Health & Fitness

Treating breast cancer

Maybe she finds a lump in her breast during a self exam. Maybe she has been asked to return for more testing after a routine mammogram. And just like that, your best friend, your sister, your mother, your daughter is headed down the road so many women have been on. Hearing "breast cancer" is scary. No two cases are alike, and we hope no one will ever need this information. But in the belief that knowledge is power, we went to some experts to find out some common questions about breast cancer treatment.

We talked to Terri Peters, nurse navigator for breast care services at the Wichita Clinic; Judy Johnston, program director of the KU Wichita Center for Breast Cancer Survivorship and a breast cancer survivor; and Fran Kentling, also a local breast cancer survivor.

The specialist can't get me in for two weeks — shouldn't I be seen right away?

Don't panic! The natural instinct is to think, "I have cancer — and I want it out NOW" but it doesn't always work that way.

Testing is needed to determine whether a lump is cancerous and what stage the cancer is, which will affect treatment. First is a diagnostic mammogram, similar to a screening mammogram but with more views.

A biopsy, usually using a needle to extract some cells, is done to confirm cancer. Sometimes it's done the day of the diagnostic screening; sometimes it's done later.

Consider finding a "cancer buddy" who can go to appointments with you, to take notes.

What happens after the biopsy?

It will take a couple of days to get the pathology report, which will be sent to your surgeon or your primary care doctor. She or he will talk to you about your particular cancer and your options.

You might want to talk with your oncologist then, too, so you're all on the same page.

How long does surgery take?

An hour and a half to three hours. For a mastectomy, you'll probably be hospitalized overnight; for a lumpectomy, in which only a small amount of tissue is removed, you'll probably go home that day. Having reconstructive surgery right away may add a day to your stay.

And though that sounds like not much time, most women are ready to go home when they see how well they're doing after surgery.

Will I get a prosthesis (a breast form) right away?

Probably not, because of swelling from surgery. You'll probably be more comfortable going braless at first, but that's an individual matter. If you have a lumpectomy, you'll need to wear a tight-fitting bra all the time for the first five days or so, to help with swelling. You may be given a soft temporary prosthesis that you'll be able to use within a week.

It's a good idea to see and touch a prosthesis ahead of surgery, so you'll know what's available. There are lots of choices.

What about clothing?

After surgery, a button-up top is best because you may not be able to lift your arms far enough to deal with a pullover.

What's next after surgery?

Chemotherapy, then radiation. Some women need only one of those.

Chemo typically is every two to three weeks, for three to four months. Radiation is daily, for about six weeks.

A note: Wichita oncologists participate in many clinical trials, so you may get cutting-edge treatment. Ask whether you're eligible.

When does my hair start falling out?

It could start as early as your second or third chemo dose. Some women get their hair cut short and go wig or hat shopping before chemo begins. If you choose a wig, you can ask your stylist to style it like your hair.

Your nails also will be affected, looking as if they've eroded. And you can't have acrylics, because of the possibility of infection.

If you don't have chemo, you probably won't lose hair. But radiation may leave you tired and your skin feeling dried out.

Will I be sick from chemo?

Anti-nausea medication will help.

The old thinking was that you should eat whatever you could — but those milkshakes can turn into extra pounds, and research shows a link between obesity and recurrence of cancer. A dietitian or nutritionist can help you with healthy eating.

What happens when I get through chemo and radiation?

You'll be followed closely for a while, with regular checkups and mammograms.

You also may experience a letdown — after months of having a medical team surround you, you're suddenly on your own. And you may fear that every bruise or bump is a new sign of cancer.

Your family doctor can help you plan for the transition to living as a healthy person.

If I want reconstructive surgery, when does it start?

Sometimes it starts during the original surgery; some women don't decide they want it until much later.

When a woman is ready, she has three main options. Two involve using an expander, to stretch the chest wall so there's room for an implant. Fluid is added to the expander over time until the right size is reached, then the implant is placed.

The third option uses muscle and fat from the belly and is done during the original surgery.

What about the psychological effects?

They can be tough; the medical questions are much easier to answer.

No two women — or their friends and families — will respond the same.

Some people will find support groups helpful; some want to power through on their own. Some people need help talking about cancer with their families; others don't.

Most physicians' offices can put you in touch with resources. Other options:

* The KU Wichita Center for Breast Cancer Survivorship, 316-293-2655; http://kuwichitasurvivorship.kumc.edu.

* Wichita Clinic's breast care services, 316-613-4707; www.wichitaclinic.com. Click on "specialties and services" then on "other services."

* Mid-Kansas Affiliate of Susan G. Komen for the Cure, 316-683-8510; www.komenmidks.org

* American Cancer Society, 316-265-3400; www.cancer.org.

* Victory in the Valley, 316- 682-7400; www.victoryinthevalley.org

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