Ask The Expert/FAQs

Frequently Asked Questions for Adolescents and Young Adults with Breast Cancer

	Q.	How many young women suffer from breast cancer?
	Q.	Where does breast cancer develop?
	Q.	What is the lymph system and what role does it play in breast cancer?
	Q.	What are the most common types of breast cancer?
	Q.	How is breast cancer staged?
	Q.	Is breast cancer hereditary?
	Q.	What is the difference between local and systemic therapy?
	Q.	What is the difference between adjuvant and neoadjuvant therapy?
	Q.	What are the surgical options for breast cancer?
	Q.	What are the possible side effects of a lumpectomy or mastectomy?
	Q.	What is an axillary lymph node dissection (ALND) and when is it used?
	Q.	What are the possible side effects of an axillary lymph node dissection (ALND)?
	Q.	What is reconstructive surgery and when is it done?
	Q.	is radiation therapy, when is it used, and what are the side effects?
	Q.	What is chemotherapy, when is it used, and what are the side effects?
	Q.	What is hormone therapy, when is it used, and what are the side effects?
	Q.	What is biological therapy, when is it used, and what are its side effects?
	Q.	What effect does breast cancer treatment have on fertility and the possibility of premature menopause?

Q. How many young women suffer from breast cancer?

A. Breast cancer is one of the most common cancers among American women, second only to skin cancers. The chance of getting invasive breast cancer at some time in a woman's life is about one in eight (12 percent). According to the CA Cancer Journal for Clinicians, in 2009 about 192,370 women will be diagnosed with breast cancer in the United States.¹

About seven percent of women with breast cancer are diagnosed before the age of 40 years old and this disease accounts for more than 40 percent of all cancer in women in this age group.²

There are more than 250,000 women living in the U.S. who were diagnosed with breast cancer at the age of 40 or younger and about 10,000 young women will be diagnosed in the next year.2 This disease is also the second leading cause of cancer death in women, following lung cancer, with an estimated 40,170 deaths in 2009.¹

Q. Where does breast cancer develop?

A. The female breast is made up of lobules (milk-producing glands), ducts (tiny tubes that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels and lymphatic vessels).

Most breast cancers begin in the cells that line the ducts (ductal cancers). Some begin in the cells that line the lobules (lobular cancers), while a small number start in other tissues.

Q. What is the lymph system and what role does it play in breast cancer?

A. The lymph system is important to understand because it is one of the ways in which breast cancer can spread. This system has several parts. Lymph nodes are small, bean-shaped collections of immune system cells (cells that are important in fighting infections) that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Lymph contains tissue fluid and waste products, as well as immune system cells. Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes.

Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillarynodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal mammary nodes) and those either above or below the collarbone (supraclavicular or infraclavicular nodes).

It’s important to know whether the cancer cells have spread to lymph nodes because if they have, there is a higher chance that the cells may have also gotten into the bloodstream and spread (metastasized) to other sites in the body. The more lymph nodes that have breast cancer, the more likely it is that the cancer may be found in other organs as well.

Q. What are the most common types of breast cancer?

A.

• Carcinoma in situ – early stage of cancer that begins in the lining layer (epithelial cells) of the breast; this is noninvasive breast cancer and is usually found in either the breast ducts or lobules.
• Ductal carcinoma in situ (DCIS) – most common type of noninvasive breast cancer. The cancer cells are inside the ducts but have not spread through the walls into the surrounding area.
• Lobular carcinoma in situ – noninvasive breast cancer that begins in the milk-producing glands but does not grow outside of the lobules.
• Invasive carcinoma – type of cancer that has already grown beyond the layer of cells where it initially started.

Q. How is breast cancer staged?

A. Staging is the process of finding out how widespread a cancer is when diagnosed. It is based on whether the cancer is invasive or noninvasive, the size of the tumor, how many lymph nodes are infected, and if it has spread to other parts of the body. A doctor may order certain imaging tests to help determine the stage of the cancer, such as chest X-ray, mammograms of both breasts, bone scans, computed tomography (CT) scans, magnetic resonance imaging (MRI), and/or positron emission tomography (PET) scans.

Stage 0: Carcinoma in situ

• Noninvasive cancerous cells in the lining of either a lobule or duct that have not spread to nearby breast tissue.

Stage I:

• Early stage of invasive breast cancer. The tumor is no more than 2 cm across. Cancer cells have not spread beyond the breast.

Stage II: (one of the following)

• The tumor is no more than 2 centimeters (three-quarters of an inch) across. The cancer has spread to the lymph nodes under the arm.
• The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has not spread to the lymph nodes under the arm.
• The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has spread to the lymph nodes under the arm.
• The tumor is larger than 5 centimeters (2 inches). The cancer has not spread to the lymph nodes under the arm.

Stage III: locally advanced cancer

• Stage IIIA (one of the following)
• The tumor is no more than 5 centimeters (2 inches) across. The cancer has spread to underarm lymph nodes that are attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone.
• The tumor is more than 5 centimeters across. The cancer has spread to underarm lymph nodes that are either alone or attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone.
• Stage IIIB:  tumor of any size that has grown into the chest wall or the skin of the breast. It may be associated with swelling of the breast or with nodules (lumps) in the breast skin.
• The cancer may have spread to lymph nodes under the arm.
• The cancer may have spread to underarm lymph nodes that are attached to each other or other structures. Or the cancer may have spread to lymph nodes behind the breastbone.
• Inflammatory breast cancer is a rare type of breast cancer. The breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast. When a doctor diagnoses inflammatory breast cancer, it is at least stage IIIB, but it could be more advanced.
• Stage IIIC: Tumor of any size (one of the following)
• The cancer has spread to the lymph nodes behind the breastbone and under the arm.
• The cancer has spread to the lymph nodes above or below the collarbone.

Stage IV: distant metastatic cancer (has spread to other parts of the body).

Q. Is breast cancer hereditary?

A. Breast cancer is a type of cancer that can run in families and immediate relatives of patients that have been diagnosed. A woman’s risk of developing breast and/or ovarian cancer is greatly increased if she inherits a harmful BRCA1 or BRCA2 mutation. BRCA1 and BRCA2 are human genes that belong to a class of genes known as tumor suppressor genes. They help ensure the stability of the cell’s DNA and help prevent uncontrolled cell growth. A mutation (change in DNA of the cell) of these genes has been linked to hereditary breast and ovarian cancer. ³

Q. What is the difference between local and systemic therapy?

A.  Local therapy is intended to treat a tumor at the site without affecting the rest of the body. Surgery and radiation therapy are examples of local therapies.
Systemic therapy refers to drugs which can be given by mouth or directly into the bloodstream to reach cancer cells anywhere in the body. Chemotherapy, hormone therapy and targeted therapy are systemic therapies.

Q:  What is the difference between adjuvant and neoadjuvant therapy?

A.  Adjuvant therapy is additional cancer treatment given after the primary treatment to lower the risk that cancer will come back. Examples: chemotherapy, radiation therapy, hormone therapy, targeted therapy and biological therapy.
Neoadjuvant therapy is treatment given as a first step to shrink a tumor before the main treatment is given (usually surgery). Examples: chemotherapy, radiation therapy and hormone therapy.

Q:  What are the surgical options for breast cancer?

A. Operations for local treatment include breast-conserving surgery, mastectomy and axillary (armpit) lymph node sampling and removal. Breast reconstruction is also an option that can be done during the main treatment or later on.

• Breast-Conserving Surgery

Only part of the affected breast is removed, depending on the size and location of the tumor. These types of surgeries are usually followed by radiation and/or chemotherapy. For most women with stage I or II breast cancer, this type of surgery (followed by radiation and/or chemotherapy) is usually recommended.
Lumpectomy removes only the actual breast lump or tumor and a surrounding area of normal tissue.

• Partial (Segmental) mastectomy or quadrantectomy – removes more breast tissue than a lumpectomy. For a quandrantectomy, one-quarter of the breast is removed.
• Mastectomy – all of the breast tissue is removed and the breast is not saved.
• Simple/total mastectomy –the surgeon removes the entire breast, including the nipple, but does not remove the underarm lymph nodes or muscle tissue beneath the breast.
• Modified radical mastectomy – the surgeon removes the entire breast and some of the axillary (underarm) lymph nodes. This is the most common surgery for women with breast cancer who are having the whole breast removed.

Q: What are the possible side effects of a lumpectomy or mastectomy?

A.  Postsurgical pain and adjusting to the change in the breast’s shape and size are the most common side effects. Other possible side effects include wound infection, hematoma (buildup of blood in the wound) and seroma (buildup of clear fluid in the wound). Post-mastectomy pain syndrome (PMPS) is chronic nerve pain after lumpectomy or mastectomy that may occur. The classic signs of PMPS are chest wall pain and tingling down the arm.

Q: What is an axillary lymph node dissection (ALND) and when is it used?

A.  This procedure is done to determine whether the breast cancer has spread to the axillary (underarm) lymph nodes. Some of the lymph nodes are removed and looked at under a microscope. It is often part of a radical or modified radical mastectomy and sometimes a lumpectomy. Anywhere between 10 and 40 lymph nodes are removed during the procedure. The presence of cancer cells in the lymph nodes under the arm is an important factor in determining adjuvant therapy (treatment given after surgery).

Q:  What are the possible side effects of an axillary lymph node dissection (ALND)?

A.  As with other operations, pain, swelling, bleeding and infection are possible side effects. The main possible long-term effect is lymphedema (swelling of the arm). This occurs because any excess fluid in the arms normally travels back into the bloodstream through the lymphatic system. Removing the lymph nodes sometimes causes this fluid to remain and build up in the arm. There can also be short or long-term limitations in moving the arm and shoulder after surgery. Numbness of the skin of the upper, inner arm is another common side effect.

Q:  What is reconstructive surgery and when is it done?

A.  Following a mastectomy or some breast-conserving surgeries, a woman may want to consider having the breast rebuilt, which is called breast reconstruction. These procedures are done solely to rebuild the breast so that it is about the same size and shape as it was before; it is not part of the cancer treatment. Decisions about the type of reconstruction and when it should be done depend on each woman's medical situation and personal preferences. You may have a choice between having your breast reconstructed at the same time as surgery (immediate reconstruction) or at a later time (delayed reconstruction). There are several types of reconstructive surgery. Some use saline (salt water) or silicone implants, while others use tissues from other parts of your body (autologous tissue reconstruction). The nipple and areola (darker area around the nipple) can also be added.

Q: What is radiation therapy, when is it used, and what are the side effects?

A.  Radiation therapy is a type of cancer treatment that uses high-energy rays or particles to destroy cancer cells. This treatment may be used to kill any cancer cells that remain in the breast, chest wall, or underarm area after breast-conserving surgery. Radiation may also be needed after mastectomy in cases with either a tumor larger than 5 centimeters, or when cancer is found in the lymph nodes. Some women have radiation therapy before surgery to destroy cancer cells and shrink the tumor. Doctors use this approach when the tumor is large or may be hard to remove. There are two types of radiation therapy to treat breast cancer.

• External Radiation

The radiation comes from a large machine outside the body. Most women go to a hospital or office for treatment. Treatments are usually five days a week for several weeks. This is the most common type of radiation therapy for breast cancer. The extent of the radiation depends on whether a lumpectomy or mastectomy was done and whether or not lymph nodes are involved.

• Internal radiation (implant radiation)

Thin plastic tubes (implants) that hold a radioactive substance are put directly in the breast. The implants stay in place for several days. A woman stays in the hospital while she has implants. Doctors remove the implants before she goes home.

The side effects of radiation therapy include the treated area becoming red, dry, tender, and itchy. The breast may feel heavy and tight and experience sunburn-like changes. You may feel fatigued. Rarer long-term side effects include the weakening and possible fracture of the ribs, and possible long-term damage to the lungs and/or heart.

Q:  What is chemotherapy, when is it used, and what are the side effects?

A.  Chemotherapy is treatment with cancer-killing drugs that may be given intravenously (injected into a vein) or orally (by mouth). The drugs travel through the bloodstream to reach cancer cells throughout the body. The chemotherapy is given in cycles, with each period of treatment followed by a recovery period. Treatment usually lasts for several months.

Adjuvant chemotherapy is given to patients after surgery that has no evidence of cancer spread. It is used to reduce the risk of breast cancer coming back.

Neoadjuvant chemotherapy is given before surgery to shrink large cancers so that they are small enough to be removed by lumpectomy instead of mastectomy. Chemotherapy can also be used as the main treatment for women whose cancer has already spread outside the breast and underarm area at the time it is diagnosed, or if it spreads after beginning treatment. In most cases, chemotherapy is most effective when combinations of more than one drug are used.

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. However, other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects including hair loss, mouth sores, loss of appetite, nausea and vomiting, increased chance of infections (due to low white blood cell counts), easy bruising and bleeding (due to low blood platelet counts), and fatigue. Some possible long-term effects include increased risk of leukemia (life-threatening cancer of white blood cells), damage to the ovaries, and permanent heart damage (when specific drugs are used for a long time in high doses).

For younger women, changes in menstrual periods are another possible side effect of chemotherapy, which can lead to premature menopause (not having any more usual periods) and infertility (inability to become pregnant).

Q:  What is hormone therapy, when is it used, and what are the side effects?

A.  Hormone therapy is another form of systemic therapy (treating the entire body). It is most often used as an adjuvant therapy to help reduce the risk of cancer recurrence after surgery, although it may also be used for more advanced breast cancers. The hormone estrogen (produced by the ovaries) promotes the growth of about two out of three breast cancers –those containing estrogen receptors (ER-positive cancers) and/or progesterone receptors (PR-positive cancers). Hormone therapy is used to treat these two types of cancers by lowering estrogen and progesterone levels. Hormone therapy does not help patients whose tumors are both ER- and PR-negative.

Tamoxifen is the most common hormone treatment. The common side effects include hot flashes, vaginal discharge, mood swings and fatigue. Rare but more serious side effects include the increased risk of developing cancers of the uterus, blood clots in the legs, and bone thinning with premenopausal women.

Q:  What is biological therapy, when is it used, and what are its side effects?

A.  Biological therapy helps the immune system (the body’s natural defense against disease) fight cancer. Women often receive the biological therapy called Herceptin, which is a monoclonal antibody (type of protein that can locate and bind to tumor cells). Herceptin is given to women whose lab tests show that a breast tumor has too much of a specific protein known as HER2. By blocking HER2, the treatment can slow or stop the growth of the cancer cells.

Herceptin is given through a vein and usually results in the immediate side effects of fever and chills. Some women also experience pain, weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing or rashes during the first treatment. This drug can also cause heart damage, leading to heart failure and can affect the lungs.

Q:  What effect does breast cancer treatment have on fertility and the possibility of premature menopause?

A.  Breast cancer patients treated with chemotherapy run the risk of developing premature ovarian failure or very early menopause. How high the risk for infertility is depends on the stage of cancer when diagnosed, what type it is, whether chemotherapy is required for treatment, and the doses and types of chemotherapy to be used. The more advanced the cancer when diagnosed, the greater the likelihood that chemotherapy will be used to treat it, and the greater chance that the treatment will affect fertility.

top »