20 most Frequently asked questions about Breast Cancer

I'm Dr. Sudipto De, a robotic Cancer Surgeon based in Delhi India, and I am here to address some of the most common questions that cancer patients often ask their doctors. I will be time stamping the questions in the description below. If you have any other queries, drop them down in the comments below, and I’ll try to answer them as soon as possible. Share this video with any breast cancer patient, you know to help them out.

1. What stage is my breast cancer?

Breast cancer is in stage one and two if the tumor is only limited to the breast. Stage one tumour are less than 2cm in size while stage two is more than 2 cm but limited to the breast. It is in stage three if it is spread to the lymph glands in the armpits. If the tumour has spread to other parts of the body, it is considered as stage four. The recent teaching also takes into account the molecular classification of breast cancer, which I’ll explain later.

Of the most common questions that a lot of patients ask the moment that they are diagnosed with breast cancer and walk into my OPD are, how long will they survive?

3. How is breast cancer diagnosed?

There are three major parts of diagnosing breast cancer. Firstly, imaging of the breast in the form of ultrasound, mammogram or MRI. Secondly, a biopsy has to be done to diagnose breast cancer along with differentiating the type. Finally, blood tests along with metastatic work up to find out if the disease has spread to other organs or not. All of these investigations can be done simultaneously.

2. What is the success rate of this treatment for someone in my situation?

It is a very common notion that breast cancer is mostly associated with death but that is not true at all. With advancement in treatment therapies, even patients with metastasis or Stage 4 Cancer can expect a prolonged survival. In early breast Cancer or Stage 1, most of the patients can survive their full lives. Breast cancer has a survival of 90% in early stages which means that more than 90% of the patients will survive the initial five years and will keep on surviving beyond that without the disease.

In regional disease, where disease may have spread to the surrounding lymph nodes, the five-year survival is approximately 60-80% followed by metastatic disease in which the disease has spread beyond the confines of the organ and the chest wall and has invaded either the lung, brain, liver or the bones. The survival rate is approximately 20% in these patients.

3. What are the different types of Breast Cancer?

But breast cancer is a very varied cancer with quite a few different types that have different traits of progression and different aggressiveness. The major categories include hormone positive, her 2 positive and triple negative. Hormone Positive is divided into Luminal A and B.

So if you take into account the molecular classification or how the different breast cancers are classified, the triple negative cancer will have a poorer prognosis. While the other two positive cancers will have moderate prognosis while the hormone positive cancers will have the best prognosis.

Patients diagnosed at an older age will have a better prognosis than patients diagnosed at a young age, for example in their 30s or 40s. Even within the cancer with metastasis, lymph node metastasis has a better prognosis than bone metastasis or any other organ metastasis.

Another question that I am asked quite commonly is how did I get breast cancer or if my breast cancer is related to what my mother and grandmother had or can I pass my breast cancer to my children? What is the role of genetics in Breast Cancer?

4. What caused my Breast Cancer?

The most important positive factor of breast cancer in females is age and uninhibited estrogen exposure. What that actually means is that breast cancer is related to the amount of estrogen that actually is present in your body. More estrogen increases chances of breast cancer. Now how do we decrease the chances of estrogen increasing in the body. There are some factors which we can obviously not change, such as the age at which we start having menses or the age at which menopause occurs. There are certain other factors which can help change the Increased estrogen exposure. One is to do breastfeeding and second is to control obesity. These are two factors which can be helped by us to actually help decrease the estrogen exposure.

5. What is the role of Genetics in Breast Cancer?

Coming to the second point. Yes, genetics do play a major role in breast cancer, although hereditary breast cancers occupy less than 10% of all the breast cancer cases that are out there. There are quite a few genes which transmit breast cancer down the generations. BRCA mutations being one of them. In this, you can have cancers of the breast and ovary. These genetic mutations can be identified by tests known as Next Generation Sequencing. If you want to know more about NGS, please connect with your oncologist or genetiscist.

We usually take a detailed genetic history and some test can also be done to find out different genetic mutations that are present which can be done by genetic panel. We can also do protective surgeries like prophylactic mastectomy and prophylactic Salpingo Oophorectomy just like Angelina Jolie had to prevent the occurrence of breast and ovarian cancer. Also, a lot of the patience to come as the younger age group with triple negative, so they tend to have a poor prognosis.

6. What will be my treatment schedule?

What are my treatment options?

Breast Cancer is one of the most widely studied cancers and involves quite a few different treatments.

Surgery which involves removal of part or whole of the breast along with addressing the lymph nodes in the armpit or the axilla by either using Sentinel Lymph Node Biopsy or Axillary Dissection. This can sometimes be followed by a reconstructive surgery by a Plastic Surgeon.

Radiotherapy which involves application of radiation beams to decrease the chances of the cancer coming back.

Chemotherapy uses a variety of medicines to help keep the cancer at bay and also deal with widespread metastatic disease.

There are quite a few novel therapies which have now been introduced into Breast Cancer treatment and these include Hormonal Therapy, Targeted Therapy using Monoclonal antibodies and the newest bullet in our arsenal, Immunotherapy.

Each and every patient will be discussed in a multidisciplinary team meeting where a Breast Cancer Surgeon, Radiation and Medical/ Clinical Oncologist along with a Plastic Surgeon, Pathologist, Radiologist and Anaesthesiologist will take part to discuss the best course of personalized treatment for you.

7. What kind of surgery do I need?

8. Will I need surgery? If so, what type of surgery?

Let’s talk about Surgery now. There are three issues to address during breast surgery.

The first of them being actual disease in breast. This can usually be tackled by the complete removal of the breast known as a mastectomy or a partial removal known as Breast Conservation Therapy/Surgery.

9. What are the potential side effects of surgery?

Side effects after surgery can be divided into short term and long term. In the short term, the side effects include pain which gradually becomes less after 2 to 3 days. There is also heaviness of the shoulder if axillary dissection has been performed. You'll need physiotherapy of the shoulder and need to keep moving your arm above your head to prevent a frozen shoulder. Alone with this, there can be blackening of skin or the plastic surgery procedure done. In the long term, There is usually Loss of

Sensation in The inner part of the arm, Seroma or collection of fluid under the breast tissue. One of the major late complications is lymphedema or swelling of the arm.

10. How long is the recovery time after surgery?

You'll be able to move approximately 4-6 hours after the surgery and eat as well. There will be some amount of dull ache which will be present for about a week and slowly decrease. You'll be able to resume your daily activities in about three days or so. These times can be extended if an additional plastic surgery procedure has been performed.

11. How will my breast look after reconstruction?

To recreate the breast, several Plastic Surgery techniques can be planned, which will be discussed with you during your treatment planning.

12. What are the lymph nodes and how to address it?

Finally, the last part of the surgery is to address the axilla or the lymph glands in the armpit. If there aren’t any nodes palpable, we can do a Sentinel Lymph Node Biopsy where dyes are injected in the breast to locate the Sentinel Node and send it for frozen section and plan further treatment. If the nodes are positive clinically or on SLNB, then a formal axillary Lymph Node Dissection is done.

After the surgery, you will be able to move in approximately 4 to 6 hours and can be discharged by the next day or so. There can be mild difficulty in lifting the arm if the whole of the armpit has been dissected but some physiotherapy exercises will be prescribed for you to regain movement in your arm.

13. Will I need further treatment after surgery (e.g., chemotherapy, radiation)?

14. How long will my Radiation Therapy be?

The radiation therapy is usually planned for 5 to 6 weeks, usually 5 days a week. But different radiation therapy techniques and schedules can be done. New Radiation techniques like hypofractionated Radiotherapy can finish your RT in even a week.

Chemotherapy

Chemotherapy can be used in different ways. After surgery(Adjuvant therapy), Before surgery (Neoadjuvant therapy) or in metastatic disease.

15. What are the side effects of Chemotherapy in Breast Cancer?

The major side effects of Chemotherapy include nausea, vomiting, decrease in appetite, loss of weight and hair, high risk of infections, diarrhoea and also cardiac issues. Each of the medications have their own set of side effects which will be informed to you and managed by your oncologist.

Other therapies Will I need further treatment after surgery (e.g., chemotherapy, radiation)?

Immunotherapy: This is one of the newest drugs in our fight against Breast Cancer. Pembrolizumab had been approved for use in Breast Cancer treatment.

Hormonal Therapy: It is one of the mainstay of treatment in Hormone Positive cancers which are easier to cure without much side effects.

PARP Inhibitors: These new medications are specifically used in highly mutant Breast cancers, specially those which have a genetic predisposition like BRCA mutations.

Targeted Therapy: there are quite a few targeted therapies against protein such as Her2 like Trastuzumab and Pertuzumab which have dramatically changed breast cancer treatment.

16. How often will I need follow-up appointments?

In the first two years, the follow up will be 6 monthly with a yearly Mammogram or MRI. After that, an annual follow up can be done up until a minimum of 10 years.

17. Can I still have children after treatment?

Yes, absolutely. Chemotherapy might prevent pregnancy for approximately 2 to 3 years after it is over. You can have children after this period is over. This will also finish your initial part of the intense follow-up when the disease has the highest chance of recurrence.