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2011-05-01 13:04:00

I’ve got breast cancer – series

Question: I’ve just been diagnosed with breast cancer. I’m frightened. I have lots of questions and concerns. If I ever needed a “coach,” I need one now. Can you help me?

Answer: As you might recall from my first three articles in this series, most women, like you, have dozens of questions. Some of these questions might deal with: a second opinion, method of treatment, alternative treatments, radiation, chemotherapy, stigmas, depression, support groups, going out in public, clothes, wigs, bras, swimsuits…and a host of other topics. To know that they all fit in one of five areas, is part of the organization that will help you go about handling this challenge. These areas are: physical, mental, social, spiritual and material. This article, as did the last two months’ articles, will be the last on the physical side of cancer, and chemotherapy. While there is much that can be written on this subject, in this series I will attempt to provide an overview of each area. In doing so, I have sought the help of information supplemented by www.cancer.org, www.breastcancer.org and a host of other sites. Chemotherapy: Chemotherapy treatment uses medicine to weaken and destroy cancer cells in the body, including cells at the original cancer site and any cancer cells that may have spread to another part of the body. Chemotherapy, often shortened to just “chemo,” is a systemic therapy, which means it affects the whole body by going through the bloodstream. There are quite a few chemotherapy medicines. In many cases, a combination of two or more medicines will be used as chemotherapy treatment for breast cancer. Chemotherapy is used to treat: •Early-stage invasive breast cancer to get rid of any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back •Advanced-stage breast cancer to destroy or damage the cancer cells as much as possible In some cases, chemotherapy is given before surgery to shrink the cancer. Chemotherapy medicines prevent cancer cells from growing and spreading by destroying the cells or stopping them from dividing. Cancer cells tend to grow and divide very quickly with no order or control. Because they’re growing so fast, sometimes cancer cells break away from the original tumor and travel to other places in the body. Chemotherapy weakens and destroys cancer cells at the original tumor site AND throughout the body. Most normal cells grow and divide in a precise, orderly way. Still, some normal cells do divide quickly, including cells in hair follicles, nails, the mouth, digestive tract, and bone marrow (bone marrow makes blood cells). Chemotherapy also can unintentionally harm these other types of rapidly dividing cells, possibly causing chemotherapy side effects. Chemotherapy is used to treat: •Early-stage invasive breast cancer to get rid of any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back •Advanced-stage breast cancer to destroy or damage the cancer cells as much as possible When treating early-stage breast cancer, it’s fairly common for chemotherapy to be given after surgery, as soon as you recover. Doctors call this “adjuvant” chemotherapy because it’s given in addition to surgery, which is considered the primary treatment. As stated above, in some cases, chemotherapy is given before surgery to shrink the cancer so that less tissue has to be removed. When chemotherapy is given before surgery, it’s called “neoadjuvant” chemotherapy. In many cases, chemotherapy medicines are given in combination, which means you get two or three different medicines at the same time. These combinations are known as chemotherapy regimens. In early-stage breast cancer, standard chemotherapy regimens lower the risk of the cancer coming back. In advanced breast cancer, chemotherapy regimens make the cancer shrink or disappear in about 30-60% of people treated. Keep in mind that every cancer responds differently to chemotherapy. Chemotherapy is used to treat all stages of breast cancer, including cancer that has come back in the breast area and breast cancer that has spread to other parts of the body (metastatic disease). Chemotherapy treatments are tailored specifically for each person’s unique situation. When deciding on which chemotherapy medicines would be best for you, you and your doctor will take into account the stage and other characteristics of the cancer, such as hormone-receptor status and HER2 status. You’ll also consider your menopausal status and any other treatments you’ve had. Chemotherapy for early-stage disease: Early-stage breast cancer generally means cancer that is classified as: • Stage 0 • Stage I • Stages IIA and IIB • Some stage III Chemotherapy is used after surgery to remove the breast cancer to get rid of any cancer cells that may be left behind and to reduce the risk of the cancer coming back. Each person’s treatment plan will be different, but there are some general guidelines about who would benefit from chemotherapy: •Chemotherapy is almost always recommended if there is cancer in the lymph nodes, regardless of tumor size or menopausal status •Doctors recommend more aggressive treatments for premenopausal women diagnosed with invasive breast cancer. Breast cancer in premenopausal women tends to be more aggressive, so chemotherapy is often part of the treatment plan. •Chemotherapy may be recommended for some women diagnosed with early-stage breast cancer if the cancer is hormone- receptor-negative and HER2- positive. Both of these characteristics are associated with cancer that is more aggressive. Chemotherapy usually is NOT recommended for non-invasive, in situ cancers such as DCIS (the most common type of non-invasive breast cancer) because they have very little risk of spreading to other parts of the body. Chemotherapy for advanced-stage/metastatic disease: Advanced-stage breast cancer generally means cancer that is classified as: •Some stage III •Stage IV Metastatic disease is breast cancer that has spread beyond the breast area and nearby lymph nodes to other parts of the body. Metastatic cancer is considered stage IV. Chemotherapy is used to treat advanced-stage breast cancer by destroying or damaging the cancer cells as much as possible. Because chemotherapy medicines affect the entire body, chemotherapy is commonly used to treat advanced-stage breast cancer. Research has shown that newer chemotherapy medicines, such as: •Taxol (chemical name: paclitaxel) •Abraxane (chemical name: albumin-bound paclitaxel) •Taxotere (chemical name: docetaxel) •Adriamycin (chemical name: doxorubicin) •Ellence (chemical name: epirubicin) These treatments are helping women diagnosed with advanced-stage breast cancer live longer. Other chemotherapies used in metastatic breast cancer include: •Gemzar (chemical name: gemcitabine) •Xeloda (chemical name: capecitabine) •Navelbine (chemical name: vinorelbine) •Ixempra (chemical name: ixabepilone). Each person’s treatment plan will be different, but there are some general guidelines that doctors follow when using chemotherapy to treat advanced-stage breast cancer. If you’ve had chemotherapy before, your doctor may recommend using only one chemotherapy medicine at a time to treat advanced-stage disease. This way you get benefits with fewer possible side effects. In general, most chemotherapy medicines can be used until side effects become a problem or the medicine stops being effective. Some chemotherapy medicines seem to work better against cancer tumors when used in combination. So your doctor may recommend a combination of medicines for you because research has shown that combining treatments has contributed to a better overall prognosis for some advanced-stage cancers. If you’ve had chemotherapy before and the cancer came back or didn’t respond, your doctor will likely recommend a different combination of medicines. There are many chemotherapy medicines and if one medicine or combination of medicines doesn’t seem to be working, there is almost always something else you can try. If the cancer is hormone-receptor-positive, your doctor may choose to use hormonal therapy before or after initiating chemotherapy. If you have metastatic breast cancer and chemotherapy is part of your treatment plan, your doctor may use different tests to determine how well the chemotherapy is working and how you’re handling the chemotherapy. Talking to your doctor about chemotherapy: Talking to your doctor about chemotherapy and all the different regimens and medicines might seem overwhelming at first. Ask your doctor for written chemotherapy information that you can take home with you. Doctors often have special kits or booklets with information about chemotherapy and how it’s given. Don’t be afraid to ask questions. Ask for a phone number so you can call someone if you think of questions after your appointment. A doctor or oncology nurse should be available to answer questions in between appointments. If you have a question, don’t hesitate to call. To help you figure out the benefits and risks of chemotherapy, you might want to ask your doctor these questions: •Why are you recommending chemotherapy? •What are the chances that I’ll get more benefits from chemotherapy compared to the treatments I’m already getting? •Is chemotherapy likely to make me live longer? •Will chemotherapy reduce the risk of the cancer coming back (recurrence)? By how much? •Which chemotherapy medicine or combination of medicines is best for me? •What are the pros and cons of the regimen you’re recommending for me? •How will we know if the chemotherapy is working? •If this chemotherapy regimen doesn’t work, are there others we can try? •What are my other treatment options? •Are there clinical trials on chemotherapy that you think would be beneficial for me? While there may not be perfect answers for every question, your doctor should be able to discuss the risks and benefits of a chemotherapy regimen with you and help you make the best decision for you and your unique situation. This concludes the first part of this series on the physical side of breast cancer. Next month, we will deal with the mental side of having been diagnosed with breast cancer, as well as during and after treatment.