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Let’s walk side by side through this journey.
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:
We are instrumental in the process of diagnosing cancer and determining if treatment in the method of medications are needed. 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:
We are instrumental in the process of diagnosing cancer and determining if treatment in the method of medications are needed. Learn more
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
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.
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
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.
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.
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.
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.
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.
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.
Increased chance of recurrence of your breast cancer, tend to be seen later with hormone positive breast cancer.
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.
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.
Increased chance of recurrence of your breast cancer, tend to be seen later with hormone positive breast cancer.
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.
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.
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.
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.
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:
This drug is given as an intravenous (IV) infusion, typically every 3 or 6 weeks.
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:
This drug is given as an intravenous (IV) infusion, typically every 3 or 6 weeks.
Uncommon but auto-immune disorders such as thyroid disease can be seen, along with diarrhea, cough, drop in blood pressure, among others.
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.
Remission means there is no identifiably evidence of cancer “NED” stands for No Evidence of Disease,
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.
Remission means there is no identifiably evidence of cancer “NED” stands for No Evidence of Disease,
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 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.
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