After Surgical Treatment of Breast Cancer
What’s Next?

I have just been diagnosed with breast cancer, what information do I need to know regarding my cancer and follow-up treatment?
Here is a review of some of the basic information you will need to know, and that your doctor will use to plan your follow-up treatment. Getting a diagnosis of cancer can be overwhelming. We work as a team. Your surgeon will be giving you a lot of information, and the nurse practitioner is also available to answer and review information with you, and provide information about resources and support services. We are available at 847-797-9000.

Pathology Report
There are several tests done on your cancer tissue to help determine what your follow-up treatment will be:

Type of breast cancer. The tissue removed is examined under the microscope to see whether the cancer is in situ, which means noninvasive, or if it is invasive. Also, the biopsy is used to determine the cell type. The most common types of breast cancer are ductal cancer which arises in the ducts, and lobular which is found in the lobules.

Tumor Size: The size of the tumor is important in determining the prognosis, or probable future outcome of the disease. In general, patients with smaller tumors of 2 centimeters or less have a better prognosis than those with larger tumors.

Grades of breast cancer: The pathologist assigns a grade to the cancer indicating how fast the cells are growing. Cells that resemble normal tissue grow more slowly, and tend to spread more slowly. Higher-grade cells tend to be more aggressive. A higher grade indicates a faster growing cancer. The system of grading cancers is used for invasive but not in situ cancers. Typically, grading is from Grade I, a well-differentiated tumor, to Grade III, a poorly differentiated tumor. Individuals with a well-differentiated tumor tend to have a better prognosis.

Margins: The pathologist will look at the tumor to determine whether or not the margins, or edges, of the specimen are free of tumor. Sometimes there are microscopic cells that your surgeon cannot see or the disease is more extensive than originally appreciated by current imaging techniques. If the tumor is at the edge or close to the edge of the specimen, your surgeon will take you back to the operating room to remove more tissue. The goal is to get the entire tumor removed with a normal ridge of tissue around it.

Lymph Nodes: Your lymph nodes will be evaluated by your surgeon by either using a sentinel node procedure or an axillary dissection. Your lymph node status will be reported to indicate whether the cancer has spread to the lymph nodes in the underarm. The number of positive lymph nodes can help predict the risk of cancer recurrence.

Estrogen and Progesterone Receptors: Your tumor will be tested for these receptors. Receptors are parts of cells that can attach to substances such as hormones that circulate in the blood. Women who are hormone receptor positive tend to have a better prognosis and respond better to hormone therapy.

HER2/neu testing: Your tumor will be tested for a growth promoting protein called HER2/neu. Tumors that over express this protein tend to grow faster and be more aggressive than other breast cancers. HER2/neu positive tumors can now be treated with a drug called Herceptin.

Staging of cancer: Staging is determined with three key pieces of information from the surgery. The size of the tumor, whether the lymph nodes are involved, and whether there is any evidence that the tumor has spread to distant organs. Once the stage is determined, this helps the physicians involved in your care select the best treatments for your care and also help predict your future survival prognosis.

Imaging Tests to Detect Cancer Spread
Depending on the stage of your cancer, some of these additional tests may be required.

Chest X-ray: This test may be done to see whether the breast cancer has spread to your lungs.

MRI: A breast MRI (Magnetic Resonance Imaging) uses strong magnets and radio waves to create clear detailed pictures of the insides of your breast. It does not use x-ray. The energy from the radio waves is absorbed and released in a pattern. A computer translates this information into a detailed image for the radiologist. You will have an IV inserted. A contrast material called gadolinium is injected by IV to better differentiate the details. MRI is now being used in some cases when a new diagnosis of breast cancer has been made in order to assist your physician in treatment planning.

Bone Scan: This test helps evaluate whether cancer has spread to any of your bones. You will receive a radioactive material for this test. The dose is very low and causes no long-term side effects. The radioactive substance is attracted to diseased bone throughout the entire skeleton. Areas that take up the substance are called hot spots. Arthritis, infections, or other bone diseases can also cause a similar pattern. To distinguish among these conditions, you may require additional x-rays or a biopsy. A bone scan can usually find metastases earlier than regular x-rays.

Computed Tomography (CT) Scan: The CT scan is an x-ray procedure that produces a detailed cross-sectional image of your body. This test can help tell if cancer has spread to your liver or other organs. Often pictures are taken with and without contrast dye. The contrast dye helps to better outline structures in your body.

PET Scan: A PET Scan, or Positron Emission Tomography, is new imaging technology that detects cancerous tumors earlier and more accurately. The scan creates computerized images of chemical changes that take place in tissue. The PET Scan is used in breast cancer patients to see if there is any evidence of cancer in other areas of their body, and to determine the effectiveness of treatment.

Treatment Modalities

Radiation Therapy: High-energy x-rays are used to kill any cancer cells that remain in your breast or lymph nodes after surgery. Most women who have lumpectomy (breast conserving surgery) receive radiation after surgery to help ensure that any remaining cancer cells are destroyed and to help prevent the chance of cancer recurrence. Some women with tumors larger than 4 centimeters who have had mastectomies will require radiation therapy as well. You will have a consultation with a radiation oncologist prior to beginning any treatment to discuss your case thoroughly.

Chemotherapy: Chemotherapy involves the use of drugs that can kill cancer cells or stop them from multiplying. After your surgery, you will have a consultation with a medical oncologist to determine whether chemotherapy is recommended as treatment for your breast cancer. Chemotherapy usually begins within 6 weeks after surgery.

Hormone Therapy: All normal breast cells have receptors that are designed to bind them to the hormones estrogen and progesterone. Receptors are protein molecules found on the surface of the cells. Your tumor will be tested to see whether or not these receptors are present in the cancer cells. If they are present or positive, you will be advised to take hormone therapy. This hormone therapy uses drugs that block the ability of the cancer cells from binding to the estrogen and progesterone. This inhibits their ability to grow. Drugs such as Tamoxifen and Arimidex fall into this classification.

Biological Therapy: Biologic therapy or immunotherapy involves the use of drugs or substances that enhance the body’s ability to detect and destroy foreign invaders like cancer cells. For breast cancer treatment, the primary biological therapy being used is a drug called Herceptin. Herceptin targets cancer cells that over express or make too much of a protein called Her-2. Herceptin slows or stops the growth of these cells.

If you have additional questions or concerns, please call us at 847-797-9000.