A breast cancer diagnosis can be scary and overwhelming. But understanding the steps that follow a diagnosis can help you feel more prepared and in control. Here’s an overview of what to expect after you receive a positive result from a mammogram, ultrasound, MRI or biopsy confirming breast cancer.
Getting Test Results and Staging
The first step after a breast cancer diagnosis is to get more information about your specific cancer. Your doctor will order tests to determine:
- The size of the tumor
- If the cancer has spread to lymph nodes or other parts of your body
- The stage of the breast cancer
Knowing the stage and characteristics of the cancer help determine the best treatment options for you.
Some common tests done after a diagnosis include:
- Imaging tests such as mammogram, breast MRI, CT, PET or bone scans to look for tumors in the breast and elsewhere in the body.
- Biopsy of nearby lymph nodes to see if they contain cancer cells that have spread from the tumor.
- Blood tests to evaluate your overall health and liver and kidney function.
- Genomic tests to analyze the genes of your tumor cells and guide personalized treatment.
The results from this further testing provides information for “staging” your breast cancer. The stage refers to how far the cancer has spread and indicates how serious the diagnosis is.
Breast Cancer Stages
Breast cancer has 5 main stages, ranging from early to advanced disease:
| Stage | Description |
|---|---|
| Stage 0 | Non-invasive breast cancer confined to ducts and lobules in the breast. Also called ductal carcinoma in situ (DCIS). |
| Stage 1 | Cancer is 2 cm or less and has not spread to lymph nodes. |
| Stage 2 | Tumor is 2-5 cm or cancer has spread to underarm lymph nodes. |
| Stage 3 | Tumor is larger than 5 cm and/or has spread to several underarm lymph nodes. |
| Stage 4 | Advanced cancer that has metastasized to other parts of the body such as bones, liver, lungs or brain. |
The stage provides key information for determining the best treatment options. Early stage breast cancers have the highest survival rates.
Choosing a Treatment Plan
After diagnosis and staging, your cancer doctor will outline your treatment options and make recommendations. Some key factors in selecting a treatment plan include:
– The type and stage of breast cancer
– Your age, overall health, and preferences
– Certain features of the cancer cells like hormone receptor status
– Whether the cancer cells have high levels of HER2 protein
– Menopausal status
For early stage breast cancers, common treatment options include:
Surgery
Surgery is typically the first line of treatment for breast cancer. Common procedures include:
– Lumpectomy – Removal of the tumor along with a small amount of normal surrounding breast tissue.
– Mastectomy – Removal of the entire breast. There are several types of mastectomies including:
– Simple or total mastectomy – Removal of the whole breast containing cancer.
– Skin-sparing mastectomy – Breast tissue is removed but the outer skin covering of the breast remains.
– Nipple-sparing mastectomy – The breast tissue is taken out but the nipple and areola are left intact.
– Modified radical mastectomy – The entire breast and some underarm lymph nodes are removed. This was once common but is now less frequently performed.
– Lymph node removal – Taking out lymph nodes from under the arm to look for cancer spread. This is called an axillary lymph node dissection. Sentinel lymph node biopsy removes just 1-3 nodes.
Radiation Therapy
Radiation uses high energy beams to kill cancer cells. It may be done after lumpectomy to lower chance of recurrence. It can also be used after mastectomy. Radiation is typically done 5 days a week for 3-6 weeks.
Chemotherapy
Chemotherapy uses anti-cancer drugs to destroy cancer cells. It may be given orally in pill form or intravenously. Chemotherapy is commonly used when breast cancer has a higher risk of recurrence or spread.
Hormone Therapy
Hormone therapy blocks effects of estrogen or progesterone which can fuel breast cancer growth. It is used for hormone receptor positive breast cancers. Tamoxifen and aromatase inhibitors are commonly used hormone therapies.
Targeted Drug Therapy
Targeted therapy uses drugs that specifically attack cancer cells. They target proteins that spur cancer growth. For example, Herceptin blocks the HER2 protein. It may be used for HER2 positive breast cancers.
After reviewing your test results and cancer specifics, your oncologist will suggest the best treatment regimen based on current medical guidelines. But the final decision is yours after considering the pros and cons of each option. Getting a second opinion is also often advised.
Considering Breast Reconstruction
If you plan to undergo mastectomy, you may want to consider breast reconstruction surgery. This reconstructs the shape and look of the breast after removal.
Breast reconstruction can be done at the same time as mastectomy or months to years later. Some factors to consider:
- Having immediate reconstruction does not appear to raise the risk of cancer recurrence.
- However, some women may prefer waiting until after radiation or chemotherapy is finished.
- Discuss options like implant vs flap procedures with your plastic surgeon.
Your team of doctors including your oncologist and plastic surgeon can help guide your decision making process regarding breast reconstruction.
Finding Support and Community
Coping with a breast cancer diagnosis often involves finding support services and connecting with others having similar experiences. Here are some ideas that may help you through this challenging time:
- Join a local support group – Bond with fellow patients and survivors
- See a therapist or counselor – Get professional help processing emotions
- Reach out to friends and family – Accept help from loved ones who care about you
- Connect with community – Many advocacy groups offer mentorship programs and resources
- Focus on self-care – Make your physical and mental wellbeing a priority
You don’t have to go through this alone. Take advantage of support systems that allow you to share your feelings and find encouragement.
Starting Treatment
Once you decide on a treatment plan with your doctor, the next step is beginning the recommended therapies. This could involve steps like:
– Meeting with a surgeon to prepare for a lumpectomy or mastectomy
– Getting set up with a radiation oncology team for planning sessions
– Having a port placed for chemotherapy administration
– Filling prescriptions for oral hormone or targeted therapies
– Making the first appointment to start chemotherapy or radiation sessions
– Arranging transportation for treatments and making work or family adjustments to accommodate the schedule
Starting treatment marks a major milestone. While it involves significant lifestyle changes, it also represents hope and a plan of action against the cancer. Staying focused on each day can help you get through this difficult period one step at a time. Communicate with your care team so they can support you along the way.
Handling Treatment Side Effects
The treatments for breast cancer can produce side effects that impact your quality of life. Being aware of potential side effects and how to minimize them can help you cope better.
Surgery
Surgical side effects may include:
- Pain, numbness and restricted mobility in the chest, arm or armpit
- Risk of arm swelling (lymphedema) if nodes removed
- Distortion or asymmetry after mastectomy requiring revision
Work closely with your care team on pain management and post-op recovery. Follow their guidelines for limiting activity and regaining strength and range of motion. Report concerning or worsening side effects promptly.
Radiation
Radiation therapy can produce skin irritation like:
- Reddening, dryness, peeling of irradiated skin
- Breast/chest swelling, heaviness, warmth or pain
- Fatigue especially in later treatments
Care for your skin carefully during radiation. Avoid sun, wear loose clothing and use recommended ointments. Rest when needed and stay hydrated.
Chemotherapy
Chemotherapy side effects depend on the specific drugs used but may involve:
- Nausea, vomiting, appetite changes
- Mouth sores
- Diarrhea or constipation
- Numbness, tingling, pain in hands/feet (peripheral neuropathy)
- Hair loss
- Fatigue
- Increased infection risk
Work with your oncology team to manage chemotherapy side effects. Medications, lifestyle changes, and complimentary therapies can often provide symptom relief.
Staying active, eating well, and getting plenty of rest can help you withstand the challenges of treatment. Reach out for help when you need it.
After Completing Treatment
Finishing treatment is a major milestone on the breast cancer journey, but there is still important work ahead. Follow-up care after treatment involves:
- Seeing your oncologist regularly for exams to check for recurrence
- Getting mammograms yearly and other screening tests as recommended
- Seeing specialists for cancer related long term effects
- Adhering to hormone therapy if prescribed to reduce risk of recurrence
- Living an overall healthy lifestyle with a cancer prevention focus
Stay vigilant about follow-up appointments and be aware of concerning symptoms like new lumps or bone pain that need prompt attention. Report side effects from ongoing medication like hormone therapy.
At the same time, focus on enjoying life and the activities important to you. Set goals and create meaning moving beyond cancer.
Seeking Reconstructive Surgery
After completing other treatments, many breast cancer survivors consider reconstructive surgery to recreate the shape of the removed breast. The options include:
Implant reconstruction
This places a breast implant under the chest muscle or skin. It involves a shorter surgery and recovery than flap methods.
Autologous tissue flap procedures
Flaps utilize fat, skin, and muscle from your own body, such as:
– TRAM flap uses tissue from the abdomen
– LAT flap uses tissue from the back
– DIEP flap takes tissue from the lower abdomen
Talk to plastic surgeons and consider the pros and cons of each reconstruction approach. Select the method that best matches your needs and preferences.
Managing Lingering Side Effects
After treatment ends, some side effects like fatigue, neuropathy, and joint pain may continue bothering cancer survivors. Be sure to tell your care team about ongoing issues. Ways to minimize lasting side effects include:
- Getting physical therapy for range of motion and strength exercise
- Seeing a lymphedema specialist for swelling management
- Trying massage, acupuncture, meditation, or yoga for pain and stiffness relief
- Wearing compression garments to reduce swelling
- Practicing good sleep habits and pacing activities to manage fatigue
Don’t assume you just have to live with treatment side effects. There are many integrative medicine therapies that can help in your recovery process.
Adjusting to a New Normal
Having your life turned upside down by cancer treatment causes significant emotional, social, physical and financial effects for survivors. Be patient with yourself as you adjust to the “new normal” after treatment. Strategies like these may help:
- Set small, realistic goals each day or week to rebuild confidence and a sense of control.
- Connect with other survivors who understand what you’re going through.
- If needed, allow yourself time to grieve the impact of cancer on your health or body image.
- Look for positive ways to redefine yourself, find new purpose and embrace life.
- Do things at your own pace – don’t push yourself to recovery too quickly.
Post-treatment, there will surely be good and bad days. But little by little, the difficult days often become less frequent as you build your new life.
Adopting Healthy Lifestyle Changes
After cancer, making positive lifestyle changes becomes especially important for survivors. Recommendations include:
- Eat more veggies, fruits and whole grains. Limit processed foods.
- Get regular exercise tailored to your needs and abilities.
- Achieve and maintain a healthy weight.
- Limit alcohol consumption.
- Manage stress with techniques like yoga, mediation, nature walks.
- If you smoke, get help quitting.
- Get enough sleep and rest when fatigued. Pace yourself.
Healthy lifestyle choices may help prevent recurrence and improve cancer survivorship. Stay motivated by noting how better fitness, nutrition and wellbeing make you feel.
Living Like You Mean It
A cancer experience often leaves survivors with a new perspective on making the most of every moment. Following dreams, deepening relationships, helping others and being present can take on new meaning.
Ways to embrace the joy of living may include:
- Spending more time with loved ones and showing appreciation
- Traveling to places you’ve always wanted to visit
- Taking up new hobbies that bring you satisfaction
- Pursuing professional or life dreams you now realize matter most
- Focusing your energy on positive thoughts and feelings
- Finding spiritual peace through practices like prayer or meditation
The difficult journey of cancer treatment prepares you for living the rest of your life more purposefully. Make the most of each new day.
Seeking Help for Anxiety or Depression
It’s normal to feel anxious, depressed or overwhelmed sometimes after breast cancer treatment. But if these feelings persist or interfere with your life, it’s important to get professional mental health support.
Counseling, medication, meditation techniques, exercise or support groups can all help survivors cope with emotional struggles. Don’t hesitate to lean on your healthcare providers, friends and family while prioritizing your mental wellness.
With time, treatment and self-care, know that anxiety and depression can be temporary setbacks, not permanent barriers to finding joy again. You have the strength to get through the difficult times.
Conclusion
A breast cancer diagnosis sets you on a challenging path full of complex medical decisions, treatment side effects, and emotional ups and downs. Take it step-by-step relying on information, your care team and support system.
Stay hopeful knowing that current treatments allow many people to live full lives after breast cancer. And appreciate each milestone of your survivorship journey, from finishing chemotherapy to getting back to activities you love. There are brighter days ahead.