Types of Breast Cancer

Breast cancer can begin in different areas of the breast – the ducts, the lobules, or in some cases, the tissue in between. In this section, you can learn about the different types of breast cancer, including non-invasive, invasive, recurrent, and metastatic breast cancers. You can also read about breast cancer in men.

DCIS – Ductal Carcinoma In Situ
IDC – Invasive Ductal Carcinoma
– IDC – Less Common Types
– ILC – Invasive Lobular Carcinoma
– Inflammatory Breast Cancer
– LCIS – Lobular Carcinoma In Situ
– Male Breast Cancer
– Paget’s Disease of the Nipple
– Phyllodes Tumors of the Breast
– Recurrent and Metastatic Breast Cancer

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Sources of support Breast Cancer

Learning that you have breast cancer can change your life and the lives of those close to you. These changes can be hard to handle. It’s normal for you, your family, and your friends to need help coping with the feelings that such a diagnosis can bring.

Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.

Several organizations offer special programs for women with breast cancer. Women who have had the disease serve as trained volunteers. They may talk with or visit women who have breast cancer, provide information, and lend emotional support. They often share their experiences with breast cancer treatment, breast reconstruction, and recovery.

You may be afraid that changes to your body will affect not only how you look but also how other people feel about you. You may worry that breast cancer and its treatment will affect your sexual relationships. Many couples find it helps to talk about their concerns. Some find that counseling or a couples’ support group can be helpful.

Here’s where you can go for support:

* Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities.

* Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.

* Support groups also can help. In these groups, women with breast cancer or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.

* Women with breast cancer often get together in support groups, but please keep in mind that each woman is different. Ways that one woman deals with cancer may not be right for another. You may want to ask your health care provider about advice you receive from other women with breast cancer.

Follow-up care Breast Cancer

You’ll need regular checkups after treatment for breast cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor.

Your doctor will check for return of the cancer. Also, checkups help detect health problems that can result from cancer treatment.

You should report any changes in the treated area or in your other breast to the doctor right away. Tell your doctor about any health problems, such as pain, loss of appetite or weight, changes in menstrual cycles, unusual vaginal bleeding, or blurred vision. Also talk to your doctor about headaches, dizziness, shortness of breath, coughing or hoarseness, backaches, or digestive problems that seem unusual or that don’t go away. Such problems may arise months or years after treatment. They may suggest that the cancer has returned, but they can also be symptoms of other health problems. It’s important to share your concerns with your doctor so that problems can be diagnosed and treated as soon as possible.

Checkups usually include an exam of the neck, underarm, chest, and breast areas. Since a new breast cancer may develop, you should have regular mammograms. You probably won’t need a mammogram of a reconstructed breast or if you had a mastectomy without reconstruction. Your doctor may order other imaging procedures or lab tests.

Nutrition and physical activity Breast Cancer

It’s important for you to take very good care of yourself before, during, and after cancer treatment. Taking care of yourself includes eating well and staying as active as you can.

You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.

Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don’t taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth blisters) can make it hard to eat well. On the other hand, some women treated for breast cancer may have a problem with weight gain.

Your doctor, a registered dietitian, or another health care provider can suggest ways to help you meet your nutrition needs.

Many women find that they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know.

Breast reconstruction

Some women who plan to have a mastectomy decide to have breast reconstruction. Other women prefer to wear a breast form (prosthesis) inside their bra. Others decide to do nothing after surgery. All of these options have pros and cons. What is right for one woman may not be right for another. What is important is that nearly every woman treated for breast cancer has choices.

Breast reconstruction may be done at the same time as the mastectomy, or later on. If radiation therapy is part of the treatment plan, some doctors suggest waiting until after radiation therapy is complete.

If you are thinking about breast reconstruction, you should talk to a plastic surgeon before the mastectomy, even if you plan to have your reconstruction later on.

There are many ways for a surgeon to reconstruct the breast. Some women choose to have breast implants, which are filled with saline or silicone gel. You can read about breast implants on the Food and Drug Administration Web site at http://www.fda.gov.

You also may have breast reconstruction with tissue that the plastic surgeon removes from another part of your body. Skin, muscle, and fat can come from your lower abdomen, back, or buttocks. The surgeon uses this tissue to create a breast shape.

The type of reconstruction that is best for you depends on your age, body type, and the type of cancer surgery that you had. The plastic surgeon can explain the risks and benefits of each type of reconstruction.
You may want to ask your doctor these questions about breast reconstruction:

* Which type of surgery would give me the best results? How will I look afterward?
* When can my reconstruction begin?
* How many surgeries will I need?
* What are the risks at the time of surgery? Later?
* Will I have scars? Where? What will they look like?
* If tissue from another part of my body is used, will there be any permanent changes where the tissue was removed?
* What activities should I avoid? When can I return to my normal activities?
* Will I need follow-up care?
* How much will reconstruction cost? Will my health insurance pay for it?

Second opinion Breast Cancer

Before starting treatment, you might want a second opinion from another doctor about your diagnosis and treatment plan. Some women worry that their doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion.

If you get a second opinion, the doctor may agree with your first doctor’s diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you’ll have more information and perhaps a greater sense of control. You may also feel more confident about the decisions you make, knowing that you’ve looked carefully at your options.

It may take some time and effort to gather your medical records and see another doctor. Usually it’s not a problem if it takes you several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this possible delay with your doctor. Some women with breast cancer need treatment right away.

There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.

The NCI Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) or at LiveHelp (http://www.cancer.gov/help) can tell you about nearby treatment centers.

Treatment choices by stage Breast Cancer

Your treatment options depend on the stage of your disease and these factors:

* The size of the tumor in relation to the size of your breast

* The results of lab tests (such as whether the breast cancer cells need hormones to grow)

* Whether you have gone through menopause

* Your general health

Below are brief descriptions of common treatments for each stage. Other treatments may be appropriate for some women. Research studies (clinical trials) can be an option at all stages of breast cancer.

Stage 0 (DCIS)

Most women with DCIS have breast-sparing surgery followed by radiation therapy. Some women instead choose to have a total mastectomy. Women with DCIS may receive tamoxifen to reduce the risk of developing invasive breast cancer.

Stages I, II, IIIA, and some IIIC

Women with Stage I, II, IIIA, or operable IIIC breast cancer may have a combination of treatments. (Operable means the cancer can be treated with surgery.)

Some may have breast-sparing surgery followed by radiation therapy to the breast. This choice is common for women with Stage I or II breast cancer. Others decide to have a mastectomy.

With either approach, women (especially those with Stage II or IIIA breast cancer) often have lymph nodes under the arm removed.

Whether or not radiation therapy is used after mastectomy depends on the extent of the cancer. If cancer cells are found in 1 to 3 lymph nodes under the arm or if the tumor in the breast is large, the doctor sometimes suggests radiation therapy after mastectomy. If cancer cells are found in more than 3 lymph nodes under the arm, the doctor usually will suggest radiation therapy after mastectomy.

The choice between breast-sparing surgery (followed by radiation therapy) and mastectomy depends on many factors:

* The size, location, and stage of the tumor

* The size of the woman’s breast

* Certain features of the cancer

* How the woman feels about how surgery will change her breast

* How the woman feels about radiation therapy

* The woman’s ability to travel to a radiation treatment center

Some women have chemotherapy before surgery. This is called neoadjuvant therapy (treatment before the main treatment). Chemotherapy before surgery may shrink a large tumor so that breast-sparing surgery is possible. Women with large Stage II or IIIA breast tumors often choose this treatment.

After surgery, many women receive adjuvant therapy. Adjuvant therapy is treatment given after the main treatment to lower the chance of breast cancer returning. Radiation treatment is local therapy that can kill any remaining cancer cells in and near the breast. Women may also have hormone therapy, chemotherapy, targeted therapy, or a combination. These systemic therapies can destroy cancer cells that remain anywhere in the body. They can prevent or delay the cancer from coming back in the breast or elsewhere.

Stage IIIB and some Stage IIIC

Women with Stage IIIB (including inflammatory breast cancer) or inoperable Stage IIIC breast cancer have chemotherapy first, and then may be offered other treatments. (Inoperable means the cancer can’t be treated with surgery without first shrinking the tumor.) They may also have targeted therapy.

If the chemotherapy or targeted therapy shrinks the tumor, then surgery may be possible:

* Mastectomy: The surgeon removes the breast. In most cases, the lymph nodes under the arm are removed. After surgery, a woman may receive radiation therapy to the chest and underarm area.

* Breast-sparing surgery: In rare cases, the surgeon removes the cancer but not the breast. The lymph nodes under the arm are usually removed. After surgery, a woman may receive radiation therapy to the breast and underarm area.

After surgery, the doctor will likely recommend chemotherapy, targeted therapy, hormone therapy, or a combination. This therapy may help prevent the disease from coming back in the breast or elsewhere.

Stage IV and Recurrent

Women with recurrent breast cancer will be treated based on where the cancer returned. If the cancer returned in the chest area, the doctor may suggest surgery, radiation therapy, chemotherapy, hormone therapy, or a combination.

Women with Stage IV breast cancer or recurrent cancer that has spread to the bones, liver, or other areas usually have hormone therapy, chemotherapy, targeted therapy, or a combination. Radiation therapy may be used to control tumors in certain parts of the body. These treatments are not likely to cure the disease, but they may help a woman live longer.

Many women have supportive care along with anticancer treatments. Anticancer treatments are given to slow the progress of the disease. Supportive care helps manage pain, other symptoms of cancer, or the side effects of treatment (such as nausea). This care can help a woman feel better physically and emotionally. Supportive care does not aim to extend life. Some women with advanced cancer decide to have only supportive care.