5 Important Questions to Ask Your Breast Cancer Doctor

Breast cancer is the most common cancer among Singaporean women. A cell will turn cancerous when there are genetic mutations that make it grow out of control. There are many contributing causes, but the exact cause for a patient may never be clearly identified.

Treating breast cancer needs a multidisciplinary and multimodality approach. It means it will take a team of specialists to coordinate surgery, chemotherapy, hormonal therapy, radiotherapy, and targeted therapy. Some patients will also need physiotherapy or emotional and psychological counselling. There may be side effects and lingering complications that will impact your health and lifestyle. Still, we believe that all cancer patients can go on to lead a normal and happy life.

So, before you decide on your breast cancer surgery, you need to gather as much vital information as possible. The only way to do so is by consulting your breast cancer doctor. Below is a list of questions you should keep in mind when speaking with your breast cancer doctor. A good doctor can guide you on the necessary and relevant key points specific to your condition, so you don’t get confused by information overload!

What kind of breast cancer do I have?

There are many types of breast cancer and many ways to describe them. The specific cells in the breast that become cancer determine the kind of breast cancer.

Firstly, breast cancers can be classified depending on where the tumor starts developing. The tumor can start in cells that make up the skin or the tissue lining body organs. More specifically, the cancer can also begin in cells in the milk ducts or the lobules (glands in the breast that make milk).

Secondly, the type can also refer to whether the cancer has spread or not (in situ vs. invasive). In situ breast cancer (ductal carcinoma in situ or DCIS) is a pre-cancer that starts in a milk duct and has not grown into the rest of the breast tissue. Invasive breast cancer spreads to surrounding breast tissue. The most common types are invasive ductal carcinoma (makes up about 70-80% of all breast cancers) and invasive lobular carcinoma.

Lastly are the rare types of cancer. There are ones that start to grow in other types of breast cells. Paget’s disease of the breast is a rare condition, causing eczema-like changes to the nipple skin and the surrounding area. It has the same treatment options as usual breast cancers. Angiosarcoma of the breast, on the other hand, is a very rare form of cancer, representing only 0.1% to 0.2% of all breast cancers.

So, regardless of the type, your breast cancer doctor will thoroughly guide you in identifying and treating it. The initial steps of biopsies and staging will be the same, as are the types of surgery. Let your breast surgeon coordinate and advise, as a cancer treatment may take up to a whole year to complete.

What stage group is it?

For all cancers, staging is important to guide treatment. For breast cancer, this is done through various tests such as a whole body scan and sentinel lymph node biopsy during surgery (if suitable). Briefly, the stage depends on the tumor size, where it has spread, and whether the lymph nodes are affected or not, and your surgeon will assign a “TNM” system.

For general knowledge, breast cancer has five possible stages:

  • Stage 0 (earliest) – No need for chemotherapy
  • Stages 1 to 2 (early)
  • Stage 3 to 4 (late)

Cancer staging can be complex. Over time, more findings are added to the staging systems, making the latter more complex than they were in the past. If you are unsure about your cancer stage or what it might mean, ask your doctor to explain it to you in a way you would understand.

What treatment options do you recommend for me?

Breast cancer can be treated in many ways, depending on the kind and how far it has spread. You are more likely to receive more than one kind of treatment.

  • Surgery – An operation where the surgeon may need to remove part or whole breast.
  • Chemotherapy – The use of particular medicines to kill cancer cells.
  • Hormonal therapy – It blocks cancer cells from getting the hormones they need to grow.
  • Biological therapy – It is about working with your body’s immune system to help it fight cancer cells or control side effects from other cancer treatments.
  • Radiation therapy – The use of high-energy rays to kill cancer cells.

It would be best to discuss this crucial question as you will likely get treatment from various medical professionals. It will also mentally prepare you for the treatment options recommended by your doctor. Again, a good surgeon will be able to brief you, guide you, and coordinate the necessary referrals for you.

Can diet, exercise, and other lifestyle choices help in my recovery?

Earlier in the article, we mentioned multiple causes of cancer. Hence, a healthy lifestyle is crucial to reducing the risk of cancer development and recurrence.

Studies have found a consistent link between physical activity and a lower risk of breast cancer recurrence and mortality rate.

Studies also found that breast cancer survivors whose eating patterns include more vegetables, fruits, whole grains, chicken, and fish tend to live long. In comparison, those who eat more refined sugars, fats, red meats, and processed meats have a shorter lifespan. It may be due to cancer or the development of other illnesses such as stroke or heart attack.

The links between diets, exercise, lifestyle choices, cancer progression, and recurrence are not bound. However, the health benefits could help you improve your quality of life, physical functioning, and fatigue symptoms. Seek advice from your doctor in detail about what she has to say about a proactive lifestyle.

What’s the risk of my cancer coming back after treatment?

After treatment, one concern you may be curious about is cancer recurrence. Recurrent breast cancer is breast cancer that comes back after initial treatment. The risk of it coming back is linked to your initial cancer stage. Signs and symptoms vary depending on where the cancer comes back.

Local recurrence. Cancer reappears in the same area as your original cancer. Signs and symptoms may include:

  • a new lump in your breast or irregular area of firmness
  • changes to the skin of your breast
  • skin inflammation or area of redness
  • nipple discharge

Regional recurrence. Cancer has come back in the nearby lymph nodes. Signs and symptoms may include a lump or swelling in the lymph nodes located:

  • under your arm
  • near your collarbone
  • in the groove above your collarbone
  • in your neck

Distant (metastatic) recurrence. Cancer has travelled to remote body parts, most commonly the bones, liver, and lungs. Signs and symptoms include:

  • persistent and worsening chest, back, or hip pain
  • persistent cough
  • difficulty breathing
  • loss of appetite
  • involuntary weight loss
  • severe headaches
  • seizures

Cancer recurrence is usually quoted as a 2-year, 5-year, or 10-year survival rate. However, with early detection and better treatment options, the survival rate for breast cancer has improved over the years. Extended and more effective breast cancer treatments have increased the prevalence of long-term survivors. You can further discuss about recurrences with your breast cancer doctor for ease of mind. Regardless, your team of doctors will keep you on regular follow-up so that any recurrence can be detected and treated early.

Conclusion

Every woman is different, and there are various combinations of cancer types. By asking your breast cancer doctor these questions, you can better understand what to expect. This way, you can be mentally and physically prepared for surgery or other treatment.

 

References

  • https://www.cancer.org/cancer/breast-cancer/living-as-a-breast-cancer-survivor/can-i-lower-my-risk-of-breast-cancer-progressing-or-coming-back.html
  • https://www.breastcancer.org/facts-statistics/myths-vs-facts
  • https://www.cancer.net/cancer-types/breast-cancer/stages
  • https://www.cdc.gov/cancer/breast/basic_info/treatment.htm
  • https://www.healthhub.sg/a-z/diseases-and-conditions/20/breastcancer
  • https://www.mayoclinic.org/diseases-conditions/recurrent-breast-cancer/symptoms-causes/syc-20377135
  • https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/breast-cancer.html
  • https://www.webmd.com/breast-cancer/guide/questions-ask-cancer-doctors
  • https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer.html
  • https://www.mycancer.com/resources/what-are-biomarkers/
  • https://www.nccs.com.sg/giving/pages/breast-cancer-research.aspx#:~:text=However%2C%20with%20early%20detection%20and,year%20survival%20rate%20of%2080%25.
  • https://doi.org/10.1093/jnci/djab202
  • https://www.cancer.org/treatment/understanding-your-diagnosis/staging.html#:~:text=Cancer%20staging%20can%20be%20complex,to%20both%20doctors%20and%20patients.
  • https://www.nhs.uk/conditions/pagets-disease-nipple/#:~:text=Paget%27s%20disease%20of%20the%20nipple%2C%20also%20known%20as%20Paget%27s%20disease,the%20tissue%20behind%20the%20nipple.
  • https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer/angiosarcoma-of-the-breast#:~:text=Angiosarcoma%20is%20a%20very%20rare,spread%20quickly%20throughout%20the%20body.

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Breast & General Surgeon
Dr Tan Yia Swam has more than 15 years of experience in patient care. She is a specialist in General Surgery, with an interest in Breast Surgery. Her experience encompasses a wide range of breast conditions such as lumps, pain, nipple discharge, cancers, abnormal imaging, and believes in personalized treatment recommendations that respect patients’ needs and concerns.
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Nexus Surgical Associates makes no representation and assumes no responsibility for the information, contained on or available through this website without consultation with our doctors. The information provided on this website is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this website is for general information purposes only. If you have concerns about your health, you should seek advice from a doctor or if you require urgent care you should go to the A&E.

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