The female breast is a very complicated, glandular organ and is the site of the most common cancer in women - breast cancer. No one knows exactly what causes breast cancer. Having a family history of breast cancer increases the risk. Other possible causes include environmental carcinogens, viruses, radiation therapy and life-style factors, including diet and hormonal function.

Cancer begins when the cells of the breast undergo changes. A normal cell converts into a cell that has an uncontrolled growth pattern. These cancer cells continue to divide and grow and may spread to other parts of the breast and then to other parts of the body if not removed. The process of cancer cells spreading throughout the body is called metastasis.

Types of Breast Cancer:
Approximately 15 different types of breast cancer have been identified. The term carcinoma is used to describe a malignant or cancerous growth. Tumors which develop from different types of breast tissue, in different parts of the breast, may have varying characteristics.

Breast cancers are named according to the part of the breast in which they develop. Cancers beginning in the ducts are called ductal carcinomas and comprise the largest number of cancers occurring in women. Cancers beginning in the lobules are called lobular carcinomas and account for a small percentage of cases. Your physician will tell you which type of cancer your have - ductal or lobular.

Ducts and lobules are lined with one or two layers of orderly, normal cells. When the cells become cancerous they grow and fill the duct or lobule. In situ carcinomas are cancers which are still contained within the walls of the breast area in which they developed. They have not invaded surrounding tissue. If the cancer grows through the cell walls, it is called an infiltrating or invasive carcinoma . Your pathology report will explain if your cancer is in situ or invasive (infiltrating).

How Fast Do Breast Cancers Grow?
Some breast cancers grow rapidly, while others grow slowly. Breast cancers have been shown to double in size every 23 to 209 days. A tumor that doubles every 100 days (the averaging doubling time) would have been in your body approximately eight to ten years when it reaches one centimeter in size (3/8 inch) - the size of the tip of your smallest finger. The cancer begins with one damaged cell and doubles until it is detected. The cancer must be surgically removed from the body, killed with chemotherapy or radiation therapy, or controlled with hormonal therapy. Some people believe a cancer grows in spurts, and the doubling time varies at different times. However, by the time a one centimeter tumor is found, the tumor has already grown from one cell to approximately 100 billion cells. The pathology report will tell how fast a tumor is estimated to grow.

Some tumors spread more rapidly to other parts of the body, while others do not spread as readily. Breast cancer spreads to other parts of the body through the lymphatic system or the blood system. The spread of the cancer can be local (in the area of the breast), regional (in the nodes or area near the breast) or distant (to other organs of the body).

The Role of the Lymphatic System
Lymph nodes play an important role in the discussion of your treatment decisions. The lymphatic system serves as the sewage system for cellular waste in the body. The lymph vessels follow closely beside the blood vessels and receive the cell's waste products. This waste is carried by the vessels and filtered through rounded areas of the lymph systems, called lymph nodes. Nodes appear as small round capsules and vary from pinhead to olive-size. Lymphocytes and monocytes (components of fluid that fight infection) are produced in the nodes. Nodes act as filters to stop bacteria, cellular waste and cancer cells from entering the blood stream. Lymph nodes may also serve as metastasis sites - places where cancer has spread from the original site to nodes, referred to as secondary sites.

Three percent of the lymphatic fluid leaving the breast is drained in the lymph nodes located near the breast bone, called internal mammary nodes . Ninety-seven percent of the fluid is drained through the nodes of the arm pit, referred to as the axillary nodes. There are three levels of nodes in the axillary area. Your surgeon may remove nodes from one or several levels, a procedure called axillary sampling. Axillary dissection is the term used when all the nodes under the arm are removed. The number of nodes in the each level varies from person to person.

Nodes are removed to determine whether your cancer has moved from the breast into the node area. The term negative nodes means that your lymph nodes did not have any evidence of cancer. Positive nodes indicate that the cancer was found in the lymph nodes. Your surgeon will tell you how many nodes were removed during your surgery and whether any were found to have cancer cells present. Treatment decisions are often based on the number of nodes in which cancer cells are found. Two important factors that determine your oncologist's treatment plan are the number of positive nodes and the size of your tumor. Before surgery, the surgeon can tell you the nodes that are planned to be sampled or removed. After surgery, the surgeon can tell you how many lymph nodes were removed and if they contained evidence of cancer cells.

Surgery and treatment with chemotherapy, radiation therapy or hormonal therapy can vary because of differences in types of cancer, sizes of tumors, potential lymph node involvement or documented metastasis, aggressiveness of tumors and hormonal sensitivity. Therefore, it is necessary for you to communicate with your physicians, who know your particular disease type, when seeking any specific information or advice on your breast cancer treatment.

Breast cancer is not a sudden occurrence, but a process that has been developing for a period of time. Therefore, when a biopsy confirms a cancerous breast tumor, you are not facing a medical emergency. You have time to get the answers to your questions and to learn about your particular disease and treatment options. Most physicians recommend surgery within several weeks of biopsy. There are exceptions; for example, cancer in the lymphatic system (also known as Inflammatory Carcinoma) requires immediate treatment with chemotherapy for maximum control. Tests performed on your tumor will reveal cell type and estimate how quickly the tumor is growing. Ask your physician about the characteristics of your tumor and treatment recommendations.

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Breast cancer occurs 85 to 90 percent of the time as a hard, stony, singular, non-mobile lump that is anchored in surrounding tissues of the breast. It is usually a painless lump that can be felt, is found in only one breast, and occurs in women over 35 years of age.

However, dangerous breast cancer signs are often ignored because they have different characteristics than the lump that is usually identified as cancer. Learning these common misconceptions about breast cancer could save a woman's life.

Misconception #1: Young women (under 35) do not have breast cancer.
Breast cancer is more likely to occur in a woman over 35, but it can occur in very young women. Any lump, at any age, needs professional evaluation by a physician.

Misconception #2: Women with high risk factors (family history, no children, etc.) are usually the ones who will have breast cancer.
76 percent of women who have breast cancer had none of the risk factors. Being female is the highest risk factor. All women are at risk.

Misconception #3: Breast cancer is not painful; fibrocystic breast condition is what causes the pain.
Breast cancer is usually not associated with pain. However, 11 percent of women diagnosed with breast cancer experienced pain as a symptom. Any pain in the breast needs thorough evaluation by a physician.

Misconception #4: A mammogram that is without signs of cancer ensures that no cancer is present
Mammography is a good diagnostic tool, but it has limitations. There are some lumps that you can feel but are not seen on mammography even though mammography is able to detect lumps that are too small to be felt. 10 percent of breast cancers never form a lump that can be felt or seen on mammography. It is important to recognize the clinical signs of breast cancer that produce changes in the breast. Because mammography does not detect 10 to 15 percent of cancers, breast self-exams and clinical exams by a physician must be performed in conjunction with mammography to insure that a woman receives every method of detection available.

Misconception #5: Breast cancer occurs as a single lump and in one breast at a time
A very small percentage of breast cancers occur with multiple lumps (multicentric) and occurs in both breasts. As always, any lump, multiple lumps in one breast or lumps in both breasts should be fully explored by a physician.

Misconception #6: Redness, pain, or bloody discharge are signs only of mastitis (inflammation/infection) in new mothers.
Mastitis is a common occurrence in the young mother, but if, after treatment with antibiotics, the symptoms do not improve or disappear, the patient should be evaluated further. Breast cancer in the young woman can cause the same symptoms as mastitis.

ALL LUMPS NEED EVALUATION BY A PHYSICIAN

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• Perform a monthly breast examination
• Have an annual breast examination by your physician
• Have annual mammography starting at age 40
• Exercise 3-4 hours a week
• Watch your weight
• Limit alcohol intake (2-3 drinks/week) and fat intake (less than 20% of your calories should be fat)
• Incorporate specific food groups into your diet such as leafy green (cruciferous) vegetables, bran (30 grams/day), soy (isoflavones), and flaxseeds
• Discuss genetic counseling with your physician if you have a strong family history of breast/ovarian cancer
• Discuss hormone replacement therapy with your physician if you have been on estrogen for a prolonged period of time (more than 10 years)

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Breast Self Exam

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Dominant Mass on Palpitation
A dominant mass is defined as a mass, lump, or nodule that stands out from the surrounding breast tissue. It is not present in the opposite breast. A dominant mass can be movable or fixed, soft or hard, tender or non-tender, smooth or irregularly shaped, and may be associated with skin changes. It is difficult to determine just from a clinical examination whether or not the mass is benign or malignant.

Breast Dimpling
This resembles the peel of an orange and can occur when cancer cells are present in the skin lymphatic channels of the breast and the breast skin accumulates with fluid. Dimpling may be associated with inflammatory cancer. It may also be seen after surgery.

Nipple Discharge
This can be clear, milky, yellow, multicolored, or bloody. A spontaneous, persistent discharge that is not milky and related to breast-feeding needs to be evaluated by a physician.

Breast or Nipple Ulceration
A crusting, scaly, red, inflamed tissue of the breast or nipple.

Breast Redness
An inflamed redness of the breast.

Breast Asymmetry
Disproportionate breast size which may occur as a result of surgery and/or radiation, breast-feeding on one side only or rapidly growing tumors.

Breast Puckering
A puckering in the breast skin.

Inverted Nipple
A newly noticed inversion of the nipple.

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Beginning the day after your surgery, remove your bandages, and bathe normally. Wash gently over the biopsy area - you don't have to protect or cover it. If steri-strips (butterfly band-aids) are present, you can expect them to begin fraying and coming off in about one week.

You will have prescription medicine for pain, but many patients only need it for the first day or so after the procedure. Soon you can treat your pain with over-the-counter medication such as Tylenol, Advil, Motrin, etc. Do not take medicine containing aspirin.

Avoid bumping the biopsy site area. You should also avoid strenuous activities involving the arm, shoulder, chest and back muscles around the site. All kinds of everyday tasks - lifting children, aerobic exercise, reaching for items overhead - may be painful so be cautious.

You may experience bruising in spots or covering the entire breast. This is the body's reaction to the incision. If, however, bruising is accompanied by excessive and constant pain, apply pressure to the area and call the office for further instructions.

Wear a comfortable but firm-fitting bra (sports bras are the best) at all times, even to bed, for 72 hours following your surgery. Wearing your bra serves 2 purposes, it will prevent movement around the biopsy site and hold the dressing in place, which in turn will increase your comfort and decrease your need for pain medication. Avoid using tape to hold your dressing.

On rare occasions, one to two weeks following the surgery, a clear, yellow, pink, or bloody fluid will drain from the incision site. It may be liquified fat or remnants of a blood clot and it is normal. Keep the area clean and use dressing inside your bra to control any spillage. Some patients have used maxi pads or nursing pads because they are absorbent and a good size.

A mild fever (up to 101 F) is normal during the first 48 hours following any procedure that requires general anesthetic. It is normal and is caused by the small areas of collapse in the air cells of the lung. The cells rejuvenate on their own but taking deep breaths and a few deliberate coughs a few times a day will help them along.

If your operative site becomes progressively reddened or if you have a fever of more that 101 F, call our office. We'll have you come in for an examination to determine the cause of these symptoms.

No question or concern is unimportant, so don't hesitate to call us at 540-344-1444. We hope and expect to hear from you often throughout your recovery.

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• Place an ice pack over the biopsy site when you get home. Unopened packs of frozen vegetables work well for ice packs.
  
  
• Remove the gauze dressing the next morning. Do NOT remove the steri-strips. The steri-strips will come off in about one week. You may shower after the gauze dressing is removed.
  
  
• You may have mild discomfort and a small amount of bruising where the needle entered the skin. This is normal.
  
  
• If you need medication for discomfort, take Tylenol or Ibuprofen (Advil, Motrin, Nuprin, etc.) Do not take aspirin for 48 hours following your procedure.
  
  
• Avoid bumping or striking your biopsy site. You should avoid strenuous activities involving the muscles around the site for 48 hours. Everyday tasks such as lifting children, aerobic exercise, reaching for items overhead may be painful, so be cautious.
  
  
• Watch for excessive bleeding, pain, or fever. If any of these occur, call our office at 540-344-1444.
  
  
• For several days or even a couple of weeks, you may have a little tenderness, “twinges”, and a tiny bump where the needle entered the skin. This can be bothersome, but is not abnormal. Hot, moist packs using a wet towel may make this feel better. Usually this will disappear with time.
  
  
• Most biopsy reports are back within 24 to 48 hours. We will call you with the results and notify your primary care physician and gynecologist. Be sure we have a daytime phone number for you.
  
  
• If you have any questions or concerns, please do not hesitate to call us at 540-344-1444.

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ANESTHETIC

If you have any questions or problems following your surgery, please do not hesitate to call us at 540-344-1444.

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Complications from major breast surgery are not common, but can happen; we would like for you to be aware of some of the potential complications. All operations are associated with the risks of bleeding, infection, and failure to heal. In addition, other complications are specific to major breast or axillary surgery. These are all unusual.

BLEEDING

Post-operative bleeding may result in a hematoma (a blood clot beneath the skin) and usually occurs during the first 24 hours after surgery. A small hematoma will resolve by itself, but a larger, painful one may require returning to the operating room for removal. Transfusions are rarely necessary. In order to minimize the possibility for bleeding problems, it is recommended they you do not take aspirin, products containing aspirin, or blood thinning medication for one week prior to surgery.

INFECTION

Infection occurs when bacteria, usually from the patient’s own skin, invades the wound. It results in the wound becoming red and tender. Sometimes is it associated with drainage of thick yellow or green fluid—pus. Antibiotics are used both to prevent and to treat this problem. If pus is present, the wound may need to be opened and allowed to heal on its own. You can help prevent this complication by bathing well the night before or the morning of surgery, taking daily showers after surgery, and taking antibiotics when indicated.

FAILURE TO HEAL

Failure for wounds to heal is associated with other medical problems such as poor blood supply, diabetes, steroid medications, radiation, infection, and smoking. Although usually not life threatening, it is a nuisance and an inconvenience requiring extended treatment and sometimes further surgery.

LOSS OF SENSATION

Breast surgery is associated with loss of sensation in the operative sites. With a mastectomy, the chest wall loses sensation, resulting in minimal post-operative pain. Patients may experience phantom breast symptoms resulting in an aching or itching sensation as though the breast were still present. This is a normal sensation that will ease with time.

With axillary lymph node dissection, a sensory nerve is sometimes sacrificed to facilitate the removal of the nodes. This is purely sensory in nature and does not result in any muscle weakness. Usually sensation will return with time, but sometimes, permanent numbness in the axilla and beneath the inside of the arm occurs.

The nerves may regenerate (grow back) over time. This can be associated with increased sensitivity, itching, burning, or shooting pains. These are normal sensations that indicate regeneration is occurring.

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Surgical Description

Partial Mastectomy: You may have one or two incisions that were closed with stitches under the skin. These stitches will dissolve on their own. The skin is closed with small pieces of paper tape called Steri-Strips®. These strips will come off on their own as your skin heals and do not need to be removed. If they begin to fray off, it is okay to remove them.

Mastectomy: You may have one or two incisions that were closed with staples. The staples will be removed approximately 10-14 days after surgery.

Drainage Tubes: These tubes help drain fluid to reduce swelling and promote healing. The drainage tubes are stitched in place so they will not fall out. They are connected to a bulb which collects the drainage. While you are in the hospital, a bulky gauze dressing covers the incision. The dressing may reduce discomfort.

SELF CARE ACTIVITIES

Pain Control: You have been prescribed medicine to control post operative pain. This medication may be taken every 4-6 hours as needed. It is best to take this medicine with something to eat to coat your stomach. You may not wish to take the prescription pain medication and may take 600mg of Ibuprofen in substitute.

Pain Medicines may cause constipation, especially when you are less active the normal. To prevent this:

· Drink plenty of fluids

· Eat a diet rich in fiber

· Stool softeners or laxatives may help if needed

Dressings:

1. Keep your dressing clean and dry.
2. You may change the dressing 24 hours after surgery. If you have had a partial mastectomy you may leave the bandage off once it has been removed.
3. If the dressing becomes soiled or damp you must change the dressing to prevent infection.
4. Observe the old dressing drainage. Normal drainage is blood-tinged or water discharge. Discharge that is thick and yellow or green and may have a foul odor, indicates possible infection, notify our office if you notice these signs of drainage.

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There are thousands of websites and publications covering breast cancer. We have looked at hundreds of them, and narrowed our selection down to a handful of the very best. If you come across websites or publications that you think should be on our list, please let us know.

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American Cancer Society - What else can we say? It's the American Cancer Society, and the site covers just about everything related to cancer. It's a little cumbersome to navigate, but there is a gold mine of information if you are patient. (800) ACS-2345.
www.cancer.org

American Institute for Cancer Research

1-800-843-8114
http://www.aicr.org/

Annie Appleseed - complementary medicine site. Loads of information, plus links to many other complementary sites. The site takes a very responsible approach to complementary therapy.
www.annieappleseedproject.org

BreastCancer.org - news, information, chat rooms, and support.
http://www.breastcancer.org/

Facing our Risk - for women at high risk for breast cancer.
1-954-255-8732
www.facingourrisk.org

Dr.Susan Love Website

866-569-0388
http://susanlovemd.org

Kids Konnected Support Group

1-800-899-2866
http://www.kidskonnected.org

Living Beyond Breast Cancer

888-753-5222
http://www.lbbc.org

Lymphadema Information

http://www.lymphnet.org
http://www.cancersupportivecare.com/lymphlive.html
http://www.lymphaware.org
http://www.lymphaticresearch.org

Male Breast Cancer/Gynecomastia

http://www.mayoclinic.com/health/male-breast-cancer/DS00661
http://www.nlm.nih.gov/medlineplus/malebreastcancer.html
http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=28
http://familydoctor.org/x1701.xml

Mothers Supporting Daughters with Breast Cancer

410-778-1982
http://www.mothersdaughters.com

National Cancer Institute

1-800-4-cancer
www.cancer.gov

National Coalition of Cancer Survivorship

888-650-9127
http://www.canceradvocacy.org

Paget's Disease

http://cis.nci.nih.gov/fact/6_39.htm

The Susan G. Komen Breast Cancer Foundation and Race for the Cure® - (972)855-1600 or (800)IM AWARE.

www.breastcancerinfo.com
www.raceforthecure.com

WebMD - a great site to begin your research. Extensive resources covering just about every aspect of breast cancer and breast disease, not to mention its excellent general medical coverage.
www.WebMD.com

Y-Me - a national breast cancer advocacy organization whose mission is to ensure, through information, empowerment, and peer support, that no one faces breast cancer alone.
www.y-me.org

WHAT YOU NEED TO KNOW ABOUT CANCER The NCI's overview booklet about cancer--what it is, who is at risk and common treatments. 34 pages. NCI'S (800) 4-CANCER. http://www.cancer.gov/cancertopics/wyntk/breast

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