Navigating Breast Cancer

Hi everyone. I’ve put together a little guide with some links at the bottom of what’s it’s like navigating breast cancer. If you have been diagnosed with breast cancer, you may be wondering what your treatment options are and what to expect from them. I’m sharing what I’ve learned about common tests for diagnosis, surgery options, radiation and chemo options for breast cancer from a patient’s perspective. It’s a lot to navigate through and I hope this helps. It’s my way of paying it forward.

Tests for diagnosis

The first step in diagnosing breast cancer is usually a physical exam of the breasts and lymph nodes in the armpit, looking for any lumps or other abnormalities. If your doctor finds something suspicious, they may order further tests, such as:

Mammogram: A mammogram is an x-ray of the breast that can detect changes in the breast tissue, such as calcifications or masses. A mammogram can also show the size and location of the tumor. You may need a diagnostic mammogram if an abnormality is found on a screening mammogram. (Since I had a palpable lump, I had the diagnostic mammogram straight away. To me this wasn’t any different of an experience that getting a regular mammogram except they took additional images. It was still the uncomfortable put your boob in a vise test that nobody likes.)
Breast ultrasound: A breast ultrasound uses sound waves to create images of the breast. It can help determine if a lump is solid or filled with fluid (a cyst). It can also show the blood flow to the tumor and the surrounding tissues. (This has been the easiest test that I’ve been through so far. When I had my ultrasound, things seemed to be going okay at first with the ultrasound on the suspicious breast. Then on the second breast the technician started going over and over again and started taking measurements. She also did it in my armpit. I looked over my head to the screen and saw it. After it was finished, I spoke with the radiologist, and he said there was a suspicious mass and that I would need a biopsy.)
Breast biopsy: A breast biopsy is a procedure that involves removing a sample of breast tissue for microscopic examination. A biopsy is the only way to confirm if a lump is cancerous or not. There are different types of biopsies, such as core needle biopsy, fine needle aspiration, or surgical biopsy. The type of biopsy you need depends on the size and location of the lump, as well as your personal preferences. (My biopsy was ultrasound guided and it wasn’t as bad as I thought it would be. The initial stick for the local hurts, of course, but the numbing took effect quickly. It was startling but not painful with the pressure of the clicks as the samples were taken. The last click was the placement of a titanium marker for surgery. I was in pain in my breast, shoulder, and arm pit after, and it lasted several days. Also, since the biopsy my breast has been aching more than a month later. Waiting for the results is emotionally exhausting and rolled in over two weeks’ time with the initial and then the longer pathology came in. I was told immediately that I did, in fact, have breast cancer.)
Breast MRI: A test that uses a magnet and radio waves to create detailed images of the breast. A breast MRI can show the extent of the tumor and its relation to other structures in the breast. It can also detect tumors in the other breast that may not be seen on a mammogram or ultrasound. You may need a breast MRI before surgery or other treatments to plan your care. (A couple of days after the biopsy I had the MRI. I was still very sore from surgery, but this was the easiest test in the process. I was face down on the table and the positioner hurt my sternum and my shoulders ached after.)

Surgery options

Surgery is often the main treatment for early-stage breast cancer. The goal of surgery is to remove the tumor and some of the surrounding healthy tissue (called margins) to make sure no cancer cells are left behind. There are two main types of surgery for breast cancer:

Lumpectomy: Also called breast-conserving surgery, this procedure removes only the tumor and a small amount of normal tissue around it. Lumpectomy is usually followed by radiation therapy to kill any remaining cancer cells in the breast. Lumpectomy can preserve most of the appearance and function of the breast. (For my particular diagnosis this was recommended for me, followed by radiation. I have not had surgery yet. I will at the end of the week. So, I’ll have to keep you updated on what that is like later.)
Mastectomy: This procedure removes the entire breast, sometimes including the nipple and the areola (the dark area around the nipple). Mastectomy may be recommended if the tumor is large, there are multiple tumors in the same breast, or if you have certain genetic mutations that increase your risk of developing more breast cancers in the future. Some women may choose mastectomy over lumpectomy for personal reasons. Mastectomy can be followed by breast reconstruction surgery to create a new breast shape using implants or your own tissue.

Radiation and chemo options

Radiation therapy and chemotherapy are two types of systemic treatments that can kill cancer cells throughout the body. They may be used before or after surgery, depending on your situation.

Radiation therapy: This treatment uses high-energy rays or particles to destroy cancer cells. Radiation therapy can be delivered externally (from a machine outside your body) or internally (by placing a radioactive source inside your breast). Radiation therapy can reduce the risk of cancer recurrence in the same breast after lumpectomy or mastectomy. It can also help relieve pain and other symptoms caused by cancer that has spread to other parts of the body (metastatic breast cancer). (Right now this is a recommendation for me post surgery. I haven’t started this yet so I can’t speak to the experience of it.)
Chemotherapy: This treatment uses drugs that kill rapidly dividing cells, such as cancer cells. Chemotherapy can be given intravenously (through a vein) or orally (by mouth). Chemotherapy can shrink tumors before surgery (neoadjuvant chemotherapy) or prevent cancer from coming back after surgery (adjuvant chemotherapy). It can also control cancer growth and improve quality of life for women with metastatic breast cancer. (Chemo scares me because of how I have seen those who have done it suffer. I’m hoping my diagnosis and plan doesn’t change to include this. But, I will do it if I have to so I can beat this.)

Hormone therapy

My current plan includes hormone therapy after surgery and radiation. I’m not sure about the timing. I have yet to research hormone therapy to understand my options.

Caveat: These are some of the common tests for diagnosis, surgery options, radiation and chemo options for breast cancer. However, every woman’s situation is unique, and your treatment plan may vary depending on your type and stage of cancer, your overall health, your personal preferences, and other factors. Talk to your doctor about the benefits and risks of each option and ask any questions you may have about your care.