Download BREAST HEALTH Patient Guide

Breast Health
Patient Guide
Table of Contents
We encourage you to use this notebook as your personal breast cancer
diary. You may find it helpful to insert your radiology, pathology, and
chemotherapy / radiation reports, in the appropriate sections.
3
Introduction
5
Your Breast Care Team
9
What is Breast Cancer?
11
Diagnosis / Pathology
15
Risk
17
Your Breast Imaging
21
Your Pathology Reports
33
Surgical Treatment
41Medical Oncology
C
hemotherapy
Hormonal Therapy
Radiation
45
Cancer Genetics
47
Terminology / Dictionary
53
Resource List
55
FAQs
57
Helpful Hints
59
Calendar
A Patient ’s Guide to Breast Cancer
1
— C.C. Scott, poet
Introduction
Introduction
“The human spirit
is stronger than anything
that can happen to it.”
Introduction
“They tell me I have Breast Cancer”
When you hear the words, “You have breast cancer,” it is hard to know what to do next. Most
women have two important questions: “Am I going to die?” and “Do I have to lose my breast?”
Fortunately, in most cases the answer to both of these questions is: “No.”
Breast cancer is the most common type of cancer diagnosed in women. Although the
incidence of breast cancer has risen over the last decade, the mortality or death rate is
declining. This means that we are diagnosing breast cancer at an early and more curable
stage. We designed this notebook to provide you with the answers to your questions about
how we can best treat your breast cancer.
Eleanor Roosevelt said, “A woman is like a tea bag. You never know how strong she is
until she gets into hot water.” Receiving a diagnosis of breast cancer can test any woman’s
strength. Knowledge can help to provide extra strength a woman needs to get through
this chapter in her life.
A Patient ’s Guide to Breast Cancer
3
— John Diamond, journalist
Your Breast
Care Team
Your Breast Care Team
“Cancer is a word,
not a sentence.”
Your Breast Care Team
“I believe it is important to treat every patient the way
I would want myself and my family to be treated — with
kindness, compassion, respect, and honesty. That is why I am
dedicated to providing the best care possible to my patients.”
Hilary M. Shapiro-Wright, DO
Physician’s Education
Dr. Shapiro-Wright is a fellowship-trained breast surgeon who is on staff at The Jewish
Hospital — Mercy Health.
Dr. Shapiro-Wright is trained to treat a spectrum of breast diseases, including new breast
masses, abnormal mammograms, nipple discharge, breast cancer, and breast pain. She also
consults with high-risk patients, such as those with a family history of breast cancer or prior
breast biopsies showing atypical findings.
Dr. Shapiro-Wright is a board-certified surgeon who is fellowship-trained in breast surgery.
After fulfilling her internship and five-year general surgery residency at Botsford Hospital
in Michigan, Dr. Shapiro-Wright completed her breast fellowship at Allegheny General
Hospital in Pennsylvania. Dr. Shapiro-Wright received her medical degree from Lake Erie
College of Osteopathic Medicine and her undergraduate degree in microbiology is from
Michigan State University.
Physician’s Activities/Affiliations
Dr. Shapiro-Wright is committed to improving patient care through on-going education of
the latest research and techniques available. Being affiliated with the following organizations
enables her to stay well-informed of current trends optimizing the best possible outcomes
for her patients.
• American College of Surgeons
• American College of Osteopathic Surgeons
• American Society of Breast Surgeons
• Society of Surgical Oncology
• American Osteopathic Association
Dr. Shapiro-Wright also volunteers with local cancer organizations and breast cancer
survivorship programs.
A Patient ’s Guide to Breast Cancer
5
Physician’s Honors
• SSM Healthcare — St. Louis Guardian Angel Award: received for exceptional care to
patients, April, 2012
• Pittsburgh, PA affiliate of the Susan G. Komen Foundation recognition for outstanding
service and dedication, 2010
• Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Lynn Sage
• Breast Cancer Symposium Breast Cancer Achievement Program Award, 2009
• Nominated for the Robert C. Irwin Award for Outstanding Research Paper, 2009
• Research paper finalist for the Botsford Hospital Alvin Yarrows Award, 2009
Physicians’ Research, Publications and Presentations
Shapiro-Wright HM, Julian TB. Sentinel Lymph Node Biopsy and Management of the Axilla
in Ductal Carcinoma In Situ. JNCI In Press
Erb, JM, Shapiro-Wright HM, Julian TB. Axillary Recurrences Following Positive Sentinel
Lymph Node Biopsy with Individual Tumor Cells or Micrometastases and No Axillary
Dissection. Breast Disease In Press
Duggal S, Shapiro-Wright HM, Julian TB. Recurrent phyllodes tumor in a 21 year old female:
a case study and comprehensive review of the literature. — In press
Croshaw R, Shapiro-Wright HM, Svensson E, Erb K, Julian T. Accuracy of clinical exam, digital
mammogram, ultrasound, and MRI in determining post-neoadjuvant pathologic tumor response
in operable breast cancer patients. Ann Surg Oncol. 2011 Oct;18(11):3160-3. Epub 2011 Sept 27.
Shapiro-Wright H, Cowher M, Erb K, Julian T. Does pre- and post-neoadjuvant breast imaging
influence treatment decisions in patients undergoing neoadjuvant chemotherapy for invasive
breast cancer? A retrospective review, abstract and poster presentation American Society of
Breast Surgeons, 2010 conference
MyChart®
As with other Mercy Health physicians, Dr. Shapiro-Wright offers MyChart to her patients.
MyChart is a complimentary internet application that provides convenient, secure online
access to your personal health record. Please ask the office for more information to sign up.
6 Mercy Health — Physicians
“I have dedicated my life to helping fight breast disease and
increased awareness of women’s health issues. I stand with
my patients every step of the way.”
Donna Stahl, MD
Physician’s Education
Dr. Stahl is board-certified in surgery and completed her Internship and Residency at the
University of Cincinnati Medical Center. She was the Assistant and Associate Professor of Surgery
there from 1978 to 1989. She completed her undergraduate degree from Augustana College,
Rock Island, Illinois and her medical degree from the University of Iowa, Iowa City, Iowa.
Her stellar career has involved collaboration with the top physicians of many disciplines in
the development of multiple Breast Centers.
For the last thirty-five years, Dr. Stahl has been practicing Breast Surgery and the
Management of Breast Disease in greater Cincinnati.
Dr. Stahl will remain in her current location, (4750 E. Galbraith Road, Suite 112, Cincinnati, Ohio
45236,) until the Women’s Center moves over to 4700 E. Galbraith Road, this summer.
A Patient ’s Guide to Breast Cancer
7
What is Breast Cancer?
Cancer is a disease characterized by DNA damage that causes
abnormal cell growth and development. Cancer cells no longer divide
and differentiate normally. They have the ability to invade surrounding
tissues and travel to distant sites. Doctors do not know exactly what
causes breast cancer, why it behaves the way it does, or why it spreads
in one woman and not in another.
Types of Breast Cancer
Ductal Carcinoma In Situ (DCIS): This is noninvasive breast cancer, meaning the cancer is
confined to the ducts of the beast. It has not spread through the walls of the ducts into the
fatty tissue. It cannot spread to other parts of the body.
Infiltrating (Invasive) Ductal Carcinoma: This is the most common type of breast cancer,
accounting for about 80% of invasive types. This cancer starts in a milk passage, or a duct,
breaks through the wall of the duct, and invades the fatty tissue of the breast. It does have
the ability to spread to other parts of the body.
Lobular Carcinoma In Situ: Also called LCIS, this is generally considered to be a pre-cancerous
condition. It is lobular because the cancer is confined to the lobules, which are the glands that
actually make milk. In situ or “in its original place” means that the cancer has not spread to any
surrounding tissues.
Infiltrating (Invasive) Lobular Carcinoma: This is a cancer that starts in the milk glands or
lobules. It can spread to other parts of the body.
Locally Advanced Cancer: This is cancer that has spread to large parts of the breast or the
nearby lymph nodes.
Inflammatory Breast Cancer: This is a fairly rare type of breast cancer. The breast looks red
and swollen and feels warm. The redness and warmth occur because the cancer cells block
the lymph vessels in the skin. The skin of the breast may also show a pitted appearance called
peau d’ orange (like the skin of an orange). Sometimes a lump is also found in the breast.
There are several less common types of breast cancer that we can provide information about,
if your diagnosis does not include one of the above.
A Patient ’s Guide to Breast Cancer
9
Anatomy of the Breast
A woman’s breast is divided into sections called lobes. Each lobe has groups of tiny bulbs
called lobules. Lobules produce milk. Thin structures called ducts start from the lobes and
carry milk to the nipple, located in the center of the areola. The areola is the dark skin around
the nipple. Surrounding the lobules and ducts is fat. Muscles are found over the ribs and under
each breast. The breast contains blood vessels and lymph vessels. Lymph is a clear fluid that
contains tissue waste-products and immune-system cells. This fluid is carried in lymph vessels
that lead to small collections of tissue called lymph nodes. Most of the lymphatic vessels of the
breast lead to lymph nodes under the arm (axillary nodes). Groups of lymph nodes are also
located near the breast, above the collarbone, in the chest, and in many other parts of the body.
Source: American Cancer Society (ACS) Web site, www.cancer.org.
Ribs
Pectoralis
minor muscle
Lobules
Milk duct
Areola
Fatty
connective
tissue
10 Mercy Health — Physicians
Pectoralis
major muscle
How is Breast Cancer Found?
The earlier breast cancer is found, the better the chances that
treatment will work. The goal is to find cancers before they start to
cause symptoms. The size of a breast cancer and how far it has spread
are the most important factors in predicting the outlook for the patient.
Most doctors feel that early detection tests for breast cancer save
thousands of lives each year.
Following the guidelines given here improves the chances that breast
cancer can be found at an early stage and treated successfully.
American Cancer Society (ACS) Guidelines for
Early Breast Cancer Detection
The ACS recommends the following guidelines for finding breast cancer early, in women
without symptoms.
Mammogram: Women age 40 and older should have a mammogram every year and should
continue to do so for as long as they are in good health. While mammograms can miss some
cancers, mammography is still a very good way to find breast cancer.
A mammogram is an x-ray of the breast. This test is used to look for breast disease in women
who appear to have no breast problems. It can also be used when women have symptoms,
such as those listed later in this notebook.
During mammography, the breast is pressed between 2 plates, to flatten and spread the
tissue. The pressure lasts only for a few seconds.
Although this may cause some discomfort for a moment, it is needed, to get a good picture.
Very low levels of radiation are used. While many people are worried about exposure to x-rays,
the low level of radiation used for acquiring mammograms does not significantly increase the
risk of breast cancer. For example, taking one mammogram requires roughly the same amount
of radiation a person would get by flying from New York to California on a jet plane.
For the mammogram, you undress above the waist. You will have a wrap to cover yourself.
A technologist (most often a woman) will position your breast correctly for the test. The
compression lasts only a few seconds, while the x-ray is taken. The whole procedure takes
about 20 minutes.
You will get your results before you leave the Breast Care Center.
A Patient ’s Guide to Breast Cancer
11
About one tenth of the women who have mammography will need more pictures taken,
but most of these women do not have breast cancer, so do not be alarmed if this happens
to you. Of every 1,000 mammograms, only 1 or 2 mammograms lead to a diagnosis of cancer.
A woman with a higher risk of breast cancer should talk with her doctor about the best
approach for her. She may benefit from starting mammography when she is younger, having
them more often, or having other tests. If you are a higher risk, your doctor might recommend
ultrasound or magnetic resonance imaging (MRI) tests.
Digital Mammograms: Digital mammography uses the same technique as film-screen
mammography, except that the image is recorded directly into a computer. The image can then
be enlarged or highlighted. This new technology is more expensive than film mammography
and not as widely available. Researchers have determined that digital mammography is
significantly better at detecting breast cancers than film mammography in three groups
of women: women who are younger than 50, women who have dense breasts and women
who are pre-menopausal or peri-menopausal (have had their last period within a year
of their mammogram.)
Clinical Breast Exam: Women in their 20s and 30s should have a clinical breast exam (CBE)
as part of a regular exam by a health expert, preferably every three years. After age 40,
women should have a breast exam by a health expert every year. It might be a good idea
to have the CBE shortly before the mammogram. You can use the exam to learn what your
own breasts feel like.
A clinical breast exam (CBE) is an exam of your breasts by a health expert, such as a doctor,
nurse practitioner, nurse, or physician assistant. For this exam, you undress from the waist up.
The examiner will first look at your breasts for changes in size or shape. Then, using the pads
of the fingers, she or he will gently feel your breasts for lumps. The area under both arms will
also be examined. This is a good time to learn how to do breast self-examination if you do not
already know how.
12 Mercy Health — Physicians
Breast Self-Examination (BSE)
It is recommended that women start to perform monthly BSEs in their 20s. Performing a
monthly exam will help you become familiar with how your breast feels normally so that you
can easily notice any change. You should examine your breast approximately 7 to 10 days after
the start of your menstrual cycle. If you are post-menopausal, you may pick any day of the
month. You can have your physician or healthcare provider check your method to ensure that
you are performing the exam correctly. A nurse from the Breast Care Center would be willing
to review the exam process with you during your visits. A shower card to help you remember
to examine your breast has been included in this notebook. The important issue is that you
establish a monthly breast health routine to examine your breast.
By being aware of how your own breasts feel, you are likely to notice any changes that take
place. You can also choose to use a step-by-step approach to checking your breasts on a set
schedule. The best time to do BSE is when your breasts are not tender or swollen. If you find
any changes, see your doctor right away.
The most important thing is to see your doctor right away if you notice any of these changes:
a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness
or scaliness of the nipple or breast skin, or a discharger other than breast milk. But remember
that most of the time these breast changes are not cancer.
Breast Self Exam Guide
Lying down or in the shower is a good place
to examine your breasts. Begin by raising your
arm behind your head. Feel for changes in your
breast, above and below your collarbone, and
in your armpit.
Using the pads of your fingers, press using light,
medium and firm pressure in a circle without lifting
your fingers off the skin. Follow an up and down
pattern, checking for lumps or thickening.
After a shower or bath, stand in front of a
mirror and check your breasts. Look for any
dimpling, swelling, or redness of the skin.
A Patient ’s Guide to Breast Cancer
13
“Turn your face to the sun
and the shadows
fall behind you.”
— Maori Proverb
Risk
Risk
Breast Cancer Risk
Anything that increases the chance of developing a disease is
called a risk factor.
Risk factors for breast cancer include the following:
• Age
• Age at the start of menstruation
• Age at first live birth
• Number of first-degree relatives (mother, sisters) with breast cancer
• Number of previous breast biopsies (whether positive or negative)
• At least one breast biopsy with atypical hyperplasia
Other risk factors — such as age at menopause, dense breast tissue on a mammogram, use
of birth control pills or hormone replacement therapy, a high-fat diet, drinking alcohol, low
physical activity, obesity, or environmental exposures — are not included in risk estimates
with the Breast Cancer Risk Assessment Tool for three reasons: evidence is not conclusive,
or researchers cannot accurately determine how much these factors contribute to the
calculation of risk for an individual woman, or adding these factors does not appreciably
increase the accuracy of the tool.
Breast cancer may also be caused by inherited gene mutations. Hereditary breast cancers
account for approximately 5% to 10% of all breast cancers. Specific hereditary predispositions
for breast cancer, such as inheriting a mutation in the BRCA1 or BRCA2 genes, are not taken
into account in risk estimates with the Breast Cancer Risk Assessment Tool. Although the
Breast Cancer Risk Assessment Tool performs well in clinics, where women have a strong
family history of breast cancer, more specific methods of projecting risk are appropriate if
a woman is known to carry a breast cancer-producing mutation in BRCA1 or BRCA2.
Researchers are, however, conducting additional studies to gather more data and to
determine whether including information on other risk factors can strengthen the statistical
model, called the Gail Model, upon which the Breast Cancer Risk Assessment Tool is based.
Nonetheless, the current model estimates breast cancer risk accurately, on average.
For more information on breast cancer risk, please visit Breast Cancer: Prevention, Genetics,
and Causes at http://www.cancer.gov/cancertopics/prevention-genetics-causes/breast
Source: National Cancer Institute (NCI) website http://www.cancer.gov/bcrisktool/breastcancer-risk.aspx
A Patient ’s Guide to Breast Cancer
15
Women at high risk
Women with a higher risk of breast cancer should talk with their doctor about the best
approach for them. This might mean starting mammography when they are younger, having
extra tests, or having more frequent exams.
Symptoms of Breast Cancer
While the widespread use of screening mammography has increased the number of breast
cancers found before they cause any symptoms, some are still missed.
The most common sign of breast cancer is a new lump or mass. A lump that is painless, hard,
and has uneven edges is more likely to be cancer. But some cancers are tender, soft, and
rounded. So it is important to have anything unusual checked by your doctor.
Other signs of breast cancer may include the following:
• A swelling of part of the breast
• Skin irritation or dimpling
• Nipple pain or the nipple turning inward
• Redness or scaliness of the nipple or breast skin
• A nipple discharge other than breast milk
• A lump in the underarm area
16 Mercy Health — Physicians
— Winston Churchill, British politician
Path To
Diagnosis
Path To Diagnosis
“Never, never, never give up.”
If Breast Cancer is Suspected
If there is any reason to think you might have breast cancer, you will
need other tests. After asking you some questions and doing a complete
physical exam (including a clinical breast exam), your doctor may
suggest further tests, such as the ones below.
Breast Imaging Tests
Mammography: Although mammograms are mostly used for screening, they can also be
used if there is reason to think you might have breast cancer. These are called diagnostic
mammograms. This kind of mammogram might show that everything is okay and you can
return to having a yearly screening mammogram. Or it might show that a biopsy should be
done. Even if the mammogram does not show a tumor, if you or your doctor can feel a lump,
you may need a biopsy. The exception is if the ultrasound scan shows that the lump is a cyst.
A mammogram cannot show for sure whether cancer is present or not. If your mammogram
points to a possible problem, a sample of breast tissue is removed and looked at under a
microscope. This is called a biopsy.
Breast Ultrasound: Also referred to as sonography, uses sound waves to outline a part of the
body. The sound wave echoes are picked up by a computer which creates an image (picture)
that is displayed on the computer screen. The image is called a sonogram.
A breast ultrasound scan has become a good method to use along with mammography. It is
widely available and costs less than other tests. Usually, it is used to look at a certain area of
concern found on a mammogram. It also helps to tell the difference between cysts and solid
masses, without using a needle to draw out fluid.
Magnetic Resonance Imaging (MRI): An MRI scan uses radio waves and strong magnets
instead of x-rays. A computer translates these waves into a very detailed picture. Special
types of MRI scans can be used to better examine cancers found on mammograms or to
diagnose women who have a high risk of breast cancer. But we do not yet know whether
finding small cancers this way really saves lives.
A ductogram (also called a galactogram) is a special kind of x-ray that is sometimes helpful
in finding the cause of a nipple discharge. A fine plastic tube is placed into the opening of the
duct at the nipple. A substance is injected to outline the shape of the duct on an x-ray picture.
It will show if there is a mass inside the duct. If there is a discharge, the fluid can be tested for
cancer cells.
There are several other tests that can help tell the doctor more about your own situation. If
you need any of these, ask your doctor to explain them to you. You can also contact the ACS
for more information.
A Patient ’s Guide to Breast Cancer
17
Biopsy
Biopsy: A biopsy is done when other tests show that you might have breast cancer. The only
way to know for sure is to have a biopsy. During this test, cells from the breast are removed so
they can be studied in the lab. There are several kinds of biopsies. The doctor will select the
one that is best for you.
Fine-Needle Aspiration Biopsy (FNAB): In this test, a very thin (fine) needle is used to try to
draw fluid out of the lump. Your doctor might use ultrasound to guide the needle into the lump.
If the fluid drawn out is clear, the lump is most likely a benign cyst. Bloody or cloudy fluid can
mean, in rare cases, cancer. If the lump is solid, small pieces of tissue are removed and looked
at under a microscope to see if they are cancer.
If the biopsy does not provide a clear answer, or if your doctor is still not sure, a second biopsy
or a different type of biopsy may be needed. Your physician will discuss further diagnostic
options with you.
Core Needle Biopsy: During this breast biopsy, a needle will be guided by x-ray (stereotactic)
or by ultrasound in order to remove pieces of tissue (core) for examination by the pathologist.
A local anesthetic is used to numb the area so that a small opening can be made in the skin
to allow the biopsy needle to enter the breast. The radiologist inserts the biopsy needle and
cores of tissue are removed. At times, the radiologists may place a non-magnetic clip at the
site to mark the area where the tissue was removed. Following the procedure, Steri-strips
(tape), a pressure dressing and ice will be applied over the biopsy site. Your physician will
be notified as soon as the biopsy results are available.
Biopsy Lab Tests: The tissue removed during a biopsy is looked at in the lab, to see whether
it is benign or cancerous. If it is not cancer, then no further immediate treatment is needed.
If it is cancer, the biopsy can help to tell the type of cancer you have and show whether it is
invasive or not.
The biopsy sample is also given a grade, from 1 to 3 or low to high. Cancers that look more like
normal breast tissue tend to grow and spread more slowly. In general, a lower grade number
means a slower-growing cancer, while a higher number means a faster-growing cancer. So the
grade helps predict the outcome (prognosis) for the woman.
The biopsy sample also can be tested to see whether it has receptors for certain hormones,
such as estrogen and progesterone. If it does, it is often referred to as ER-positive or
PR-positive. Such cancers tend to have a better outlook than cancers without these
receptors, because they are much more likely to respond to hormone treatment.
About 2 of 3 breast cancers have these receptors.
Other lab tests may also be done to help figure out how quickly the cancer is growing and
what treatments might work best.
18 Mercy Health — Physicians
Test to Find Breast Cancer Spread
Chest X-ray: This test may be done, to see whether the cancer has spread to the lungs.
Bone Scan: This test can help show whether the cancer has spread to the bones. The patient
is given a very low does of radiation. The bone attracts the radiation, which shows up on the
scan as a “hot spot.” A hot spot could be cancer, but might be caused by a different problem
such as arthritis; therefore, x-rays of hot spots may be needed.
CT (computed tomography): A CT scan is a special type of x-ray. Many pictures are taken,
from different angles. These images are combined by a computer to produce a detailed
picture of the internal organs. This test can help tell if the cancer has spread to the liver
or other organs. It can also be used to guide a biopsy needle into a suspicious area.
MRI (magnetic resonance imaging): An MRI scan uses radio waves and strong magnets
instead of x-rays. This test can be helpful in looking at the brain and spinal cord.
PET (positron emission tomography): This test uses a form of sugar that contains a
radioactive atom. Cancer cells absorb high amounts of this sugar. A special camera can
then spot these cells. PET scanning is useful when the doctor thinks the cancer has spread,
but doesn’t know where. It may also be useful to check lymph nodes for cancer, before the
nodes are removed.
There are other tests that might be done to help the doctor decide the best treatment for you.
Ask the doctor to explain any other tests you are having.
If cancer is found, there is time for you to learn about the disease. A biopsy is done first,
followed by further testing, and then a decision about treatment is made. You have time to
talk to your doctor and family before choosing a course of action. There is no need to rush
into treatment. You may also want to get a second opinion before you decide on the
treatment that is best for you.
A Patient ’s Guide to Breast Cancer
19
“Each day comes
bearing its own gifts.
Untie the ribbons.”
— Ruth Ann Schabacker, author
Pathology
Pathology
Your Guide to the Breast
Cancer Pathology Report
Developed for you by breastcancer.org, the world’s leading
Internet-based nonprofit breast cancer organization.
A report is written each time that tissue is removed from the body to check for cancer. It is
called a pathology report. Each report has the results of the studies of the tissue that was
removed. The information in these reports will help you and your doctor decide about the
best treatment for you.
Reading your pathology report can be scary and confusing. The words are like a foreign
language. Different labs may use different words to describe the same thing. We hope
we can help you make sense of this information so you can get the best care possible.
Remember: No matter what the pathology report says about the cancer, there are many
effective treatments available to deal with it.
This is what the inside of the breast looks like.
Ribs
Duct
Pectoralis
minor muscle
Pectoralis
major muscle
Nipple
Areola
Fatty
connective
tissue
A Patient ’s Guide to Breast Cancer
21
Explanation of Biopsy Pathology Report
EXAMPLE BIOPSY PATHOLOGY REPORT
PATIENTS NAME: Jane Doe
CASE ID: JHS-12-000001
DOCTOR: Doctor’s Name
DATE OF PROCEDURE: month/day/year
PRE-PROCEDURE DIAGNOSIS: Reason procedure is being done
POST- PROCEDURE DIAGNOSIS: Should be the same as Pre-Procedure Diagnosis
SPECIMEN: Right/Left, breast mass (breast tissue)
PATHOLOGIC DIAGNOSIS: What the pathologist is telling us they find, Example: DCIS or
infiltrating ductal carcinoma
COMMENT: Descriptive section following diagnosis that gives more information
-Description of what tissue the pathologist is looking at (example: 2 core biopsy specimens)
-What the pathologist sees when they look under the microscope (example: microscopic evaluation of the specimens
shows breast ductal cells infiltrated by neoplastic (cancer) cells.
-Description of what the cancer cells look like, the size, and amount of cancer present (example: the cancer
cells are found in solid sheets with longest contiguous length of 9 mm. Marked nuclear changes are noted
with increased mitoses up to 10-12 per 10 high power field. No in situ component, lymphvascular invasion
or calcifications are seen.
GROSS DESCRIPTION: Describes what the pathologist sees when he looks at the tissue with his eyes
-How the pathologist receives the specimen (example: Specimen received in formalin in a single container labeled
with the patient's name and "right breast" and consists of 2 needle core fragments each measuring about 1 cm. )
ESTROGEN/PROGESTERONE RECEPTOR: What is the status of the receptors found on
your tumor cells (are they positive or negative). Are your tumor cells sensitive to the hormones
estrogen and progesterone.
-ER status (strongly positive, weakly positive, negative)
-PR status (strongly positive, weakly positive, negative)
HER2NEU RECEPTOR: This test is always completed on invasive cancers, and sometimes on
non-invasive cancers. What is the status of the receptors found on your tumor cells
-This test can be performed two different ways (IHC and FISH). IHC is most commonly performed first and if
found to be indeterminate (2+) then FISH is completed.
-Her2neu status (amplified (3+), non amplified (1+))
22 Mercy Health — Physicians
“It’s always too early to quit.”
— Norman Vincent Peale, minister
My Diagnosis
My Diagnosis
Explanation of Surgical Pathology Report
EXAMPLE SURGICAL PATHOLOGY REPORT:
PATIENT’S NAME: Jane Doe
CASE NUMBER: JHS-12-00001
SPECIMEN(S): List of all tissue obtained (usually labeled by number or letter)
CLINICAL HISTORY: information about the patient; what’s known about the patient’s cancer
FINAL DIAGNOSIS: Description of the final results. Each tissue will be resulted individually
A. Sentinel lymph node #1: One lymph node negative for metastatic carcinoma
B. Sentinel lymph node #2: One lymph nodes negative for metastatic carcinoma
C. Left/ Right breast tissue: Invasive and in situ ductal carcinoma, 11mm in greatest diameter
FROZEN SECTION DIAGNOSIS: What was seen by the pathologist and reported to the surgeon
during surgery/on the day of surgery. The preliminary results reported from the first look during surgery
GROSS DESCRIPTION: What the pathologist sees with his eyes when looking at each piece of
tissue. Each piece of tissue will be described separately. It will include how the specimen is oriented,
inked, and size.
SYNOPTIC REPORT: Summary to all involved information
Procedure completed: Partial mastectomy with sentinel lymph node biopsy
Specimen Laterality (side surgery was completed on): Right
Histologic Type (type of cancer): Invasive ductal/lobular carcinoma
Tumor Size: How big the tumor is, measured in either millimeters or centimeters
Histologic Grade: Number grade assigned to the tumor based on cells characteristics, number 1-3
Tumor Focality: How many areas of tumor are seen (single or multiple foci)
Ductal Carcinoma In Situ (DCIS): is non invasive cancer present (yes/no)
Margins: are the margins of the specimen involved by invasive and/or noninvasive cancer
Distance from closest margin: How far is the cancer from the closest margin
Number of sentinel lymph nodes examined: #
Total number of lymph nodes examined (sentinel and non-sentinel): #
Number of lymph nodes with macrometastases (disease in lymph node measuring more than 2 mm): #
Number of lymph nodes with micrometastases (disease in lymph node measuring greater than 0.2 mm up
to 2 mm and/or >200cells): #
Number of lymph nodes with isolated tumor cells (disease in lymph node measuring less than 0.2 mm and
less than 200 cells): #
Number of lymph nodes without tumor cells identified: #
PATHOLOGIC STAGING(pTNM): What stage the pathologist gives to the cancer based on the
information they obtain from looking at everything (breast tumor and lymph nodes) under the
microscope- T=tumor size, N=lymph node status, M=metastatic disease
A Patient ’s Guide to Breast Cancer
23
Introduction: Wait for the Whole Picture
Waiting is so hard! But just one test can lead to several different reports. Some tests take
longer than others. Not all tests are done by the same lab. Most information comes within
one to two weeks after surgery, and you will usually have all the results within a few weeks.
Your doctor can let you know when the results come in. If you do not hear from your doctor,
give the office a call.
Get All the Information You Need
Be sure that you have all the test information you need before you make a final decision about
your treatment. Also, do not focus too much on anyone piece of information by itself. Try to
look at the whole picture as you think about your options.
Different labs and hospitals may use different words to describe the same thing. If there are
words in your pathology report that are not explained in this booklet, do not be afraid to ask
your doctor what they mean.
Breast Cancer Stage
The pathology report will help your doctor decide the stage of your breast cancer. It could be
Stage 0, I (1), II (2), IIA (2A), IIB (2B), IIIA (3A), IIIB (3B), or IV (4).
Staging is based on the size of the tumor, whether lymph nodes are involved, and whether the
cancer has spread beyond the breast. Your doctors use all parts of the pathology report, as
well as the breast cancer stage, to shape your treatment plan.
How to Start Using Your Reports
First, check the top of the report for your name, the date you had your operation, and the
type of operation you had. Make sure they are right for you.
Expert Tip: Pathology reports often come in bits and pieces. Just after surgery, the cancer
cells are first looked at under the microscope. Results from additional studies that require
special techniques may take longer. So you may have one, two, or three pathology reports
from one surgery. Try to put them all together and keep them in one place, so that when
you go for your treatment evaluations, the doctors will have all the information they need.
24 Mercy Health — Physicians
Parts of Your Report
Specimen: This section describes where the tissue sample(s) came from. Tissue samples could
be taken from the breast, from the lymph nodes under your arm (axilla), or both.
Clinical History: This is a short description of both you and how the breast abnormality
was found. It also describes the kind of surgery that was done.
Clinical Diagnosis: This is the diagnosis the doctors were expecting before your tissue
sample was tested.
Gross Description: This section describes the tissue sample or samples. It talks about the size,
weight, and color of each sample.
Microscopic Description: This section describes the way the cancer cells look under
the microscope.
Special Tests or Markers: This section reports the results of tests for proteins, genes, and
how fast the cells are growing.
Summary or Final Diagnosis: This section is the short description of all the important findings
related in each tissue sample.
A Patient ’s Guide to Breast Cancer
25
The Breast Cancer
1. Is the tumor cancer?
A tumor is an overgrowth of cells. It can be made of normal cells or cancer cells. Cancer cells
are cells that grow in an uncontrolled way. They may stay in the place where they started to
grow, or they may grow into the normal tissue around them.
The pathology report will tell you what kinds of cells are in the tumor.
2. Is the breast cancer invasive?
The single most important fact about any breast cancer is whether it has grown beyond the
milk ducts or lobules of the breast where it first started.
Non-invasive cancers stay within the milk ducts or milk lobules in the breast. They do not grow
into or invade normal tissues within or beyond the breast. These are sometimes called in situ
cancers or pre-cancers.
If the cancer has grown beyond where it started, it is called invasive. Most cancers are
invasive. Sometimes cancer cells can also spread to other parts of the body through
the blood or lymph system.
This is what the cells inside a mile duct look like under a microscope.
NORMAL
26 Mercy Health — Physicians
NON-INVASIVE
INVASIVE
You may see these descriptions of cancer in your report.
DCIS (Ductal Carcinoma In Situ): This is a cancer that is not invasive. It stays inside the milk ducts.
Note: There are subtypes of DCIS.
LCIS (Lobular Carcinoma In Situ): This is a tumor that is an overgrowth of cells that stay
inside the milk-making part of the breast (called lobules). LCIS is not a true cancer. It is a
warning sign for an increased risk of having an invasive cancer in the future, in either breast.
IDC (Invasive Ductal Carcinoma): This is a cancer that begins in the milk duct but grows into
the surrounding normal tissue inside the breast. This is the most common kind of breast cancer.
ILC (Invasive Lobular Carcinoma): This is a cancer that starts inside the milk-making glands
(called lobules), but grows into the surrounding normal tissue inside the breast.
Note: There are other, less common types of invasive breast cancer.
My Report says:
I have the
type of cancer.
3. H
ow different are the cancer cells from normal cells?
Experts call this “grade.” They compare cancer cells to normal breast cells. Based on these
comparisons, they give a “grade” to the cancer.
There are three cancer grades:
Grade 1 (Low Grade or Well Differentiated): Grade 1 cancer cells still look a lot like normal
cells. They are usually slow-growing.
Grade 2 (Intermediate/Moderate Grade or Moderately Differentiated): Grade 2 cancer cells
do not look like normal cells. They are growing somewhat faster than normal cells.
Grade 3 (High Grade or Poorly Differentiated): Grade 3 cancer cells do not look at all like
normal cells. They are fast-growing.
My report says the cancer is:
Grade I
Grade 2
Grade 3
A Patient ’s Guide to Breast Cancer
27
4. How big is the cancer?
Doctors measure cancers in centimeters (cm). The size of the cancer helps to determine its stage.
Size does not tell the whole story. Lymph node status is also important. A small cancer can be
very fast-growing. A larger cancer can be a “gentle giant.”
My report says:
The size of the cancer is
centimeters.
5. What is the difference between stages?
The pathology report will help your doctor decide the stage of your breast cancer. It could be
Stage 0, I (1), II (2), IIA (2A), IIB (2B), IIIA (3A), IIIB (3B), or IV (4).
Staging is based on the size of the tumor, whether lymph nodes are involved, and whether
the cancer has spread beyond the breast. Your doctors use all parts of the pathology report,
as well as the breast cancer stage, to shape your treatment plan.
Tumor Sizes
2 cm
20 mm
3/4 in
1 cm
10 mm
3/8 in
28 Mercy Health — Physicians
3 cm
30 mm
1 1/8 in
5 cm
50 mm
2 in
Categories of T, N, and M
T categories: T categories are based on the size of the breast cancer and whether it has
spread to nearby tissues.
• Tis: Tis is used only for carcinoma in situ or non-invasive breast cancer, such as ductal
carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS).
• Tl: The cancer is 2 cm in diameter (about 3/4 inch) or smaller.
• T2: The cancer is more than 2 cm in diameter but not more than 5 cm in diameter.
• T3: The cancer is more than 5 cm in diameter.
• T4: The cancer is any size and has spread to the chest wall or the skin.
N Categories: The N category is based on which of the lymph nodes near the breast, if any,
are affected by the cancer. There are 2 classifications used to describe N. One is the clinical —
before surgery — in other words, what the doctor can feel or see on imaging studies. The other
is pathological — what the pathologist can see in lymph nodes removed during surgery.
• NO Clinical: The cancer has not spread to lymph nodes, based on clinical exam.
• NO Pathological: The cancer has not spread to the lymph nodes, based on examining them
under the microscope.
• Nl Clinical: The cancer has spread to lymph nodes under the arm on the same side as the
breast cancer. Lymph nodes are not attached to one another or to the surrounding tissue.
• Nl Pathological: The cancer is found in 1 – 3 lymph nodes under the arm.
• N2 Clinical: The cancer has spread to lymph nodes under the arm on the same side as
the breast cancer and the lymph nodes are attached to one another or to the surrounding
tissue. Or the cancer can be seen to have spread to the internal mammary lymph node
(next to the sternum), but not to the lymph nodes under the arm.
• N2 Pathological: The cancer has spread to 4 – 9 lymph nodes under the arm.
• N3 Clinical: The cancer has spread to lymph nodes above or just below the collarbone on
the same side as the cancer, and may or may not have spread to lymph nodes under the
arm. Or the cancer has spread to internal mammary lymph nodes and lymph nodes under
the arm, both on the same side as the cancer.
• N3 Pathological: The cancer has spread to 10 or more lymph nodes under the arm or also
involves lymph nodes in other areas around the breast.
M Categories: The M category depends on whether the cancer has spread to any distant
tissues and organs.
• MO: No distant cancer spread
• M1: Cancer has spread to distant organs
A Patient ’s Guide to Breast Cancer
29
Breast Cancer Stages
Overall StageT CategoryN Category
M Category
Stage 0TisN0M0
Stage IT1N0MO
Stage IIAT0N1M0
T1N1M0
T2 N0 M0
Stage IIB
N1M0
T2
T3N0M0
Stage IIIAT0N2M0
T1N2M0
T2N2M0
T3N2M0
T4N1M0
T5N2M0
Any N M0
Stage IIIB
T4
Stage IIIC
Any T N3
Stage IV
Any T Any N M1
MO
My report says:
Clinically, I am stage
My final pathological stage is
.
.
6. H
ow fast are the cancer cells growing? (Rate of Growth)
Two tests may be used to see how fast the cancer is growing: the S-phase fraction test and the
Ki-67 test. Both tests measure if the cells are growing at a normal rate or faster than normal.
Even in very experienced labs, these tests are hard to do reliably. That is why many doctors
depend on other information to make the best treatment decisions.
30 Mercy Health — Physicians
7. Do the cancer cells have hormone receptors?
Hormone receptors are like ears on breast cells that listen to signals from hormones.
These signals “turn on” growth in breast cells that have receptors.
A cancer is called “ER-positive” if it has receptors for the hormone estrogen. It is called
“PR-positive” if has receptors for the hormone progesterone. Breast cells that do not have
receptors are “negative” for these hormones.
Breast cancers that are either ER-positive or PR-positive, or both, tend to respond well to
hormone therapy.
These cancers can be treated with medicine that reduces the amount of estrogen in your
body. They can also be treated with medicine that keeps estrogen away from the receptors.
If the cancer has no hormone receptors, there are still very effective treatments available.
You will see the results of your hormone receptor test written in one of these three ways:
1. The number of cells that have receptors, out of 100 cells that were tested. You will see a
number between 0% (no receptors) and 100% (all have receptors).
2. A
number between 0 and 3. You will see the number:
• 0 (no receptors),
• 1+ (a small number),
• 2+ (a medium number), or
• 3+ (a large number of receptors) .
3. The word “positive” or “negative.”
Note: If your report just says “negative,” ask your doctor or lab to give you a number. This is
important because sometimes a low number may be called “negative.” But even cancers with
low numbers of receptors may respond to hormone therapy.
My report says hormone receptors are:
ER-positive
ER-negative
PR-positive
PR-negative
A Patient ’s Guide to Breast Cancer
31
8. Does the cancer have genes that are not normal?
HER-2 status (also called HER-2/neu) HER-2 is a gene that helps control how cells grow,
divide, and repair themselves. About one out of four breast cancers has too many copies of
the HER-2 gene. The HER-2 gene directs the production of special proteins, called HER-2
receptors, in cancer cells.
Cancers with too many copies of the HER-2 gene or too many HER-2 receptors tend to grow
fast. They are also associated with an increased risk of spreading. But they do respond very
well to treatment that works against HER-2. This treatment is called anti-HER-2 antibody therapy.
My report says HER-2 status is:
Positive
Negative
Test used:
IHC
FISH
There are two tests for HER-2
1. IHC Test (IHC stands for ImmunoHistoChemistry)
• The IHC test shows if there is too much HER-2 receptor protein in the cancer cells
• The results of the IHC test can be 0 (negative), 1+ (negative), 2+ (borderline), or 3+ (positive)
2. F
ISH Test (FISH stands for Fluorescence In Situ Hybridization)
• The FISH test shows if there are too many copies of the HER-2 gene in the cancer cells
• The results of the FISH test can be “positive” (extra copies) or “negative”
(normal number of copies)
Find out which test for HER-2 you had. This is important. Only cancers that test IHC “3+” or
FISH “positive” will respond well to therapy that works against HER-2. An IHC 2+ test result
is called borderline. If you have a 2+ result, you can and should ask to have the tissue tested
with the FISH test.
32 Mercy Health — Physicians
— Alex Karras, actor
Surgical Oncology
Surgical Oncology
“Toughness is in the soul
and spirit, not in muscles.”
Surgical Treatment
Determining if you need to have surgery.
For years, surgery has been the first line of attack against breast cancer. The goal today is
precise, targeted surgery that tries to preserve as much of the healthy breast and surrounding
area as possible.
Surgery is one part of the plan that we all develop to treat your breast cancer. It is hard for
some women to think about losing a breast (having a mastectomy). Fortunately, many women
can be successfully treated with a lumpectomy.
It is important for you to understand that breast cancer does not affect just the breast. When
a breast cell changes into a cancer cell, it has the capability of spreading to other parts of your
body through the blood or lymph system. This is called metastatic disease. It is only when
cancer spread to other areas — like bone, the lungs and liver — that breast cancer can hurt
you and ultimate cause your death. So we are never focused on just taking care of your breast.
We will use the information obtained from your surgery to determine if chemotherapy,
hormonal therapy and radiation therapy may be of benefit to you.
Breast-conserving Therapy
It is hard for any woman to imagine having to lose her breast. Fortunately, with early detection,
most women can have a lumpectomy (removal of the breast lump and a rim of normal tissue)
followed by radiation treatment to the remaining breast tissue, and know that her chances for
survival are the same as if she had her breast removed.
Lumpectomy is often referred to as segmental mastectomy or partial mastectomy. All these
terms mean that the breast will be preserved.
Lymph-node dissection or sentinel lymph-node biopsy is often done at the same time as
the lumpectomy.
Mastectomy
In a simple (total) mastectomy procedure, surgeons remove the entire breast, but do not
cut away any lymph nodes form under the arm or muscle tissue from beneath the breast.
This procedure is used to treat noninvasive breast cancer. In a modified radical mastectomy,
surgeons remove the entire breast and some axillary (underarm) lymph nodes.
Doctors rarely perform a radical mastectomy, which removes not only the entire breast and
lymph nodes under the arm, but also the chest wall muscles under the breast. At one time,
this surgery was quite common, but it left women disfigured and caused side effects. The
modified radical mastectomy has been proven as effective as the radical mastectomy.
A Patient ’s Guide to Breast Cancer
33
Choosing between Lumpectomy and Mastectomy
The advantage of lumpectomy is that it saves the appearance of the breast. A disadvantage
is the need for several weeks of radiation therapy after surgery. However, some women who
have a mastectomy still need radiation therapy.
Women who choose lumpectomy and radiation can expect the same chance of survival as
those who chose mastectomy.
Although many women and their doctors prefer lumpectomy and radiation therapy, your
choice will depend on a number of factors, such as those that follow:
• How you feel about losing your breast
• How far you have to travel for radiation therapy
• Whether you are willing to have more surgery or reconstruct your breast after mastectomy
• Your preference for mastectomy as a way to “get rid of all your cancer as quickly as possible”
Lumpectomy and radiation are not appropriate if:
• You have had radiation to the breast or chest wall
• The disease is in several areas of the breast
• There are suspicious areas of calcium spread out in the breast
Lumpectomy and radiation may not be appropriate if:
• Two separate incisions are needed to remove the disease
• You have a connective-tissue disease, such as Scleroderma
• The tumor is larger than 5 cm (about 2 inches)
• You are pregnant
Source: ACS/NCI
34 Mercy Health — Physicians
Lymph Node Surgery
Whether a woman has a mastectomy or lumpectomy for invasive cancer, she and her doctor
usually need to know if the cancer has spread to the lymph nodes. If the lymph nodes are
affected, that increases the likelihood that cancer cells have spread through the bloodstream
to other parts of the body. Most commonly, women with ductal carcinoma in situ do not need
lymph node testing. It is only in specific instances (example: when having a mastectomy) that
lymph node evaluation with ductal carcinoma in situ needs to be performed.
Sentinel Lymph Node Biopsy
Sentinel lymph-node biopsy (SNLB) is a new technique used to evaluate whether a woman’s
breast cancer has spread to the lymph nodes under her arm. Historically, a woman with a
diagnosis of breast cancer would have a lymph node dissection (removal of most lymph
nodes under the arm). Removal of lymph-nodes can lead to swelling and infection, in
addition to numbness and discomfort in the arm and armpit. With SNLB, your surgeon
is able to identify the first (sentinel) lymph node, which filters fluid draining away from the
area of the breast that contained the breast cancer. If cancer cells are breaking away from
the tumor and traveling away from your breast via the lymph system, the sentinel node is
more likely than other lymph nodes to contain cancer. In reality, the surgeon usually
removes a cluster of two or three nodes — the sentinel node and those closest to it.
This spares the woman the side effects of a standard lymph node dissection.
Source: ACS/NCI
A Patient ’s Guide to Breast Cancer
35
Lymphedema
Lymphedema is a swelling of the arm on the side of the body where breast or lymph node
surgery (or radiation of the lymph nodes) was performed. The swelling is caused by a buildup
of the lymph fluids, which are unable to drain from the arm due to the treatment received.
While lymphedema can be a permanent condition, there are many women who experience
very mild swelling. There are many effective ways to treat lymphedema; however, the best
action is to try to prevent it from happening.
The following suggestions are from the National Lymphedema Network, and have proven
helpful to many survivors.
• Absolutely do not ignore any slight increase of swelling in the arm, hand, fingers, or chest
wall; (consult with your healthcare provider immediately)
• Never allow an injection into, or blood to be drawn from, the affected arm(s)
• Use the unaffected arm to have your blood pressure checked
• Keep the swollen arm, or the “at-risk” arm, clean
• Avoid vigorous, repetitive movements against resistance (scrubbing, pushing, pulling)
with the affected arm
• Avoid heavy lifting with the affected arm; never carry heavy (more than 12 pounds)
handbags, luggage, or totes with over-the-shoulder straps.
• Do not wear tight jewelry or elastic bands around affected fingers or arm(s)
• Avoid extreme temperature changes when bathing, washing dishes, or sunbathing
(no sauna or hot tub); keep the arm protected from the sun
• Avoid any type of trauma, such as bruising, cuts, sunburn or other burns, sports injuries,
insect bites, cat scratches
• Wear gloves while doing housework, gardening, or any type of work that could result in
even a minor injury
• When manicuring your nails, avoid cutting your cuticles; inform your manicurist
• Exercise is important, but consult with your physical therapist. Do not overtire an arm
that is at risk. If it starts to ache, lie down and elevate it. Recommended exercises: walking,
swimming, light aerobics, bicycling, and specially designed ballet or yoga. Do not lift more
than 12 pounds.
This information is courtesy of Y-ME National Breast Cancer Organization ©2005.
36 Mercy Health — Physicians
Has the whole cancer been removed?
When cancer cells are removed from the breast, the surgeon tries to take out the whole
cancer along with an extra area or “margin” of normal tissue around it. This is to be sure
that all of the cancer is removed.
The tissue around the very edge of what was removed is called the margin of resection.
It is looked at very carefully to see if it is clear of cancer cells.
The pathologist also measures the distance between the cancer cells and the outer edge
of the tissue.
Note: What is called “negative” (or “clean”) margins can be different, from hospital to hospital.
In some places, doctors want at least 2 millimeters (mm) of normal tissue beyond the edge of
the cancer. In other places, just one healthy cell is called a negative margin.
1 cm
1 mm
1 in
Margins around a cancer are described in three ways:
Negative: No cancer cells can be seen at the outer edge. Usually, no more surgery is needed.
Positive: Cancer cells come right out to the edge of the tissue. More surgery may be needed.
Close: Cancer cells are close to the edge of the tissue, but not right at the edge. More surgery
may be needed.
NEGATIVE MARGINS
POSITIVE MARGINS
Edge
Edge
Normal
cells
Cancer
cells
Normal
cells
Cancer
cells
My report says the margins are:
Negative
Positive
Close
A Patient ’s Guide to Breast Cancer
37
Are there cancer cells in your lymph or blood vessels?
The breast has a network of blood vessels and lymph channels that connect breast tissue
to other parts of the body. These are the “highways” that bring in nourishment and takeover
waste products.
There is an increased risk of cancer coming back when cancer cells are found in the fluid
channels of the breast. In these cases, your doctor may recommend treatment to your
whole body, not just the breast area.
The test result will look like this:
Lymphatic/vascular invasion: PRESENT (yes, invasion was found) or ABSENT (no, invasion
was not found).
My report says lymphatic or vascular invasion is:
Present
38 Mercy Health — Physicians
Absent
The Lymph Nodes
1. Are there breast cancer cells in your lymph nodes?
Having cancer cells in the lymph nodes under your arm is associated with an increased risk
of the cancer spreading. Lymph nodes are filters along the lymph fluid channels. Lymph fluid
leaves the breast and goes back into the bloodstream. The lymph nodes try to catch and trap
cancer cells before they reach other parts of the body.
When lymph nodes are free or “clear” of cancer, the test results are called “negative.” If lymph
nodes have some cancer cells in them, they are called “positive.”
My report says the lymph nodes are:
Positive
Negative
If positive:
The number of involved nodes is
.
2. How many lymph nodes are involved?
The more lymph nodes have cancer cells in them, the more serious the cancer might be. For
this reason, doctors use the number of involved lymph nodes to help make treatment decisions.
Doctors also look at the amount of cancer in the lymph nodes.
You may see these words describing how much cancer is in each lymph node:
Microscopic: Only a few cancer cells are in the node. A microscope is needed to find them.
Gross: There is a lot of cancer in the node. You can see or feel the cancer without a microscope.
Extracapsular Extension: Cancer has spread outside the wall of the node.
For more information, go to: www.breastcancer.org.
Permission to use contents from www.breastcancer.org.
A Patient ’s Guide to Breast Cancer
39
— Eleanor Roosevelt, first lady
Medical and
Radiation Oncology
Medical and Radiation Oncology
“A woman is like a teabag –
you never know how strong she
is until she gets in hot water.”
Chemotherapy, Hormonal
Therapy and Radiation Therapy
Treating breast cancer involves using multiple therapies. Surgery is one
treatment modality. If a lumpectomy was done it is always necessary
to include radiation therapy. Chemotherapy and hormonal therapy are
used to prevent any cancer cell that may have traveled outside of the
breast from multiplying.
To reach cancer cells that my have spread beyond the breast and nearby tissues, doctors give
cancer drugs by mouth or into a vein. This type of treatment is called systemic therapy.
Examples of systemic therapy include chemotherapy and hormone therapy. Systemic therapy
given to patients after surgery is adjuvant therapy. The goal of adjuvant therapy is to kill
undetected cells. Even in the early stages of the disease, cancer cells can break away from
the primary breast tumor and spread through the bloodstream. These cells usually don’t show
up on an x-ray and can’t be felt during a physical examination. But they can establish new
tumors in other places in the body. Systemic therapy given to patients before surgery is
called neo-adjuvant therapy. Sometimes oncologists give patients neo-adjuvant therapy to
try to shrink the tumor enough to make surgical removal possible. This may allow women who
would otherwise need mastectomy to have breast-conserving surgery. Systemic therapy is
the main treatment for women diagnosed with metastatic breast cancer.
Chemotherapy: The most recognized form of systemic treatment. It involves receiving drugs
that attack rapidly multiplying cells, like cancer cells. Many times, a medical oncologist gives
multiple drugs through a vein, to attack any cancer cells that might have escaped from the
breast. Chemotherapy drugs can be given by mouth, by injection, by infusion into a vein, or
through a flexible tube called a central venous catheter. Chemotherapy involves a person’s
entire body and produces a number of side effects. Most side effects are temporary and go
away after the course of chemotherapy is finished. Most women are able to continue their
normal activities, but have less energy.
A Patient ’s Guide to Breast Cancer
41
Hormonal Therapy: Another systemic therapy used for women with breast cancer. Some breast
cancers (60%) respond to or grow with estrogen/progesterone normally produced by the body.
These breast cancers are said to be estrogen/progesterone positive. Antiestrogen medicines
are very effective against these types of breast cancers. They work by blocking the effects of
the hormones that promote tumor growth. Selective estrogen receptor modulators
SERM (Tamoxifen) and aromatase inhibitors are the two types of drugs most commonly used
to treat estrogen receptor-positive breast cancer.
Radiation Therapy: X-ray treatment localized to only the breast that had cancer. It is a
targeted, highly effective way to destroy cancer cells that may linger after surgery. This
reduces the risk of recurrence. Radiation is painless, relatively easy to tolerate and lasts
only a few minutes. You will receive treatment five days a week for about six weeks.
Radiation therapy is important because breast cancer surgery cannot guarantee that every
cancer cell has been removed from your breast. Individual cancer cells are too small to be
felt and seen at surgery or detected by x-rays. Radiation therapy provides an extra insurance
policy to help eradicate any remaining cells. Most women are able to work throughout the
treatments, although they may feel more tired than usual.
Studies are looking at the use of partial breast irradiation in women with DCIS or early-stage
breast cancer. Partial Breast Irradiation (PBI) is the practice of delivering radiation to only the
tissue immediately surrounding the removed tumor, limiting radiation exposure to healthy
tissue and enabling treatment to be completed in five days.
42 Mercy Health — Physicians
MERCY HEALTH PROVIDERS
Oncology
Anderson Hospital Oncology
7500 State Road, Cincinnati, Ohio 45255
513-624-3200
Clermont Hospital Oncology
3000 Hospital Drive, Batavia, Ohio 45103
513-732-8565
Fairfield Hospital Oncology
3050 Mack Road, Suite 300, Fairfield, Ohio 45014
513-682-4800
Mt. Airy Hospital Oncology
2446 Kipling Avenue, Cincinnati, Ohio 45239
513-751-2273
The Jewish Hospital — Mercy Health Oncology
4777 E. Galbraith Road, Cincinnati, Ohio 45236
513-686-5260
Western Hills Hospital Oncology
3131 Queen City Avenue, Cincinnati, Ohio 45238
513-751-2273
Imaging Services
Anderson Hospital
7500 State Road, Cincinnati, Ohio 45255
513-624-4500
Anderson Imaging and Lab Services
7755 Five Mile Road, Cincinnati, Ohio 45230
513-233-3320
Clermont Hospital
3000 Hospital Drive, Batavia, Ohio 45103
513-732-8200
Fairfield Hospital
3000 Mack Road, Fairfield, Ohio 45014
513-870-7000
Harrison Medical Center
10450 New Haven Road, Harrison, Ohio 45030
513-367-2222
A Patient ’s Guide to Breast Cancer
43
Liberty Falls Imaging and Lab Services
6770 Cincinnati-Dayton Road, Suite 107, Liberty Township, Ohio 45044
513-981-4100
Mason Imaging
7450 Mason-Montgomery Road, Suite 102, Mason, Ohio 45040
513-398-5878
Milford Imaging and Lab Services
201 Old Bank Road, Cincinnati, Ohio 45150
513-831-4425
Mt. Airy Hospital
2446 Kipling Avenue, Cincinnati, Ohio 45239
513-853-5000
Mt. Orab Medical Center Imaging Services
154 Health Partners Circle, Mt. Orab, Ohio 45154
513-981-4700
The Jewish Hospital — Mercy Health
4777 E. Galbraith Road, Cincinnati, Ohio 45236
513-686-3000
The Jewish Hospital — Outpatient MRI/Women’s Center
4750 E. Galbraith Road, Cincinnati, Ohio 45236
513-686-3300
Tri-County Imaging
12037 Sheraton Lane, Springdale, Ohio 45246
513-671-3320
Western Hills Hospital
3131 Queen City Avenue, Cincinnati, Ohio 45238
513-389-5000
Westside Imaging
5575 Cheviot Road, Cincinnati, Ohio 45247
513-385-8994
White Oak Imaging
5819 Cheviot Road, Cincinnati, Ohio 45247
513-741-8200
44 Mercy Health — Physicians
Cancer Genetics
“When life kicks you,
let it kick you forward.”
— Kay May, college basketball coach
Cancer Genetics
Cancer Genetics
All women are at risk for developing breast cancer; however, it is especially
important to be aware of your family history. A positive family history,
in other words, having a first-degree relative — such as a mother, sister,
daughter, aunt, or grandmother — who had breast cancer, particularly
before menopause, indicates that a woman may have an increased risk
for developing breast cancer. The reason for this increase is that the
cancer may be caused by an inherited susceptibility, which might also
have been inherited by her close relatives.
Genes are the fundamental unit of heredity and contain the “operating instructions” for the
body to grow and develop to keep the body healthy. If a gene is altered, the protein may not
be able to keep the cells healthy and cancer may develop. Alterations in two of these genes,
BRCAl and BRCA2, have been found to be associated with increased risk for breast and
ovarian cancer.
Analysis of BRCA genes is a sophisticated process that examines these genes in their entirety.
A blood sample is drawn in the physician’s office or clinic and is sent to a specialized laboratory
for analysis. The cost of gene testing ranges from about $300 to more than $3000, depending
on the type of test, and it is several weeks before the results.
Before any testing is done, an important meeting, called genetic counseling, is needed.
All persons considering genetic testing should receive pre- and post-test counseling from
a trained genetic counselor knowledgeable in the implications of the test results. Having an
inherited BRCA mutation increases cancer risk. That is, it increases the chance the person
will develop cancer, but it does not mean cancer is certain to occur.
Ideally, the first member of a family to be tested should be someone who has already had
breast or ovarian cancer. Starting with this family member can be a shortcut to identifying
an inherited BRCA mutation.
We offer cancer genetics to help uncover links to cancer in your family and help you
understand what you can do about them. We partner with Cincinnati Children’s Hospital to
offer genetic counseling. Appointments with a genetic counselor can be made through our
office. A cancer expert will meet with you to provide understanding, awareness and hope
while evaluating links to cancer in your family.
Source: American Medical Association “Gene Testing for Breast and Ovarian Cancer.”
A Patient ’s Guide to Breast Cancer
45
“We acquire the strength
we have overcome.”
— Ralph Waldo Emerson, poet
Terminology / Dictionary
Terminology /
Dictionary
Breast Cancer Dictionary
Adjuvant Therapy: Treatment given in addition to the primary treatment (i.e., hormonal
therapy, chemotherapy, or radiation therapy given after surgery to reduce the chance of
breast cancer recurrence).
Areola: The area of dark-colored skin that surrounds the nipple.
Atypical Hyperplasia: A benign (noncancerous) condition, in which breast tissue has certain
abnormal features. Women with this condition have an increased risk of breast cancer.
Axilla: The underarm.
Axillary Dissection: Surgery to remove lymph nodes under the arm.
BRCA1: A gene which, when damaged (mutated), places a woman at greater risk of developing
breast and/or ovarian cancer than women who do not have the mutation. A woman with a
BRCA1 mutation has an estimated lifetime risk of developing breast cancer of about 50
percent, compared to about 12 percent in the general population. A woman who has this
mutated gene has a 50 percent chance of passing the gene to each of her children. A genetic
test is available, but is recommended only for women who are known to be at risk because
several women in her family have had breast or ovarian cancer at an early age (before
menopause). Before testing, a woman should receive genetic counseling.
BRCA2: A gene which, when damaged (mutated), places a woman at a much higher risk of
developing breast and/or ovarian cancer than the general population. A woman with a BRCA2
mutation has an estimated lifetime risk of developing breast cancer of about 50 to 60 percent.
Together, BRCA2 and BRCA1 account for about 80 percent of the breast cancer that occurs in
women with strong family history of the disease. BRCA2 is also thought to raise the risk for
breast cancer in men. A genetic test is available, but is recommended only for women with
a strong family history of breast or ovarian cancer. Before testing, a woman should receive
genetic counseling.
Benign: Not cancerous, does not invade nearby tissue or spread to other parts of the body.
Bilateral: On both sides of the body. Bilateral breast cancer is cancer occurring in both breasts.
Bone Scan: An imaging method to detect if cancer has spread to the bones. This outpatient
procedure takes place in nuclear medicine. A low-dose radioactive substance is injected into
a vein. Two-and-a-half hours after the injection, images of the bones are taken to see if the
radioactive material accumulates, pointing to an abnormality in the bones.
Breast Reconstruction: Surgery that rebuilds the breast contour, using either a breast implant
or the woman’s own tissue immediately after mastectomy or later. The nipple and areola may
also be re-created.
A Patient ’s Guide to Breast Cancer
47
Calcifications: Tiny deposits of calcium in the breast, which cannot be felt but can be detected
on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is
present. These are also called microcalcifications.
Cancer: A term for more than 100 diseases in which abnormal cells divide without control. Cancer
cells can spread through the bloodstream and lymphatic system to other parts of the body.
Carcinoma: Cancer that begins in the lining or covering of an organ.
Chemotherapy: Treatment with anticancer drugs.
Clinical Trials: Research studies that involve patients. Each study is designed to answer
scientific questions and to find better ways to prevent or treat cancer.
Cyst: A closed sac or capsule filled with fluid.
Cytology: Tests used to diagnose cancer and other diseases, by examination of cells under
the microscope.
Digital Mammography: A method of storing an x-ray image of the breast as a computer
image, rather than on x-ray film. Digital mammography can be combined with computerassisted diagnosis (CAD), a process in which the radiologist uses the computer to help
interpret the mammogram.
Duct: A small channel in the breast through which milk passes from the lobules to the nipple.
Cancer that begins in a duct is called ductal carcinoma.
Ductal Carcinoma In Situ, or DCIS, or Intraductal Carcinoma: Cancer cells that involve only
the lining of a duct. The cells have not spread outside the duct to other tissues in the breast.
This form of breast cancer is highly curable and is treated with surgery or surgery plus
radiation therapy.
Estrogen Receptor Assay: A laboratory test done on a sample of the cancer, to see whether
estrogen receptors are present. Growth of some breast cancers is stimulated by estrogen.
Breast cancer cells with these receptors are called ER-positive cancer, and are likely to
respond to hormonal therapy. ER-negative cancers (breast cancers cells without receptors)
are unlikely to respond to hormonal therapy.
Fibroadenoma: A type of benign breast tumor, usually occurring in young women; it is
composed of fibrous and glandular tissue. On examination, a fibroadenoma feels like a firm,
round, smooth lump.
Fibrocystic changes: Certain benign changes in the breast. Women with this condition may
complain of breast swelling, tenderness, or pain.
48 Mercy Health — Physicians
Fine Needle Aspiration: The removal of fluid from a cyst or cells from a solid lump, using a
thin needle to reach the cyst or lump. The sample is drawn up into the syringe and then
placed on a slide, for cell examination under a microscope. See “Cytology.”
Hematoma: A collection of blood that may occur in the breast after surgery or a breast injury.
It may feel like a lump. Examination is important; to be sure that it is a hematoma and not a
more serious problem.
HER2/neu Gene: This oncoprotein is present, in very small amounts, on the outer surface of
normal breast cells. About 25 to 30 percent of breast cancers have too much of this protein,
which stimulates cell growth and tends to make the cancer more aggressive and less sensitive
to chemotherapy.
Hormonal Therapy: Treatment of cancer by removing, blocking, or adding hormones.
Hormone Receptor Test: A test to measure the amount of certain proteins, called hormone
receptors, in breast cancer tissue. Hormones can attach to these proteins. A high level of
hormone receptors means that hormones probably help the cancer grow. See “Estrogen
Receptor Assay” and “Progesterone Receptor Assay.”
Infiltrating Cancer, or Infiltrating Carcinoma, or Invasive Cancer: Cancer that has spread
beyond the layer of tissue in which it developed.
Inflammatory Carcinoma: A type of infiltrating carcinoma, with spread to lymphatic vessels
in the skin covering the breast. The skin of the affected breast is red, feels warm, and may
thicken to the consistency of an orange peel. About 1 percent of invasive breast cancers are
inflammatory carcinomas.
Infraclavicular Nodes: Lymph nodes located beneath the clavicle (collar bone).
Lobe: A part of the breast: each breast contains six to nine lobes.
Lobular Carcinoma In Situ, or LCIS: A very early type of breast cancer, with abnormal cells
in the lobules of the breast. This condition seldom becomes invasive cancer; however, having
LCIS means an increased risk of developing breast cancer.
Lobule: A subdivision of the lobe of the breast. Cancer than begins in a lobule is called
lobular carcinoma.
Local Therapy: Treatment that affects cells in the tumor and the area close to it.
Lumpectomy: Surgery to remove only the cancerous breast lump; usually followed by
radiation therapy. Also known as partial mastectomy, segmental resection, or breast
conservation therapy.
A Patient ’s Guide to Breast Cancer
49
Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells
that helps fight infection and disease.
Lymph Nodes: Small, bean-shaped structures located along the channels of the lymphatic
system. Bacteria or cancer cells that enter the lymphatic system may be found in the nodes.
Lymphatic System: The tissues and organs (including the bone marrow, spleen, thymus, and
lymph nodes) that produce and store cells that fight infection and disease. The channels that
carry lymph also are part of this system.
Lymphedema: Swelling of the hand and arm caused by extra fluid that my collect in tissues
when underarm lymph nodes are removed or blocked.
Malignant: Cancerous; can spread to other parts of the body.
Mammogram: An x-ray of the breast.
Mammography: The use of x-rays to create a picture of the breast. See “Digital Mammography.”
Mastectomy: Surgery to remove the breast (or as much of the breast as possible). Also known
as modified radical mastectomy.
Mestastasis: The spread of cancer from one part of the body to another. Cells in the
metastatic (secondary) tumor are like those in the original (primary) tumor.
Oncologist: A doctor who specializes in treating cancer.
Palpation: A simple technique in which a doctor presses on the surface of the body with his
or her fingers to feel the organs or tissues underneath.
Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope.
Prognosis: The probable outcome or course of a disease; the chance of recovery.
Prosthesis: An artificial replacement of a part of the body. A breast prosthesis is a breast-form
worn under clothing.
Radiation therapy: Treatment with high-energy rays to kill cancer cells. Radiation therapy
that uses a machine located outside the body to aim radiation at the cancer is called external
radiation. When radioactive material is placed in the breast in thin plastic tubes, the treatment
is called brachytherapy.
Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the
body. The pictures are produced with x-rays, sound waves, or other types of energy.
50 Mercy Health — Physicians
Remission: Disappearance of the signs and symptoms of cancer. When this happens, the
disease is said to be “in remission.” A remission can be temporary or permanent.
Risk Factor: Something that increases a person’s chance of developing a disease.
Screening: Checking for disease when there are no symptoms.
Stage: The extent of the cancer. The stage of breast cancer depends on the size of the cancer
and whether it has spread.
Systemic Therapy: Treatment that reaches and affects cells throughout the body.
Tissue: A group or layer of cells that performs a specific function.
Tumor: An abnormal mass of tissue.
Ultrasonography: A test in which high-frequency sound waves which cannot be heard by
humans are bounced off tissues and the echoes are converted into a picture (sonogram).
These pictures are shown on a monitor, like a TV screen. Tissues of different densities look
different in the picture because they reflect sound waves differently. Often, a sonogram can
show whether a breast lump is a fluid-filled cyst or a solid mass.
X-ray: High-energy radiation. It is used, in low doses, to diagnose diseases, and, in high doses,
to treat cancer.
A Patient ’s Guide to Breast Cancer
51
“Don’t count the days,
make the days count.”
— Muhammad Ali, athlete
Resource List
Resource List
Sources for Breast
Cancer Information
American Academy of Family Physicians
1-888-794-7481
www.familydoctor.org
American Cancer Society
1-800-ACS-234S
www.cancer.org
click on the CSN (Cancer Survivors Network) link
American College of
Obstetricians and Gynecologists
1-800-762-2264
www.acog.org
American College of Radiology
www.radiologyinfo.org
Breast Cancer.org
www.breastcancer.org
Cancer Care, Inc.
1-800-813-HOPE (4673)
www.cancercare.org
Cancer Research Foundation of America
1-800-227-CRFA
www.preventcancer.org
National Alliance of Breast Cancer Organizations
www.nabco.org
National Cancer Institute
Cancer Information Service
1-800-4-CANCER (1-800-422-6237)
www.cancer.gov
Y-ME National Breast Cancer Organization
1-800-221-2141
www.y-me.org
A Patient ’s Guide to Breast Cancer
53
Local Resources and Support Groups
Cincinnati Area
Blue Ash Wellness Community Breast Cancer Support Group/Cancer Support Community
Provides free and professionally facilitated programs of support, education and hope to
people affected by any type of cancer
Meeting Locations: L
ynn Stern Center, 4918 Cooper Road, Blue Ash, Ohio 45242
1717 Dixie Highway Suite 160, Ft. Wright, Kentucky 41011
Phone: OH: 513-791-4060
KY: 859-331-5568
Website: http://www.cancer-support.org/lynnstern/
http://www.cancersupportcincinnati.org
Breast Cancer Alliance of Greater Cincinnati
A nonprofit organization offering breast cancer education, events, and support.
Phone: 513-588-4142
Website: www.BCACincy.org
Cancer Family Care
The mission of this organization is to strengthen the well-being and alleviate the suffering of
children, families, and adults coping with cancer
Main address: 2421 Auburn Avenue, Cincinnati, Ohio 45219
Phone: 513-731-3346
Website: www.cancerfamilycare.org
Dayton Area
Miami Valley Hospital Support Groups
Phone: 937-208-3272
Kettering Medical Center Breast
Cancer Support Groups
Phone: 973-384-4857
54 Mercy Health — Physicians
“We must embrace pain
and burn it as fuel
for our journey.”
— Kenji Miyazawa, poet
FAQs / Helpful Hints
FAQs / Helpful Hints
Frequently Asked Questions
After the Diagnosis of Breast Cancer
The following is a list of commonly asked questions immediately following the diagnosis or
suspected diagnosis of breast cancer. You will have many more questions as you go through
each phase of your treatment and the healthcare professionals treating you will be happy to
answer each question as they arise.
1. Every year I get a mammogram. Why was this not found last year?
Mammography is the best screening tool available for early diagnosis of breast cancer.
Unfortunately, it is not able to detect all breast cancers, especially when they are small, or
in women who have dense breast tissue, consequently we encourage all women to not only
get annual mammograms but do self breast exams and have a physician do a breast exam
yearly. It is the combination of these tools that provide the earliest detection of breast
cancer. (See the section on diagnosis)
2. What kind of breast cancer do I have?
Under the section “What is Breast Cancer” we have provided a list of the most common
types of breast cancer. The majority of breast cancers arise in either the ducts (tubes that
carry the milk to the nipple) or the lobules (the sacs that store the milk) of the breast.
Breast cancer is considered invasive when the breast cancer cells break out of the ducts
or the lobules and into the surrounding fat, blood vessels and lymphatics of the breast.
3. H
ow does cancer spread outside of the breast?
The blood vessels and lymphatics that are in the breast tissue surrounding the ducts and
lobules are the most common way breast cancer spreads to other parts of the body. We do
not have a blood test that can show if a breast cancer cell is in the bloodstream. We can
check the lymph nodes under your arm to see if any cancer cells have spread through the
lymphatics. This is called sentinel lymph node biopsy or axillary node dissection. (See the
section on surgery)
4. I have no one in my family with breast cancer. Why did I get breast cancer?
The majority of breast cancer is not caused by having a family history. Most breast cancer
is an accident or because a breast cell becomes abnormal when it is multiplying. In a very
small percentage of times breast cancer is caused by a gene that is inherited (less than 10%).
(see the section on genetics)
5. Will a needle biopsy spread my breast cancer?
It has never been found that cancer spreads with a biopsy or surgical procedure.
6. D
on’t I need to have surgery immediately to prevent the spread of my breast cancer?
We know that most breast cancers are slow growing and do not spread rapidly. It is
thought that most breast cancers take several years before they can be seen on a
mammogram. It is ok to take time for a second opinion or talk with family members
about your decisions. In fact, we encourage it.
A Patient ’s Guide to Breast Cancer
55
7. H
ow do I know if my cancer has spread outside of my breast?
We will be asking you to have a chest x-ray, and blood work and sometimes other scans to
help us look at your lungs, liver and bones. We have found when breast cancer does spread
outside the breast it commonly travels to the lungs, liver and bones. Unfortunately, we do
not have any tests that can pick up just a few cells so your doctors will follow you closely
to evaluate those areas.
8. Isn’t a mastectomy better than a lumpectomy in curing breast cancer?
A large study of women with breast cancer was done several years ago comparing
whether women lived longer with a mastectomy or lumpectomy. It was found that
women who had a lumpectomy with radiation therapy lived as long as women who
had a mastectomy. Women who have a lumpectomy are at a slightly greater risk for
the breast cancer returning in their breast but it does not affect their survival.
9. W
ill my arm swell with lymph node surgery?
With the new surgical technique, sentinel lymph node biopsy, the risk for lymphedema
(swelling of the arm) is dramatically reduced. This is because of the limited number of
lymph nodes that are removed with this technique versus a complete axillary dissection.
(See the section on surgery)
10. W
hat stage am I in?
Staging can be done after size of the cancer, the number of lymph nodes and if there
is any spread outside of the breast is determined. (See section on understanding your
pathology report) Surgery will provide this information and then staging can be determined.
11. Did taking hormone replacement therapy cause my breast cancer?
At this time, we do not know what causes breast cancer except in a small percentage of
women who possess the breast cancer gene. It has been found in clinical studies that the
use of hormone replacement therapy for greater than five years can increase the risk of
breast cancer development.
12. H
ow will I know if I am cured?
We have no test to tell a woman she is cured of her breast cancer. But with every year that
passes and you remain cancer free, the likelihood that the cancer will return lessens. Living
with breast cancer and the possibility it may return is difficult. Support groups can be
helpful to help decrease your anxiety. (See the section on helpful hints.)
56 Mercy Health — Physicians
Helpful Hints
• Organization gives you some measure of control at a time when you really need it.
• Keep on top of your treatment.
• Keep tests and appointments close at hand.
• Keep track of your medical progress.
• Keep track of the members of your healthcare treatment team.
• Record current treatment, medications and hospital stays.
• Record personal and family medical history.
• Keep track of the healthcare providers you saw, when you saw them and what was important.
• Keep a calendar to plan ahead, schedule tests and treatment on the same day to
save extra trips.
• Keep track of your treatments including chemotherapy, radiation, surgery or hormone therapy.
• Keep track of side effects and report them right away to a member of your treatment team.
• Ask for copies of your imaging test results and track your progress — ask for results as soon
as it’s reasonable.
• Keep track of all your laboratory test results — ask for copies.
• Keep notes of conversations you have with insurance companies.
• Always get the name of the person you are talking to.
• Don’t throw anything away.
• If possible, send periodic group emails to family outside the home and close friends to let
them know how you are doing. It will save you from spending large amounts of time on the
telephone and you will have more time for yourself.
A Patient ’s Guide to Breast Cancer
57
2013 Calendar
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64 Mercy Health — Physicians
4600 McAuley Place
Cincinnati, Ohio 45242
www.e-mercy.com