Frequently Asked Questions About Breast Cancer
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Signs of breast cancer - What are they?
Often there are no outward signs or symptoms of breast cancer that you can see or feel. However, you may feel a lump, an area of thickening or a dimple in the breast. Swelling or redness in the breast or an enlarged underarm lymph node may also be signs of breast cancer. If you notice any of these signs, call your doctor. They may not be cancerous--most breast lumps are benign (noncancerous). A physical exam by your doctor is one way to determine if further testing is needed.
Is mastectomy a better treatment for breast cancer than lumpectomy?
Women who choose lumpectomy and radiation can expect the same chance of survival as those who choose mastectomy. The advantage of lumpectomy is that it saves the appearance of the breast. A disadvantage is the need for several weeks of radiation therapy after surgery. However, some women who have a mastectomy will still need radiation therapy. When considering mastectomy, you must consider how you feel about losing your breast and whether you want to undergo additional surgery to reconstruct your breast.
In determining the preference for lumpectomy or mastectomy, be sure to get all the facts. Though you may have a gut feeling for mastectomy to "take it all out as quickly as possible," the fact is that doing so does not provide any better chance of long term survival or a better outcome from treatment in most cases. According to research studies over 2 decades, mastectomy does not provide a better chance of survival than lumpectomy.
How many lymph nodes are removed during axillary dissection?
Axillary dissection is performed on patients whose breast cancer has spread to the lymph nodes or who are not candidates for sentinel node biopsy. The lymph nodes are buried in fat and cannot be seen during surgery. Most women have 10-30 underarm lymph nodes. In axillary dissection, the surgeon removes the pad of fat containing these lymph nodes. Following surgery, the tissue is examined under a microscope to determine how many lymph nodes were removed and whether any contain cancer cells (This takes about 5 days.). After axillary dissection, a small drain tube is left in place to collect the lymph fluid that forms after surgery. This drain tube is removed in the doctor's office once the drainage has decreased to a minimal amount.
I have a lump in my breast and I'm afraid it's cancer. Should I be worried?
Eighty percent of lumps are noncancerous. Usually these lumps are a collection of normal or hyperactive breast gland cells or a cyst. However, if you detect a lump, you should see a doctor for a definitive diagnosis. It is helpful to know what your breasts normally feel like. That is why monthly breast self-exams are so important. If you notice any changes in your breasts that last over a full month's cycle or that seem to get worse or more obvious over time, tell your doctor.
Can benign (noncancerous) cysts become cancerous?
Cysts are very common and rarely turn into cancers. But it's extremely important to find out whether what you have is just a cyst or something else. If you feel a lump in your breast and you don't know what it is, have your doctor check it. Some women get what is called fibrocystic change: cyst-like changes that can appear before the start of the menstrual cycle and later shrink or disappear. These are generally harmless. Even if you've had cysts in the past, if you find a new lump in your breast, don't assume it's a cyst. If the lump doesn't go away or gets larger, it's important to check it out with a doctor.
Ultrasound is the easiest way to see if a lump is a cyst or not. Your doctor may insert a needle into a lump to see if it's a cyst. In a simple cyst, the needle will drain off the fluid. A pathologist will check the fluid to make sure there are no cancer cells in it. If the lump is made up of breast cells, a tissue sample can be taken out with the needle and checked by a pathologist under the microscope.
In some women, the examination under the microscope may reveal epithelial hyperplasia, a harmless overgrowth of normal breast cells. Another finding, atypical hyperplasia, is an increase in breast cells that have started to look different from normal cells. The atypical form is associated with breast cancer and should be removed.
Can I inherit breast cancer from someone in my family?
There's no simple answer to this question. Some abnormal genes are associated with an increased risk of breast cancer. In families that have an abnormal gene, it can be passed down from a parent to a child.
Only 10% (1 in 10) of women with breast cancer have inherited an abnormal breast cancer gene. Breast cancer due to an inherited gene abnormality tends to happen at an early age (under 40), in multiple relatives and in one or both breasts (but usually not at the same time). The abnormal gene is also associated with an increased risk of ovarian cancer. Here are a few other important facts to remember:
- Just because your mother or another relative had breast cancer DOES NOT mean you will get breast cancer.
- Most women who get breast cancer DO NOT have breast cancer in the family.
- There are many risk factors for breast cancer and having it in the family is only one of them.
If you're worried about getting breast cancer, talk to your doctor about your risk factors.
What are the side effects of tamoxifen?
Tamoxifen (brand name: Nolvadex) is a medicine that is very effective in preventing the recurrence of estrogen receptor-positive breast cancer. But it does have side effects. The most common are menopausal symptoms including hot flashes, vaginal dryness, low libido (sex drive), mood swings and nausea. If you're at an age when you would soon enter natural menopause, Tamoxifen may induce menopause sooner.
If tamoxifen gives you uncomfortable menopausal symptoms and your doctor advises you not to take hormone replacement therapy (HRT), you should asked your doctor about other effective treatments. Tamoxifen may also cause non-cancerous changes in the uterus. In some women, it may increase the risk of blood clots or endometrial cancer (cancer in the lining of the uterus). Each woman's risk factors are different. When you discuss your medical history with your doctor, you may find that the benefits of tamoxifen far outweigh the risks.
If you have further questions about breast cancer, not addressed here, please call your doctor or 1-888-FOX CHASE (1-888-369-2427).
For more information about breast cancer treatment and prevention at Fox Chase Cancer Center or to make an appointment, call 1-888-FOX CHASE (1-888-369-2427). The breast cancer scheduling department can be reached at 215-728-3001.