Most people have many questions to ask on the subject of breast care. And, we do our best to give helpful, relevant answers to everyone's questions.
Before contacting the Centre with your questions, please read through the following list to see if your concern is answered. If not, feel free to submit a question here.
- What is an oncologist?
- What do I expect during the first medical oncology visit?
- What happens during my first radiation oncology visit?
- What is chemotherapy? Why do I need it? How does it work?
- What is radiation treatment? Why do I need it?
- How do I know that chemotherapy works?
- Will I be able to work while I am receiving treatment?
- How long does it take to receive chemotherapy?
- What does Estrogen and progesterone receptor test mean?
- What are the side effects of chemotherapy?
- How will my chemotherapy be administered? Can I eat during my treatment days?
- Having been diagnosed with cancer, can my children get it too?
- How long will the feeling of numbness and tingling in my armpit last?
- Since the day of my diagnosis I have been teary and feeling depressed, is this normal?
- How soon can I go for breast reconstruction?
- What is a mammogram?
- Does a mammogram hurt?
- How do I prepare for a mammogram?
- What are calcifications seen on mammogram?
- Why do some patients have to undergo a breast ultrasound?
- Why are hormones sometimes used to treat breast cancer?
- Who is at risk?
- What is Herceptin?
1. What is an oncologist?
An oncologist is a doctor who specializes in cancer treatment. A medical oncologist is a physician who specializes in drug treatment. A radiation oncologist is a physician who specializes in using radiation (x-ray) therapy to treat cancer. A surgical oncologist is a physician who specializes in surgical treatment of cancer.
2. What do I expect during the first medical oncology visit?
Your oncologist will review your past and present medical history; the pathology report of your cancer and other tests performed, a breast examination and then recommend a treatment plan.
3. What happens during my first radiation oncology visit?
The radiation oncologist will review your pathology report, all other diagnostic test findings, perform a physical examination and offer treatment recommendations.
4. What is chemotherapy? Why do I need it? How does it work?
Chemotherapy involves the use of drugs to destroy or reduce the growth of cancer. It is sometimes recommended to reduce the risk of recurrence of cancer by killing any undetected cells that may have remained in the body.
Even if the surgeon feels that all of the tumour has been removed, there is still a possibility that some cells may have gone away from the original site and spread to the lymphatic or blood vessels to other parts of the body where they cannot be detected. At other times it is recommended to shrink cancer deposits that cannot be removed surgically.
Chemotherapy works by killing the dividing cells in the body. Cancer cells divide rapidly and are often more susceptible to chemotherapy than non-cancer cells.
5. What is radiation treatment? Why do I need it?
Radiation treatment refers to the use of high energy x-rays to damage or destroy cancer cells in the local area (breast). A lumpectomy is usually followed with radiation therapy to the breast area to reduce the risk of local recurrence. In some cases, it is indicated for cancer pain control because it lessens the size of the tumour thus alleviating tumour pressure.
6. How do I know that chemotherapy works?
This depends on whether the chemotherapy is being given for recurrent breast cancer or in an attempt to reduce the risk of recurrence. If it is given for recurrence, your physician will follow the site of recurrence (using a combination of physical examination, blood tests and other x-rays or scans). If the recurrences become smaller or disappear, the chemotherapy is working.
If the chemotherapy is being given to reduce the risk of recurrence, also known as adjuvant chemotherapy, neither you nor your physician will know whether it is working in you as an individual - you are receiving the chemotherapy because large research studies have shown it leads to better outcomes overall.
7. Will I be able to work while I am receiving treatment?
Many women will be able to continue their normal lives while receiving treatments. Others may have to modify their lifestyles somewhat, depending on how they feel during treatment days. It is an individual decision, based on how the treatment affects you.
8. How long does it take to receive chemotherapy?
It will vary depending on the type of drugs being prescribed, the institution giving the treatment and the protocol. Different combinations of drugs may be used, each requiring a different length of time to administer. The actual time for drug administration may vary from 30 minutes to four hours depending on the protocol.
9. What does Estrogen and progesterone receptor test mean?
These are tests done on the tumour sample removed during your breast surgery to find out whether or not the tumour is likely to be sensitive to hormones. In general, post-menopausal women are more likely to be estrogen receptor positive than pre-menopausal. The test helps your physician decide whether the tumour can be treated with some kind of hormonal therapy, like Tamoxifen.
10. What are the side effects of chemotherapy?
There are many different types of drugs used to treat breast cancer. Side effects vary depending on the type of drugs that are used. Some of the side effects might include:
- nausea and vomiting - there are new drugs to treat nausea such as Ondansetron (Zofran) and Granisetron (Kytril);
- either partial (thinning) or total hair loss involving the scalp, eyelashes, eyebrows, legs and arms depending on the drugs used and the duration of treatment
- hot flashes in pre-menopausal women, because these drugs can induce early menopause. There may be some weight gain (between 5 to 15 pounds), a change in the taste of food, and the experience of a peculiar odour;
- sexual problems often caused by vaginal dryness;
- blood counts may be affected because the drugs will not only attack the bad cells but also the normal cells. This may lead to an increased risk of infection and bleeding.
- fatigue, especially towards the end of the treatment, because of the cumulative effect of the chemotherapy drugs in the body;
- mouth sores, runny eyes and nose, diarrhea and constipation.
- in rare cases, some drugs cause effects including second cancers like leukemia, heart or nerve toxicity. These small risks usually are less than the benefits of the treatment - you can discuss your specific risks and benefits with your doctor.
11. How will my chemotherapy be administered? Can I eat during my treatment days?
Chemotherapy treatments are usually given in 21- day cycles or in 28-day cycles. If the drug is given on a 21-day cycle, you come in once every three weeks. For the 28-day cycle, you come in for an injection on day 1 and day 8 and off for two weeks. Some treatments are given weekly. The treatment may be given intravenously, or a combination of intravenous and pills taken orally at home. The treatment can last anywhere from 12 weeks to 6 months.
12. Having been diagnosed with cancer, can my children get it too?
Learn more about genetics and breast cancer and our Familial Breast Clinic.
13. How long will the feeling of numbness and tingling in my armpit last?
The numbness or tingling sensation may improve in a few months if the nerve is stretched or injured during surgery. If these symptoms last more than two years, they are likely permanent. Although the numbness may persist, the use of the arm is not affected.
14. Since the day of my diagnosis I have been teary and feeling depressed, is this normal?
Sad mood is frequent when people first get the diagnosis of breast cancer and when they start treatment. Although you can always relate this to your health care team, there are things which can guide you as to whether or not you need help:
- Is the sad mood with you all, or almost all of the time?
- Are you feeling guilty or to blame for your cancer?
- Have you lost touch with your ability to enjoy yourself even on ordinary days?
- Are you having trouble with sleep, appetite, or concentration?
- Are you very anxious?
- Are you suicidal?
A "yes" answer to any of these suggests that your sadness may become an obstacle to adapting to your diagnosis and treatment and merits a consultation from a member of the psychosocial staff. If you feel sad but don’t fit into these questions, it is still alright to meet and discuss your mood, to see if there are ways we can help.
15. How soon can I go for breast reconstruction?
A decision to have breast reconstruction involves discussion with your surgeon and oncologist. Some women will decide to have immediate reconstruction at the time of initial breast surgery. Other women decide to wait until their treatments for breast cancer are completed, and some will choose not to have reconstruction at all.
16. What is a mammogram?
A mammogram is an x-ray of the soft tissue of the breast. A screening mammogram is a routine x-ray of the breast in women who have no symptoms to detect an abnormality. This generally involves two pictures of each breast.
A diagnostic mammogram is an x-ray of the breast taken when an abnormality is detected or suspected in the breast. Usually, extra views are taken to help determine what the abnormality is. An ultrasound and/or needle biopsy may also be recommended.
17. Does a mammogram hurt?
Some women have very sensitive breasts, which causes a painful mammogram. The procedure can be uncomfortable and unpleasant. The tighter the breasts are squeezed, the more accurate picture can be obtained. If possible, try and book your appointment after your menstrual cycle when your breasts are least sensitive.
18. How do I prepare for a mammogram?
On the day of your scheduled mammogram, do not wear talcum powder or deodorant. Flecks of talcum powder can show up as calcifications. Lotions can make the breast slippery.
19. What are calcifications seen on mammogram?
They are small calcium deposits in the breast tissue that can be seen by mammography.
They occur with benign or malignant changes. The radiologist’s job is to determine the type of calcification present in the breast. About 80% of micro-calcifications have nothing to do with cancer. They are probably caused by the breast’s wear and tear. Calcifications in the breast won’t cause problems if they are not indications of cancer or pre-cancer. The appearance of this calcium in your body has no relation to how much calcium you eat or drink.
20. Why do some patients have to undergo a breast ultrasound?
Ultrasound is useful in interpreting a mammogram. It helps us determine if the lump is solid tissue or is fluid filled like a cyst. It is not recommended as a screening procedure.
21. Why are hormones sometimes used to treat breast cancer?
Many breast cancers contain hormone receptors - their presence makes it more likely the cancer will respond (shrink) with hormone treatment, like Tamoxifen. When these receptors are present, hormone treatment may be as effective as chemotherapy, and less toxic.
22. Who's at risk?
Read the Who is at Risk? document (155 KB pdf) to find out more.
23. What is Herceptin?
Find more information about Herceptin.