Week 15

"Often breast cancer has no symptoms, but there are certain clues that can serve as a warning for breast cancer. When examining your breasts every month, pay attention to their appearance and consult your doctor about any changes you see, such as the following:

Nipple discharge. It's not unusual for nipples to leak fluid; after all, they're built to discharge milk. If the nipples are stimulated — during sex, by persistent squeezing, or during a mammogram — the breasts may react and produce whatever fluid they contain. Birth control pills, blood pressure drugs such asAldomet, tranquilizers such as Thorazine, or marijuana can cause normal, nipple discharge, usually in both breasts and from multiple ducts. This finding is usually not associated with cancer.

Another type of nipple discharge is galactorrhea, a spontaneous, persistent production of milk from both breasts when the woman isn't breast-feeding. In certain circumstances, your physician may want to evaluate various hormone or endocrine levels in the blood, imbalances of which can occasionally be associated with breast discharge. Rarely these imbalances may be associated with tiny growths in the pituitary gland, a small gland in the central portion of the brain.

The kind of discharge that may indicate breast disease usually occurs only from one duct of one nipple and is spontaneous (not caused by nipple stimulation). The cause most often is one or several papillomas (nonmalignant, pimple-like growths in the lining of a breast duct) or duct ectasia (an inflammation of the lining of the milk gland). Less commonly, the discharge is the sign of a cancer, either ductal carcinoma in situ (DCIS) or an invasive cancer. Surgery usually is required to make a diagnosis. The surgeon identifies the involved duct and removes it through an incision in the skin. In the laboratory, a pathologist examines the tissue for cancer cells.

Inverted nipples. Inverted nipples are not uncommon, and some women live with one or both nipples inverted for most of their lives. However, if the nipple inversion is a recent occurrence, it may be a sign of cancer. Arrange to be seen promptly by your doctor. Your doctor will examine you and likely refer you for a mammogram.

Paget's disease of the breast. This form of cancer may first appear as an itchy sore on the nipple and can progress to crustiness and oozing that fails to improve. It is a rare cancer, accounting for less than 3% of all new diagnoses of female breast cancer. Although it resembles eczema, eczema almost always affects only the areola, the dark area around the nipple.

Paget's disease looks different: It affects the nipple and not the areola. Your doctor will examine both breasts, order a mammogram and arrange for a biopsy of the nipple skin. If it's cancer, the cancer cells can be seen under a microscope, growing into the skin.

In most patients with Paget's, there's an underlying breast cancer below the level of the skin.

If the cancer does appear to only involve the nipple, Paget's disease has a better prognosis than other breast cancers. Historically, many breast surgeons preferred to remove the entire breast to treat this cancer, even when only the nipple area was affected. Today, however, just the nipple and the areola are removed, along with the underlying cancer. The unaffected portion of the breast is spared."

http://www.aolhealth.com/breast-cancer/learn-about-it/warning-signs-of-breast-cancer

Week 14

"Beginning in their 20s, women should be told about the benefits and limitations of breast self-exam (BSE). Women should know how their breasts normally look and feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not necessarily mean there is a cancer.A woman can notice changes by being aware of how her breasts normally look and feel and by feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach (see below) and using a specific schedule to examine her breasts.If you choose to do BSE, the information below is a step-by-step approach for the exam. The best time for a woman to examine her breasts is when the breasts are not tender or swollen. Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.Women with breast implants can do BSE, too. It may be helpful to have the surgeon help identify the edges of the implant so that you know what you are feeling. There is some thought that the implants push out the breast tissue and may actually make it easier to examine. Women who are pregnant or breast-feeding can also choose to examine their breasts regularly.It is acceptable for women to choose not to do BSE or to do BSE once in a while. Women who choose not to do BSE should still be aware of the normal look and feel of their breasts and report any changes to their doctor right away.

How to examine your breasts

• Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.

• Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
  • Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you're not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.
  • Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
  • • There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.
    • Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.
    • While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
    • Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

    This procedure for doing breast self exam is different from previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman's ability to find abnormal areas."

    http://www.cancer.org/docroot/CRI/content/CRI_2_6x_How_to_perform_a_breast_self_exam_5.asp

Week 13

"Chemotherapy is a systemic breast cancer therapy. The anticancer drugs enter the bloodstream to reach cancer cells throughout the entire body, not just the breast. Chemotherapy is typically used to treat patients with locally advanced or metastatic breast cancer. Neo-adjuvant (or primary systemic) breast cancer chemotherapy may be used before surgery to reduce the size of large breast tumors and to destroy cancer cells. This type of chemotherapy often makes breast-conserving surgery possible. It also helps our cancer doctors determine the effectiveness of a particular regimen on the breast tumor. Adjuvant breast cancer chemotherapy may be used after surgery or radiation therapy to eliminate any remaining cancer cells that may not have been removed during breast cancer surgery and/or radiation therapy. It may also prevent the disease from spreading to other parts of the body. Chemotherapy treatment uses medicine to weaken and destroy cancer cells in the body, including cells at the original cancer site and any cancer cells that may have spread to another part of the body. Chemotherapy, often shortened to just "chemo," is a systemic therapy, which means it affects the whole body by going through the bloodstream. For breast cancer, chemotherapy drugs are given intravenously (directly into a vein) or orally (by mouth). Once the drugs enter the bloodstream, they travel to all parts of the body in order to reach cancer cells that may have spread beyond the breast -- therefore chemotherapy is considered a "systemic" form of breast cancer treatment.Chemotherapy is given in cycles of treatment followed by a recovery period. The entire chemotherapy treatment generally lasts several months to one year, depending on the type of drugs given. When breast cancer is limited to the breast or lymph nodes, chemotherapy may be given after a lumpectomy or mastectomy. This is known as adjuvant treatment and may help reduce the chance of breast cancer recurrence.Chemotherapy may also be given as the main treatment for women whose cancer has spread to other parts of the body outside of the breast and lymph nodes. This spread is known as metastatic breast cancer and occurs in a small number of women at the time of diagnosis, or when the cancer recurs some time after initial treatment for localized (non-metastatic) breast cancer."

http://www.webmd.com/breast-cancer/chemotherapy-treatment

Week 12

"Radiation therapy may have both localized side effects in the treated area and more general side effects that affect your overall feeling of well-being. The majority are temporary and can often be relieved with medication and natural therapies your doctors and other caregivers recommend for you. Internal radiation, such as MammoSite radiation therapy, generally has fewer side effects than external radiation therapy. Fatigue. This is one of the most common symptoms of radiation treatment, especially in the later weeks of treatment and for sometime afterward. Resting is important, but many doctors also advise people undergoing treatment to remain reasonably active, matching their activities to their energy level. Skin irritation. People receiving external radiation may develop red, dry, tender, or itchy skin in the treated area. As treatment progresses, the skin may become moist and weepy. Most changes to the skin are temporary and will gradually heal once treatment is over. However, you may experience permanent changes to skin color where you received radiation, or more or less sensitivity of the breast skin than you did previously. Your doctor may prescribe special creams and topical medications to apply to the treated area. Here are steps you can take to prevent infection and help your skin heal: Expose the skin to the air as much as possible, Ask your doctor before using any deodorants, lotions, or creams he or she didn’t prescribe on the affected area, Wear loose-fitting, non-binding cotton clothes next to irritated skin. Changes to the breast. A few people may find that the treated breast is firmer after therapy. Others may find that it’s bigger, because of fluid buildup, while some may notice that it’s smaller, because of tissue changes caused by the radiation.

Make sure to discuss any of the following side effects of chemotherapy with your healthcare providers. There are a variety of medicines and natural therapies available that may be able to dramatically lessen their severity. Most of the following symptoms gradually go away during the recovery period of the treatment cycle or after treatment is over: Fatigue, Bruising or bleeding easily, Hair loss, Nausea and vomiting, Diarrhea, Mouth sores."

http://www.cancercompass.com/learn/cancer-information/breast-cancer/side-effects/chemotherapy

Week 11

"Radiation therapy uses a special kind of high-energy beam to damage cancer cells. (Other types of energy beams include light and x-rays.) These high-energy beams, which are invisible to the human eye, damage a cell’s DNA, the material that cells use to divide. Over time, the radiation damages cells that are in the path of its beam — normal cells as well as cancer cells. But radiation affects cancer cells more than normal cells. Cancer cells are very busy growing and multiplying — 2 activities that can be slowed or stopped by radiation damage. And because cancer cells are less organized than healthy cells, it's harder for them to repair the damage done by radiation. So cancer cells are more easily destroyed by radiation, while healthy, normal cells are better able to repair themselves and survive the treatment.

Radiation is an important and often necessary form of anti-cancer therapy because it is able to reduce the risk of recurrence after surgery. Although it's quite possible that your surgeon removed all the cancer, breast cancer surgery cannot guarantee that every last cancer cell has been removed from your body. Individual cancer cells are too small to be felt or seen during surgery or detected by testing. Any cells that remain after surgery can grow and eventually form a new lump or show up as an abnormality on a test such as a mammogram. Research has shown that people who are treated with radiation after lumpectomy are more likely to live longer, and remain cancer-free longer, than those who don't get radiation. In one large study, women who didn't get radiation after lumpectomy were shown to have a 60% greater risk of the cancer coming back in the same breast. Other research has shown that even women with very small cancers (1 centimeter or smaller) benefit from radiation after lumpectomy.

There are two main types of radiation:

External Radiation

External radiation is the most common type of radiation, typically given after lumpectomy and sometimes, mastectomy. In this section, you can read about how external radiation is given.

Internal Radiation

Internal radiation is a less common method of giving radiation. It is being studied for use after lumpectomy. In this section, you can read about how radiation is delivered inside the breast."

http://www.breastcancer.org/treatment/radiation/types/