Class Notes: A Woman’s Guide to Breast Cancer Treatment

California Department of Public Health, 2010

1. Introduction

• Booklet provided to women diagnosed with breast cancer in California.
• Purpose: Information on treatment options; not a replacement for medical advice.
• Encouragement to work with healthcare team; suggestions for managing information overload.
• Second opinions are a patient’s right.
• Key resources:
  • American Cancer Society (ACS): 1-800-227-2345, www.cancer.org
  • National Cancer Institute (NCI): 1-800-422-6237, www.cancer.gov

2. About Breast Cancer

What is Breast Cancer?

• Cancer develops when cells grow and divide uncontrollably in breast tissue.

Causes

• Exact cause unknown; most cases occur in women, particularly those over age 50.
• Only 20-30% have family history. Not caused by stress, injury, antiperspirants, bras, or caffeine.

Prevalence

• 2nd most common cancer in women in US (after skin cancer).
• Risk increases with age (1 in 8 by age 80).
• About 25,000 cases per year in California; 250,000 in the US.

Types

• Non-Invasive (in situ):
  • DCIS (Ductal Carcinoma in Situ): Not spread, but can become invasive.
  • LCIS (Lobular Carcinoma in Situ): Not true cancer, but a risk marker.
• Invasive:
  • IDC (Invasive Ductal Carcinoma): ~80%
  • ILC (Invasive Lobular Carcinoma): 10–15%
  • Less common types: Inflammatory, Medullary, Metaplastic, Mucinous, Paget’s Disease.

Staging (Roman numerals 0-IV; see details below)

• Determined by tumor size, spread to lymph nodes, distant metastasis.
• Stage 0: In situ (DCIS)
• Stages I–III: Local/regional spread (vary by tumor size and lymph node involvement)
• Stage IV: Metastatic, spread to distant organs

Additional Tests

• Hormone receptor status (estrogen/progesterone)
• HER2 status
• Gene expression profiling

3. Types of Treatment

Main Approaches

• Surgery (local therapy)
• Radiation Therapy (local)
• Chemotherapy (systemic)
• Hormonal Therapy (systemic; for hormone receptor-positive types)
• Targeted Therapy (systemic; especially for HER2-positive)
• Clinical Trials
• Complementary Therapies (used alongside standard care for supportive purposes)

Surgery Types

• Breast-Conserving Surgery (lumpectomy/partial mastectomy): Removes tumor and margin; typically followed by radiation.
• Mastectomy: Removes entire breast (total/simple or modified radical).
• Lymph Node Removal:
  • Axillary Dissection: Removes ≥10 lymph nodes.
  • Sentinel Node Biopsy: Removes first 1–3 likely to have cancer.

Lymphedema

• Swelling caused by lymph node removal or radiation.
• Prevention tips: Avoid pressure, extreme temperatures, infections, and injury to affected arm.

Radiation Therapy

• External Beam: Common, 5–7 weeks of daily sessions.
• Internal (Brachytherapy)/APBI: Radioactive material placed at surgery site.

Chemotherapy

• Can be adjuvant (after surgery) or neoadjuvant (before surgery).
• Side effects: Fatigue, nausea, hair loss, infection risk, possible organ damage, infertility.

Hormonal Therapy

• Used for hormone receptor-positive cancers.
• Common drugs: Tamoxifen, aromatase inhibitors.
• Side effects: Menopausal symptoms, rare serious effects (uterine cancer, clots).

Targeted Therapy

• For HER2-positive: Trastuzumab (Herceptin), lapatinib.
• Side effects: Flu-like symptoms, potential heart damage, infection risk.

Clinical Trials

• Research studies for new treatments; participation is voluntary and monitored.

Complementary Therapies

• E.g., acupuncture, meditation, massage.
• Used for symptom relief alongside standard treatment; consult physician before use.

4. Treatment by Stage

Stage 0 (DCIS)

• Options:
  • Breast-conserving surgery + radiation ± hormonal therapy
  • Total mastectomy ± hormonal therapy
  • Clinical trials

Stages I, II, III

• Options:
  • Breast-conserving surgery + lymph node removal + radiation
  • Modified radical mastectomy ± radiation
  • Systemic therapy as needed (chemo, hormonal, targeted, clinical trials)

Stage IV (Metastatic)

• Options:
  • Systemic therapy (chemo, hormonal, targeted)
  • Surgery/radiation for symptom relief
  • Bisphosphonates for bone pain
  • Clinical trials

Recurrent Breast Cancer

• Treatment depends on location and prior treatments.

5. Breast Reconstruction & Prostheses

Reconstruction

• Timing: Immediate or delayed.
• Types:
  • Implants: Increased risk of rupture/scar.
  • Own tissue (TRAM, LAT flaps): Major surgery, longer recovery, not for all patients.
• Nipple/Areola Reconstruction: Outpatient, may use tattooing.

Prostheses

• Custom-made external forms.
• Insurance often covers cost if prescribed by a doctor.
• Decision is personal; prosthesis, reconstruction, or none.

6. Follow-up Care

• Regular medical appointments (every 3–6 months first 3–5 years, then yearly).
• Ongoing imaging (mammogram, MRI as needed), pelvic exams (if on tamoxifen), and bone density (aromatase inhibitors).
• Self-exam encouraged.
• Report any suspicious symptoms or health changes promptly.
• Maintain healthy lifestyle, consider support groups.

7. Glossary ("Words to Know")

• Definitions of key medical terms (e.g., adjuvant therapy, carcinoma, lymphedema, mastectomy, systemic/local therapy, TNM staging, etc.)

Key Questions to Ask Your Doctor

• What type/stage/grade of breast cancer do I have?
• What are my treatment and reconstruction options?
• What side effects should I expect and how will they be managed?
• Should I participate in clinical trials?
• What follow-up care will I need?

Important Contacts & Resources

• American Cancer Society: 1-800-227-2345, www.cancer.org
• National Cancer Institute: 1-800-422-6237, www.cancer.gov
• National Lymphedema Network: 1-800-541-3259, www.lymphnet.org
• American Society of Plastic Surgeons: 1-888-475-2784

Closing Thought

“Cancer might rob you of the blissful belief that tomorrow stretches into forever. In exchange, you are granted the vision to see each day as precious, a gift to be used wisely and richly. No one can take that away.”
—National Cancer Institute

(For physician copy requests or more information, see the publication details at the end of the booklet.)