Cancer Land – Learning the language!

When going to a foreign country, you need to either learn the language or at least key phrases to get by. It is no different when entering Cancer Land.

It starts with your annual mammogram, which screens for irregularities in your breast. If anything irregular is found you will undergo diagnostic test to determine if cancer is present and to find out more information about the cancer. You will continue to be monitored with tests during and following your treatment to check for signs of recurrence.

Have the doctor write down the name of each test you are scheduled to receive and explain it to you carefully. Asks you doctor the following questions:

1. What is the exact name of the test?

2. What is the purpose of the test and intended findings?

3. How does it work and how long will it take?

4. What do I need to do to prepare for this test?

5. Does it involve radiation?

6. Will there be any discomfort?

7. What will it tell us?

8. How long will it take us to get the results?

9. Please explain the results carefully to me and provide a copy of the result in writing.

Remember, if you have any known allergies, make sure and alert the lab tech.

A pathologist will analyze your test results and will prepare a pathology report for each test for your doctor to review with you. The reports may not all be ready at the same time since tissue analysis will take longer. Make sure and schedule your meeting with the doctor after all reports are in. Face to face with the doctor is always best. Take someone with you, this way, you have two sets of ears listening when your doctor carefully explains the results, show diagrams and pictures and provide whatever else you need to understand the information. Keep all information received from your doctors in a binder.

Key Terms:

1. Screening Test

A. Mammogram-most common screening test for breast cancer. If your mammogram reveals a suspicious abnormality, you may have to get a diagnostic mammogram, which will screen the area in more detail.

B. BI-RADS (breast imaging report and data system)-standardized breast imaging terminology and responding system was created to assess and clarify test results for mammograms, ultrasounds, and MRI’s of the breast to determine the level of suspicion for possible breast cancer. Scaled from zero(additional information needed) to six (known malignancy).

C. Mass-suspicious, lump that could be a tumor, a fluid filled cyst, or an abscess. A tumor is an abnormal mass or lump that may be either benign (noncancerous) or malignant. A tumor that test malignant is a carcinoma (cancer).

2. Diagnostic Test

A. Fine Needle Biopsy-fluid, cells or tissue are removed with a fine needle.

B. Core Needle Biopsy-slightly larger, hollow core needle is used to remove a larger sample of tissue from the tumor. Performed in office, breast numbed, procedure uses an instrument that sounds like a gun when it removes the sample.

C. Incisional Biopsy-removing tissue by incision.

D. Excisional Biopsy-surgical procedure which removes entire tumor.

E. Sentinel Node Biopsy-blue radioactive dye or radioactive tracer is injected into the tumor during surgery. The first lymph node that receives the dye is removed. If it contains any microscopic particles of cancer, more lymph nodes will need to be removed. One benefit to sentinel node biopsy is that it could reduce the risk of lymphedema (swelling of the arm).

F. Blood Test-blood is taken and tested regularly to check your white and red blood cell count and blood platelet counts.

G. Bone Scan-an imaging test to determine if cancer has traveled to the bone.

H. CT (CAT) Scan-computerized x-ray imaging that enables doctors to look at your internal organs. You may be injected with contrast solutions.

I. Chest X-ray-to determine whether any cancer has spread to the lungs. If you develop a cough, a chest x-ray will also check for pneumonia or other inflammation in the chest or lung area.

J. MRI (magnetic resonance imaging)-imaging technology which uses magnets and waves to examine inside the body, gathering information about the breast area prior to surgery and for monitoring for recurrence after treatment.

K. PET Scan (positron emission tomography)-computerized x-ray imaging to obtain images of the body’s cells, used to determine if the cancer has spread to the lymph nodes or other parts of the body and assess how metastatic breast cancer is responding to treatment.

L. Ultrasound (sonography)-imaging test using high frequency sound waves to check whether an abnormality found on a mammogram is solid or fluid filled. Usually one of the first diagnostic test you will undergo.

3. Monitoring

A. Blood Marker-evaluates how the body is responding during and after treatment and can check blood proteins to detect if there is any cancer progression.

B. Bone Scans and Bone Density Tests

C. Chest Examination-examination of chest wall and surrounding area for any suspicious masses. Doctor will manually examine your chest.

D. Mammogram-will continue unless you have double mastectomy.

4. Reports

A. Benign-absence of cancer

B. Stage-scale of 0 to IV based on the size of the cancer, whether it is invasive or noninvasive, whether is was also detected in the lymph nodes, and whether it has spread elsewhere in the body.

C. Lymphatic System-your bodies by internal network of tissues and organs that produce, store, and carry white blood cells to fight infection. It also houses lymph fluid, which helps filter and clear bacteria, viruses, and cancer cells out of the body.

D. Lymph Nodes-located throughout your lymphatic system and are the vacuum cleaners for your lymphatic system keeping it clean of unwanted substances.

E. Malignant-invasive and progressive

F. Margins-normal rims of tissue around the cancer that was removed during surgery. Clear margins, means no cancer cells were found. Having “close” or “positive” margins means that more surgery may be needed to remove cancer cells.

G. Recurrence-cancer can recur in a localized area of the chest or in lymph nodes adjacent to the breast.

5. Type of Cancer

A. Ductal Carcinoma In Situ (DCIS)-cancer cells are contained in the milk duct of the breast and have not spread into the surrounding tissue. Noninvasive breast cancer.

B. Invasive Ductal Carcinoma (IDC)-cancer cells start in the milk duct but can spread into the surrounding breast tissue.

C. Invasive Lubular Carcinoma (ILC)-cancer cells start in the milk producing glands of the breast but spread into the surrounding beast tissue.

D. Lubular Carcinoma In Situ (LCIS)-while no really cancer, LCIS is defined as such when abnormal cells occur in the milk producing glands of the breast and have not spread to surrounding breast tissue. LCIS tends to be asymptomatic, and increases the risk of developing invasive breast cancer.

E. Estrogen receptors-type of protein in some cancer cells that attracts estrogen. When estrogen attaches to the cells, the cancer can grow.

i. Estrogen receptor positive (ER+)-breast cells that are estrogen receptor positive depend on estrogen to grow. Antiestrogen endocrine Theropy is used to block the receptors to shrink or eliminate cancer cells. Most breast cancers are estrogen receptor positive.

ii. Estrogen receptor negative (ER-)-cancer cells that do not rely on estrogen to grow; therefore, antiestrogen endocrine theropy is not required.

iii. Progesterone receptor (PR)-the presence of progesterone in your system can accelerate cancer growth.

F. Human Epidermal Growth Factor Receptor 2 (HER2/neu)-protein in the cancer cell that helps determine aggressiveness.

G. Triple Negative-estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2/neu) tests are negative. This type of cancer is not responsive to hormone receptor targeted treatments but it can be responsive to chemotherapy. Triple negative cancer can be more aggressive than any other types of breast cancer and more likely to recur depending on the stage of diagnosis.

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