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After a Breast Cancer Diagnosis: Questions to Ask Your Doctor
After you receive a breast cancer diagnosis, your doctor will order various diagnostic tests that provide important details about your type and stage of breast cancer. The results of these tests help guide his or her treatment recommendations. If you have early-stage breast cancer, you may also be a candidate for newer tests that can estimate your risk of recurrence and/or predict how likely it is that you will benefit from the hormonal therapy.
The following are questions you may want to ask your doctor about the results of your diagnostic tests:
Is my tumor invasive or noninvasive? Invasive breast tumors are tumors that have started growing into nearby healthy breast tissues. Noninvasive, or in situ tumors, are confined to the milk ducts; this is the earliest stage of breast cancer. As is true for most cancers, breast cancer in the earliest stage usually has the best chance of being cured.
What stage is my tumor? A tumor’s stage refers to its size and extent of spread in the body—e.g. whether it has spread to lymph nodes or other organs. Cancer confined to the breast may be called localized cancer. Cancer that has spread to other organs is called metastatic cancer. A cancer’s stage is often denoted by a Roman numeral (I, II, III or IV). The higher the numeral, the more the cancer has spread within the body.
What grade is my tumor? A tumor’s grade refers to how the tumor cells look under a microscope. The more different they look from healthy cells, the higher the grade and the more quickly the cancer is likely to grow.
What is my hormone receptor status? Some breast tumors are stimulated to grow by the hormone estrogen. Tumors take in estrogen via structures on tumor cell surfaces called estrogen or progesterone receptors. Tumor cells that have many of these receptors on their surfaces are said to be estrogen- or progesterone-receptor positive. These tumors are often successfully treated with hormonal therapy (e.g. tamoxifen and aromatase inhibitors).
What is my her2/neu status? HER2/neu is a substance that is overproduced in about 25 percent of all breast cancers. Tumors that overproduce HER2/neu are called HER2 positive and may respond to treatment with drugs like trastuzumab (Herceptin), which target HER2/neu.
How likely is my cancer to spread or to come back? To estimate the likelihood that the cancer will spread or come back, doctors usually look at tumor features such as size, stage and grade, as well as hormone receptor and HER2/neu status. Today, there are also new tests that can estimate risk of recurrence for women with early-stage breast cancer. Such prognostic tests are performed on samples of tumor tissue removed during surgery. They analyze the activity of various genes to predict how the tumor will behave—that is, whether it is likely to come back or spread. Two tests on the market, Oncotype DX and MammaPrint, can estimate the risk that certain early-stage breast tumors will recur.
What is my recommended treatment plan? Depending on the information that your doctor has learned about your tumor, your treatment options may include surgery, chemotherapy, radiation therapy, hormone blockers or targeted treatments. Your doctor may also perform sentinel node mapping to determine if your breast cancer has spread to other lymph nodes. This minimally invasive procedure spares women from having to remove many lymph nodes in the underarm to find out if their cancer has spread, reducing the possibility of developing lymphedema, a painful swelling of the arm.
What are the side effects of treatment? Sometimes, side effects from medications can make people coping with cancer feel worse. Maintaining a good quality of life is an important part of your treatment because it will enable you to finish taking your medication. A key to managing side effects is to be aware of them and communicate with your health care team when they arise. Your health care team can help prevent and reduce side effects of breast cancer treatment.