for you each and every day. It is important to have things to look forward to, so maybe schedule an outing with friends, or a day at the beach; things to get you out of the house and into the world. Remember, you are sick, not dead. Life is for the living.

Questions to consider asking before treatment
Rahul Singh, M.D.-Learn Look Locate Medical Advisor
“Don’t let the cancer define you, instead define what you want to be independent of the cancer.”
Who am I?

I am a board-certified medical oncologist and hematologist, with a personal focus in breast cancer. I am involved with the local breast leadership committee and promoting breast cancer awareness. My goal is to arm people coping with this condition, with knowledge to help bridge the gap in understanding. Knowledge is power and the key to winning the battle with breast cancer.

"Let's walk side by side on this journey."-Rahul Singh, MD

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