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Advanced Breast Cancer: Managing Your Medical Care: Diagnosis To Treatment Decision

A General Overview Of What Happens After A Breast Cancer Diagnosis

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As a general matter:

  • Treating breast cancer starts with a biopsy - a surgically removed sample of your particular cancer. A biopsy is the key to making a diagnosis of breast cancer. (If you have not had a biopsy, or if you had a biopsy but have not received the results yet, read: Managing Your Medical Care: Prior To Diagnosis)
  • The type of cancer is described in a report known as a Pathology Report. Doctors use it to assess the risk and choose the appropriate treatment.
  • Additional tests provide staging - a categorization of your particular situation.
  • The first line of treatment is usually surgery to remove the tumor. This is done by a medical specialist known as a surgical oncologist. 
    • Surgery removes part of the affected breast ("lumpectomy"), more of the breast (a "Quadrantectomy"/"partial mastectomy") or all of the breast ("mastectomy"). Current mastectomies are less disfiguring than previously. 
    • A lumpectomy or mastectomy may be followed by cosmetic surgery by a plastic surgeon. (This can generally be done during the same operation as the lumpectomy or mastectomy). With a lumpectomy, you are left with a scar and sometimes a dimpling of the skin which can be filled in. With a mastectomy, the breast can be reconstructed. As a general matter, if the initial surgery is covered by health insurance, so is breast reconstruction.
  • Surgery is generally followed by chemotherapy and/or radiation.                                      
    • Chemotherapy is generally performed by a medical specialist known as a medical oncologist. Radiation by a radiation oncologist.
    • Which treatment will be recommended, if any, depends on the type of breast cancer, your staging and receptors. 
    • Whether or not to undergo these treatments, and if so, which ones, is up to you. The decision is generally made after consultation with medical and/or radiation oncologists by balancing benefits, risks and short and long term side effects.
    • Not all cancer treatments harm fertility. However, if the treatment you may receive does include a risk of infertility, fertility preservation treatments are available. The earlier you discuss your options, the greater the chance of maintaining your fertility.
  • Treatment is generally followed by a prescription for medication to help keep cancer in check.
  • No one doctor provides all the care for a woman with breast cancer. Instead, a team of specialists is involved. 
    • The team generally includes a surgeon, a specialist in radiation and a specialist in chemotherapy.
    • The surgeon typically starts off as the leader of the team. 

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