Pink Ribbon Pakistan
Pink Ribbon Pakistan

Frequently Asked Questions

We aim to provide adequate information about breast cancer, educate our people to not only acquire basic knowledge but advanced as well so you can make the right choices!

General Questions

What is Cancer?

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems.

What is Tumour?

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

What are the different types (benign & malignant) of tumors?

Normal cells in the breast and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a lump, growth, or tumor. Tumors in the breast can be benign (not cancer) or malignant (cancer):
Benign tumors:

Are usually not harmful
Rarely invade the tissues around them
Don’t spread to other parts of the body
Can be removed and usually don’t grow back

Malignant tumors:
May be a threat to life
Can invade nearby organs and tissues (such as the chest wall)
Can spread to other parts of the body
Often can be removed but sometimes grow back

What are the common (ductal or lobular) types of carcinomas?

The most common type of breast cancer is ductal carcinoma. This cancer begins in cells that line a breast duct. Most women with breast cancer have ductal carcinoma.

The second most common type of breast cancer is lobular carcinoma. This cancer begins in a lobule of the breast. Few women with breast cancer has lobular carcinoma.
Other women have a mixture of ductal and lobular type or they have a less common type of breast cancer.

Are all breast lumps cancerous?

Not all breast lumps are cancerous. Some are benign. There are many possible causes of non-cancerous (benign) breast lumps. Two of the most common causes of benign single breast lumps are cysts and fibroadenomas. In addition, several other conditions can present themselves as lumps, such as fat necrosis and sclerosing adenosis. Only your healthcare provider can diagnose your breast lump.

How are breast cancers categorized by the hormone receptor status?

There are two main receptors used to categorize breast cancers: estrogen (ER) and progestrone (PR). Breast cancers may have one, both or none of these receptors. The presence of the receptor is called positive and denoted with a plus (+) sign and the absence of the receptor negative and denoted with (-) sign.

Hormone receptor-positive (or hormone-positive) breast cancer cells have either estrogen (ER) or progesterone (PR) receptors. These breast cancers can be treated with hormone therapy drugs that lower estrogen levels or block estrogen receptors. This includes cancers that are ER-negative but PR-positive. Hormone receptor-positive cancers tend to grow more slowly than those that are hormone receptor-negative. Women with hormone receptor-positive cancers tend to have a better outlook in the short-term, but these cancers can sometimes come back many years after treatment.

Hormone receptor-negative (or hormone-negative) breast cancers have neither estrogen nor progesterone receptors. Treatment with hormone therapy drugs is not helpful for these cancers. These cancers tend to grow faster than hormone receptor-positive cancers. If they come back after treatment, it’s often in the first few years. Hormone receptor-negative cancers are more common in women who have not yet gone through menopause.

Triple-negative breast cancer cells don’t have estrogen or progesterone receptors and also don’t make too much of the protein called HER2. Triple-negative breast cancers grow and spread faster than most other types of breast cancer. Because the cancer cells don’t have hormone receptors, hormone therapy is not helpful in treating these cancers. And because they don’t have too much HER2, drugs that target HER2 aren’t helpful, either. Chemotherapy can still be useful.

Triple-positive cancers are ER-positive, PR-positive, and HER2-positive. These cancers can be treated with hormone drugs as well as drugs that target HER2

What are the common lab tests (such as hormone receptor or HER2) performed to determine breast cancer treatment options?

The breast tissue that was removed during your biopsy can be used in special lab tests: Hormone receptor tests: Some breast cancers need hormones to grow. These cancers have hormone receptors for the hormones estrogen, progesterone, or both. If the hormone receptor tests show that the breast cancer has these receptors, then hormone therapy is often recommended as part of the treatment plan.

HER2 test: Some breast cancers have large amounts of a protein called HER2, which helps them to grow. The HER2 test shows whether a woman’s breast cancer has a large amount of HER2. If so, then targeted therapy against HER2 may be a treatment option.

It may take several weeks to get the results of these tests. The test results help your doctor decide which cancer treatments may be options for you.

What is triple negative breast cancer

Very few women have triple-negative breast cancer. These women have breast cancer cells that:
Do not have estrogen receptors (estrogen negative)
Do not have progesterone receptors (progesterone negative)
Do not have a large amount of HER2 (HER2 negative)

What are gene expression (Oncotype DX, MammaPrint) tests?

Looking at the patterns of a number of different genes at the same time can help predict if certain stage 1 or 2 breast cancers are likely to come back after initial treatment. Tests like these are part of what’s being called “personalized medicine” – learning more about your cancer to specially tailor your treatment.

The Oncotype DX® and the MammaPrint® are examples of tests that look at different sets of breast cancer genes. And there are more tests in development.

Oncotype DX®: The Oncotype DX test is used for small hormone receptor-positive tumors that have not spread to more than 3 lymph nodes, but it may be used for more advanced tumors, too. It can also be used for DCIS (ductal carcinoma in situ or stage 0 breast cancer).

This test looks at a set of 21 genes in cancer cells from tumor biopsy samples to get a “recurrence score,” which is a number between 0 and 100. The score reflects the risk of the breast cancer coming back (recurring) in the next 10 years and how likely you will benefit from getting chemo after surgery.

A lower score (usually 0-10) means a low risk of recurrence. Most women with low-recurrence scores probably do not benefit from chemotherapy.

An intermediate score (usually 11-25) means an intermediate risk of recurrence. Most women with intermediate-recurrence scores probably will not benefit from chemo, although women younger than 50 with a higher intermediate score (16-25) might. Women in this group should discuss the possible risks and benefits of chemo with their doctor.
A high score (usually 26-100) means a higher risk of recurrence. Women with high-recurrence scores are more likely to benefit from chemo to help lower the chance of the cancer coming back.

MammaPrint®: This test can be used to help determine how likely breast cancers are to recur in a distant part of the body after treatment. It can be used in any type of breast cancer that’s small (stage 1 or 2) and has spread to no more than 3 lymph nodes. Hormone and HER2 status are assessed as part of this test.

The test looks at 70 different genes to determine if the cancer is at low risk or high risk of coming back (recurring) in the next 10 years. The test results come back as either “low risk” or “high risk.”

What is ploidy?

The ploidy of cancer cells refers to the amount of DNA they contain. If there’s a normal amount of DNA in the cells, they are said to be diploid. These cancers tend to grow and spread more slowly.
If the amount of DNA is abnormal, then the cells are called aneuploid. These cancers tend to be more aggressive. (They tend to grow and spread faster.)
Tests of ploidy may help figure out long-term outcomes, but they rarely change treatment and are considered optional. They are not usually recommended as part of a routine breast cancer work-up.

What is cell proliferation (or Ki-67 test)?

Cell proliferation is how quickly a cancer cell copies its DNA and divides into 2 cells. If the cancer cells are dividing more rapidly, it means the cancer is faster growing or more aggressive.

The rate of cancer cell division can be estimated by doing a Ki-67 test. The S-phase fraction is the percentage of cells in a sample that are copying their DNA. DNA is copied when the cell is getting ready to divide into 2 new cells. If the S-phase fraction or Ki-67 labeling index is high, it means that the cancer cells are dividing more rapidly.

In some cases, Ki-67 testing to measure cell proliferation may be used to help plan treatment or estimate treatment outcomes. But test results vary depending on things like the lab doing the testing, the testing method, and what part of the tumor is tested. Still, there’s a lot of interest in measuring tumor proliferation and standardizing testing methods, so this test is being used more often.

What are the stages of breast cancer?

Staging system most often used for breast cancer is the American Joint Committee on Cancer (AJCC). TNM system, which is based on 7 key pieces of information:

The extent (size) of the tumor (T): How large is the cancer? Has it grown into nearby areas?

The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? If so, how many?

The spread (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs or liver?

Estrogen Receptor (ER) status: Does the cancer have the protein called an estrogen receptor?

Progesterone Receptor (PR) status: Does the cancer have the protein called a progesterone receptor?

Her2/neu (Her2) status: Does the cancer make too much of a protein called Her2?

Grade of the cancer (G): How much do the cancer cells look like normal cells?

Oncotype Dx® Recurrence Score results may also be considered in the stage in certain circumstances.
The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer. The pathologic stage (also called the surgical stage) is determined by examining tissue removed during an operation. Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage is used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patient’s outlook as accurately as a pathologic stage.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories, as well as ER, PR, Her2 status and grade of the cancer have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information see Cancer Staging. Detailed explanations of the TNM categories are seen below. The addition of information about ER, PR, and Her2 status along with grade has made stage grouping complex, so, it is best to ask your doctor about your specific stage and what it means.

Details of the TNM staging system

T categories for breast cancer

T followed by a number from 0 to 4 describes the main (primary) tumor’s size and if it has spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.

TX: Primary tumor cannot be assessed.
T0: No evidence of primary tumor.
Tis: Carcinoma in situ (DCIS, or Paget disease of the nipple with no associated tumor mass)
T1 (includes T1a, T1b, and T1c): Tumor is 2 cm (3/4 of an inch) or less across.
T2: Tumor is more than 2 cm but not more than 5 cm (2 inches) across.
T3: Tumor is more than 5 cm across.
T4 (includes T4a, T4b, T4c, and T4d): Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
N categories for breast cancer

N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.

Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has improved. Newer methods have made it possible to find smaller and smaller collections of cancer cells, but experts haven’t been sure how much these tiny deposits of cancer cells affect outlook.
It’s not yet clear how much cancer in the lymph node is needed to see a change in outlook or treatment. This is still being studied, but for now, a deposit of cancer cells must contain at least 200 cells or be at least 0.2 mm across (less than 1/100 of an inch) for it to change the N stage. An area of cancer spread that is smaller than 0.2 mm (or fewer than 200 cells) doesn’t change the stage, but is recorded with abbreviations (i+ or mol+) that indicate the type of special test used to find the spread.

If the area of cancer spread is at least 0.2 mm (or 200 cells), but still not larger than 2 mm, it is called a micrometastasis (one mm is about the size of the width of a grain of rice). Micrometastases are counted only if there aren’t any larger areas of cancer spread. Areas of cancer spread larger than 2 mm are known to affect outlook and do change the N stage. These larger areas are sometimes called macrometastases, but are more often just called metastases.

NX: Nearby lymph nodes cannot be assessed (for example, if they were removed previously).
N0: Cancer has not spread to nearby lymph nodes.
N0(i+): The area of cancer spread contains less than 200 cells and is smaller than 0.2 mm. The abbreviation “i+” means that a small number of cancer cells (called isolated tumor cells) were seen in routine stains or when a special type of staining technique, called immunohistochemistry, was used.
N0(mol+): Cancer cells cannot be seen in underarm lymph nodes (even using special stains), but traces of cancer cells were detected using a technique called RT-PCR. RT-PCR is a molecular test that can find very small numbers of cancer cells. (This test is not often used to find breast cancer cells in lymph nodes because the results do not influence treatment decisions.)
N1: Cancer has spread to 1 to 3 axillary (underarm) lymph node(s), and/or tiny amounts of cancer are found in internal mammary lymph nodes (those near the breast bone) on sentinel lymph node biopsy.
N1mi: Micrometastases (tiny areas of cancer spread) in the lymph nodes under the arm. The areas of cancer spread in the lymph nodes are at least 0.2mm across, but not larger than 2mm.
N1a: Cancer has spread to 1 to 3 lymph nodes under the arm with at least one area of cancer spread greater than 2 mm across.
N1b: Cancer has spread to internal mammary lymph nodes on the same side as the cancer, but this spread could only be found on sentinel lymph node biopsy (it did not cause the lymph nodes to become enlarged).
N1c: Both N1a and N1b apply.
N2: Cancer has spread to 4 to 9 lymph nodes under the arm, or cancer has enlarged the internal mammary lymph nodes
N2a: Cancer has spread to 4 to 9 lymph nodes under the arm, with at least one area of cancer spread larger than 2 mm.
N2b: Cancer has spread to one or more internal mammary lymph nodes, causing them to become enlarged.
N3: Any of the following:
N3a: either:
Cancer has spread to 10 or more axillary lymph nodes, with at least one area of cancer spread greater than 2 mm,
Cancer has spread to the lymph nodes under the collarbone (infraclavicular nodes), with at least one area of cancer spread greater than 2 mm.
N3b: either:
Cancer is found in at least one axillary lymph node (with at least one area of cancer spread greater than 2 mm) and has enlarged the internal mammary lymph nodes, OR
Cancer has spread to 4 or more axillary lymph nodes (with at least one area of cancer spread greater than 2 mm), and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
N3c: Cancer has spread to the lymph nodes above the collarbone (supraclavicular nodes) with at least one area of cancer spread greater than 2 mm.
M categories for breast cancer
M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.
MX: Distant spread (metastasis) cannot be assessed.
M0: No distant spread is found on x-rays (or other imaging tests) or by physical exam.
cM0(i+): Small numbers of cancer cells are found in blood or bone marrow (found only by special tests), or tiny areas of cancer spread (no larger than 0.2 mm) are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.
M1: Cancer has spread to distant organs (most often to the bones, lungs, brain, or liver). Examples using the new staging system
Example #1
If the cancer size is between 2 and 5 cm (T2) but it has not spread to the nearby lymph nodes (N0) or to distant organs (M0) AND is:
Grade 3
Her2 negative
ER positive
PR positive
The cancer stage is IB.
Example #2
If the cancer is larger than 5 cm (T3) and has spread to 4 to 9 lymph nodes under the arm or to any internal mammary lymph nodes (N2) but not to distant organs (M0) AND is:
Grade 2
Her2 positive
ER positive
PR positive
The cancer stage is IB.
Example #3
If the cancer is larger than 5 cm (T3) and has spread to 4 to 9 lymph nodes under the arm or to any internal mammary lymph nodes (N2) but not to distant organs (M0) AND is:
Grade 2
Her2 negative
ER negative
PR negative
The cancer stage is IIIB.

What is metastatic breast cancer?

When breast cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if breast cancer spreads to a lung, the cancer cells in the lung are actually breast cancer cells. The disease is metastatic breast cancer, not lung cancer. For that reason, it’s treated as breast cancer, not lung cancer

What are the tests that are performed to determine breast cancer stage?

Staging tests can show whether cancer cells have spread to other parts of the body. When breast cancer spreads, cancer cells are often found in the underarm lymph nodes (axillary lymph nodes). Breast cancer cells can spread from the breast to almost any other part of the body, such as the lungs, liver, bones, or brain. Your doctor needs to learn the stage (extent) of the breast cancer to help you choose the best treatment. Staging tests may include:
Lymph node biopsy: If cancer cells are found in a lymph node, then cancer may have spread to other lymph nodes and other places in the body. Surgeons use a method called sentinel lymph node biopsy to remove the lymph node most likely to have breast cancer cells. The NCI fact sheet Sentinel Lymph Node Biopsy has more information, including pictures of the method. 6 If cancer cells are not found in the sentinel node, the woman may be able to avoid having more lymph nodes removed. The method of removing more lymph nodes to check for cancer cells is called axillary dissection.
CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your chest or abdomen. You may receive contrast material by mouth and by injection into a blood vessel in your arm or hand. The contrast material makes abnormal areas easier to see. The pictures from a CT scan can show cancer that has spread to the lungs or liver.
MRI: A strong magnet linked to a computer is used to make detailed pictures of your chest, abdomen, or brain. An MRI can show whether cancer has spread to these areas. Sometimes contrast material makes abnormal areas show up more clearly on the picture. Bone scan: The doctor injects a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. Because higher amounts of the substance collect in areas where there is cancer, the pictures can show cancer that has spread to the bones.
PET scan: You’ll receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan can show cancer that has spread to other parts of the body.

What is an Axillary Dissection?

Axillary dissection is a surgical procedure that incises the axilla (arm pit) to identify, examine, or remove lymph nodes. Axillary dissection has been the standard technique used in the staging and treatment of the axilla in breast cancer. Staging of the axilla is an important step in the treatment of breast carcinoma. Axillary lymph node status is a significant prognostic pathologic variable in patients with operable primary breast cancer, and it remains the most powerful predictor of recurrence and survival.

What are the questions to ask your doctor about breast cancer tests?

What did the hormone receptor test show?
What did the HER2 test show?
May I have a copy of the report from the pathologist?
Do any lymph nodes show signs of cancer?
What is the stage of the disease?
Has the cancer spread?
Would genetic testing be helpful to me or my family?

What questions should I ask my doctor about my breast cancer diagnosis?

Exactly what type of breast cancer do I have?
How big is the cancer? Where exactly is it?
Has the cancer spread to my lymph nodes or other organs?
What’s the stage of the cancer? What does that mean?
Will I need any other tests before we can decide on treatment?
Do I need to see any other doctors or health professionals?
What is the hormone receptor status of my cancer? What does this mean?
What is the HER2 status of my cancer? What does this mean?
How do these factors affect my treatment options and long-term outlook (prognosis)?
What are my chances of survival, based on my cancer as you see it?
Should I think about genetic testing? What are my testing options? Should I take a home-based genetic test? What would the pros and cons of testing be?
How do I get a copy of my pathology report?
If I’m concerned about the costs and insurance coverage for my diagnosis and treatment, who can help me

At a high level, what are the different treatment options available to treat breast cancer?

Treatment options include:
Radiation therapy
Hormone therapy
Targeted therapy

You may receive more than one type of treatment. You and your doctor will develop a treatment plan. The treatment that’s best for one woman may not be best for another. The treatment that’s right for you depends mainly on
The stage of breast cancer
Whether the tumor has hormone receptors
Whether the tumor has too much HER2
Your general health
In addition, your treatment plan depends on:
The size of the tumor in relation to the size of your breast
Whether you have gone through menopause

What questions should I ask my doctor about breast cancer treatment plans?

How much experience do you have treating this type of cancer?
Should I get a second opinion? How do I do that?
What are my treatment choices?
What treatment do you recommend and why?
What would the goal of the treatment be?
How soon do I need to start treatment?
How long will treatment last? What will it be like? Where will it be done?
What should I do to get ready for treatment?
What risks or side effects are there to the treatments you suggest? Are there things I can do to reduce these side effects?
How will treatment affect my daily activities? Can I still work fulltime?
Will I lose my hair? If so, what can I do about it?
Will I go through menopause as a result of the treatment? Will I be able to have children after treatment? Would I be able to breastfeed?
What are the chances the cancer will come back (recur) after this treatment?
What would we do if the treatment doesn’t work or if the cancer comes back?
What if I have transportation problems getting to and from treatment?

What are the different surgical options available to treat breast cancer?

Surgery is the most common treatment for breast cancer. There are several kinds of surgery. Your surgeon can describe each kind of surgery, compare the benefits and risks, and help you decide which kind might be best for you:
Removing part of the breast: Breast-sparing surgery is an operation to remove the cancer and a small amount of the normal tissue that surrounds it. This is also called breast-conserving surgery. It can be a lumpectomy or a segmental mastectomy (also called a partial mastectomy). A woman usually has radiation therapy after breast-sparing surgery to kill cancer cells that may remain in the breast area. Some women will have more tissue removed but not the whole breast. For these women, the surgeon will remove lymph nodes under the arm and some of the lining over the chest muscles below the tumor.

Removing the whole breast: Surgery to remove the whole breast (or as much of the breast tissue as possible) is a mastectomy. In some cases, a skin-sparing mastectomy may be an option. For this approach, the surgeon removes as little skin as possible. In total (simple) mastectomy, the surgeon removes the whole breast but not the underarm lymph nodes. In modified radical mastectomy, the surgeon removes the whole breast and most or all of the lymph nodes under the arm. Often, the lining over the chest muscles is removed. A small chest muscle may also be taken out to make it easier to remove the lymph nodes.

The choice between breast-sparing surgery and mastectomy depends on many factors:

The size, location, and stage of the tumor
The size of your breast
Certain features of the cancer
How you feel about how surgery will change your breast
How you feel about radiation therapy
Your ability to travel to a radiation treatment center for daily treatment sessions

The surgeon usually removes one or more lymph nodes from under the arm to check for cancer cells. If cancer cells are found in the lymph nodes, other cancer treatments will be needed.
After mastectomy, you may choose to have breast reconstruction. This is plastic surgery to rebuild the shape of the breast. If you’re considering breast reconstruction, talk with a plastic surgeon before having cancer surgery.

It’s common to feel tired or weak for a while after surgery for breast cancer. The time it takes to heal is different for each woman.

Surgery causes pain and tenderness, and the skin where your breast was removed may feel tight. Your arm and shoulder muscles may feel stiff and weak, and your neck and back may hurt. Medicine can help control your pain. Before surgery, discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain control.
Any kind of surgery carries a risk of infection, bleeding, or other problems. Tell your healthcare team right away if you develop any problems.

Removing the underarm lymph nodes slows the flow of lymph fluid. The fluid may build up in your arm and hand and cause swelling. This swelling is called lymphedema. It can develop soon after surgery or months or even years later.

Always protect the arm and hand on the treated side of your body from cuts, burns, or other injuries. Remind nurses not to measure your blood pressure or give you injections on the treated side of your body.

The doctor, nurse, or physical therapist can suggest exercises to help you regain movement and strength in your arm and shoulder. Exercise can also reduce stiffness and pain. You may be able to begin gentle exercise within days of surgery.

What is the surgery to remove lymph nodes?

To find out if the breast cancer has spread to axillary (underarm) lymph nodes, one or more of these lymph nodes will be removed and looked at under the microscope. This is an important part of figuring out the stage (extent) of the cancer. Lymph nodes may be removed either as part of the surgery to remove the breast cancer or as a separate operation.

The two main types of surgery to remove lymph nodes are:
Sentinel lymph node biopsy (SLNB) – A procedure in which the surgeon removes only the lymph node(s) under the arm to which the cancer would likely spread first. Removing only one or a few lymph nodes lowers the risk of side effects from the surgery.
Axillary lymph node dissection (ALND) – A procedure in which the surgeon removes many (usually less than 20) lymph nodes from under the arm. ALND is not done as often as it was in the past, but it might still be the best way to look at the lymph nodes in some situations.

What are breast reconstruction options after my surgery to treat cancer?

Any women undergoing surgery for breast cancer may have the option of breast reconstruction. In the case of a mastectomy, a woman might want to consider having the breast mound rebuilt to restore the breast’s appearance after surgery. In some breast-conserving surgeries, a woman may consider having fat grafting in the affected breast to correct any dimples left from the surgery. The options will depend on each women’s specific situation.
There are several types of reconstructive surgery, although your options may depend on your medical situation and personal preferences. You may have a choice between having breast reconstruction at the same time as the breast cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction). If you are thinking about having reconstructive surgery, it’s a good idea to discuss it with your breast surgeon and a plastic surgeon before your mastectomy or BCS. This gives the surgical team time to plan out the treatment options that might be best for you, even if you wait and have the reconstructive surgery later.

Are surgeries a viable treatment option for advanced breast cancer?

Although surgery is very unlikely to cure breast cancer that has spread to other parts of the body, it can still be helpful in some situations, either as a way to slow the spread of the cancer, or to help prevent or relieve symptoms from it. For example, surgery might be used:
When the breast tumor is causing an open wound in the breast (or chest) To treat a small number of areas of cancer spread (metastases) in a certain part of the body, such as the brain
When an area of cancer spread is pressing on the spinal cord
To treat a blockage in the liver
To provide relief of pain or other symptoms
If your doctor recommends surgery for advanced breast cancer, it’s important that you understand its goal—whether it’s to try to cure cancer or to prevent  or treat symptoms

What is wire localization to guide surgery?

Sometimes, if the cancer in your breast can’t be felt, is hard to find, and/or is difficult to get to, a mammogram or ultrasound may be used to place a wire in the cancerous area to guide the surgeon to the right spot. This is called wire localization or needle localization. If a mammogram is used you may hear the term stereotactic wire localization. Rarely, a MRI might be used if the mammogram or ultrasound are not successful.

After your breast is numbed, a mammogram or ultrasound is used to guide a thin hollow needle to the abnormal area. Once the tip of the needle is in the right spot, a thin wire is put in through the center of the needle. A small hook at the end of the wire keeps it in place. The needle is then taken out. The surgeon uses the wire as a guide to the part of the breast to be removed.

The surgery done as part of the wire localization may be enough to count as breast conserving surgery if the margins are negative. If cancer cells are found at the edge of the removed tissue (also called a positive margin), more surgery may be required. It should be noted that a wire-localization procedure is sometimes used to perform a surgical biopsy of a suspicious area in the breast to determine if it is cancer or not.

When might radiation therapy be used to treat breast cancer?

Radiation therapy may be used to treat breast cancer at almost every stage. The timing for radiation therapy depends on several factors. The treatment may take place:
• After a lumpectomy: A lumpectomy removes the cancerous tumor, leaving most of the breast. Radiation therapy lowers your risk of cancer coming back in the remaining breast tissue or nearby lymph nodes as well as reduces your chance of passing away of breast cancer.
• After a mastectomy: Most people don’t get radiation therapy after a mastectomy (complete breast removal). Your provider may recommend radiation if the tumor was larger than 5 cm (about 2 inches); if there’s cancer in surrounding lymph nodes, skin tissue or muscle; or if all the cancer can’t be removed (positive margins).
• Before surgery: Rarely, healthcare providers use radiation to shrink a tumor before surgery.
• Instead of surgery: Sometimes, providers use radiation therapy to shrink a tumor that they can’t surgically remove (unresectable). A tumor may be unresectable due to its size or location. Or you may not be a candidate for surgery because of concerns about your health.
• To treat cancer spread: Stage 4 breast cancer is cancer that spreads (metastasizes) to other parts of the body. Your provider may use radiation therapy to treat cancer that spreads to other parts of the body.

What is brachytherapy?

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called implant radiation therapy, internal radiation therapy, and radiation brachytherapy

what is an X-ray?

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.

What is a Tissue?

A group or layer of cells that work together to perform a specific function

What is Targeted therapy?

A type of treatment that uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells. Targeted therapy may have fewer side effects than other types of cancer treatments

What is Tamoxifen?

A drug used to treat certain types of breast cancer in women and men. It is also used to prevent breast cancer in women who have had ductal carcinoma in situ (abnormal cells in the ducts of the breast) and in women who are at a high risk of developing breast cancer. It blocks the effects of the hormone estrogen in the breast

What is a Side effect?

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

What is a sentinel lymph node biopsy?

Removal and examination of the sentinel node(s) (the first lymph node(s) to which cancer cells are likely to spread from a primary tumor). To identify the sentinel lymph node(s), the surgeon injects a radioactive substance, blue dye, or both near the tumor. The surgeon then uses a scanner to find the sentinel lymph node(s) containing the radioactive substance or looks for the lymph node(s) stained with dye. The surgeon then removes the sentinel node(s) to check for the presence of cancer cells.

What is segmental mastectomy?

The removal of 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 also taken out. Also called partial mastectomy.

Who is a registered dietitian?

A health professional with special training in the use of diet and nutrition to keep the body healthy. A registered dietitian may help the medical team improve the nutritional health of a patient.

Who is a radiation oncologist?

A doctor who specializes in using radiation to treat cancer. Radiation therapy (RAY-dee-AY-shun THAYR-uh-pee): The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors.
Radiation may come from a machine outside the body (externalbeam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and Radiotherapy.

What is radiation?

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

What is progesterone?

A type of hormone made by the body that plays a role in the menstrual cycle and pregnancy. Progesterone can also be made in the laboratory. It may be used as a type of birth control and to treat menstrual disorders, infertility, symptoms of menopause, and other conditions.

Who is a physical therapist?

A health professional who teaches exercises and physical activities that help condition muscles and restore strength and movement

What is a PET Scan?

A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. Also called positron emission tomography scan.

What is a modified radical mastectomy

Surgery for breast cancer in which the breast, most or all of the lymph nodes under the arm, and the lining over the chest muscles are removed. Sometimes the surgeon also removes part of the chest wall muscles.

Who is a medical oncologist?

A doctor who specializes in diagnosing and treating cancer using chemotherapy, targeted therapy, hormonal therapy, and biological therapy. A medical oncologist often is the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists.

What is a mammogram?

Mammogram is a specific type of breast imaging that uses low-dose x-rays to detect cancer.

What is malignant?

It means Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.

What is lymphedema?

A condition in which excess fluid collects in tissue and causes swelling. It may occur in the arm or leg after lymph vessels or lymph nodes in the underarm or groin are removed or treated with radiation.

What is a Lymph vessel?

A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.

What is a Lymph node?

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

What is a lobule?

A small part of a lobe in the breast. A breast lobule is a gland that makes milk. Embedded in the breast’s fatty and fibrous tissue are 15 to 20 glands called lobes, each of which has many smaller lobules, or sacs, that produce milk. Lobules are arranged in clusters, like bunches of grapes.

What is Breast-sparing surgery?

An operation to remove the breast cancer but not the breast itself. Types of breast sparing surgery include lumpectomy (removal of the lump), quadrantectomy (removal of one quarter, or quadrant, of the breast), and segmental mastectomy (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). Also called breast-conserving Surgery.

What is lumpectomy?

Surgery to remove abnormal tissue or cancer from the breast and a small amount of normal tissue around it. It is a type of breast-sparing surgery.

What is inflammatory breast cancer?

A type of breast cancer in which the breast looks red and swollen and feels warm. The skin of the breast may also show the pitted appearance like the skin of an orange. The redness and warmth occur because the cancer cells block the lymph vessels in the skin.

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