Breast cancer treatment options can be confusing and overwhelming. Take your partner, friend or relative with you to your oncology appointments. Prepare a list of question to take with you and ask your companion to jot down notes during the meeting. That way you will have a record of the important points of discussion.

   SURGERY

Surgery is the premier local option available in the treatment of breast cancer. The type of surgery chosen depends on the size of the tumour, location of the tumour and risk for recurrence. This treatment option removes the tumour in its entirety.

Make sure that you understand the surgical options and do not hesitate to get a second opinion if you are still unsure. The majority of breast surgeons will attempt to choose breast conserving surgery where possible.

   SURGICAL PROCEDURES

Four kinds of surgical procedures are used:

1. Biopsy
   1. surgical removal of part of the lump or the whole lump
2. Lumpectomy
   1. surgical removal of the lump and surrounding tissue
   2. can include surgical removal of the axilla lymph nodes
3. Partial Mastectomy or Segmental
   1. surgical removal of the lump and a section of the breast including surrounding tissue
   2. can include surgical removal of the axilla lymph nodes
4. Mastectomy
   1. simple - surgical removal of the entire breast tissue
   2. modified radical - surgical removal of the entire breast tissue, lymph nodes and small muscle
   3. radical - rarely performed surgical removal of the entire breast tissue, lymph nodes and all muscle on the chest wall

   SIDE EFFECTS

Every woman's experience is unique and different. Some of the side effects are:

• arm may be stiff on the surgery side
• pins and needles sensations in the incision and arm
• some temporary swelling in the arm and hand
• may have a drain in the incision for about one week
• lymphedema is a possibility
• may experience emotional ups and downs (grief, fear, shock, anger, resentment)
• physical changes to the breast area

   HELPFUL HINTS

1. Do the arm exercises that are recommended (contact Reach to Recovery Program with the American or Canadian Cancer Society, or online at Recovercises for Wellness.com)
2. Bring a temporary, soft, light breast replacement or prosthesis for your bra if you are having a mastectomy
3. Discuss breast reconstruction prior to your mastectomy
4. If you are having a hard time coping with a mastectomy, get professional help
5. Join a support group or organization

   Send Us Your Surgery Helpful Hint

   CHEMOTHERAPY

Chemotherapy is a systemic option available in the treatment of breast cancer. Patients are prescribed potent anti-cancer or cytotoxic drug combinations. These may or may not include Hormone Therapy. Chemotherapy is sometimes referred to as adjuvant treatment.

The chemotherapy treatment can be taken by mouth, by injection, by intravenous injection or by intravenous pump at set cycles or rounds that are determined by the drugs prescribed. These treatments cause the fast growing cancer cells to stop dividing, stop growing and die. Chemotherapy can be given before surgery to shrink a tumour or after surgery to reduce the chances of recurrence.

New cytotoxic drugs introduced in the fight against breast cancer go through several stages of testing or clinical trials to determine their toxicity and efficacy.

We have included information about Tamoxifen on this page because it was the standard hormone therapy used after Carol had her initial chemotherapy treatment.

For more information about the chemotherapy prescription that is being suggested for your treatment plan, go to Profiles of Breast Cancer Drugs.

   SIDE EFFECTS

Chemotherapy can also cause some fast growing healthy cells to die. That is why patients experience side effects. Not everyone who receives chemotherapy will experience all the side effects that can occur:

• mouth sores
• nausea
• vomiting
• loss or thinning of hair
• loss of appetite
• tiredness
• loss of energy
• sleep disturbances
• temporary or permanent menopause (and side effects)
• hot flashes
• low red blood cell count
• low white blood cell count

Contact your oncologist at the first sign of an infection to assess the need for antibiotic therapy.

   HELPFUL HINTS

1. Report side effects of chemotherapy
2. Take medicines prescribed for side effects
3. Severe side effects might improve with treatment changes or dose reduction
4. Restrict activities
5. Ask for help with chores
6. If necessary cut back on hours at work
7. Rest when tired
8. Plan meals ahead for day of treatment and a couple of days after
9. Arrange for help with young children at treatment time
10. Nibble dry crackers to help nausea
11. If you are unable to eat, drink lots of liquids (juice, peppermint tea, soup, Boost etc.)
12. Sea-Bands that are available at marine stores can help with nausea
13. Meditation and visualization can help reduce side effects
14. Reward yourself with a small gift after each treatment (flower, perfume, bubble bath etc)

  HORMONE THERAPY - TAMOXIFEN

Breast cancer cells require estrogen for growth and development. Estrogen is supplied to the cancer cells via receptors on the cell surface. Tamoxifen blocks estrogen from binding with these receptors especially if the breast cancer tumour is estrogen receptor (ER) positive, progesterone receptor (PR) positive, and lymph node involvement positive. In addition, Tamoxifen displays an estrogenic-like effect on several body systems (endometrium, bone, blood lipids).

   USE OF TAMOXIFEN

1. delays or prevents the recurrence of breast cancer
2. reduces recurrence and mortality rates in stage I and stage II breast cancer
3. reduces risk for new primary in other breast
4. decreases cardio-vascular disease
5. stabilizes bone loss
6. delay or preventative agent for breast cancer in women at high risk (Clinical Trials)

   SIDE EFFECTS

Every woman's experience is unique and different. Some of the side effects are:

• hot flashes
• night sweats
• nausea
• vomiting
• vaginal bleeding or unusual discharge
• change in menstrual period
• rash
• sleep pattern disturbances
• increased risk for uterine cancer
• increased risk for gastro-intestinal cancer
• increased risk for pulmonary embolism
• increased risk for deep-vein thrombosis
• vision problems
• liver problems
• peripheral edema
• depression
• light headedness
• headache
• some hair loss

  HORMONE THERAPY - ARIMIDEX

An important advance in the treatment of breast cancer has been shown by the trials (ATAC) of the drug Arimidex. Even though a woman is post menopausal (loss of ovary function) there is still estrogen being produced in her body. An enzyme called aromatase is required to facilitate the production of estrogen via the adrenal gland. Arimidex, an aromatase inhibitor blocks the action of aromatase thereby lowering the production of estrogen. Breast cancer tumours that are hormone receptor positive require estrogen and or progesterone to grow. When the level of estrogen is diminished, the breast cancer tumour shrinks in size or disappears.

   USE OF ARIMIDEX

1. for the treatment of post menopausal, early stage hormone receptor positive breast tumours
2. adjuvant therapy (post surgery and / or radiation therapy)
3. reduces risk of recurrence
4. has less serious side effects than Tamoxifen
5. a treatment option for post menopausal, hormone receptor positive or hormone receptor unknown, locally advanced or metastatic breast cancer
   1. after Tamoxifen
   2. for patients who do not respond to Tamoxifen

   SIDE EFFECTS

Every woman's experience is unique and different. Some of the side effects are:

• general feelings of weakness
• decreased energy level
• increased or decreased appetite
• hot flashes
• vaginal dryness
• temporary hair thinning
• joint problems (fractures of spine, hip, wrist) It is important to be monitored for osteoporosis
• headache
• mood changes
• gastro-intestinal disturbances
• nausea, vomiting
• skin rash
• sore throat

   HELPFUL HINTS

1. inform your physician about all prescriptions and medicines you are taking
2. inform your physician if you are pregnant
3. Clonidine in patch or pill form can help night sweats
4. have regular gynecologic exams
5. report abnormal vaginal bleeding or discharge

   Send Us Your Chemotherapy Helpful Hint

   RADIATION THERAPY

Radiation Therapy is a one of the options available in the local treatment of breast cancer. Patients receive radiation therapy following a lumpectomy, mastectomy and/or chemotherapy because research has shown that local recurrence of breast cancer can be significantly lowered.

Radiation utilizes high-energy electromagnetic waves to kill any remaining cancer cells by aiming a radiation beam to predetermined spots on the breast, axilla and surrounding area.

Radiation Therapy is usually administered several weeks after a lumpectomy or whenever the surgery has healed after a mastectomy. Treatment can last from three to six weeks. It is administered externally but in some cases treatment can be administered internally.

Sometimes there can be local side effects during the treatment or two to three weeks later. They usually disappear in four to six weeks and no further changes are likely ten to twelve months after treatment is completed.

Remember, report all breast changes during treatment to your radiation oncologist or nurse.

   SIDE EFFECTS

Not everyone will experience any or all of the following side effects:

• tiredness
• inflamed, dry, itchy skin
• peeling or darkening skin
• wet, moist, blistering skin surface (like a bad sunburn)
• swelling, heaviness, tenderness of the breast
• pinching or mild jabbing sensations
• thickening of the breast skin or tissue
• change in size of the breast
• lump in the throat during treatment
• heartburn during treatment
• difficulty swallowing during treatment

   HELPFUL HINTS

1. Do not remove coloured ink marks on the skin unless told to do so
2. Wash with lukewarm water only and blot dry
3. Avoid soap, lotion, ointment or perfume on treatment area
4. Do not shave or use deodorant in armpit on the treatment side
5. You can dust your armpit with cornstarch
6. Avoid exposing treatment area to sun or hair dryers
7. Wear a very loose fitting bra or camisole. If you have had a mastectomy ask you doctor if you can wear your prosthesis.
8. Do not scratch when itchy
9. If side effects persist or are aggressive ask your doctor for special treatment products.
10. Continue doing post surgery exercises
11. Maintain a well balanced diet

   Send Us Your Radiation Helpful Hint

   RESOURCES

Web Sites

• Clinical Practice Guidelines for the Care and Treatment of Breast Cancer Canadian Medical Association
  
  
• Questions For Your Doctor About Surgery  CancerHelp UK
• Questions For Your Doctor About Chemotherapy  CancerHelp UK
• Questions For Your Doctor About Radiation  CancerHelp UK
  
  
• Chemocare.com  Scott Hamilton CARES Initiative, authored by the Cleveland Clinic
  
  
• Top Ten Decision Lessons CBHP Stanford U. (click on Support and Practical Information)
• NCI Booklets About Cancer Treatment
• National Cancer Institute: PDQ - Breast Cancer Treatment
• Treating Breast Cancer  CancerHelp UK
  
  
• AstraZeneca Pharmaceuticals Tamoxifen.com
• Questions and Answers About Tamoxifen
• What is the Optimal Duration of Adjuvant Tamoxifen Therapy?
  
  
• Welcome to ARIMIDEX.com
• MedlinePlus Drug Information: Anastrozole
• ATAC-news.com
  
  
• Profiles of Breast Cancer Drugs
• Hormone Therapy  CancerHelp UK