Support & Give Hope

Testing Positive:

    The results are back from Pathology. A diagnosis has been made. It’s malignant; in other words, it’s cancer. This can be a very traumatic time. Information can help you better understand your diagnosis and aid you in decision-making. Emotional support can help you cope, so that you can focus clearly on information you are receiving about possible treatment options. Visit the Resources section of this site to learn how Breast Cancer Support Services can help.

Whom to tell and when:

    Cancer is a lonely experience. Whom should you tell? When? Hear it from a the perspective of a breast cancer survivor...

Cathy Fenwick’s - You Have Breast Cancer: Whom Do You Tell and How?

Surgery:

    Treatment is recommended to remove the cancer and prevent it from spreading to other parts of your body. This step involves decision-making about what is best for you and your prognosis (expected or probable outcome). The surgical procedures you will likely discuss and decide upon are: mastectomy, lumpectomy, auxiliary dissection and reconstruction.

    This is a time when talking to someone with experience before and after your surgery, can help. Remember: Information helps take away fear. The better informed you are, the better prepared. Contact Us.

    The type of surgery you can have will depend on a number of things, which you should discuss with your surgeon.

    If you are still menstruating and haven’t yet gone through menopause, you might ask your physician’s opinion about the best time to have surgery. Some researchers believe that hormone levels at the time of surgery can influence the outcome of treatment. Some studies have found that there is an increased risk of recurrence if surgery is done in the early (follicular phase) of your cycle, while other studies have found just the opposite - that the worst time for surgery is the later stage (luteal phase).

    Said, Mark Levine, one of Canada’s leading authorities, "This just goes to show that we really don’t know. I don’t think we can make any recommendations concerning the timing of surgery." The research on this subject is still ongoing, so physicians may have different opinions about it.

    A Pathology Report follows your surgery. Information at this step is far more comprehensive than your first pathology reports. You now will have information on size, type, grade (degree of aggressiveness), receptors (estrogen and/or progesterone) and lymph nodes (number recovered, number involved).

    A post-surgery check-up follows to remove stitches and drains and to discuss the pathology report. If further treatment is recommended, referral to a Cancer Centre is your next step.

Cancer Team:

    A team of specialists - oncologist, nurse, social worker, radiation therapist, nutritionist, pharmacist and volunteers -- joins with your surgeon and family physician in caring for you. 

    Having reviewed your pathology report, your oncologist orders tests to assist in planning treatment. The tests provide more information on your general health and show whether the cancer has spread to other parts of your body. Your oncologist will discuss treatment options with you. Treatment varies according to the results of tests and pathology report. Your plan could include chemotherapy, radiation, and/or hormonal therapy. Participation in a clinical trial may be suggested.

    Many people making this journey before you have found that using a variety of coping mechanisms helped them emotionally and physically to manage both treatment and life after a diagnosis of breast cancer. Here are a few suggestions to consider: meditation, relaxation, visualization, listening to music, journaling, Reiki and healing touch.

Radiation:

    A partial mastectomy of a lumpectomy is usually followed by radiation treatment to the breast. What radiation treatment can do is help prevent a recurrence of the cancer in the breast. Although many specialists consider this treatment standard and necessary after surgery, it is important to remember that you have a choice in this. If your tumor was very small and noninvasive and you had a lumpectomy, you may not want radiation. 

    The chance of recurrence in the breast is greater in younger women (under 46) than in older women (over 70), so this factor should be considered, as well. If you choose not to have radiation treatments after your lumpectomy, and you later develop a recurrence in the breast, you will most likely be able to have radiation at the time of recurrence.

    Radiation treatment used high-energy x-rays to kill cancer cells and shrink tumors by heating the cells to a high temperature, causing cell death. External radiation is done by machines directing the x-rays to precise areas of the body such as a part of the breast. This is the type of radiation that most women receive. A smaller number of women receive internal radiation therapy, which is produced by implanting thin plastic tubes into the breast area at the site of your tumor. The plastic tubes contain materials that produce radiation (radioisotopes). Radiation treatments affect only the area to which the x-rays are directed. Marks will be put on your breast and you will be asked not to wash them off until treatment is complete. Sometimes the marks are tattooed and these are permanent marks.

    Because radiation therapy treatments require the use of sophisticated and expensive machinery, this treatment is usually available only in regional cancer centers and certain hospitals. This may require that you travel on a daily basis or stay away from home for a period of 4 to 6 weeks. Many cancer centers can make arrangements to assist patients with daily travel (volunteer drivers) or staying overnight (such as lodge accommodations). Ask the center staff if you can take advantage of this assistance.

Systemic Treatments:

    When very small cancer cells have been found in the lymph nodes, there is a chance that cancer may also have spread to other parts of the body. If this is the case, you may hear your cancer being referred to as "node positive". Systemic treatments are used to treat cancer cells that may have traveled from the breast tumor to other parts of the body by means of the blood system or the lymph system.

    The treatments include chemotherapy and hormone therapy, both of which affect various systems of the body and not just one local area. A medical oncologist may also suggest systemic therapy for women who do not have cancer cells in the lymph nodes (node-negative) as a form of prevention if there are other signs that the cancer could spread. This may be suggested for women with a large-sized tumor, high-grade or invasion of cancer into the lymph vessels or veins in the breast. Be sure to ask your cancer specialist to describe why chemotherapy is being recommended if there are no cancer cells in the lymph nodes.

    Sometimes, chemotherapy or radiation is given before surgery to shrink the tumor. When this is possible, you might be referred to an oncologist before surgery, or you might ask for a referral before deciding on treatment.

    After you have undergone surgery, if your lymph nodes show that the cancer may have spread, or if there are other worrisome features, your doctor should discuss with you the choice of systemic treatment. Ask questions and consider getting the opinion of an oncologist even if no further treatment is recommended after surgery.

Chemotherapy:

    This treatment uses drugs to kill cancer cells. The drugs work by preventing the cancer cells from dividing or reproducing, which forces the cancer cells to die. But the drugs are not very selective. They will kill many other healthy cells that are also dividing, including hair cells and bone marrow cells. This explains why some women lose their hair when they are having chemotherapy treatments. The effects these drugs have on bone marrow cells is to lower the body’s production of red and white blood cells and platelets. This can affect your level of energy, your ability to fight off infection, and the ability of your blood to clot properly. Remember that these effects are only temporary. Your blood cells will begin to function normally once you have stopped having treatments.

    Several different chemotherapy regimens are used in early-stage breast cancer. The duration of treatment is usually between 3 and 6 months. Ask you oncologist to explain which way you will be given chemotherapy and why. Systemic therapy is usually given following the initial treatment of surgery or following surgery combined with radiation therapy.

    If needed, chemotherapy treatments are usually given in cancer treatment centers but can also be administered through community clinics through hospital out-patient departments. The location will depend on where you live and which oncologist you see. When you are receiving chemotherapy, you should be sure to advise your dentist, chiropractor, or other health-care providers that you are in treatment.

Learn more about chemotherapy drugs and their side effects.

Hormone Therapy:

    Therapies such as tamoxifen (Nolvadexâ) are medications which interfere with your body’s hormones to lessen the growth of certain estrogen-sensitive tumors. The side effects of these drugs may not be as harsh as chemotherapy, but their purpose is the same: to keep cancer cells from growing.

    There has been a lot of media attention about the drug tamoxifen in the past few years. Researchers have found that it may be linked to the development of uterine cancer in humans and liver cancer in animals. If your doctor is recommending tamoxifen for you, ask about the degree of benefit compared to these and other side effects of the drug. If you get any vaginal spotting or bleeding, or changes in your vision while taking tamoxifen, you should tell your doctor.

    Another category of treatment which is relatively new is called biologic response modifiers, also known as immunotherapies. These are natural substances which can be used to assist your body’s natural immune response. These therapies are in the early stages of research and have not yet proven to be very effective.

Unconventional Therapies:

    More and more people in North American society are looking to unconventional therapies not only to prevent illness but also to help them through a difficult illness. Many of these therapies have not been put through rigorous scientific testing to prove whether or not they are effective. Also, as many cancer patients have learned, they may sometimes be viewed by medical doctors as "quackery". It is important to remember, however, that many of the treatments we have come to view as standard cancer care (such as radiation) were also once viewed as "quackery" and dismissed by the medical profession. Some medical doctors view any unconventional therapies as useless because the effectiveness of some of them has not be scientifically proven.

    There was a time when the food we ate was not seen to be important in relation to the development of cancer. We now know from research that certain types of food eaten on a regular basis - like broccoli cauliflower, and brussels sprouts - can help prevent the development of certain types of cancer. As well, some unconventional therapies gaining popularity in western countries today (such as herbal remedies and Chinese medicine) have been used for centuries in other cultures and countries. The health-care community’s understanding of which unconventional treatments do and do not work is continually evolving.

    We sometimes refer to unconventional therapies as "complementary" because they may also be used with and "complement" standard medical treatments. Proponents claim that certain unconventional treatments help to strengthen our body’s immune system and its ability to fight disease. 

    If you are going through radiation or chemotherapy, certain complementary therapies (e.g. vitamin therapy or acupuncture) used at the same time may possibly help to strengthen your body’s natural ability to fight the disease. The two forms of treatment may help each other. It is important not to abandon potentially helpful conventional therapies if you plan to also explore unconventional ones. This treatment uses high-energy, penetrating rays to treat disease. Radiation is recommended with lumpectomy and occasionally with mastectomy. It is usually given daily over a course of five to six weeks. Sources of radiation include x-ray, gamma rays, cobalt and isotopes.

Lymphedema:

(pronounced LIM-FA-DEE-MA) is a medical term that describes the collection of fluid in the arms or legs. The fluid is made up of water and protein. It is not the same as water retention and needs very different care.

    Most people who undergo surgery for cancer also have some lymph nodes removed and tested for the presence of cancer cells. These tests are necessary because the doctor will plan treatment based on the results of these tests. Unfortunately, removal of these nodes can sometimes prevent the lymph system from draining fluid normally.

    Radiation therapy, which kills cancer cells, can cause scar tissue to form in the lymph collecting tubes. Scar tissue blocks the flow of the lymph fluid. One out of every four women who have surgery for breast cancer and two out of every five women who have both surgery and radiation therapy will go on to develop lymphedema at some point. Some will have hand or arm swelling begin almost immediately after the treatment; others will not have symptoms until years later.

    Removing lymph nodes from the groin or having radiation therapy to this area can result in swelling of the legs. It is not possible to know who will develop lymphedema.

    For more information, check out our FAQ section and Manual Lymph Drainage.

Monitoring:

    You will be scheduled for a series of routine tests and examinations by your oncologist and family physician allowing doctors to keep an eye on how your body is managing treatments and how your cancer is responding. Concerns about potential side effects such as lymphedema can be addressed.

    Once you have completed your treatment, you will continue to be monitored for some time through routine check-ups and tests. Duration of follow up varies from patient to patient. Your surgeon, family physician and the Cancer Centre may all be involved with your plan. The journey does not end here, but continues with YOU and your emotional and physical recovery. The support and information resources you have accessed throughout your journey will continue to help you as you recover.