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PATH 1: Early Stage Breast Cancer

PATH 2: Neoadjuvant Therapy

PATH 3: Pregnancy During Breast Cancer

PATH 4: DCIS

PATH 5: Metastatic Stage 4

PATH 1: Early Stage Breast Cancer

Post-Treatment

Now that you have finished all of your treatments, your survivorship period begins. During this time after treatment, the main goals are to stay healthy, monitor for recurrence and to manage any long-term side effects. Your follow up plans may differ from other breast cancer patients—it depends on the types of treatment you underwent, your tumor factors and your own personal health history. 

On this page, you will find answers to common questions, resources for coping with your new normal and information about recurrence prevention. 

WHAT YOU NEED TO KNOW NOW

These are some common questions you may have at this stage:


How can I stay healthy? 

The main things are to:
  • Maintain a healthy weight;
  • Maintain an active lifestyle—exercise for at least 15 minutes, three times per week and aim for 150 minutes a week total;
  • Eat healthy well-balanced meals including 5-6 servings of fruits and vegetables per day;
  • Avoid smoking, excess alcohol and illicit drugs, and;
  • Continue regular routine health check-ups with your family doctor.


What changes in my body should I share with my doctor?

You should report any new symptoms in the breast/chest, under the arms or any other location to your health care team. Some symptoms to be aware of include changes in the breast, chest, underarms (axilla), or collarbone (clavicle) regions such as: 
  • Change in breast tissue (size, shape, new thickening or lump);
  • Change in breast or chest wall skin (dimpling, rash, new lump or thickening);
  • Change in nipple (nipple inversion, nipple discharge, itchy/scaly nipple), and;
  • Change in axilla or clavicle region (new lump or mass).
On the rest of the body, be aware of: bone pain, chest pain, chronic cough, abdominal pain, new or chronic headaches, increasing fatigue, new bowel or urine problems, ongoing nausea, persistent loss of appetite and unintentional weight loss.


What follow up should I have with my doctor?

A clinical exam can be performed by one of your health care practitioners every three to six months for the first two years after treatment, and then every six to 12 months for the next three years. After five years, a check-up every year is sufficient. This schedule is not fixed and may vary by patient and treatment site. Your family doctor may also be the one doing your ongoing follow up, transitioning on after two to five years after your treatment. More information is available from the Canadian Cancer Society.

Another form of follow-up is imaging. If you have had a lumpectomy, mammograms are recommended every year starting at least six months after the end of your treatment (i.e. after radiation finishes). If you have had a mastectomy, mammograms are recommended for the opposite breast only on a yearly basis. If you have had a double mastectomy, no imaging is needed. Yearly clinical exams are recommended. If any abnormalities are found on exam, imaging may be ordered. 

Even if you have had your breast reconstructed, mammograms or MRIs are not indicated. There is also no need for routine scans of other areas of the body (e.g. bone scan or CT scans) in the absence of any new symptoms.


What are the long-term side effects of my treatments?

Surgery
There are a few long-term side effects from surgery that your doctors will tell you about. For patients who have had lymph node removal and/or radiation to the axilla, there is a chance of developing lymphedema. Patients who have had both complete removal of the underarm lymph nodes as well as radiation to the area are at the highest risk of developing lymphedema.

Lymphedema is swelling in the arm (but may also affect the breast, back and other areas), and symptoms usually begin as “heaviness.” Lymphedema cannot be reversed, but the symptoms can be managed—especially if treatment is sought early. A physiotherapist or occupational therapist with special training usually treats lymphedema. Therapies may include manual drainage and/or compression garments. 

Healthy habits for those at risk for Lymphedema can be found here.

Chemotherapy
There may also be long-term effects of chemotherapy. These may include: fatigue, changes to cognitive function, early menopause and infertility. Cardiac effects may depend on the type of chemotherapy you have received (e.g. Herceptin).
 
Radiation
After radiation therapy, you may experience a little or a lot of change in the size and shape of the breast. It may contract and appear smaller. You may also have some swelling (like lymphedema in the arm) affecting the breast. You will also not be able to breast feed from that breast in the future.

There are a few very rare long-term side effects of radiation, and these include rib fracture, heart problems and inflammation of the lungs.

WHAT YOU NEED TO DO NOW 

At this stage, you should continue to maintain follow up with your health care team and take care of yourself. 

As you begin to find your new normal, you may need help navigating the change in your life. There are community services available to you for support during this time.

In time, you might consider going back to work. This will depend on many factors, including energy levels and how you're feeling, but it is possible. Many women sucessfully return to work following their treatment. If you feel unable to return to work full-time or at all, there are options available to help you financially.

HOW YOU MIGHT BE FEELING

Many women feel a variety of emotions at this stage as they return to their 'normal' life. Certainly, you have come through the hard part with many patients having undergone surgery, radiation or some combination of them.

It is not uncommon for women to experience "scanxiety" or anxiety, depression or post traumatic stress disorder during and after treatment. Understanding the signs and symptoms of each will help you to spot the conditions early and seek necessary help. Speak with your cancer centre to find out what resources are available to you. 
 
You will undoubtedly feel relieved, tired, and unsure of what lays ahead. You may need some help in re-establishing your life and getting used to the changes in your body and how you are feeling.

There are great support networks for you to help you through this transition.

WHO IS THE TEAM AT THIS POINT

Post-treatment follow-up and monitoring may involve one or all of your medical oncologist, radiation oncologist, surgeon, family doctor or a dedicated GP oncologist. 

Other team members may include a psychologist, psychiatrist, gynecologist (to deal with post-menopausal symptoms) and support groups.


 

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