WHAT SHOULD I DO AND WHAT SHOULD I EXPECT IF I AM DIAGNOSED WITH BREAST CANCER?
Doctors will first evaluate how far along the cancer is by grading it and staging it. Grading and staging help doctors predict the prognosis (course and outcome) of the cancer, as well as selecting the best treatment for their patients. Grading tells us the rate at which the cancer is growing, and how similar the cancer cells look like as compared to normal cells and staging tells us the size of the cancer and how much it has spread.
Doctors will first evaluate how far along the cancer is by grading it and staging it. Grading and staging help doctors predict the prognosis (course and outcome) of the cancer, as well as selecting the best treatment for their patients. Grading tells us the rate at which the cancer is growing, and how similar the cancer cells look like as compared to normal cells and staging tells us the size of the cancer and how much it has spread.
Grading and staging are two different assessments altogether. Grading is done by looking at cancer tissue under the microscope. Staging is done by measuring the size of the tumour, assessing the lymph nodes involved, and extent of spread of the cancer. In short, grading is derived from what is seen under the microscope and staging is derived from what is seen with the naked eye.
Grading System
Bloom-Richardson Grading System
As mentioned above, it is done by looking at the cells of tissue biopsy under a microscope. It is done by a pathologist. Scores are given based on the degree of abnormality of the cells seen. The higher the abnormality, the higher the score.
Based on these scores, grades are given. There are 3 grades to breast cancer.
Tumour Grade | Score | Characteristics | Prognosis |
1 | 3 – 5 | Well-differentiated cancer cells Cancer cells similar to normal cells Slow growth | Good |
2 | 6 – 7 | Moderately-differentiated cancer cells Cancer cells differ slightly from normal cells Moderate growth | Moderate |
3 | 8 – 9 | Poorly-differentiated cancer cells Cancer cells very different from normal cells Fast growth | Poor |
(breastcancer.about.com 2008)
Staging System
The table below shows the stages of breast cancer, signs and symptoms, methods of detection, and treatment options. The stages are developed and maintained by the American Joint Committee on Cancer.
Treatment
As shown above, breast cancer treatment involves surgery, chemotherapy, radiotherapy, hormonal therapy and targeted therapy. It is advisable that treatment for breast cancer be done as soon as possible after the diagnosis for better outcome.
- Breast surgery
Surgical treatments involve lumpectomy (removal of tumour and a small margin of surrounding healthy tissue), mastectomy (removal of all breast tissue) and removal of lymph nodes; either one or several.
Surgical treatments will definitely leave scars, which might be accompanied by tightness, pain, swelling and/or bruising in the region of the surgery. Surgical removal of lymph nodes increases the risk of swelling in the arm.
- Radiotherapy
The spread of the cancer to the nearby lymph nodes helps the doctor to decide whether to give you radiotherapy or not. Radiotherapy is a treatment which uses high-powered rays of energy to kill cancer cells. These energy rays are aimed at your body. Radiotherapy is usually done for patients with early-stage breast cancer that had a lumpectomy but may also be recommended for patients with mastectomy done with large breast cancers.
Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed.
- Chemotherapy
Chemotherapy uses chemicals and drugs to destroy cancer cells. Chemotherapy’s main aim is to control the spread of the cancer. Chemotherapy is usually recommended for patients where the cancer has a high chance of recurring or spreading to other parts of the body. This is called as adjuvant systemic chemotherapy.
Sometimes, chemotherapy is given before a surgery instead of after. This is usually for women with large breast tumours and by doing so, helps shrink the size of the tumour in order to facilitate its removal. Doctors call this neoadjuvant chemotherapy.
One cycle of chemotherapy is around RM1 800 inclusive of the chemotherapy drugs, drugs which counter the side effects and hospital fees.*
Chemotherapy might damage various organs; depress the immune function, cause nausea, vomiting, hair loss, and infertility. There is also a risk of a secondary cancer developing after treatment, which is commonly leukaemia. Both chemotherapy and radiotherapy are not suitable for pregnant patients due to its harmful effects on foetus.
- Hormone therapy
Hormone therapy is a treatment which blocks hormones that certain cancers are sensitive to. These cancers are occasionally referred to as oestrogen and progesterone receptor positive cancers. Hormone therapy aims to decrease the chance of the cancer returning and to control the cancer. The treatments that can be used are:
- Medications that block hormones from attaching to cancer cells. For example, Tamoxifen.
- Medications that stop the body from making oestrogen after menopause. Oestrogen is speculated to stimulate the growth of breast tissue. Aromatase inhibitors are drugs that block the action of an enzyme that converts certain precursors into oestrogen. However, they are only effective in postmenopausal women.
- Surgery or medication to stop hormone production in the ovaries.
Side effects of hormone therapy vary depending on which medication you receive, but typically include hot flashes, decreased sex drive and mood changes. Side effects of aromatase inhibitors include joint and muscle pain, as well as an increased risk of thinning of the bones.
- Targeted therapy
Targeted drug treatments attack specific abnormalities within cancer cells. For example:
o Trastuzumab (Herceptin)
Some breast cancer cells multiple and survive with the help of a protein called HER2. Trastuzumab targets this protein and cause cancer cells to die.
In the United States, the cost of a month’s use of Herceptin is around $3 000 and in Malaysia, six cycles of Herceptin is around RM50 000.*
o Lapatinib (Tykerb)
Lapatinib is another drug which targets HER2 protein. This is usually reserved for women who already tried Trastuzumab which does not seem to be effective.
One tablet of Lapatinib is around RM65 and each month, this medication will accumulate to approximately RM7 800.*
Side effects of targeted drugs depend on the drug you receive. Targeted drugs can be very expensive and are not always covered by health insurance.
Survival Rate
The prognosis (course and outcome) of the cancer can be determined using the Nottingham Prognostic Index, NPI. The NPI has a formula which involves the tumour diameter (centimetre, cm), lymph node stage (0, 1, 2, or 3 which indicates how far the tumour has spread in the lymphatic system) and tumour grade (1, 2, or 3).
Nottingham Prognostic Index Formula
Nottingham Prognostic Index, NPI = (0.2 x tumour diameter in centimetre, cm) + lymph node
stage + tumour grade
Nottingham Prognostic Index, NPI | Prognosis | 5-Year Survival |
2.0 – 2.4 | Excellent | 93% |
2.4 – 3.4 | Good | 85% |
3.4 – 5.4 | Moderate | 70% |
More than 5.4 | Poor | 50% |
(Ganfyd.org 2010)
The 5-year survival rate is just an average taken from patients and it varies from person to person.
*All prices stated are rough estimates and may or may not apply to your local health care institutes.
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