WHAT YOU NEED TO KNOW NOW What is early breast cancer? Breast cancer arises in the ducts and/or lobules of the breast. The majority of breast cancers come from the ducts of the breast, which is called “invasive duct carcinoma.” The other main type of breast cancer comes from the lobules of the breast and is called “invasive lobular carcinoma.” For all intents and purposes, both invasive duct and lobular cancer are treated the same. The following information is most relevant for women with a diagnosis of early breast cancer, with no current signs of spread to other parts of the body. In general, the tumour in the breast is less than 5 cm and may have spread to the lymph nodes, but the spread is not extensive. The main focus of treatment for early breast cancer is to remove the tumour and prevent it from returning in the future. Generally, surgery is performed first to remove the tumour and to see how extensive it is. Additional treatments such as chemotherapy, anti-hormone therapy and radiation are often used to help prevent the tumour from coming back in the breast/chest area or elsewhere in the body. Surgery The two most common surgeries for early breast cancer are breast-conserving surgery (either a lumpectomy or partial mastectomy), where just the tumour with a rim of normal breast tissue is removed and mastectomy, where the whole breast is removed. If mastectomy is required (or desired) based on the extent of your disease, reconstruction of the breast is commonly part of treatment covered by your provincial health care. Sometimes reconstruction is performed at the same time as the mastectomy, called “immediate breast reconstruction,” or at a later date, called “delayed reconstruction.” Treatment with either breast conserving surgery or mastectomy results are no different in terms of survival. The decision between breast conserving surgery and mastectomy will depend on a number of factors including your tumour (see surgery for more information. Radiation After breast conserving surgery, radiation is given to the whole breast to reduce the risk of recurrence in the cancer. Sometimes radiation is given to your chest after mastectomy to reduce the risk of the tumour returning in your chest. Radiation may also be given to your armpit lymph nodes to reduce the risk of the tumour returning in your armpit. The recommendation for radiation to your chest after mastectomy or to your armpit after any surgery will often depend on the results of your surgery (pathology). Lymph nodes Often, a sampling of your armpit lymph nodes is performed with a “sentinel node biopsy” where one or two lymph nodes are removed to be examined for signs of tumour spread under the microscope (see surgery for more information). Sometimes, removal of most of your lymph nodes under your arm is required, this is called an “axillary node dissection.” Systemic Therapy To further reduce the risk of recurrence after surgery, systemic therapy or drugs (that are given intravenously or by mouth) may be recommended (see systemic therapy for more information). Systemic or drug therapy travels throughout your whole body (including your breasts) to attack any microscopic tumour cells that may have spread but are too small to be detected. The main forms of drug therapy are chemotherapy, anti-hormone pills and/or injections or other intravenous therapy (biologic therapy).
WHAT YOU NEED TO DO NOW If you are working, there is no need to stop working if you feel up to it, but this is the time to take care of yourself. At this point, you may be preparing to tell your loved ones about your diagnosis if you haven't already. This is a personal decision, but confiding in someone may provide you with some emotional support. You may also decide that participating in clinical trials is the right choice for you. Again, this is a personal decision, but many options are available.
HOW YOU MIGHT BE FEELING At this stage you will start to process the information and begin the process of coping with the diagnosis emotionally and physically. You may feel scared, angry, sad and out of control. Many people begin to experience anxiety as well. These feelings are common, normal and expected. Your personal and medical support team can help you work through these feelings, and you may find that reading other women's stories is beneficial. Our resource directory may also help guide you through your feelings. Many women feel that the cancer is growing every second, spreading rapidly, and that every new pain or feeling in the body is a sign of the cancer. This is a very normal reaction to the news, and while it feels like treatment can’t happen fast enough, the important thing to remember that the majority of breast cancers do not spread like that and that the very first cell was probably there months or even a year or so ago.
WHO IS THE TEAM AT THIS POINT Depending on who organized your biopsy, you will be referred to a specialist who will meet with you and discuss a treatment plan. This may be a surgeon or an oncologist or both. You will also see a nurse and radiologist throughout the diagnosis stage. Depending on your treatment plan, you may see a medical and/or radiation oncologist, psychologist/psychiatrist and genetic counselor as well. Ideally, you should prepare for your appointment and bring along someone who knows you well and can be a second set of ears during the consultation. You might consider recording your appointments on your smart phone as well. Be sure to ask plenty of questions to help yourself gain the best understanding of your situation.