Mark Citron, M.D.
You have breast cancer.
These dreaded words will be heard by roughly one in nine women during their lifetime. However, what does that really mean? The phrase breast cancer treatment often evokes images of hair loss, nausea, and extended drug treatment, yet it doesn’t have to be that way. Today cancer therapy, from diagnosis to tailoring a course of treatment, has become a very personalized process that does not necessarily reflect some of these old cancer stereotypes.
Due to rapid advances in the field, modern cancer treatment is now so specific that cancer doctors – also known as medical Oncologists – specialize in cancer for different parts of the body. This allows patients to have one doctor care for them from time of time of the initial diagnosis, through the development and implementation of a personalized treatment plan, and continuing during their years of follow-up. Other physicians, such as surgeons and radiation Oncologists, may contribute to your care in a well-organized team approach. However, you should expect to have one doctor supervising your care from start to finish.
How do you describe breast cancer?
Your breast is composed of several parts: lobules, milk ducts, areola, nipple and some fleshy tissue. It’s the lobules and milk ducts that are often the problem with breast cancer. The lobules of the breast produce milk and allow the ducts to carry the milk to the nipple. Two out of three cancers start in the duct. If the cancer is confined within this duct tube, this is known as Stage 0 (zero) or noninvasive ductal cancer.
Invasive breast cancers have invaded through the duct wall, potentially spreading to other parts of body such as the lymph nodes (under your arms) and possibly to major organs. Depending on the size of the cancer and its lymph node presence, tumors are categorized by different stages.
1. Stage I breast cancer – is an invasive tumor smaller than 2 centimeters (about the size of a marble) that do not involve the lymph nodes.
2. Stage II breast cancer – is an invasive cancer in which the tumor measures between two to five centimeters or has spread to the lymph nodes on the same side of the breast cancer.
3. Stage III breast cancer – is also called locally advanced cancer. The tumor is more than 5 cm in diameter across and has spread to the underarm lymph nodes, other lymph nodes or tissues near the breast.
4. Stage IV breast cancer – is the highest category and signifies the spread of cancer throughout the body.
What’s my treatment?
Your treatment is based on your stage and subtype of cancer. Surgery removes the primary cancer. The tumor is then tested to check which type of breast cancer it is, whether there is lymph node involvement, and its biologic features. These tests are critical in designing your therapy.
There are three biomarkers on the surface of the tumor cell that can affect your type of treatment.
- – ER Receptor: Signifies the ability of estrogen to fuel tumor growth.
- – PR Receptor: When positive, it supports the estrogen receptor.
- – Her-2: This is a gene causing cancer to grow and spread fast
All three of these factors are considered when we design your course of systemic therapy. Systemic therapy includes medications, such as hormone pills, injections, or chemotherapy. Radiation is often used as a follow-up to surgery.
What’s my prognosis?
Breast cancer is not a death sentence. The vast majority of patients are curable. Our treatment is structured to prevent the return of your cancer by eliminating microscopic spread of the tumor in your organs. Today, modern detection techniques coupled with advances in cancer research signal a brighter future for all breast cancer patients.