If you’ve gotten the results that everyone dreads after having an abnormal mammogram or feeling a breast mass, you’re likely set up for a visit with an oncologist or a surgeon to review results and set up a plan. But what can you expect at your first breast cancer visit? I’m going to review the common topics and some common questions that patients have at the first visit. My goal with this post is to ensure that you leave the visit feeling like you have the knowledge that you need to make informed decisions about your cancer care.
What kind of cancer do I have?
There are many kinds of breast cancer. Your doctor will review with you what type you have in order to make recommendations for the right treatment plan. The most common type originates in the ducts, or the tubes that bring the milk out to the nipple. There are several other types including those that originate in the breast gland tissue, as well some other rarer types. There are several things we look for under the microscope to determine other characteristics. The most common things expressed on breast cancer cells are receptors or “plugs” for the female hormones estrogen and progesterone. If these are present, it is possible for these hormones to “feed” the cancer and help it grow. We also look for the presence of a protein called Her2/neu (commonly referred to as “Her2”). These factors, among a few others, help us determine how aggressive your cancer is and what treatment it would respond best to. It is very important to remember that every patient’s breast cancer is different. A treatment plan recommended for one type may not be the same as for another type.
How do I know if my cancer has spread?
The first place most breast cancers will spread are the axillary, or underarm, lymph nodes. There are many lymph nodes in this area. During your initial ultrasound, these were evaluated by radiology for any evidence of abnormality. If they appeared suspicious, biopsy would be recommended. In the absence of suspicious findings on ultrasound or on exam by your provider, there is no indication to biopsy these prior to surgical intervention. If your lymph nodes were biopsied and showed cancer, part of your initial workup will be to check the rest of your body for evidence of cancer with a PET scan or a CT scan. If there are no abnormal appearing lymph nodes prior to surgery, your lymph node will be checked at the time of surgery. If there is no cancer that has spread to your lymph nodes, we can be confident that there is no spread to the rest of your body.
What stage is my cancer?
A lot of factors go into the staging of breast cancer. The most common factors include size, spread to lymph nodes, and spread to other places in your body. Other factors that go into staging include receptor status (see above) and grade (microscopic evaluation of how fast the cancer is growing). Staging can be complex, and, while it is ok to ask your provider about staging at your initial visit, it is not always the determining factor in your treatment plans.
Will I need chemotherapy?
Every breast cancer is different. Many will respond well to upfront chemotherapy, while others do not. Traditional chemotherapy, sometimes referred to as “cytotoxic chemotherapy,” has many side effects. Your providers will weigh these side effects against the benefits. Some cancers require additional testing after surgery to determine how chemotherapy could benefit you. Your oncologist will review with you what type of chemotherapy will benefit you and what side effects to expect.
If your cancer is hormone receptor positive, you may benefit from anti-hormone therapy. This is a pill that is sometimes referred to as the “pill chemotherapy.” It is not traditional chemotherapy and has fewer side effects, which your provider will review with you upon prescribing.
Will I need surgery?
In short, almost every patient with breast cancer will require surgery at some point during their treatment course, unless the cancer has spread beyond the breast and underarm lymph nodes. In general, there are 2 main types of surgical intervention: lumpectomy (also referred to as “partial mastectomy” or “breast conservation”) and mastectomy. With breast conservation therapy, the tumor is removed surrounding the previously placed biopsy marker. Radiation is nearly always recommended after surgery to the remaining breast tissue. There are several methods that different providers use to localize the tumor. Your surgeon will review with you which method they will use in your case. Mastectomy refers to removal of the entire breast, either with flat closure or reconstruction of breast mounds by a plastic surgeon. Some patients will still require radiation after removal of the entire breast, but some will not. If you choose to pursue mastectomy, removal of the opposite breast can be offered. However, this has no impact on your cancer outcomes or whether or not your cancer returns. Many patients still desire this procedure for cosmetic symmetry.
These are many of the commonly asked questions and discussion topics at your initial breast cancer visit. I cannot stress enough the importance of understanding that each cancer -- and patient -- is different and treatment plans will vary accordingly. I encourage you to write down any questions that you have for your doctor prior to your visit so that you don’t forget to ask. You will not hurt anyone’s feelings by asking many questions and even for a second opinion if you feel you need it! Your doctors are working hard to take the best care of you possible, and we want you to feel comfortable in your decision making. I hope you gained insight into your first breast cancer visit, and, if you choose Baptist Cancer Center for your treatment, we can promise you that we will take good care of you.
Written by Dr. Rebecca Bittenbinder
Dr. Rebecca Bittenbinder is a Germantown native who is so excited to be serving her hometown community. She attended the University of Tennessee in Knoxville for her undergraduate degree and the University of Tennessee Health Sciences Center in Memphis for medical school and residency in general surgery. Breast surgery quickly became a passion for her during residency due to her interest in women’s health. Her fellowship in diseases of the breast was completed at the University of Arkansas for Medical Sciences in 2020. She met her husband (also a general surgeon) during residency and they have 3 young children. She enjoys traveling to Disney World, watching her daughter in swim meets, and spending time with her family.
Her office is located at Baptist Cancer Center in Southaven, MS, at 363 Southcrest Circle, Suite 202.
