Re: [MOL] Re:The Beauty of Our World Is Our Differences! [02643] Medicine On Line


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Re: [MOL] Re:The Beauty of Our World Is Our Differences!



The staging is what determines the treatment to be used.  I have it below for you
to read.  Several things make up the staging, the size of tumor, is it aggressive
(type of tumor) ,is it ductal or not and are there or aren't there lympth node
involvement. Hey, you know Marty just sent all this information out in the
educational series we have been so busy preparing for our mol friends, did you
ladies not keep your copy?  AAABBBUT BUUUT BUTTTTTT! Judy is the only one
excused.  I guess Marty and I will have to give quizes just to make sure everyone
is learning at the same rate and wait till Marty starts on the nutrition aspect
of this series,  thoes questionaires should really be fun.  Buckle under folks.
We have to beat this thing called cancer and can only do so armed with
knowledge.  Love you, lillina

What is breast cancer?

This summary discusses the treatment of breast cancer. PDQ also contains
summaries of information
on screening for and prevention of breast cancer.

Breast cancer, a common cancer in women, is a disease in which cancer (malignant)
cells are found
in the tissues of the breast. Each breast has 15- 20 sections called lobes, which
have many smaller
sections called lobules. The lobes and lobules are connected by thin tubes called
ducts. The most
common type of breast cancer is ductal cancer. It is found in the cells of the
ducts. Cancer that
begins in the lobes or lobules is called lobular cancer. Lobular cancer is more
often found in both
breasts than other types of breast cancer. Inflammatory breast cancer is an
uncommon type of breast
cancer. In this disease, the breast is warm, red, and swollen.

Hereditary breast cancer makes up approximately 5%-10% of all breast cancer
cases. The genes in
cells carry the hereditary information that is received from a person's parents.
Several genes have
been found to be defective in some breast cancer patients. Relatives of breast
cancer patients who
carry these defective genes may be more likely to develop breast or ovarian
cancer. Some defective
genes are more common in certain ethnic groups. Tests are being developed to
determine who has
the genetic defect long before any cancer appears. Refer to the PDQ summaries on
screening for
breast cancer and prevention of breast cancer for more information.

Hormonal contraceptives may be another factor to consider. Research findings
suggest a link
between contraceptive use and a slightly increased risk of developing breast
cancer.

A doctor should be seen if changes in the breasts are noticed. The doctor may
suggest that you have
a mammogram. A mammogram is a special x-ray of the breast that may find tumors
that are too
small to feel. If a lump in the breast is found, the doctor may need to cut out a
small piece of the
lump and look at it under the microscope to see if there are any cancer cells.
This procedure is called
a biopsy. Sometimes the biopsy is done by inserting a needle into the breast and
drawing out some
of the tissue. If the biopsy shows that there is cancer, it is important that
certain tests (called estrogen
and progesterone receptor tests) be done on the cancer cells.

Estrogen and progesterone receptor tests may tell whether hormones affect the way
the cancer
grows. They may also give information about the chances of the tumor coming back
(recurring). The
results help a doctor decide whether to use hormone therapy to stop the cancer
from growing.
Tissue from the tumor needs to be taken to the laboratory for estrogen and
progesterone tests at the
time of biopsy because it may be hard to get enough cancer cells later, although
newer techniques
can be used on tissue that is not fresh.

The chance of recovery (prognosis) and choice of treatment depend on the stage of
the cancer
(whether it is just in the breast or has spread to other places in the body), the
type of breast cancer,
certain characteristics of the cancer cells, and whether the cancer is found in
the other breast. A
woman's age, weight, menopausal status (whether or not a woman is still having
menstrual periods),
and general health can also affect the prognosis and choice of treatment.



STAGE EXPLANATION


Stages of breast cancer

Once breast cancer has been found, more tests will be done to find out if the
cancer has spread from
the breast to other parts of the body. This is called staging. To plan treatment,
a doctor needs to
know the stage of the disease. The following stages are used for breast cancer.


Carcinoma in situ

About 15%-20% of breast cancers are very early cancers. They are sometimes called
carcinoma in
situ. There are two types of breast cancer in situ. One type is ductal carcinoma
in situ (DCIS; also
known as intraductal carcinoma); the other type is lobular carcinoma in situ
(LCIS). LCIS is not
cancer, but for the purpose of classifying the disease, it is called breast
cancer in situ, carcinoma in
situ, or stage 0 breast cancer. Sometimes LCIS is found when a biopsy is done for
another lump or
abnormality found on the mammogram. Patients with this condition have a 25%
chance of
developing breast cancer in either breast in the next 25 years.


Stage I

The cancer is no larger than 2 centimeters (about 1 inch) and has not spread
outside the breast.


Stage II

Any of the following may be true:

     The cancer is no larger than 2 centimeters but has spread to the lymph
     nodes under the arm (the axillary lymph nodes).

     The cancer is between 2 and 5 centimeters (from 1 to 2 inches). The cancer
     may or may not have spread to the lymph nodes under the arm.

     The cancer is larger than 5 centimeters (larger than 2 inches) but has
     not spread to the lymph nodes under the arm.


Stage III

Stage III is divided into stages IIIA and IIIB.

Stage IIIA is defined by either of the following:

     The cancer is smaller than 5 centimeters and has spread to the lymph nodes
     under the arm, and the lymph nodes are attached to each other or to
     other structures.

     The cancer is larger than 5 centimeters and has spread to the lymph
     nodes under the arm.

Stage IIIB is defined by either of the following:

     The cancer has spread to tissues near the breast (skin or chest wall,
     including the ribs and the muscles in the chest).

     The cancer has spread to lymph nodes inside the chest wall along the breast
     bone.


Stage IV

The cancer has spread to other organs of the body, most often the bones, lungs,
liver, or brain. Or,
tumor has spread locally to the skin and lymph nodes inside the neck, near the
collarbone.


Inflammatory breast cancer

Inflammatory breast cancer is a special class of breast cancer that is rare. The
breast looks as if it is
inflamed because of its red appearance and warmth. The skin may show signs of
ridges and wheals
or it may have a pitted appearance. Inflammatory breast cancer tends to spread
quickly.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may
come back in the breast, in the soft tissues of the chest (the chest wall), or in
another part of the
body.



TREATMENT OPTION OVERVIEW


How breast cancer is treated

There are treatments for all patients with breast cancer. Four types of treatment
are used:

     surgery (taking out the cancer in an operation)
     radiation therapy (using high-dose x-rays to kill cancer cells)
     chemotherapy (using drugs to kill cancer cells)
     hormone therapy (using drugs that change the way hormones work or taking out
organs that
     make hormones, such as the ovaries)

Biological therapy (using the body's immune system to fight cancer), bone marrow
transplantation,
and peripheral blood stem cell transplantation are being tested in clinical
trials.

Most patients with breast cancer have surgery to remove the cancer from the
breast. Usually, some
of the lymph nodes under the arm are also taken out and looked at under a
microscope to see if
there are any cancer cells.

Different types of operations used:

Surgery to conserve the breast:

     Lumpectomy (sometimes called excisional biopsy or wide excision) is the
     removal of the lump in the breast and some of the tissue around it. It is
     usually followed by radiation therapy to the part of the breast that
     remains. Most doctors also take out some of the lymph nodes under the arm.

     Partial or segmental mastectomy is the removal of the cancer as well as some

     of the breast tissue around the tumor and the lining over the chest muscles
     below the tumor. Usually some of the lymph nodes under the arm are taken
     out. In most cases, radiation therapy follows.

Other types of surgery:

     Total or simple mastectomy is the removal of the whole breast. Sometimes
     lymph nodes under the arm are also taken out.

     Modified radical mastectomy is the removal of the breast, many of the lymph
     nodes under the arm, the lining over the chest muscles, and sometimes part
     of the chest wall muscles. This is the most common operation for breast
     cancer.

     Radical mastectomy (also called the Halsted radical mastectomy) is the
     removal of the breast, chest muscles, and all of the lymph nodes under the
     arm. For many years, this was the operation most used, but it is used now
     only when the tumor has spread to the chest muscles.

Radiation therapy is the use of high-energy x-rays to kill cancer cells and
shrink tumors. Radiation
may come from a machine outside the body (external radiation therapy) or from
putting materials that
produce radiation (radioisotopes) through thin plastic tubes into the area where
the cancer cells are
found (internal radiation therapy).

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken
by mouth or it
may be put into the body by inserting a needle into a vein or muscle.
Chemotherapy is called a
systemic treatment because the drugs enter the bloodstream, travel through the
body, and can kill
cancer cells outside the breast area.

If tests show that the breast cancer cells have estrogen receptors and
progesterone receptors,
hormone therapy may be given. Hormone therapy is used to change the way hormones
in the body
help cancers grow. This may be done by using drugs that change the way hormones
work or by
surgery to take out organs that make hormones, such as the ovaries. Hormone
therapy with
tamoxifen is often given to patients with early stages of breast cancer. Hormone
therapy with
tamoxifen or estrogens can act on cells all over the body and may increase the
chance of getting
cancer of the uterus. A doctor should be seen for a pelvic examination every
year. Any vaginal
bleeding, other than menstrual bleeding, should be reported to a doctor as soon
as possible.

Even if the doctor removes all the cancer that can be seen at the time of the
operation, the patient
may be given radiation therapy, chemotherapy, or hormone therapy after surgery to
try to kill any
cancer cells that may be left. Therapy given after an operation when there are no
cancer cells that
can be seen is called adjuvant therapy.

Biological therapy tries to get the body to fight cancer. It uses materials made
by the body or made
in a laboratory to boost, direct, or restore the body's natural defenses against
disease. Biological
therapy is sometimes called biological response modifier (BRM) therapy or
immunotherapy. This
treatment is currently only being given in clinical trials.

Bone marrow transplantation is a newer type of treatment that is being studied in
clinical trials.
Sometimes breast cancer becomes resistant to treatment with radiation therapy or
chemotherapy.
Very high doses of chemotherapy may then be used to treat the cancer. Because the
high doses of
chemotherapy can destroy the bone marrow, marrow is taken from the bones before
treatment. The
marrow is then frozen and the patient is given high-dose chemotherapy with or
without radiation
therapy to treat the cancer. The marrow that was taken out is then thawed and
given back to the
patient through a needle inserted into a vein to replace the marrow that was
destroyed. This type of
transplant is called an autologous transplant. If the marrow that is given is
taken from another person,
the transplant is called an allogeneic transplant.

Another type of autologous transplant is called a peripheral blood stem cell
transplant. The patient's
blood is passed through a machine that removes the stem cells (immature cells
from which all blood
cells develop) and then returns the blood back to the patient. This procedure is
called leukapheresis
and usually takes 3 or 4 hours to complete. The stem cells are treated with drugs
to kill any cancer
cells and then frozen until they are transplanted back to the patient. This
procedure may be done
alone or with an autologous bone marrow transplant.

A greater chance for recovery occurs if the doctor chooses a hospital that does
more than five bone
marrow transplantations per year.


Treatment by stage

Treatment of breast cancer depends on the type and stage of the disease, and the
patient's age,
menopausal status, and overall health.

Standard treatment may be considered because of its effectiveness in patients in
past studies, or
participation in a clinical trial may be considered. Not all patients are cured
with standard therapy
and some standard treatments may have more side effects than are desired. For
these reasons,
clinical trials are designed to find better ways to treat cancer patients and are
based on the most
up-to-date information. Clinical trials are ongoing in most parts of the country
for all stages of breast
cancer. To learn more about clinical trials, call the Cancer Information Service
at
1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.



CARCINOMA IN SITU

The treatment depends on whether the patient has ductal carcinoma in situ (DCIS)
or lobular
carcinoma in situ (LCIS). Since it is difficult to distinguish between these two
types, it may be helpful
to have a second opinion by having the patient's biopsy preparations (slides)
studied by pathologists
at another hospital.

If the patient has DCIS, treatment may be one of the following:

     1. Surgery to remove the whole breast (total mastectomy).

     2. Breast-conserving surgery with radiation therapy.

     3. Clinical trial of surgery to remove only the cancer (lumpectomy) followed
by radiation
     therapy with or without hormone therapy.

Rarely, some of the lymph nodes under the arm may also be removed during the
above surgeries.

If a patient has LCIS, the patient may have a higher risk of developing invasive
cancer in both
breasts: about a 25% chance over 25 years. LCIS is not breast cancer, and many
women with
LCIS never develop breast cancer. The treatment options for LCIS are varied and
quite
controversial. Treatment may be one of the following:

     1. Biopsy to diagnose the LCIS followed by regular examinations and yearly
mammograms to
     find any changes as early as possible.

     2. A large clinical trial is testing hormone therapy with the drug tamoxifen
to see whether it can
     prevent cancer from occurring. The Cancer Information Service can be called
for more
     information (1-800-4-CANCER).

     3. Surgery to remove both breasts (total mastectomy).

If a patient is going to have a mastectomy, breast reconstruction (making a new
breast mound) may
be considered. It may be done at the time of the mastectomy or at some future
time. The breast may
be made with the patient's own (non- breast) tissue or by using implants.
Different types of implants
can be used. The Food and Drug Administration (FDA) has announced that breast
implants filled
with silicone gel may only be used in clinical trials. Saline-filled breast
implants, which contain
saltwater rather than silicone gel, may also be used. Before the decision to get
an implant is made,
patients can call the FDA (1-800-532-4440) to obtain additional information.
Additional questions
can then be discussed with a doctor.



STAGE I BREAST CANCER

Treatment may be one of the following:

     1. Breast-conserving surgery to remove only the cancer and some surrounding
breast tissue
     (lumpectomy) or to remove part of the breast (partial or segmental
mastectomy); both are
     followed by radiation therapy. Some of the lymph nodes under the arm are
also removed.
     This treatment provides identical long-term cure rates as those from
mastectomy. A doctor's
     recommendation on which procedure to have is based on tumor size and
location and its
     appearance on mammogram.

     2. Surgery to remove the whole breast (total mastectomy) or the whole breast
and the lining
     over the chest muscles (modified radical mastectomy). Some of the lymph
nodes under the
     arm are also taken out.

Adjuvant therapy (given in addition to the treatments listed above):

     1. Chemotherapy.

     2. Hormone therapy.

     3. Clinical trials of adjuvant chemotherapy in certain patients.

     4. Clinical trials of no adjuvant therapy for patients with a good chance of
recovery
     (prognosis).

     5. Clinical trials of treatment to keep the ovaries from working.

If a patient is going to have a mastectomy, breast reconstruction (making a new
breast mound) may
be considered. It may be done at the time of the mastectomy or at some future
time. The breast may
be made with the patient's own (non- breast) tissue or by using implants.
Different types of implants
can be used. The Food and Drug Administration (FDA) has announced that breast
implants filled
with silicone gel may only be used in clinical trials. Saline-filled breast
implants, which contain
saltwater rather than silicone gel, may also be used. Before the decision to get
an implant is made,
patients can call the FDA (1-800-532-4440) to obtain additional information.
Additional questions
can then be discussed with a doctor.



STAGE II BREAST CANCER

Treatment may be one of the following:

     1. Breast-conserving surgery to remove only the cancer and some surrounding
breast tissue
     (lumpectomy) or to remove part of the breast (partial or segmental
mastectomy); both are
     followed by radiation therapy. Some of the lymph nodes under the arm are
also removed.
     This treatment provides identical long-term cure rates as those from
mastectomy. A doctor's
     recommendation on which procedure to have is based on tumor size and
location and its
     appearance on mammogram.

     2. Surgery to remove the whole breast (total mastectomy) or the whole breast
and the lining
     over the chest muscles (modified radical mastectomy). Some of the lymph
nodes under the
     arm are also taken out.

Adjuvant therapy (given in addition to the treatments listed above):

     1. Chemotherapy with or without hormonal therapy.

     2. Hormone therapy.

     3. Clinical trial of chemotherapy before surgery (neoadjuvant therapy).

     4. Clinical trials of high-dose chemotherapy with bone marrow
transplantation for patients
     with cancer in more than three lymph nodes.

If a patient is going to have a mastectomy, breast reconstruction (making a new
breast mound) may
be considered. It may be done at the time of the mastectomy or at some future
time. The breast may
be made with the patient's own (non- breast) tissue or by using implants.
Different types of implants
can be used. The Food and Drug Administration (FDA) has announced that breast
implants filled
with silicone gel may only be used in clinical trials. Saline-filled breast
implants, which contain
saltwater rather than silicone gel, may also be used. Before the decision to get
an implant is made,
patients can call the FDA (1-800-532-4440) to obtain additional information.
Additional questions
can then be discussed with a doctor.



STAGE III BREAST CANCER

Stage III breast cancer is further divided into stage IIIA (can be operated on)
and IIIB (biopsy is
usually the only surgery performed).

Stage IIIA cancer:

     1. Treatment may be one of the following surgeries: Surgery to remove the
whole breast, the
     lining over the chest muscles, and many of the lymph nodes (modified radical
mastectomy) or
     the whole breast, the chest muscles, and all of the lymph nodes (radical
mastectomy).

     2. Radiation therapy given after surgery.

     3. Chemotherapy with or without hormone therapy given with surgery and
radiation therapy.

     4. Clinical trials are testing new chemotherapy with or without hormonal
drugs; they are also
     testing chemotherapy before surgery (neoadjuvant therapy).

     5. Clinical trials of high-dose chemotherapy with bone marrow or peripheral
stem cell
     transplantation.

Stage IIIB cancer:

     Treatment will probably be biopsy followed by radiation therapy to the
     breast and the lymph nodes. In some cases, a mastectomy may be done
     following radiation therapy.
          1. Chemotherapy to shrink the tumor, followed by surgery and/or
radiation therapy.

          2. Hormonal therapy followed by additional therapy.

          3. Clinical trials are testing new chemotherapy drugs and biological
therapy, new drug
          combinations, and new ways of giving chemotherapy.

          4. Clinical trials of high-dose chemotherapy with bone marrow or
peripheral stem cell
          transplantation.



STAGE IV BREAST CANCER

The patient will probably have a biopsy and then be given one or more of the
following:

     1. Radiation therapy or, in some cases, a mastectomy to reduce the symptoms.

     2. Hormonal therapy with or without surgery to remove the ovaries.

     3. Chemotherapy.

     4. Clinical trials are testing new chemotherapy and hormonal drugs and new
combinations of
     drugs and biological therapy.

     5. Clinical trials of high-dose chemotherapy with bone marrow or peripheral
stem cell
     transplantation.



INFLAMMATORY BREAST CANCER

Treatment will probably be a combination of chemotherapy, hormonal therapy, and
radiation
therapy, which may be combined with surgery to remove the breast. The treatment
is usually similar
to that for stage IIIB or IV breast cancer.



RECURRENT BREAST CANCER

Breast cancer that comes back (recurs) can often be treated, but usually cannot
be cured when it
recurs in another part of the body. Some patients with recurrence in the breast
can be cured,
however. The choice of treatment depends on hormone receptor levels, the kind of
treatment the
patient had before, the length of time from first treatment to when the cancer
came back, where the
cancer recurred, whether the patient still has menstrual periods, and other
factors.

Treatment may be one of the following:

     1. Hormonal therapy with or without surgery to remove the ovaries.

     2. For the small group of patients whose cancer has come back only in one
place, surgery
     and/or radiation therapy.

     3. Radiation therapy to help relieve pain due to the spread of the cancer to
the bones and
     other places.

     4. Chemotherapy.

     5. Clinical trials of new chemotherapy drugs, new hormonal drugs, biological
therapy, or bone
     marrow or peripheral stem cell transplantation.



TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about breast cancer, call the National Cancer Institute's Cancer
Information Service
at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this
toll-free
number, you can speak with a trained information specialist who can answer your
questions.

The Cancer Information Service also has booklets about cancer that are available
to the public and
can be sent on request. The following booklet about breast cancer may be helpful:

     What You Need To Know About Breast Cancer

The following general booklets on questions related to cancer may also be
helpful:

     What You Need To Know About Cancer
     Chemotherapy and You: A Guide to Self-Help During Treatment
     Radiation Therapy and You: A Guide to Self-Help During Treatment
     Eating Hints for Cancer Patients
     Taking Time: Support for People with Cancer and the People Who Care About
          Them
     What Are Clinical Trials All About?
     Advanced Cancer: Living Each Day
     When Cancer Recurs: Meeting the Challenge Again
     Research Report: Bone Marrow Transplantation

There are many other places where people can get material and information about
cancer treatment
and services. The social service office at a hospital can be checked for local
and national agencies
that can help with getting information about finances, getting to and from
treatment, getting care at
home, and dealing with problems.

For more information from the National Cancer Institute, please write to this
address:

     National Cancer Institute
     Office of Cancer Communications
     31 Center Drive, MSC 2580
     Bethesda, MD 20892-2580


Joicy Becker-Richards wrote:

> Hi, Liz,
> Don't know Judy's particular case, but do know that sometimes the
> differences are based on the individual case -- sometimes on the
> protocols of particular drs. and hospitals. For example, not everyplace
> does core biopsies (there's some diagreement on their effectiveness.) I
> had a needle biopsy to rule out cysts, but no core biopsy. Then I had 2
> surgeries -- the first was a surgical biopsy, which would have been a
> lumpectomy if they could have gotten it all. Regardless, they would have
> done a 2nd ancillary surgery for the lymph nodes if they determined it
> was cancer. (In my case, they took the nodes when they did the
> mastectomy). Hope that's helpful. Hang in there, ok, and don't overdo
> it! Love, Joicy
>
> Elizabeth Patterson wrote:
> >
> > Hi Judy,
> > I just read your post to Joicy. I have a question. If there was no cancer
> > in the lymph nodes why are you taking chemo? I had a lumpectomy in July and
> > my lymph nodes were free of cancer, too. I am taking 7 weeks of radiation
> > therapy, but I am not having chemo. Opinions differ I guess, but my
> > radiation therapist said that the statistical survival difference in my
> > case is not significant enough to justify the chemo. He does feel it is
> > worth it to take tamoxifen, however. I think I would discuss this with the
> > oncologist. Also, why did they have to do two surgeries. They took out the
> > surrounding tissue and the lymph nodes at the same time they took the lump
> > when I had mine done. Had you had a biopsy (needle core) before your
> > surgery? That is how they determined my lump was malignant so I had the
> > whole surgery at one time.
> >
> > I am sure there are oncologists who would encourage me to have chemo, but
> > based on the reports I received and the opinions of a couple of my doctors,
> > I will choose not to have chemo unless, down the line somewhere another
> > lump develops. I don't want any more treatment than is necessary. By the
> > way, radiation does not make you lose your hair.
> >
> > Liz P.
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