Can Breast Cancer Be Prevented?

From the American Cancer Society

There is no sure way to prevent breast cancer. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage.

Lowering your risk: You can lower your risk of breast cancer by changing those risk factors that can be changed. If you limit alcohol use, exercise regularly, and keep a healthy weight, you are decreasing your risk of getting breast cancer. Women who choose to breast-feed for at least several months may also reduce their breast cancer risk.

Not using post-menopausal hormone therapy (PHT) if you don't need it can also help you avoid raising your risk.

Finding breast cancer early: It is also important for women to follow the American Cancer Society's guidelines for finding breast cancer early. (See the section, "How is breast cancer found?")

For women who are or may be at increased risk

If you have a higher risk for breast cancer there may be some things you can do to reduce your chances of getting breast cancer. Before deciding which, if any, of these may be right for you, talk with your doctor.

Genetic testing: There are tests that can tell if a woman has certain changed (mutated) genes linked to breast cancer. With this information, women can then take steps to reduce their risk. Recently the U.S. Preventive Services Task Force made recommendations for genetic testing. They suggest that only women with a strong family history be evaluated for genetic testing for BRCA mutations. This group is only about 2% of adult women in the United States.

If you are thinking about genetic testing, you should talk to a genetic counselor, nurse, or doctor qualified to explain the results of these tests. It is very important that you know what genetic testing can and can't tell you, and to carefully weigh the benefits and risks of testing before these tests are done. Testing is expensive and may not be covered by some health insurance plans. For more information, see our document, Genetic Testing: What You Need to Know.

Breast cancer chemoprevention: Chemoprevention is the use of drugs to reduce the risk of cancer. Many drugs have been studied for use in lowering breast cancer risk. The drug tamoxifen has already been used for many years as a treatment for some types of breast cancer. Studies have shown that women at high risk for breast cancer are less likely to get the disease if they take tamoxifen. Another drug, raloxifene, has been approved to help reduce breast cancer risk in women past menopause who are at high risk for breast cancer. Other drugs are also being studied.

Preventive surgery for women with very high breast cancer risk: For the few women who have a very high risk for breast cancer, preventive surgery such as bilateral (double) mastectomy may be an option.

Preventive (prophylactic) double (bilateral) mastectomy: For some who are at very high risk for breast cancer, this surgery (a double mastectomy) may be an option. In this operation both breasts are removed before there is any known breast cancer. While this operation removes nearly all of the breast tissue, a small amount remains. So although this operation greatly reduces the risk of breast cancer, the disease can still start in the breast tissue that remains after surgery. To date, this has been a rare problem.

The reasons for thinking about this type of surgery need to be very strong. There is no way to know ahead of time whether this surgery will benefit a particular woman. A second opinion is strongly recommended before making a decision to have this type of surgery.

Preventive ovary removal (prophylactic oophorectomy): Women with a certain gene change (BRCA mutation) who have their ovaries removed may reduce their risk of breast cancer by half or more. This is because taking out the ovaries removes the main sources of estrogen in the body.

Although this document is not about ovarian cancer, it is important that women with this gene change also know that they also have a high risk of getting ovarian cancer. Most doctors recommend that these women have their ovaries removed after they are done having children.

Stages of Breast Cancer

From breastcancer.org

Stages of Breast Cancer. Cancer stage is based on the size of the tumor, whether the cancer is invasive or non-invasive, whether lymph nodes are involved, and whether the cancer has spread beyond the breast.

The purpose of the staging system is to help organize the different factors and some of the personality features of the cancer into categories, in order to:

• best understand your prognosis (the most likely outcome of the disease)
• guide treatment decisions (together with other parts of your pathology report), since clinical studies of breast cancer treatments that you and your doctor will consider are partly organized by the staging system
• provide a common way to describe the extent of breast cancer for doctors and nurses all over the world, so that results of your treatment can be compared and understood

Stage 0

Stage 0 is used to describe non-invasive breast cancers, such as DCIS and LCIS. In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or of getting through to or invading neighboring normal tissue.

Stage I

Stage I describes invasive breast cancer (cancer cells are breaking through to or invading neighboring normal tissue) in which:

• the tumor measures up to 2 centimeters, AND
• no lymph nodes are involved

Stage II

Stage II is divided into subcategories known as IIA and IIB.

Stage IIA describes invasive breast cancer in which:

• no tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm), OR
• the tumor measures 2 centimeters or less and has spread to the axillary lymph nodes, OR
• the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes

Stage IIB describes invasive breast cancer in which:

• the tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes, OR
• the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes

• Larger Version

Stage III

Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.

Stage IIIA describes invasive breast cancer in which either:

• no tumor is found in the breast. Cancer is found in axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone, OR
• the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are clumped together or sticking to other structures, OR
• the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures

Stage IIIB describes invasive breast cancer in which:

• the tumor may be any size and has spread to the chest wall and/or skin of the breast AND
• may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone
• Inflammatory breast cancer is considered at least stage IIIB.

Stage IIIC describes invasive breast cancer in which:

• there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast, AND
• the cancer has spread to lymph nodes above or below the collarbone, AND
• the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone

Stage IV

Stage IV describes invasive breast cancer in which:

• the cancer has spread to other organs of the body -- usually the lungs, liver, bone, or brain

"Metastatic at presentation" means that the breast cancer has spread beyond the breast and nearby lymph nodes, even though this is the first diagnosis of breast cancer. The reason for this is that the primary breast cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.

Additional staging information

You may also hear terms such as "early" or "earlier" stage, "later," or "advanced" stage breast cancer. Although these terms are not medically precise (they may be used differently by different doctors), here is a general idea of how they apply to the official staging system:

Early stage

• Stage 0
• Stage I
• Stage II
• Some stage III

Later or advanced stage

• Other stage III
• Stage IV

Doctors use a staging system to determine how far a cancer has spread. The most common system is the TNM staging system. You may hear the cancer described by three characteristics:

• size (T stands for tumor)
• lymph node involvement (N stands for node)
• whether it has metastasized (M stands for metastasis)

The T (size) category describes the original (primary) tumor:

• TX means the tumor can't be measured or found.
• T0 means there isn't any evidence of the primary tumor.
• Tis means the cancer is "in situ" (the tumor has not started growing into the breast tissue).
• The numbers T1-T4 describe the size and/or how much the cancer has grown into the breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.

The N (node involvement) category describes whether or not the cancer has reached nearby lymph nodes:

• NX means the nearby lymph nodes can't be measured or found.
• N0 means nearby lymph nodes do not contain cancer.
• The numbers N1-N3 describe the size, location, and/or the number of lymph nodes involved. The higher the N number, the more the lymph nodes are involved.

The M (metastasis) category tells whether there are distant metastases (whether the cancer has spread to other parts of body):

• MX means metastasis can't be measured or found.
• M0 means there are no distant metastases.
• M1 means that distant metastases were found.

Once the pathologist knows your T, N, and M characteristics, they are combined in a process called stage grouping, and an overall stage is assigned.

For example, a T1, N0, M0 breast cancer would mean that the primary breast tumor:

• is less than 2 centimeters across (T1)
• does not have lymph node involvement (N0)
• has not spread to distant parts of the body (M0)

This cancer would be grouped as a stage I cancer.

Log On 60%

Mr. Moneybags called on the intercom to tell me he was going to shut the server down and reset it.

Two minutes later, someone knocked on my door. Guess who? Loathsome.

"What did your computer do this morning?"

"You mean what's it doing now?"

Loathsome looks confused now that I've posed that question. Try again.

"What's the problem with it?"

It was doing things he'd never seen before and wouldn't allow him to log on. I suggested that he wait a few minutes until Bags reset the server and try again.

"No, that's not it. I've already done that three times, " he said.

I tried to explain why he should try one more time. Sometimes Loathsome gets this look on his face that's part confusion, part frustration, part dumb suffering. If he were a horse, I'd shoot him to end his misery. Instead, I proceeded to his office. I restarted and it got stuck. We did this four times and finally I restartedt in safe mode. At least that way Loathsome could look at his email and surf the net for whatever hugely important tasks must be accomplished today.

I went back to my office and finished up some work on my computer, then went to make some copies in the foyer in our suite of offices. While I was copying, I noticed Loathsome's shadow like carrion ready to lunch on dead meat. Dead meat. That would be me.

"Did you get an email from me?"

I had no idea.

"I don't know. Why?"

"It's not working," he said. I was about to go back to his office when Moneybags appeared at the printer right next to the copier I was using. Bags told Loathsome to log on again.

"Huh?" The famous Loathsome response to everyone, generally repeated 3 times before you can move on to the next sentence.

Moneybags said, "Log on again. Log on again."

Loathsome looked at me like I was his life line. "All the way?"

No, I did not tell him to log on 60%, but you know I wanted to.


Nine days.

Anniversary

Ten days until the 11th anniversary of my father's suicide.

Grief never ends.

Chemo Brain

From breastcancer.org

“Chemo brain” or “chemo fog” are terms used for thinking and memory difficulty that some associate with chemotherapy treatment. While some research suggests a link between chemotherapy and problems with thinking and memory, findings are not yet consistent and more studies need to be done. What we do know is that for many breast cancer patients, “chemo brain” is a very real issue. You may not remember where you put your keys or why you went to the store, or you may simply not be able to think of the right word. Join us to find out how other aspects of treatment can affect your cognitive abilities, learn ways to improve your mental skills, get the latest research on chemo brain, and more.
Join us tomorrow night between 7:00 p.m. and 8:30 p.m (EDT)* for this month's Ask-the-Expert Online Conference: Managing Chemo Brain. Christina Meyers, Ph.D., A.B.P.P. and George Sledge, M.D. will answer your questions about how long memory issues can last, what you can do to keep your brain active including tips to sharpen your memory, and more.
Christina Meyers, Ph.D., A.B.P.P. is a board certified neuropsychologist. She created the Neuropsychology Service in the newly formed Department of Neuro-Oncology at M.D. Anderson Cancer Center in 1984.
George Sledge, M.D. is the Ballvé-Lantero Professor of Oncology at Indiana University at Indianapolis, where he co-directs Indiana University Simon Cancer Center's Breast Cancer Program.
If you'd like to ask a question for our MANAGING CHEMO BRAIN conference, but will not be able to join the conference tomorrow night, you can submit your question now.
We'll answer as many questions as we can during the conference. A conference transcript will be posted at Breastcancer.org by October 22, 2008.
To join the conference, visit Breastcancer.org any time between 7:00 p.m. and 8:30 p.m. EDT* tomorrow night and click on the "Join Conference" button. It’s easy to participate; no special software is required. The live conference will appear in text on your screen.
Visit the Ask-the-Expert Online Conference page for more details.

Reprieve

Owner came into my office yesterday morning and delivered a rambling recitation of the reasons why Crazy Land was being terminated with extreme prejudice. They were perfectly understandable in this rough and tumble economic environment. Unfortunately, at least some of the information upon which the decision was made was purely speculative. Rumors.

Furthermore, Owner's children were now going to face the brutal realities of making one's own way in the world. They still receive economic support even though they are in their mid to late twenties. So they need to get with that program in 24 hours? It seemed unlikely to me.

An emergency shareholders' meeting was called for 10:00 a.m. yesterday. Owner can't merely decide for himself whether to shut down the Land of Crazy. After five hours of discussion, they emerged with a renewed commitment to growing the Land.

So here we are, walking in quicksand just like every other business in the world. Sooner or later, the money hemorrhage will end if things don't improve. Most of the corporate employees were blissfully unaware of the looming joblessness sitting right outside their offices. As for me, I developed some action items and tried to come to terms with the prospect of no health insurance. Cancer patients aren't generally welcomed by insurers or, if they're invited into the fold, it comes with a price tag I certainly can't afford.

Having gotten a reprieve from the proverbial ax, I'm looking for a new Crazy Land in which to settle. Trust me, if it's an insane work environment, I will inevitably find it and be sucked in to a black hole of psychodrama and inefficiency. I've learned from history, but I feel certain that I'm nonetheless doomed to repeat it.

On the up side, new entertainment awaits.

Screening for Breast Cancer

From the National Cancer Institute

Screening

Screening for breast cancer before there are symptoms can be important. Screening can help doctors find and treat cancer early. Treatment is more likely to work well when cancer is found early.

Your doctor may suggest the following screening tests for breast cancer:

• Screening mammogram
• Clinical breast exam
• Breast self-exam

You should ask your doctor about when to start and how often to check for breast cancer.

Screening Mammogram

To find breast cancer early, NCI recommends that:

• Women in their 40s and older should have mammograms every 1 to 2 years. A mammogram is a picture of the breast made with x-rays.
• Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.

Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.

If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present. (The "Diagnosis" section has more information on biopsy.)

Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect:

• A mammogram may miss some cancers. (The result is called a "false negative.")
• A mammogram may show things that turn out not to be cancer. (The result is called a "false positive.")
• Some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them.

Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.

Clinical Breast Exam

During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.

Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.

Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.

A thorough clinical breast exam may take about 10 minutes.

Breast Self-Exam

You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period.

You should contact your health care provider if you notice any unusual changes in your breasts.

Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.

You may want to ask the doctor the following questions about screening: Which tests do you recommend for me? Why? Do the tests hurt? Are there any risks? How much do mammograms cost? Will my health insurance pay for them? How soon after the mammogram will I learn the results? If the results show a problem, how will you learn if I have cancer?

Risk Factors

From the National Cancer Institute.

Risk Factors

No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.

Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for breast cancer:

• Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause.
• Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
• Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
• Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
• Gene changes: Changes in certain genes increase the risk of breast cancer. These genes include BRCA1, BRCA2, and others. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes. NCI offers publications on gene testing.
• Reproductive and menstrual history:
  • The older a woman is when she has her first child, the greater her chance of breast cancer.
  • Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.
  • Women who went through menopause after age 55 are at an increased risk of breast cancer.
  • Women who never had children are at an increased risk of breast cancer.
  • Women who take menopausal hormone therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer.
  • Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer.
• Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.
• Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.
• Breast density: Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer.
• Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.
• Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.
• Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.
• Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.

Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.

Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.

But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.

If you think you may be at risk, you should discuss this concern with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

Crazy Land Crumbles, Writer Goes Insane

That's me there on the left, standing in the wilderness, looking up to Heaven. Like everyone else on the planet, my financial plight looks very iffy.

Tomorrow morning, the Crazy Land stockholders are holding a meeting to decide the fate of the company. The good news is that I'll definitely be employed at the end of today. Tomorrow is anybody's guess.

This is where what I learned from breast cancer is shoring me up. Can I control any of this--the state of the world economy, the state of Crazy Land or my own financial future? Well, not particularly. If you can't control it, gotta let it go. I'm letting it go again and again. About every 15 minutes at this point.

In the meantime, I'm going about my business, filing workers' comp claims, updating databases, searching for unbilled expenses. What else can you do? It's difficult to stay motivated when it's entirely possible very little of my work will mean anything in 24 hours (give or take a few). Nonetheless, it's important to take care of my responsibilities until they're not mine anymore.

Loss. As I recently shared with a friend, it's been my big lesson for the past decade. I wish I could learn the truth behind it so life won't continue to slap me in the face with it. All I know is that you have to let go. What am I missing here?

A life of constant instability, conflict, lovelessness and loss--what am I to make of that? I don't even have a therapist to help me work through this. Okay, that's kinda funny. I guess the only thing to do is continue to open my heart to compassion and to pain--not just my own but for everyone who suffers or has or will. Finding humor always helps, so I have to hold on to that understanding, too. Other than that? Beats me.

Oh yeah...a postscript. The great things in my life. I live in a house. I have adequate food and clothing. I'm receiving medical care (at the moment). There are many people in my life who love me and many whom I love. I have an entertaining and brilliant (though not financially productive) husband. My mom is still with me and we're close friends. I have two great dogs. I am not going through chemo, nor am I looking at another surgery (again, fingers crossed). I am not in excessive pain. I can think. I can see. I can communicate. I have a sense of humor, even though it's rather dark and warped. All in all, I'm a very lucky woman.

Prayers, finger crossing, throwing salt over shoulder, saying a mantra...whatever you do, feel free to include me.

Understanding Cancer

From the National Cancer Institute:

Understanding Cancer

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer:

• Benign tumors are rarely life-threatening.
• Generally, benign tumors can be removed. They usually do not grow back.
• Cells from benign tumors do not invade the tissues around them.
• Cells from benign tumors do not spread to other parts of the body.

Malignant tumors are cancer:

• Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
• Malignant tumors often can be removed. But sometimes they grow back.
• Cells from malignant tumors can invade and damage nearby tissues and organs.
• Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.

When breast cancer cells spread, the cancer cells are often found in lymph nodes near the breast. Also, breast cancer can spread to almost any other part of the body. The most common are the bones, liver, lungs, and brain. The new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. For that reason, it is treated as breast cancer, not bone cancer. Doctors call the new tumor "distant" or metastatic disease.

Breast Structure

(from The National Cancer Institute)

The Breasts

The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20 lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.

The breasts also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the collarbone, in the chest behind the breastbone, and in many other parts of the body. The lymph nodes trap bacteria, cancer cells, or other harmful substances.

These pictures show the parts of the breast and the lymph nodes and lymph vessels near the breast.

Questions About Lymphedema

Do you or someone you know have questions about lymphedema?

Janet Scheetz, Physical Therapy Supervisor at M. D. Anderson, joins Ask the Expert October 6-10, 2008 to answer patients' and their caregivers' questions about lymphedema.

Ask the Expert, Anderson Network’s online message board, allows cancer patients and caregivers to submit questions to M. D. Anderson experts on specific topics. Log on to the board at www.mdanderson.org/asktheexpert to submit questions October 6-10, 2008 or to view past topics archived on the site. These include nutrition, clinical trials, fatigue, cancer prevention, patient safety, exercise and bone health, as well as site-specific questions and answers.

Questions About Lymphedema

Do you or someone you know have questions about lymphedema?

Janet Scheetz, Physical Therapy Supervisor at M. D. Anderson, joins Ask the Expert October 6-10, 2008 to answer patients' and their caregivers' questions about lymphedema.

Ask the Expert, Anderson Network’s online message board, allows cancer patients and caregivers to submit questions to M. D. Anderson experts on specific topics. Log on to the board at www.mdanderson.org/asktheexpert to submit questions October 6-10, 2008 or to view past topics archived on the site. These include nutrition, clinical trials, fatigue, cancer prevention, patient safety, exercise and bone health, as well as site-specific questions and answers.

Breast Cancer Awareness Month

From Breastcancer.org

Your Pathology Report

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Page last modified on: June 26, 2008

At a Glance

Manage Your Anxiety

Getting tests done and waiting for their results can create a lot of anxiety. Here are some suggestions to help you manage your anxiety:

• Get to know the people on your medical team and make every effort to meet them in person. You'll find out who is the best communicator, who can answer which questions, who is available to help you when you need it most.
• Find a doctor who communicates with you who invites your questions and takes your concerns seriously, who gives you as much or as little information as you feel comfortable with.
• Make plans with your doctor about how to receive test results in a prompt way. Try to schedule important tests early in the beginning of the week, so you don't have to wait over a long weekend, when lab work may slow down or doctors aren't communicating with each other.

In this section you'll find the web version of the breastcancer.org booklet: Your Guide to the Breast Cancer Pathology Report.

Wait for the Whole Picture

Waiting is so hard! But just one test can lead to several different reports. Some tests take longer than others. Not all tests are done by the same lab. Most information comes within one to two weeks after surgery, and you will usually have all the results within a few weeks. Your doctor can let you know when the results come in. If you don't hear from your doctor, give her or him a call.

Get All the Information You Need

Be sure that you have all the test information you need before you make a final decision about your treatment. Also, don't focus too much on any one piece of information by itself. Try to look at the whole picture as you think about your options.

Different labs and hospitals may use different words to describe the same thing. If there are words in your pathology report that are not explained in this booklet, don't be afraid to ask your doctor what they mean.

Breast anatomy showing close up of ductal cells

• Larger Version

Breast Cancer Stage

The pathology report will help your doctor decide the stage of your breast cancer. It could be:

• stage 0
• stage I (1)
• stage II (2)
• stage IIIA (3A)
• stage IIIB (3B)
• stage IV (4)

Staging is based on the size of the tumor, whether lymph nodes are involved, and whether the cancer has spread beyond the breast. Your doctors use all parts of the pathology report as well as the breast cancer stage to shape your treatment plan.

How to Start

First, check the top of the report for your name, the date you had your operation, and the type of operation you had. Make sure they are right for you.

Parts of Your Report

• Specimen: This section describes where the tissue samples came from. Tissue samples could be taken from the breast, from the lymph nodes under your arm (axilla), or both.
• Clinical history: This is a short description of you and how the breast abnormality was found. It also describes the kind of surgery that was done.
• Clinical diagnosis: This is the diagnosis the doctors were expecting before your breast tissue sample was tested.
• Gross description: This section describes the tissue sample or samples. It talks about the size, weight, and color of each sample.
• Microscopic description: This section describes the way the cancer cells look under the microscope.
• Special tests or markers: This section reports the results of tests for proteins, genes, and how fast the cells are growing.
• Summary or final diagnosis: This section is the short description of all the important findings in each tissue sample.

All Hell Inevitably Breaks Loose

Just a brief update today. There's even more madness than usual at Crazy Land. Our bank was bought out by Citigroup, thus flipping Owner out. One of our biggest clients is probably going to file for bankruptcy within the next several months. They owe us a huge amount of money. Both Bags and Owner believe that we'll never receive any of it and that will spell the end of Crazy Land. I'm attempting to maintain some shred of serenity.

This is where the gift of breast cancer really helps. The question to ask is, "Can I control anything in this situation?" If the answer is no, then I have to let go of worry and obsession. I had to ask myself that question about 20 times yesterday to regain my sanity. I did yoga when I got home and felt much better. I see a lot of yoga in my future.

On my own personal crazy front, my therapist and I will see each other once a month. As long as I have this job, I can afford that much at least. It's so incredibly predictable that all hell would break loose within days of being, essentially, on my own. On the other hand, as we all know, I can survive anything. Sometimes you have to ask yourself, though, whether that's such a good thing.

Tomorrow is the beginning of Breast Cancer Awareness Month. I'll be posting breast cancer information all this month.

Stop Loss

Okay, let's pause for a moment and review. In the past ten years, I've

*lost my father to suicide
*lost my oldest and dearest friend to a heart attack
*lost another old and dear friend because our relationship had become toxic to me
*lost my Malamute
*lost two beloved cats
*lost my breast
*lost three years of my life to breast cancer

and now I've lost my therapist of 14 years. If the universe is trying to teach me something about loss, I hope I figure out the mystery some time soon. I'm not up for any more losses (as though any of us has a choice).

I really think I get it, though. Life is about loss. Sooner or later, we will lose everything and everyone we love. Refusal to accept that fact is the very definition of suffering. I understand that down to the marrow of my bones.

I'm trying to keep an open mind and open heart so that, if there are lessons I haven't yet learned, they will reveal themselves to me. Of course, I'd just have to move on to another set of lessons I haven't gotten yet. That's kind of scary.

I'd really like to just coast for a while.

No One Left To Talk To

I lost my therapist on Friday. I've maxed out my lifetime therapy limit.

Now you're the only one left to talk to.

How Would You Like To Be Remembered?

Before he died of cancer, one of my heroes (Leroy Sievers) asked his readers to tell him how they'd like to be remembered. I watched a bit of his memorial service yesterday and thought some more about it.

I'd like people to remember all the times when I could have judged, but didn't. I'd like them to remember my warmth. I'd like them to remember the times I made them laugh or shared with them one of those random facts no one else would know.

I wish there were someone who could share, when the time comes, how hard my life has been and how I rose above it, time and time again. That's really the greatest accomplishment of my life. I have thrived in an environment that could have destroyed me. My cousins survived, but I triumphed over bad genes and dismal nurturing.

I hope they remember how brave I've been. Not because I've lived through breast cancer. Not because I lived through my dad's suicide. I've been courageous by refusing let go of compassion, no matter what. It's a work in progress, letting go of anger and resentment, but I continue to put one foot in front of the other.

When all is said and done, there aren't many choices to make in life. You're born into certain circumstances and, as terrible as things eventually may get, all you can do is keep going. As I've said before, no one gets to call in sick to life. We wake up every day and try to get through it, no matter what. That's all we can do.

Getting up and going on doesn't require courage. Maintaining humor, gentleness, compassion and integrity--for those qualities I've had to reach deep inside. I have had to bring my attention back day after day. They've tested my mettle.

I wish people would remember that about me. How would you like to be remembered?

Do I Look Like An Accountant?

Do I look like an accountant to you? Okay, that's a rhetorical question since I've never posted a photo anywhere. The answer is, no I do not.

I spent virtually all day yesterday doing Bags' job. We need to cultivate new business and have an opportunity to work 0n a project in New York. The problem is, in order to do that, we have to know the potential costs to factor into billing rates. I did my part of the investigation--I found tax information and instructions on registering as a foreign corporation. I generally handle all of the activities required to get us going in a new state.

I attempted to give the tax rates to Bags, but he had no interest in pursuing it. I tried to give it to him twice. Owner decided I should give it to him. That set off a flurry of copying and highlighting and flagging. I have to tell you, I am incapable of understanding a lot of it, having never filed franchise taxes before. Again, not an accountant.

Meanwhile, the Superhighway decided to retrieve the mail from the post office and I was inundated with bills that have to be entered into the Famous Endless Database. Furthermore, Hemorrhoid Guy and I have been planning to change the purchase order process for one of our clients. That means I need to find out how to establish access privileges so Our Man On The Scene doesn't accidentally delete all of the records for the past year. Once they're gone, they are most definitely gone, unless he calls our IT Boy to recover the records. Do I trust him to do that? Well, no.

Finally, Owner decided it was imperative to get some specific information regarding a workers' comp accident that occurred two years ago. There have been lots of injured bodies under the bridge since then, so more scrambling about to compile the relevant data.

After that, home to do yoga and cook red snapper for dinner. I've been trying to finish a novel for the past three weeks, but after my day yesterday, I started to fall asleep at around 8:00 as I read.

Last rhetorical question: Do I look like a superwoman? I think you know the answer to that.

Not So Brave

I haven't been reading comments or emails lately. I've been sharing difficult material and, frankly, sometimes I lack the courage to read responses. Please continue to comment and know that, whenever I'm brave enough, I'll read and respond.

Thank you for caring enough to say what's on your mind. I may be scared of that that is, but I'm grateful you join me in my explorations of pain.