Tag: mammogram

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What to Ask Your Doctor About Breast Cancer

Written by Dee Holli — Updated on September 24, 2018

This is an excellent article with great questions to ask your oncologist after being diagnosed with breast cancer. Hearing “This is most likely breast cancer” were some of the worst words a doctor has ever said to me. My surgeon took one look at the ultrasound machine screen and uttered those words to my husband and me. I was numb and barely heard anything he said after that. I had questions, but my mind was reeling from what I was sure was true but had just had confirmed by a specialist. When I saw my surgeon a few days later for my first biopsy, I did ask him a few of these questions, and he answered what applied to his part of my treatment, and then the oncologist he referred me to answered the rest. Talk to your doctor; if you don’t like how they treat you, find another doctor, this is a long journey, and you must trust and respect the doctors working with you to save your life.

Not sure where to begin when it comes to asking your doctor about your breast cancer diagnosis? These 20 questions are a good place to start:

Now that I’ve been diagnosed with breast cancer, are there other imaging tests I will need?

Ask your oncologist whether you will need other imaging tests to determine whether or not the tumor has spread to lymph nodes or other parts of your body.

What type of breast cancer do I have, where is it located, and what does this mean for my outlook?

Ask your oncologist, based on your biopsy, what subtype of breast cancer you have, where it is located in the breast, and what that means for your treatment plan and your outlook after treatment.

How far has my tumor spread?

Understanding what stage of breast cancer you have is important. Ask your doctor to explain the stage to you and find out where else besides the breast any tumors are located.

According to the National Cancer InstituteTrusted Source, the stage of your breast cancer is based on the size of the tumor, whether the cancer has spread to any lymph nodes, and whether the cancer has spread to other areas in the body.

What is the tumor grade?

Particular characteristics of breast cancer cells affect how aggressive your tumor is. These include the amount of tumor cells that are reproducing, and how abnormal the tumor cells appear when examined under a microscope.

The higher the grade, the less the cancer cells resemble normal breast cells. The grade of your tumor can influence your outlook and treatment plan.

Is my cancer hormone receptor-positive or hormone receptor-negative?

Ask your doctor whether your cancer has receptors. These are molecules on the cell surface that bind to hormones in the body that can stimulate the tumor to grow.

Specifically ask whether your cancer is estrogen receptor-positive or receptor-negative, or progesterone receptor-positive or receptor-negative. The answer will determine whether or not you can use medicines that block the effect of hormones to treat your breast cancer.

If your biopsy didn’t include testing for hormone receptors, ask your doctor to have these tests performed on the biopsy specimen.

Do my cancer cells have other receptors on the surface that can affect my treatment?

Some breast cancer cells have receptors or molecules on the surface that can bind to other proteins in the body. These can stimulate the tumor to grow.

For example, the American Cancer Society (ACS) recommends that all patients with invasive breast cancer be tested to see if their tumor cells contain high levels of the HER2 protein receptor. This is important because there are additional treatment options for HER2-positive breast cancers.

Ask your oncologist if your cancer is HER2-positive. And if you haven’t been tested for HER2 protein receptors, ask your oncologist to order the test.

What symptoms of breast cancer might I experience?

Find out what symptoms of breast cancer you are likely to experience in the future, and what symptoms you should contact your doctor about.null

What are my treatment options for breast cancer?

Your treatment will depend on the following:

  • type of cancer
  • grade of cancer
  • hormone and HER2 receptor status
  • stage of cancer
  • your medical history and age

What types of surgical options are available for me?

You may be a candidate for surgical removal of the tumor (lumpectomy), surgical removal of the breast (mastectomy), and surgical removal of affected lymph nodes. Have your doctors explain the risks and benefits of each option.

If your doctors recommend a mastectomy, ask them whether surgical reconstruction of the breast is an option for you.

What types of medical therapy are available for me?

Ask your oncologist if any of the following therapies are available to you:

  • chemotherapy
  • radiation
  • hormone therapy
  • monoclonal antibody therapy

What types of chemotherapy are options for me?

If your doctor recommends chemotherapy, ask them which combination chemo regimens are being considered. Find out what the risks and benefits of chemotherapy are.

It’s also important to ask what the possible side effects of the combination chemo regimens are. For example, if losing your hair temporarily is a concern for you, ask your oncologist whether the medications recommended would cause hair loss or alopecia.

What types of hormone therapy are options for me?

If your oncologist recommends hormone therapy, ask which of these therapies is being considered. Find out what the risks and benefits of hormone therapy are and the possible side effects.

What types of monoclonal antibody therapy are options for me?

Monoclonal antibodies block binding of substances to receptors on the surface of the tumors. If your oncologist recommends therapy with monoclonal antibodies, ask your doctor what therapies are being considered.

Find out what the risks and benefits are and what the possible side effects of the monoclonal antibodies are.

What types of radiation therapy are options for me?

Find out what the risks and benefits of radiation are for your cancer, and what the possible side effects are.

Will I need to take off time from work for any of the therapies. And when would I be able to go back to work?

Ask your oncologist if the side effects of your treatment will require you to take time off from work during or after treatment. And let your employer know in advance what your healthcare team recommends.

What is my outlook after treatment?

Your outlook after treatment depends on the following:

  • your medical history
  • your age
  • type of tumor
  • grade of tumor
  • location of tumor
  • stage of the cancer

The earlier your stage of breast cancer is at the time of diagnosis and treatment, the greater the likelihood that the therapy will be successful.

Are there any clinical trials for treatments that I can participate in?

If you have an advanced stage of breast cancer, you may want to think about clinical trials. Your oncologists may be able to point you in the right direction, or you can take a look at http://www.clinicaltrials.gov/ for more information.

Why did I get breast cancer?

This question may be impossible to answer, but it never hurts to ask. There may be risk factors like family history or lifestyle practices such as smoking cigarettes. Obesity can also increase the risk of getting breast cancer.

What things can I do at home to improve my outlook after treatment and improve my quality of life?

Ask your oncologist if there are lifestyle changes you can make. Recommended changes may include:

  • making changes to your diet
  • lowering stress
  • exercising
  • stopping smoking
  • reducing alcohol intake

These things will help speed your recovery from treatment and increase your chances of a better outcome.

What resources for support are available to me?

Getting help and support is important during this time. Think about attending local support groups for things like financial issues and getting practical support like finding transportation if needed. You’ll also be able to get emotional support from advocacy groups like the American Cancer Society.

If you have any questions for me, please do not hesitate to reach out to me. I will answer as honestly as I can regarding what I have experienced, and if I can’t answer, I will try to point you in the right direction.

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2nd PET Scan and Information About PET Scans

I had my second PET scan on Friday since starting iBrance and Faslodex. I wasn’t nervous about the scan; that part is relatively easy; it’s the uncertainty and having to wait to see my oncologist for the results that is the most difficult part. I also deal with pain during my scan because ever since my first surgery in April 2019, I have had pain when raising my arms over my head, which can become very uncomfortable when I have to stay still in that position for more than a few minutes.

Unfortunately, PET Scans are not as quick and easy as getting X-rays. From checking in to registering, going through the scan process to leaving, I was there for 3 hours. I go alone to the appointments because my husband can’t go back with me while I am being scanned, so it doesn’t make sense for him to be there. He goes with me to my oncologist appointment after my scan, so he will be with me when I get my results. I never know what to expect, so it is comforting to have him with me, no matter what the results turn out to be.

Until I faced breast cancer in 2019, I had never had surgery, a biopsy, a CT Scan, a Bone Scan – Nuclear Medicine, or a PET Scan. I have learned so much in the last three years and eight months about things I wish I had never had to experience. I share as much information as I can with my readers because I want you to not only understand what I have been through and what I am going through now as a stage 4 metastatic breast cancer patient but also to help those who are going through the same journey. It is terrifying when you don’t know what to expect, and you are overwhelmed with information. I try to make it a little easier for those interested in getting the information needed to help themselves through whatever they may be facing or helping a friend or loved one through a difficult time.

What is a PET Scan?

A positron emission tomography (PET) scan is an imaging test that can help reveal the metabolic or biochemical function of your tissues and organs. The PET scan uses a radioactive drug (tracer) to show both normal and abnormal metabolic activity. A PET scan can often detect the abnormal metabolism of the tracer in diseases before the disease shows up on other imaging tests, such as computerized tomography (CT) and magnetic resonance imaging (MRI).

The tracer is most often injected into a vein within your hand or arm. The tracer will then collect into areas of your body that have higher levels of metabolic or biochemical activity, which often pinpoints the location of the disease.

Why it’s done

A PET scan is an effective way to help identify a variety of conditions, including cancer, heart disease and brain disorders. Your doctor can use this information to help diagnose, monitor or treat your condition.

Cancer

PET scan combined with CT scan

Cancer cells show up as bright spots on PET scans because they have a higher metabolic rate than do normal cells. PET scans may be useful in:

  • Detecting cancer
  • Revealing whether your cancer has spread
  • Checking whether a cancer treatment is working
  • Finding a cancer recurrence

PET scans must be interpreted carefully because noncancerous conditions can look like cancer, and some cancers do not appear on PET scans. Many types of solid tumors can be detected by PET-CT and PET-MRI scans, including:

  • Brain
  • Breast
  • Cervical
  • Colorectal
  • Esophageal
  • Head and neck
  • Lung
  • Lymphatic system
  • Pancreatic
  • Prostate
  • Skin
  • Thyroid

Heart disease

PET scan image of the heart

PET scans can reveal areas of decreased blood flow in the heart. This information can help you and your doctor decide, for example, whether you might benefit from a procedure to open clogged heart arteries (angioplasty) or coronary artery bypass surgery.

Brain disorders

PET scans of the brain for Alzheimer's disease

PET scans can be used to evaluate certain brain disorders, such as tumors, Alzheimer’s disease and seizures.

Risks

For your PET scan, a radioactive drug (tracer) will be injected into a vein. Because the amount of radiation you’re exposed to in the tracer is small, the risk of negative effects from the radiation is low. But the tracer might:

  • Expose your unborn baby to radiation if you are pregnant
  • Expose your child to radiation if you are breastfeeding
  • Cause an allergic reaction, although this is rare

Talk with your doctor about the benefits and risks of a PET scan.

How you prepare

Tell your doctor:

  • If you’ve ever had a bad allergic reaction
  • If you’ve been sick recently or you have another medical condition, such as diabetes
  • If you’re taking any medications, vitamins or herbal supplements
  • If you’re pregnant or you think you might be pregnant
  • If you’re breastfeeding
  • If you’re afraid of enclosed spaces (claustrophobic)

Your doctor will give you detailed instructions on how to prepare for your scan. A general rule is to avoid strenuous exercise for a couple of days before the scan and to only drink water after midnight before the day of the scan.

What you can expect

The PET-CT or PET-MRI scanner is a large machine that looks a little like a giant doughnut standing upright, similar to CT or MRI scanners.

From start to finish, the procedure takes about two hours to complete and typically does not require an overnight hospital stay. When you arrive for your scan, you may be asked to:

  • Change into a hospital gown
  • Empty your bladder

A member of your health care team injects the radioactive drug (tracer) into a vein in your arm or hand. You may briefly feel a cold sensation moving up your arm. You rest and remain silent in a reclining chair for 30 to 60 minutes while the tracer is absorbed by your body.

During the procedure

When you are ready, you lie on a narrow, padded table that slides into the part of the scanner that looks like a doughnut hole. During the scan you must be very still so that the images aren’t blurred. It takes about 30 minutes to complete a PET-CT scan and 45 minutes for a PET-MRI scan. The machine makes buzzing and clicking sounds.

The test is painless. If you’re afraid of enclosed spaces, you may feel some anxiety while in the scanner. Be sure to tell the nurse or technologist about any anxiety causing you discomfort. He or she may give you a drug to help you relax.

After the procedure

After the test you can carry on with your day as usual, unless your doctor tells you otherwise. You’ll need to drink plenty of fluids to help flush the tracer from your body.

Results

A doctor specially trained to interpret scan images (radiologist) will report the findings to your doctor.

The radiologist may compare your PET images with images from other tests you’ve undergone recently, such as MRI or CT. Or the PET images may be combined to provide more detail about your condition.

I hope this explanation of PET scans helps you to understand what is involved and what cancer patients go through as a regular part of their care. Depending on the type of cancer and the treatment plan, most cancer patients are scanned every three to six months. I am scanned every four months because my cancer, in both 2019 and currently, has proven to be aggressive, so my oncologist feels that every three months is too often, but every six months is too long between scans, making both him and me nervous.

I will post again once I have my results, but in the meantime, if you have any questions, don’t hesitate to get in touch with me. Thank you for being here! 💕

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September & October Doctor’s Appointments

I have had several doctor’s appointments over the last two months, seeing my oncologist twice, my surgeon, and having my annual mammogram done.

On Monday, September 12th, I had my monthly oncologist appointment to chat with my doctor, check my blood, and get my Faslodex injections. As far as my bloodwork is concerned, it is a little better. My white blood cell count went up a little bit from last month, so my ANC went up as well, which is good. My PA explained that my white blood cell count, red blood cell count, and ANC levels would go up and down from month to month, but it is normal, and as long as I am not too far off from a normal range, there is no reason to worry.

Friday, September 16th: I had my annual mammogram appointment. This appointment is made along with my annual check-up with my surgeon, so he orders the mammogram and then follows up to do my annual exam and go over my results. My mammogram appointments are not routine, mainly because of the scar tissue I have from my surgeries. As usual, they had to do extra imaging, but at least this time, I didn’t have to go through an ultrasound as well as a mammogram. The hospital has a 3D mammogram machine now so that they can get amazingly clear images. The tech I had was the same one I saw back in 2019, and she was very open about showing me the side-by-side pictures from 2019 and now. It was both sad and a relief to see the comparison because my tumors were very easy to see in 2019, just as it is easy to see that there is nothing in my imaging now to be concerned about. My appointment took 3 hours; as I said, not routine, but when I leave, I had my results in my hand, which was a relief because I didn’t have to wait until the following week when I saw my surgeon. All of my imaging was clear, with no sign of cancer.

Wednesday, September 21st: I went to see my surgeon for my annual check-up and to discuss my mammogram results. As soon as he walked into the exam room, he asked me about having a biopsy done on one of the ribs on my back, so I explained the imaging I had that led up to my getting the biopsy. Once we discussed what I had been through since I last saw him in February, he went through my annual exam. He said that I might have some slight capsular contracture developing in both breasts. I was alarmed by this news, but at this time, I am not overly concerned as I am not in any pain, and I can’t physically feel anything myself. But my surgeon is the expert. So if he feels something, then I believe him; he certainly knows better than I do. He mentioned a few times that I don’t have to limit my visits to once a year, so I agreed and said I would feel better if he kept a closer eye on things, so we decided to do a checkup every six months. I love that my surgeon genuinely cares about his patients and that I can fully trust him.

My oncologist appointment on October 11th was pretty routine. My white blood cell count dropped by .1, but again, it will fluctuate a little from month to month, so there is no reason to be worried. This time my Faslodex injection on the right side hurt for days. I do have some discomfort, usually in the evening after I have had my injections, but this time the pain lasted for days. I can’t explain why it hurt so much this time, but I am sure the thickness of the medicine is part of it. Unfortunately, I now dread the injection part of my appointments, but I must have them because the treatment will help keep my cancer from spreading more than it already has.

I’m sorry for the late update. I have been struggling with several things but mainly with depression. I might write about it in the future, but for now, I need to keep the details to myself. All I can say is that having stage 4 cancer is hard, especially mentally and emotionally. People compliment me on how good I look, and I appreciate that because I try my best not to look as ill as I feel on any given day. On the bad days, I stay at home because I can’t face people, and on the good days, especially days when I have little to no fatigue, I get out of the house or do a workout; anything I can do to take advantage of feeling better on that particular day.

Take care and remember, tomorrow is never promised, so live your life as best as you can. Be kind to people, treat people the way you want to be treated, and don’t judge people; you have no idea what someone else is going through, so always be kind and keep hate out of your heart. 💕

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6 Overlooked Signs of Breast Cancer

Over the last few years, and again now that my cancer has returned, many people have asked me if I had any signs of breast cancer before I found the first tumor in my breast. Yes, I did have a few of these signs, and I had pain. Please, remember to do your monthly breast self-exam and watch for these signs.

Medically reviewed by Amy Tiersten, MD — Written by Jennifer Bringle on October 5, 2020

Everyone talks about the importance of catching breast lumps as early as possible. But did you know there’s a host of lesser known breast cancer symptoms that might not show up on a self-exam or mammogram?

According to the American Cancer Society (ACA), breast cancer is the most common cancer in American women, other than skin cancers, and it’s the second-most deadly cancer for women behind lung cancer.

On average, there’s about a 1 in 8 chance that a U.S. woman will develop breast cancer at some point in their life. The ACA estimates that more than 40,000 women will die from breast cancer in 2020.

The most common form of breast cancer is invasive breast cancer, which is any type that has invaded the breast tissue.

Less common forms include inflammatory breast cancer (which is caused by cancer cells blocking lymph vessels in the skin, causing the breast to look inflamed) and Paget’s disease, which involves the skin of the nipple or areola.

With the high rates of breast cancer, the American Cancer Society recommends women have the choice to start annual mammograms at age 40. The organization says women between the ages of 45 and 54 should get mammograms every year.

And while the disease is most commonly discovered by detecting a lump during a mammogram, there are other lesser known signs and symptoms of breast cancer that women should look out for.

Nipple discharge

Unusual discharge from the nipple can be an indicator that something is wrong in the breast.

According to Marisa Weiss, MD, breast oncologist and founder of BreastCancer.org, discharge that’s bloody or pink and generally only on one side can possibly indicate the presence of cancer in the breast tissue, particularly if it’s persistent.

Skin changes

Skin changes are actually one of the most common lesser known signs of breast cancer.

“Thickness or redness of the skin, along with a little puffiness like the skin of an orange is a sign,” says Weiss. “You see dimpling where the hair follicles are, like a navel orange.”

Skin differences like thickening, dimpling, and changes in color can indicate the presence of inflammatory breast cancer.

Nipple crust

Redness, scaling, crusting, or flaking of the nipple or areola can be a sign of Paget’s disease, which can be an early indication of breast cancer.

The skin changes on the nipples often look like more benign conditions like psoriasis or eczema, but don’t respond to traditional treatments for those issues and instead worsen.

New shape or increase in breast size

An enlarged breast — particularly if the swelling is isolated to one breast — or a change in the shape of the breast, can indicate issues within the tissue.

“An unusual shape where the contour is distorted and there’s a bulge in one part of the breast can be a sign of cancer,” says Weiss.

“It could feel like a lump, but it could also just be a region of the breast that feels firmer, and you can’t really feel a lump within it,” she says. “It also often becomes more pronounced when moving in different positions.”

Inverted nipple

A nipple that looks flat or inverted, as well as a nipple that points in a different direction than it once did, can be a sign of breast cancer.

“Instead of pointing straight outward or downward, it no longer looks in the same direction, but in a different spot,” says Weiss.

A flat or inverted nipple is another sign of Paget’s disease.

Red or hot spots

Red or hot spots on the breast, sometimes covering the entire breast, can be an indicator of inflammatory breast cancer.

While red or hot spots can also indicate mastitis — inflammation of breast tissue due to infection, most often experienced during lactation — mastitis symptoms are usually accompanied by fever.

Red or hot spots without fever that persist and don’t improve can mean breast cancer is present.

The takeaway

Weiss says it’s important to remember that these signs and symptoms can indicate other benign issues that aren’t breast cancer, but it’s critical to monitor the symptoms and act if they don’t subside.

And for those who’ve already had breast cancer, it can be even more difficult to discern the innocuous from the malignant. In that case, Weiss says it’s particularly crucial to monitor changes in the breasts and alert your doctor when something doesn’t look or feel right.

“You’re always worried about recurrence of a new problem, so the ability to recognize the less common symptoms and signs may be a little trickier,” she says.

It’s sometimes difficult to distinguish between leftover scar tissue from your prior breast cancer. And if you’ve had mastectomy and reconstruction, you could have lumps and bumps in there that are due to scar tissue from all the healing where they removed and recreated your breast, says Weiss.

No matter what, Weiss advises women to pay attention to their bodies and maintain regular self-exams and mammograms. And should they notice something out of the ordinary? Let their doctor know.

Jennifer Bringle has written for Glamour, Good Housekeeping, and Parents, among other outlets. She’s working on a memoir about her post-cancer experience.

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CT Guided Biopsy

A few days ago, I had a CT Guided Biopsy of my 8th rib on the left side, on my back. Everything went well; I am in a little bit of pain, but nothing that Tylenol can’t help. The doctor instructed me to rest for the rest of the day on Thursday, remove my bandage on Friday, and resume my normal activities.

After finishing my paperwork in the hospital registration office, I went to the lab to have my blood drawn for a few panels; among a few other things, they had to check my kidney function before doing the CT, and after that, I went to radiology to wait to be taken to the pre-op area.

Once my nurse was done prepping me for my procedure, my anesthesiologist came to get me and take me to the CT room. He explained that he would only give me enough medication to make me relaxed and a little sleepy but not entirely out. He said that if I did get sleepy not fight it and let myself fall asleep. I did fall asleep for some of the procedure, but I don’t think it was for very long because the process only took about 30 minutes.

When I walked into the CT room, they had me lay on my stomach on the CT table. I was shocked to find out that the lesion is actually on my 8th rib on the left side of my back, not in the front, and it is very close to my spine, so that has me a bit concerned. The rib that I fractured some 18 years ago, that I was thinking was what was showing up in my scans, was a few ribs down from where the lesion is located, so it has nothing to do with the lesion at all. So with that said, I don’t know what to expect when I meet with my oncologist next Tuesday to get my biopsy results.

I have had many people ask me what I think of all of this, how I am feeling, and what my gut is telling me. I can’t help but see the similarities to the first time I went through cancer three years ago. With every appointment, things get worse and worse, more scans, more biopsies, etc. As before, I want to know what type of cancer I have to fight against, and I want to get started on whatever treatment plan my doctors and I agree on as soon as possible so I can get this over with and move on.

I am feeling OK so far. Even if the lesion on my rib is positive for cancer, it appears to be localized like the tumors in my neck, so it is not as aggressive as it was in 2019, and because of that, I have been feeling much better physically this time around so far. Mentally I am up and down; the stress is unreal because this is the moment as a cancer survivor that I have been fearful of, having to deal with recurrence.

Lastly, what is my gut telling me? I will be shocked if the lesion on my rib is negative for cancer. After reading the PET scan report and looking up a few medical terms that I had not seen before, I immediately thought that it would be a bad result once the biopsy results came in. I, of course, hope that I am wrong, and in a few days, I will know for sure.

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I Have Cancer, Again

I received my biopsy results yesterday, and they were positive for cancer. My oncologist’s office called me in the morning and scheduled an appointment right away for today to discuss our next steps.

I was hoping that my oncologist could tell me what type of cancer I have today, but we do not have those results back yet, so I will hopefully know in a few more days. There are a couple of possibilities as far as my treatment goes, but I won’t have a definite plan until scans are done, and the results are back.

On Monday, I will be going to the hospital for a bone scan-nuclear medicine, CT neck with contrast, and CT C/A/P with contrast {ct scan of chest, abdomen, and pelvis.} If there is cancer anywhere besides my neck, we will know for sure once the scans are completed and analyzed.

On Friday next week, I will meet with my oncologist to review the scan results and my treatment plan. I do know that I will most likely have radiation therapy on my neck; anything beyond that will be determined during my appointment.

More to come…

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