Rhode Island Monthly Breast Health 2014 : Page 3

? ? ? ? ? ? ? ? ? SPECIAL ADVER TISING SECTION ? Need to Know continued Questions every breast cancer patient needs to ask. Need to Know » continued from page 107 for lobular carcinoma in situ (LCIS), which is confi ned to the milk-producing glands. Invasive ductal carcinoma (IDC) refers to cancer that has broken through the milk duct into the nearby tissue, and in-vasive lobular carcinoma means the can-cer has broken through the milk-produc-ing glands into the surrounding tissue. Infl ammatory breast cancer is an ag-gressive form of breast cancer that in-vades the skin and lymph vessels of the breast and often produces no palpable tumor. Symptoms normally do not appear until the breast cancer cells block the lymph vessels. 2. What are the stage and grade of the cancer? Although breast cancer can be detected through radiographic imaging, such as a mammogram, ultrasound or breast MRI, the actual stage and grade of the cancer cannot be known until it is removed surgi-cally and undergoes a pathological study. Typically one or more lymph nodes are removed from the armpit during this same surgery. Lymph nodes are part of the immune system and act as a fi ltering device. The stage of breast cancer is identifi ed by assigning a number zero through four. The higher the number, the more advanced the cancer. Staging is determined by TNM — T for tumor size, N for lymph node involvement and M for metastatic involvement. The grade of the cancer refers to the microscopic evaluator of the tumor cells. The pathology looks at how closely the tumor cells resemble normal breast cells. The more poorly differentiated, the higher the grade. The stage and the grade help doctors determine the best course of treatment for your cancer. ER/PR positive receptor, drugs can be used to turn off the HER2 receptor. 5. Should I get a second opinion? Getting a second opinion does not necessarily mean going to a completely different doctor. It could mean getting an opinion from your oncologist or radiation oncologist. But, if you feel strongly that you need a second opinion regarding your diagnosis and treatment plan, you should seek an appointment with another doctor im-mediately. 3. Do I need additional surgery? Further surgery will depend on the stage and grade of the cancer, as well as the surgical margins. Surgical margins refer to healthy tissue surrounding the tumor. If the tissue is free of cancer cells, it is considered negative margins. If cancer cells are identifi ed, it is labeled as positive margins and additional surgery is indicated. The type of surgery is a personal decision and one that should be discussed with your surgeon in detail. 6. Do I need an MRI or PET (positron emission to-mography) scan? Your oncologist, surgeon, radiologist and radiation oncologist can answer this question as a team. These imaging tests are used to determine if the cancer has metastasized to other areas of the body. 7. What are my treatment options? Your oncologist, surgeon and radiation oncologist can answer this question. It is important to understand what the treatment is, how it can affect you in the short-term and the long run and why your doctor is prescribing a particular treatment. This is your cancer and your treatment. Your oncologist and radiation oncologist expect you to ask these types of questions. 4. What is my hormone receptor status? Breast cancer is either fueled by the estrogen and progesterone we have in our bodies or it is not. ER/PR (estrogen and proges-terone) positive cancer uses hormones to fuel its growth. This sounds discouraging, but doctors can use drugs that jam the hormone receptor signal or reduce the levels of hormones to reduce the cancer cells’ fuel. The growth of ER/PR negative is not driven by hormones and this type of cancer is more aggressive. In addi-tion, whether the HER2 (human epidermal growth factor receptor 2) is positive or negative will play a big factor in treatment. Like the 108 RHODE ISLAND MONTHLY 8. Should I have genetic testing? Genetic testing has come a long way over the years. Your age at diagnosis and your family history may warrant an appointment with a genetic counselor who can determine whether or not you are a candidate for testing. Need to Know continued on page 117 » l OCTOBER 2014

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