7 Questions to Ask About Your Breast Cancer Diagnosis
Being diagnosed with cancer or any major illness is overwhelming and confusing. Here are seven questions to ask your oncologist so you can understand your stage, prognosis and treatment options.
Contributor: Jame Abraham, MD
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Being diagnosed with cancer or any major illness is overwhelming and confusing. You don’t know what questions to ask when you walk into a doctor’s office. Here are seven questions to ask your oncologist about your diagnosis so you can understand your stage, prognosis and treatment options:
Not all breast cancers are the same. Doctors classify them in a number of different ways.
Probably the most basic is where the cancer cells originate. Their origin is a factor in whether your cancer may spread and helps decide the kind of treatment you’ll get.
Most breast cancers – 70 percent to 80 percent – start in the milk ducts. They’re known as infiltrating or invasive ductal carcinomas, meaning they’ve broken through the milk duct’s wall and have proliferated into the breast’s fatty tissue.
Ten percent of breast cancers start in the milk-producing glands, or lobules, and are called invasive lobular carcinomas. They’re also capable of spreading.
Some breast cancers are non-invasive, meaning they haven’t spread. They’re contained within the milk ducts and are called ductal carcinoma in situ, or DCIS.
Tumor size is another factor that will determine your course of treatment. The tumor’s dimensions are estimated by a physical exam, mammogram and an ultrasound or MRI of the breast. The precise size won’t be known until a pathologist studies the tumor after surgical removal.
Whether your breast cancer has spread to your lymph nodes – the filtering mechanisms in your armpits – is one of the most important predictors of the severity of your disease. When breast cancer cells have spread to the lymph nodes, we tend to discuss more aggressive treatment options such as chemotherapy.
Staging is a standardized way of classifying the severity of a patient’s cancer. There are various systems that use number or letter codes to designate the cancer’s status and how far it may have spread.
You may have heard of stages I through IV, which reflect a tumor’s size and the extent of metastasis. A higher stage means a larger tumor and wider distribution of cancer cells.
Your doctor uses staging to plan your treatment, gauge your prognosis and communicate with other cancer specialists.
Grading is not the same as staging. Both are indicators of a cancer’s severity and prognosis, but using different criteria. While staging deals with tumor size, location and cancer cell distribution, grading is based on the cancer cells’ appearance under a microscope.
The more abnormal-looking the cells are, the more likely they are to quickly grow and spread. Grades usually run from 1 to 3. Grade 3 and 4 tumors tend to grow rapidly and spread faster than tumors with a lower grade.
Your body’s hormones, such as estrogen and progesterone, may play a role in how your breast cancer progresses. Normal cells are equipped with receptors that, as the name suggests, allow them to receive information (including growth signals) from circulating hormones, like your TV receiver picks up cable or satellite signals.
If your breast cancer cells have estrogen and progesterone receptors — in medical language, if they’re ER/PR positive — then they’re capable of detecting estrogen’s signal and using it to fuel growth. If the cancer cells lack the receptors — ER-/PR-negative — then they can’t hear the growth-signaling message.
About 70 percent of breast cancer patients have positive ER/PR hormone status. While being ER/PR-positive sounds bad, there’s actually a benefit.
Doctors can take advantage of the receptors’ presence, either by using an anti-estrogen drug such as tamoxifen that blocks the receptors and jams estrogen’s growth signal, or by using drugs such as aromatase inhibitors such as anastrazole, letrozole or exemestane, which lower your body’s estrogen levels to deprive the cancer cells of fuel.
Those are highly effective approaches. ER/PR-positive patients may be advised to take anti-estrogen pills for as long as five to 10 years. ER/PR-negative tumors, which are more aggressive, can’t be treated this way. Because they lack receptors, anti-estrogen pills don’t work, so chemotherapy is generally the preferred treatment. Your ER/PR status is determined by testing a sample of breast cancer cells removed during a biopsy.
HER2 (which stands for human epidermal growth factor receptor 2) is another type of growth signal receptor, or antenna, which may be present on your breast cancer cells. About 25 percent of breast cancers are HER2-positive.
HER2-positive cancers are a mix of good and bad news. The bad news is the tumors tend to grow more aggressively than those without the HER2 receptor. The good news is that, like ER/PR-positive cancers, medicines can switch the HER2 growth receptor off.
New drugs such as trastuzumab, pertuzumab, T-DM1 and lapatinib are extremely effective at this and have dramatically improved the prognosis for HER2-positive patients. Treatment outcomes are now as good as those with HER2-negative tumors.
Breast cancer treatment guide
This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic.