Breast Cancer F.A.Q.'s

Answers from the World Renowed Medical Oncologist, Pasquale Benedtto, M.D.

What is the longest time a woman can consider herself safe after having had breast cancer?

For breast cancer the majority of recurrences would be within the first five years. But it has been noted that between five and ten years there are some additional recurrences. Then after that it’s pretty rare. But there are known cases of recurrences very late after the original tumor as long as thirty years. For most women who have not had a recurrence in ten years, it’s pretty unlikely that person is going to have a recurrence. Those curves are beginning to flatten out meaning that the number of women alive at ten to fourteen years without disease is pretty similar through time.


Why does each woman have different amount of lymph nodes?

That has two explanations. One is that it may be the degree of surgery being done, how much tissue was removed, and it also may be how larger the lymph nodes are so that the pathologist can find them. If the pathologist spends a lot of time getting out all the lymph nodes from the tissue or they are fairly large because they are inflamed even if not involved with cancer sometimes there is an inflammatory reaction that makes them bigger, it would be easier to pick them out. If they are not involved at all then they may be very small and the pathologist has to spend a lot of time and he or she may or may not do that. That is the difference in which the surgeon provides an adequate specimen, and the compulsiveness by which the pathologist tries to find all those lymph nodes.


Do you recommend chemotherapy for everyone?

If a tumor is very small (less than 5 mm) then that would be detected by a mammogram we have much less information with regard to the value of chemotherapy for that population. If the characteristics of that tumor is otherwise good (e.g., if it’s a 5 mm tumor and you can determine its estrogen sensitivity) those would be all good factors and the chance of recurrence is really very small. We might not recommend that women receive chemotherapy because we do not have enough data that’s beneficial. Not everyone with a breast cancer would get chemotherapy. A patient with a very large tumor we are more inclined to give chemotherapy because the risk of the recurrence becomes much higher.


If the tumor is large why does chemotherapy have to be administered instead of just being removed?

The larger the tumor the greater chance there is that a tumor cell escaped from the tumor and is circulating in a person’s body. So tumor size is associated with risk of recurrence, for example microscopically. So as a tumor goes from a very small to a much larger size it has a greater chance of spreading through the lymph or blood system to get to another location in the body. Large tumors can be removed but that does not reduce the chance of a cancer coming back because that cell already has escaped. It’s a matter of time before it can recur. Chemotherapy is aimed at trying to kill those cells before they are visible and there is a small number of them.


How is chemotherapy administered?

 Primarily by injection into the vein. So women will come to a doctors office will have a needle inserted into a vein or a port-a-cath. A port-a-cath is a special device to have access to a vein and is surgically implanted by a surgeon before treatment. This surgical technique is used when a woman either has to small a vein to administer the chemotherapy and injecting the chemotherapy through the port-a-cath makes it a lot easier. Therefore, a woman does not have to be stuck every time for treatment.

Some chemotherapy treatments are given by pill form. That’s becoming a large area of investigation. It certainly would be preferable for many people to be able to take a pill rather than an injection. There are only a certain amount of drugs where that’s feasible.


Even after chemotherapy can breast cancer return?

First of all breast cancer can return because not every breast cancer cell may be killed by the treatment. In a patient who is getting chemotherapy in the adjuvant setting, that means that the woman had some kind of definitive surgery and the cancer has all been removed. But we understand by the characteristics of the pathology how many lymph nodes, estrogen receptor status, how big the tumor was, that there is a risk of some degree for the cancer to come back, we will recommend chemotherapy treatment.  Once the patient completes the chemotherapy treatment then they are on a follow-up schedule of getting periodic blood tests, x-rays and scans.

Usually, patients are seen every three months and they will have scans at various intervals sometimes once a year. There is a lot more controversy about the follow-up of patients who are breast cancer survivors and so there are different philosophies with regard


Would chemotherapy actually cure the cancer or prolong it?

That’s entirely dependent on the stage. We believe that women who have high risk breast cancer will benefit at various levels by getting chemotherapy. Various levels means what depending on what we think the risk of recurrence is can determine an absolute improvement in that risk of recurrence. Maybe as small as a couple of percent it may be much higher than that. So there are situations in which we think we are going to cure more women by giving them chemotherapy.

In breast cancer, at least at the moment, once the cancer has spread to another organ like the lung, bones, or liver, cure is a very infrequent circumstance. Prolonging time, survival, or controlling the disease so that it gives more quality time is usually what we are trying to do in that situation.


If chemotherapy did not work how would you as the physician/oncologist tell the patient?

Generally, over time you are going to have a relationship with the patient. The relationship should be based on your initial visits on setting up a truthful relationship and foundation. So, when a person is going to get treatment it should be clear to the patient what the expectation of the treatment is. If the expectation is that we are trying to cure the problem then it’s certainly harder to deliver the news that the treatment isn’t working. If the expectation is controlling the tumor for a period of time then it’s easier to say in the course of treatment “well you know we have come to an end of the usefulness of this chemotherapy and we will have to consider what else to do”.

For the most part breaking the news is trying to maintain some level of hope that some alternative strategy will be helpful for the patient. A physician may also say ‘well you know I think we got as much mileage out of this medicine as we can and we need to think what other options and how we can change treatments.


Can a patient who is diabetic still get chemotherapy?

It doesn’t have a significant impact. Sometimes you give steroids like prednisone and Decadron to help with the side effects of chemotherapy particularly nausea or vomiting. Steroids will actually make your sugar go out of control. So if your diabetic and getting chemotherapy and part of the chemotherapy includes getting steroids, then you may have to alternate the medication for a diabetic patient. That’s not a permanent affect. It’s temporary while you are getting the drug.


If you have a bone marrow disorder how does it affect chemotherapy?

If your bone marrow is already not working then it may be much more difficult to be able to get chemotherapy because you will develop much more severe side affects. That combination is not very common. Bone marrow disorder of itself is a complex situation. You may not be able to get any kind of chemotherapy it it’s severe enough. But, it will affect how much drugs you can get and how quickly you recover from the side effects of the drug.


Could you loose hair on other parts of your body other than your head?

It would be more obvious on your head when you loose hair. In other places like your arms and legs where it’s thinner are less noticeable. If you get chemotherapy long enough and intense enough you could loose hair on your eyebrows, eyelashes, and pubic hair.


How long is chemotherapy administered?

That depends entirely on the stage of the disease that is being treated. If your treating early stage breast cancer most chemotherapy is probably completed in four months. If you are treating a later stage of breast cancer than treatments may be indefinite depending on how well the disease is being controlled.


Will chemotherapy change the color of my hair if it doesnÂ’t fall out?

It’s not very likely to change the color of your hair if it doesn’t fall out. More likely it will fall out and if it does the first growth of the hair coming back is a different color or of different texture. For example if you had straight hair before your hair fell out your hair possibly would come back in curly, and if you had curly hair it would come back in straight. Some women could possibly have more or less gray hair, darker color or lighter color. Over time your hair goes back to what it was previously. Obviously, if your hair was artificially colored then unless you artificially color it again, your natural hair will go back to normal eventually.


What type of cells does chemotherapy actually kill?

Chemotherapy will kill any type of cancer cell. There are not that many different types of breast cancer. The breast is made up of long tubes called ducts and then at the end of those ducts are lobules, which produce milk. Breast cancer is either lobular or ductal. There are other types of cancers in the breast. There are some subtle differences in how likely a woman with one of the other diseases will be responsive to an estrogen or how frequently a tumor might metastasize to lymph nodes. Basically, the disease is treated the same. The natural history of the disease might be slightly better.

Lobular carcinoma tend to occur in older women and are likely to be in both breasts, and are also likely to be estrogen receptor positive meaning the cancer is stimulated by estrogen in the body. So that puts women in a better category. The most common, however, are intraductal and infiltrating carcinoma. Tumors arise from the ducts.


How does chemotherapy affect the brain?

This is a very good question. There is a syndrome that some women, especially some breast cancer women, will tell you called “chemo brain”. It may be the chemotherapy itself or it may be all the drugs you get to try and prevent side effects. Since we give certain sedatives that may make people a little cloudy when they get the medication, one of the drugs we give has an amnesic effect. We like that but it’s that you don’t remember if you have a bad time, but on the other hand there may be some carry over to other things. Function may be affected by the medicine to prevent side effects. There is also the possibility that if you become anemic you get less oxygen to the brain and that may have an impact. There is a thought that giving growth factors may actually improve cognitive function in people getting chemotherapy, which is how your brain works. Some drugs may directly affect the brain although that’s infrequent. Not many drugs have a direct toxic affect on the brain.


Are there medications to take if you get very sick during chemotherapy?

It’s pretty standard that when a person gets chemotherapy for any cancer that we anticipate certain side affects and we can give drugs to try and prevent those side affects instead of treating them before they happen. Most drugs have a risk of nausea and vomiting and we give drugs to prevent that and not wait for it to happen. There are a number of different kinds of anti-nausea drugs that are affective. They are Zophrane and Compazine.


Would a person have the desire to having sex during chemotherapy?

Sometimes you might. It depends on the intensity of the chemotherapy. If you are getting very intensive chemotherapy and you’re anemic and your blood counts are low you might not be interested in to many things including sex. If your tolerating chemotherapy very well and your blood counts are better and your working and going out then sex is part of your normal activity, then your desire would not be affected in that situation.


Can you have sex during chemotherapy?

At times during treatment you may not have the motivation but if you have the motivation there is not necessarily a contradiction to having sex, and there is no risk to the partner or the person getting chemotherapy.


Is termination recommended if breast cancer is found while a woman is pregnant?

I think that most doctors have a difficult time making that recommendation because there are so many other issues in addition to the medical. I think what doctors will say is in order to treat your disease properly you need to get medications that may have an adverse affect on the fetus and leave the decision to the patient and spouse. However, the implication there is that you have to make a decision between the best treatment for your disease and the child. It may be the case that a family doesn’t perceive that another child is possible and that many women want the child no matter what.

This must be respected. Then treatment will be delayed until a time when it is safer to give the drug during the pregnancy. 


Can chemotherapy affect pregnancy?

If you happen to be pregnant at the same time chemotherapy is given and you did not know about it then that could have a very serious affect for the embryo. If the woman is of child bearing age before we give the first dose of chemotherapy you make sure that she is not pregnant. If a person finds out they have breast cancer late in the course of the pregnancy actually certain drugs can be given that don’t affect the baby, and can treat the mother until the time of delivery. So the issue really is the kind of drugs that you are going to give and the time in the pregnancy. If it’s the first trimester you cannot give any drugs. If it’s in the third trimester you can give most of the drugs.









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