U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of Health

What You Need To Know AboutTM

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This booklet is about breast cancer.The Cancer Information Service canhelp you learn more about this disease.The staff can talk with you in English orSpanish.

The number is 1–800–4–CANCER(1–800–422–6237). The number forcallers with TTY equipment is1–800–332–8615. Your call is free.

Este folleto es acerca del cáncer deseno. Llame al Servicio de Informaciónsobre el Cáncer para saber más sobreesta enfermedad. Este servicio tienepersonal que habla español.

El número a llamar es el1–800–4–CANCER (1–800–422–6237).Personas con equipo TTY pueden llamaral 1–800–332–8615. Su llamada esgratis.

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Contents

The Breasts 2

Understanding Cancer 3

Risk Factors 5

Screening 8

Symptoms 12

Diagnosis 13

Additional Tests 17

Staging 17

Treatment 21

Breast Reconstruction 43

Complementary and Alternative Medicine 44

Nutrition and Physical Activity 46

Follow-up Care 47

Sources of Support 48

The Promise of Cancer Research 50

Dictionary 54

National Cancer Institute Information Resources 72

National Cancer Institute Publications 73

U.S. DEPARTMENT OF HEALTH ANDHUMAN SERVICESNational Institutes of HealthNational Cancer Institute

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What You Need To Know About™ Breast Cancer

his National Cancer Institute (NCI) booklet hasimportant information about breast cancer.*

Breast cancer is the most common type of canceramong women in this country (other than skin cancer).Each year, more than 211,000 American women learnthey have this disease.

You will read about possible causes, screening,symptoms, diagnosis, treatment, and supportive care.You will also find ideas about how to cope with thedisease.

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Breast Cancer in Men

Each year, about 1,700 men in this countrylearn they have breast cancer. Most information inthis booklet applies to men with breast cancer.However, more specific information about breastcancer in men is available on NCI’s Web site athttp://www.cancer.gov and from NCI’s CancerInformation Service at 1–800–4–CANCER.

*Words that may be new to readers appear in italics. The“Dictionary” section explains these terms. Some words in the“Dictionary” have a “sounds-like” spelling to show how topronounce them.

Scientists are studying breast cancer to find out moreabout its causes. And they are looking for better waysto prevent, find, and treat it.

NCI provides information about cancer, includingthe publications mentioned in this booklet. You canorder these materials by telephone or on the Internet.

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You can also read them online and print your owncopy.

• Telephone (1–800–4–CANCER): InformationSpecialists at NCI’s Cancer Information Service cananswer your questions about cancer. They also cansend NCI booklets, fact sheets, and other materials.

• Internet (http://www.cancer.gov): You canuse NCI’s Web site to find a wide range ofup-to-date information. For example, you canfind many NCI booklets and fact sheets athttp://www.cancer.gov/publications. People in theUnited States and its territories may use this Website to order printed copies. This Web site alsoexplains how people outside the United States canmail or fax their requests for NCI booklets.

You can ask questions online and get helpright away from Information Specialiststhrough LiveHelp. (Click on “Need Help?” athttp://www.cancer.gov. Then click on “Connect toLiveHelp.”)

The Breasts

he breasts sit on the chest muscles that cover theribs. Each breast is made of 15 to 20 lobes. Lobes

contain many smaller lobules. Lobules contain groupsof tiny glands that can produce milk. Milk flows fromthe lobules through thin tubes called ducts to thenipple. The nipple is in the center of a dark area of skincalled the areola. Fat fills the spaces between thelobules and ducts.

The breasts also contain lymph vessels. Thesevessels lead to small, round organs called lymph nodes.

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Groups of lymph nodes are near the breast in the axilla(underarm), above the collarbone, in the chest behindthe breastbone, and in many other parts of the body.The lymph nodes trap bacteria, cancer cells, or otherharmful substances.

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LobeLobules

Ducts

Lymph

nodes Lymph

vessels

Nipple

Areola

Fat

These pictures show the parts of the breast and thelymph nodes and lymph vessels near the breast.

Understanding Cancer

ancer begins in cells, the building blocks thatmake up tissues. Tissues make up the organs of

the body.

Normally, cells grow and divide to form new cells asthe body needs them. When cells grow old, they die,and new cells take their place.

Sometimes, this orderly process goes wrong. Newcells form when the body does not need them, and oldcells do not die when they should. These extra cells canform a mass of tissue called a growth or tumor.

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Tumors can be benign or malignant:

• Benign tumors are not cancer:

—Benign tumors are rarely life-threatening.

—Generally, benign tumors can be removed. Theyusually do not grow back.

—Cells from benign tumors do not invade thetissues around them.

—Cells from benign tumors do not spread to otherparts of the body.

• Malignant tumors are cancer:

—Malignant tumors are generally more serious thanbenign tumors. They may be life-threatening.

—Malignant tumors often can be removed. Butsometimes they grow back.

—Cells from malignant tumors can invade anddamage nearby tissues and organs.

—Cells from malignant tumors can spread(metastasize) to other parts of the body. Cancercells spread by breaking away from the original(primary) tumor and entering the bloodstream orlymphatic system. The cells invade other organsand form new tumors that damage these organs.The spread of cancer is called metastasis.

When breast cancer cells spread, the cancer cells areoften found in lymph nodes near the breast. Also,breast cancer can spread to almost any other part of thebody. The most common are the bones, liver, lungs,and brain. The new tumor has the same kind ofabnormal cells and the same name as the primarytumor. For example, if breast cancer spreads to thebones, the cancer cells in the bones are actually breastcancer cells. The disease is metastatic breast cancer,not bone cancer. For that reason, it is treated as breastcancer, not bone cancer. Doctors call the new tumor“distant” or metastatic disease.

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Risk Factors

o one knows the exact causes of breast cancer.Doctors often cannot explain why one woman

develops breast cancer and another does not. They doknow that bumping, bruising, or touching the breastdoes not cause cancer. And breast cancer is notcontagious. You cannot catch it from another person.

Research has shown that women with certain riskfactors are more likely than others to develop breastcancer. A risk factor is something that may increase thechance of developing a disease.

Studies have found the following risk factors forbreast cancer:

• Age: The chance of getting breast cancer goes up asa woman gets older. Most cases of breast canceroccur in women over 60. This disease is notcommon before menopause.

• Personal history of breast cancer: A woman whohad breast cancer in one breast has an increased riskof getting cancer in her other breast.

• Family history: A woman’s risk of breast cancer ishigher if her mother, sister, or daughter had breastcancer. The risk is higher if her family member gotbreast cancer before age 40. Having other relativeswith breast cancer (in either her mother’s or father’sfamily) may also increase a woman’s risk.

• Certain breast changes: Some women have cells inthe breast that look abnormal under a microscope.Having certain types of abnormal cells (atypicalhyperplasia and lobular carcinoma in situ [LCIS])increases the risk of breast cancer.

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• Gene changes: Changes in certain genes increasethe risk of breast cancer. These genes includeBRCA1, BRCA2, and others. Tests can sometimesshow the presence of specific gene changes infamilies with many women who have had breastcancer. Health care providers may suggest ways totry to reduce the risk of breast cancer, or to improvethe detection of this disease in women who havethese changes in their genes. NCI offers publicationson gene testing.

• Reproductive and menstrual history:

—The older a woman is when she has her firstchild, the greater her chance of breast cancer.

—Women who had their first menstrual periodbefore age 12 are at an increased risk of breastcancer.

—Women who went through menopause after age55 are at an increased risk of breast cancer.

—Women who never had children are at anincreased risk of breast cancer.

—Women who take menopausal hormone therapywith estrogen plus progestin after menopause alsoappear to have an increased risk of breast cancer.

—Large, well-designed studies have shown no linkbetween abortion or miscarriage and breastcancer.

• Race: Breast cancer is diagnosed more often inwhite women than Latina, Asian, or AfricanAmerican women.

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• Radiation therapy to the chest: Women who hadradiation therapy to the chest (including breasts)before age 30 are at an increased risk of breastcancer. This includes women treated with radiationfor Hodgkin’s lymphoma. Studies show that theyounger a woman was when she received radiationtreatment, the higher her risk of breast cancer laterin life.

• Breast density: Breast tissue may be dense or fatty.Older women whose mammograms (breast x-rays)show more dense tissue are at increased risk ofbreast cancer.

• Taking DES (diethylstilbestrol): DES was given tosome pregnant women in the United States betweenabout 1940 and 1971. (It is no longer given topregnant women.) Women who took DES duringpregnancy may have a slightly increased risk ofbreast cancer. The possible effects on theirdaughters’risk for breast cancer are under study.

• Being overweight or obese after menopause: Thechance of getting breast cancer after menopause ishigher in women who are overweight or obese.

• Lack of physical activity: Women who arephysically inactive throughout life may have anincreased risk of breast cancer. Being active mayhelp reduce risk by preventing weight gain andobesity.

• Drinking alcohol: Studies suggest that the morealcohol a woman drinks, the greater her risk ofbreast cancer.

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Other possible risk factors are under study.Researchers are studying the effect of diet, physicalactivity, and genetics on breast cancer risk. They arealso studying whether certain substances in theenvironment can increase the risk of breast cancer.

Many risk factors can be avoided. Others, such asfamily history, cannot be avoided. Women can helpprotect themselves by staying away from known riskfactors whenever possible.

But it is also important to keep in mind that mostwomen who have known risk factors do not get breastcancer. Also, most women with breast cancer do nothave a family history of the disease. In fact, except forgrowing older, most women with breast cancer have noclear risk factors.

If you think you may be at risk, you should discussthis concern with your doctor. Your doctor may be ableto suggest ways to reduce your risk and can plan aschedule for checkups.

Screening

creening for breast cancer before there aresymptoms can be important. Screening can help

doctors find and treat cancer early. Treatment is morelikely to work well when cancer is found early.

Your doctor may suggest the following screeningtests for breast cancer:

• Screening mammogram

• Clinical breast exam

• Breast self-exam

You should ask your doctor about when to start andhow often to check for breast cancer.

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Screening MammogramTo find breast cancer early, NCI recommends that:

• Women in their 40s and older should havemammograms every 1 to 2 years. A mammogram isa picture of the breast made with x-rays.

• Women who are younger than 40 and have riskfactors for breast cancer should ask their health careprovider whether to have mammograms and howoften to have them.

Mammograms can often show a breast lump beforeit can be felt. They also can show a cluster of tinyspecks of calcium. These specks are calledmicrocalcifications. Lumps or specks can be fromcancer, precancerous cells, or other conditions. Furthertests are needed to find out if abnormal cells arepresent.

If an abnormal area shows up on your mammogram,you may need to have more x-rays. You also may needa biopsy. A biopsy is the only way to tell for sure ifcancer is present. (The “Diagnosis” section on page 13has more information on biopsy.)

Mammograms are the best tool doctors have to findbreast cancer early. However, mammograms are notperfect:

• A mammogram may miss some cancers. (The resultis called a “false negative.”)

• A mammogram may show things that turn out not tobe cancer. (The result is called a “false positive.”)

• Some fast-growing tumors may grow large or spreadto other parts of the body before a mammogramdetects them.

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Mammograms (as well as dental x-rays, and otherroutine x-rays) use very small doses of radiation. Therisk of any harm is very slight, but repeated x-rayscould cause problems. The benefits nearly alwaysoutweigh the risk. You should talk with your healthcare provider about the need for each x-ray. You shouldalso ask for shields to protect other parts of your body.

Clinical Breast ExamDuring a clinical breast exam, your health care

provider checks your breasts. You may be asked toraise your arms over your head, let them hang by yoursides, or press your hands against your hips.

Your health care provider looks for differences insize or shape of your breasts. The skin of your breastsis checked for a rash, dimpling, or other abnormalsigns. Your nipples may be squeezed to check for fluid.

Using the pads of the fingers to feel for lumps, yourhealth care provider checks your entire breast,underarm, and collarbone area. A lump is generally thesize of a pea before anyone can feel it. The exam isdone on one side, then the other. Your health careprovider checks the lymph nodes near the breast to seeif they are enlarged.

A thorough clinical breast exam may take about 10minutes.

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Breast Self-Exam You may perform monthly breast self-exams to

check for any changes in your breasts. It is importantto remember that changes can occur because of aging,your menstrual cycle, pregnancy, menopause, or takingbirth control pills or other hormones. It is normal forbreasts to feel a little lumpy and uneven. Also, it iscommon for your breasts to be swollen and tender rightbefore or during your menstrual period.

You should contact your health care provider if younotice any unusual changes in your breasts.

Breast self-exams cannot replace regular screeningmammograms and clinical breast exams. Studies havenot shown that breast self-exams alone reduce thenumber of deaths from breast cancer.

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You may want to ask the doctor the followingquestions about screening:

• Which tests do you recommend for me? Why?

• Do the tests hurt? Are there any risks?

• How much do mammograms cost? Will myhealth insurance pay for them?

• How soon after the mammogram will I learnthe results?

• If the results show a problem, how will youlearn if I have cancer?

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Symptoms

ommon symptoms of breast cancerinclude:

• A change in how the breast or nipple feels

—A lump or thickening in or near the breast or inthe underarm area

—Nipple tenderness

• A change in how the breast or nipple looks

—A change in the size or shape of the breast

—A nipple turned inward into the breast

—The skin of the breast, areola, or nipple may bescaly, red, or swollen. It may have ridges orpitting so that it looks like the skin of an orange.

• Nipple discharge (fluid)

Early breast cancer usually does not cause pain.Still, a woman should see her health care providerabout breast pain or any other symptom that does notgo away. Most often, these symptoms are not due tocancer. Other health problems may also cause them.Any woman with these symptoms should tell herprovider so that problems can be diagnosed and treatedas early as possible.

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Diagnosis

f you have a symptom or screening test result thatsuggests cancer, your doctor must find out

whether it is due to cancer or to some other cause.Your doctor may ask about your personal and familymedical history. You may have a physical exam. Yourdoctor also may order a mammogram or other imagingprocedure. These tests make pictures of tissues insidethe breast. After the tests, your doctor may decide noother exams are needed. Your doctor may suggest thatyou have a follow-up exam later on. Or you may needto have a biopsy to look for cancer cells.

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Clinical Breast ExamYour health care provider feels each breast for

lumps and looks for other problems. If you have alump, your health care provider will feel its size, shape,and texture. Your health care provider will also checkto see if it moves easily. Benign lumps often feeldifferent from cancerous ones. Lumps that are soft,smooth, round, and movable are likely to be benign. Ahard, oddly shaped lump that feels firmly attachedwithin the breast is more likely to be cancer.

Diagnostic Mammogram Diagnostic mammograms are x-ray pictures of the

breast. They take clearer, more detailed images of areasthat look abnormal on a screening mammogram.Doctors use them to learn more about unusual breastchanges, such as a lump, pain, thickening, nippledischarge, or change in breast size or shape. Diagnosticmammograms may focus on a specific area of thebreast. They may involve special techniques and moreviews than screening mammograms.

UltrasoundAn ultrasound device sends out sound waves that

people cannot hear. The waves bounce off tissues. Acomputer uses the echoes to create a picture. Yourdoctor can view these pictures on a monitor. Thepictures may show whether a lump is solid or filledwith fluid. A cyst is a fluid-filled sac. Cysts are notcancer. But a solid mass may be cancer. After the test,your doctor can store the pictures on video or printthem out. This exam may be used along with amammogram.

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Magnetic Resonance Imaging Magnetic resonance imaging (MRI) uses a powerful

magnet linked to a computer. MRI makes detailedpictures of breast tissue. Your doctor can view thesepictures on a monitor or print them on film. MRI maybe used along with a mammogram.

BiopsyYour doctor may refer you to a surgeon or breast

disease specialist for a biopsy. Fluid or tissue isremoved from your breast to help find out if there iscancer.

Some suspicious areas can be seen on a mammo-gram but cannot be felt during a clinical breast exam.Doctors can use imaging procedures to help see thearea and remove tissue. Such procedures includeultrasound-guided, needle-localized, or stereotacticbiopsy.

Doctors can remove tissue from the breast indifferent ways:

• Fine-needle aspiration: Your doctor uses a thinneedle to remove fluid from a breast lump. If thefluid appears to contain cells, a pathologist at a labchecks them for cancer with a microscope. If thefluid is clear, it may not need to be checked by alab.

• Core biopsy: Your doctor uses a thick needle toremove breast tissue. A pathologist checks forcancer cells. This procedure is also called a needlebiopsy.

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• Surgical biopsy: Your surgeon removes a sample oftissue. A pathologist checks the tissue for cancercells.

—An incisional biopsy takes a sample of a lump orabnormal area.

—An excisional biopsy takes the entire lump orarea.

If cancer cells are found, the pathologist can tellwhat kind of cancer it is. The most common type ofbreast cancer is ductal carcinoma. Abnormal cells arefound in the lining of the ducts. Lobular carcinoma isanother type. Abnormal cells are found in the lobules.

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You may want to ask the doctor the followingquestions before having a biopsy:

• What kind of biopsy will I have? Why?

• How long will it take? Will I be awake? Will ithurt? Will I have anesthesia? What kind?

• Are there any risks? What are the chances ofinfection or bleeding after the biopsy?

• How soon will I know the results?

• If I do have cancer, who will talk with meabout the next steps? When?

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Additional Tests

f you are diagnosed with cancer, your doctor mayorder special lab tests on the breast tissue that was

removed. These tests help your doctor learn moreabout the cancer and plan treatment:

• Hormone receptor test: This test shows whether thetissue has certain hormone receptors. Tissue withthese receptors needs hormones (estrogen orprogesterone) to grow.

• HER2 test: This test shows whether the tissue has aprotein called human epidermal growth factorreceptor-2 (HER2) or the HER2/neu gene. Havingtoo much protein or too many copies of the gene inthe tissue may increase the chance that the breastcancer will come back after treatment.

Staging

o plan your treatment, your doctor needs to knowthe extent (stage) of the disease. The stage is

based on the size of the tumor and whether the cancerhas spread. Staging may involve x-rays and lab tests.These tests can show whether the cancer has spreadand, if so, to what parts of your body. When breastcancer spreads, cancer cells are often found in lymphnodes under the arm (axillary lymph nodes). The stageoften is not known until after surgery to remove thetumor in your breast and the lymph nodes under yourarm.

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These are the stages of breast cancer:

• Stage 0 is carcinoma in situ.

—Lobular carcinoma in situ (LCIS): Abnormalcells are in the lining of a lobule. (See picture oflobule on page 3.) LCIS seldom becomes invasivecancer. However, having LCIS in one breastincreases the risk of cancer for both breasts.

—Ductal carcinoma in situ (DCIS): Abnormalcells are in the lining of a duct. DCIS is alsocalled intraductal carcinoma. The abnormal cellshave not spread outside the duct. They have notinvaded the nearby breast tissue. DCIS sometimesbecomes invasive cancer if not treated.

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DCIS Wall of duct

This picture shows ductal carcinoma in situ.

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• Stage I is an early stage of invasive breast cancer.The tumor is no more than 2 centimeters (three-quarters of an inch) across. Cancer cells have notspread beyond the breast.

Invasive cancer cellsWall of duct

This picture shows cancer cells spreading outside theduct. The cancer cells are invading nearby breasttissue.

• Stage II is one of the following:

—The tumor in the breast is no more than 2centimeters (three-quarters of an inch) across. Thecancer has spread to the lymph nodes under thearm.

—The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer mayhave 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 nodesunder the arm.

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• Stage III may be a large tumor, but the cancer hasnot spread beyond the breast and nearby lymphnodes. It is locally advanced cancer.

—Stage IIIA is one of the following:

• The tumor in the breast is smaller than 5centimeters (2 inches). The cancer has spreadto underarm lymph nodes that are attached toeach other or to other structures.

• The tumor is more than 5 centimeters across.The cancer has spread to the underarm lymphnodes.

—Stage IIIB is one of the following:

• The tumor has grown into the chest wall or theskin of the breast.

• The cancer has spread to lymph nodes behindthe breastbone.

• Inflammatory breast cancer is a rare type ofStage IIIB breast cancer. The breast looks redand swollen because cancer cells block thelymph vessels in the skin of the breast.

—Stage IIIC is a tumor of any size. It has spread inone of the following ways:

• The cancer has spread to the lymph nodesbehind the breastbone and under the arm.

• The cancer has spread to the lymph nodesunder or above the collarbone.

• Stage IV is distant metastatic cancer. The cancer hasspread to other parts of the body.

• Recurrent cancer is cancer that has come back(recurred) after a period of time when it could notbe detected. It may recur locally in the breast orchest wall. Or it may recur in any other part of thebody, such as the bone, liver, or lungs.

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Treatment

any women with breast cancer want to take anactive part in making decisions about their

medical care. It is natural to want to learn all you canabout your disease and treatment choices. Knowingmore about breast cancer helps many women cope.

Shock and stress after the diagnosis can make ithard to think of everything you want to ask yourdoctor. It often helps to make a list of questions beforean appointment. To help remember what the doctorsays, you may take notes or ask whether you may use atape recorder. You may also want to have a familymember or friend with you when you talk to thedoctor—to take part in the discussion, to take notes, orjust to listen.

You do not need to ask all your questions at once.You will have other chances to ask your doctor ornurse to explain things that are not clear and to ask formore details.

Your doctor may refer you to a specialist, or youmay ask for a referral. Specialists who treat breastcancer include surgeons, medical oncologists, andradiation oncologists. You also may be referred to aplastic surgeon.

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Getting a Second OpinionBefore starting treatment, you might want a second

opinion about your diagnosis and treatment plan. Manyinsurance companies cover a second opinion if you oryour doctor requests it. It may take some time andeffort to gather medical records and arrange to seeanother doctor. You may have to gather yourmammogram films, biopsy slides, pathology report,and proposed treatment plan. Usually it is not aproblem to take several weeks to get a second opinion.In most cases, the delay in starting treatment will notmake treatment less effective. To make sure, youshould discuss this delay with your doctor. Somewomen with breast cancer need treatment right away.

There are a number of ways to find a doctor for asecond opinion:

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• Your doctor may refer you to one or morespecialists. At cancer centers, several specialistsoften work together as a team.

• NCI’s Cancer Information Service, at1–800–4–CANCER, can tell you about nearbytreatment centers. Information Specialists also canprovide online assistance through LiveHelp athttp://www.cancer.gov.

• A local or state medical society, a nearby hospital, ora medical school can usually provide the names ofspecialists.

• The American Board of Medical Specialties(ABMS) has a list of doctors who have had trainingand passed exams in their specialty. You can findthis list in the Official ABMS Directory of BoardCertified Medical Specialists. This Directory is inmost public libraries. Also, ABMS offers thisinformation at http://www.abms.org. (Click on“Who’s Certified.”)

• NCI provides a helpful fact sheet called “How ToFind a Doctor or Treatment Facility If You HaveCancer.”

Treatment MethodsWomen with breast cancer have many treatment

options. These include surgery, radiation therapy,chemotherapy, hormone therapy, and biologicaltherapy. These options are described on pages 26through 38. Many women receive more than one typeof treatment.

The choice of treatment depends mainly on the stageof the disease. Treatment options by stage aredescribed on pages 39 through 42.

Your doctor can describe your treatment choices andthe expected results. You may want to know howtreatment may change your normal activities. You may

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want to know how you will look during and aftertreatment. You and your doctor can work together todevelop a treatment plan that reflects your medicalneeds and personal values.

Cancer treatment is either local therapy or systemictherapy:

• Local therapy: Surgery and radiation therapy arelocal treatments. They remove or destroy cancer inthe breast. When breast cancer has spread to otherparts of the body, local therapy may be used tocontrol the disease in those specific areas.

• Systemic therapy: Chemotherapy, hormonetherapy, and biological therapy are systemictreatments. They enter the bloodstream and destroyor control cancer throughout the body. Some womenwith breast cancer have systemic therapy to shrinkthe tumor before surgery or radiation. Others havesystemic therapy after surgery and/or radiation toprevent the cancer from coming back. Systemictreatments also are used for cancer that has spread.

Because cancer treatments often damage healthycells and tissues, side effects are common. Side effectsdepend mainly on the type and extent of the treatment.Side effects may not be the same for each woman, andthey may change from one treatment session to the next.

Before treatment starts, your health care team willexplain possible side effects and suggest ways to helpyou manage them. NCI provides helpful booklets aboutcancer treatments and coping with side effects. Theseinclude Radiation Therapy and You, Chemotherapyand You, Biological Therapy, and Eating Hints forCancer Patients.

At any stage of disease, supportive care is availableto control pain and other symptoms, to relieve the sideeffects of treatment, and to ease emotional concerns.Information about such care is available on NCI’s Web

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site at http://www.cancer.gov/cancertopics/copingand from Information Specialists at1–800–4–CANCER or LiveHelp.

You may want to talk to your doctor about takingpart in a clinical trial, a research study of newtreatment methods. The section on “The Promise ofCancer Research” on page 50 has more informationabout clinical trials.

You may want to ask your doctor thesequestions before your treatment begins:

• What did the hormone receptor test show?What did other lab tests show?

• Do any lymph nodes show signs of cancer?

• What is the stage of the disease? Has thecancer spread?

• What is the goal of treatment? What are mytreatment choices? Which do you recommendfor me? Why?

• What are the expected benefits of each kind oftreatment?

• What are the risks and possible side effects ofeach treatment? How can side effects bemanaged?

• What can I do to prepare for treatment?

• Will I need to stay in the hospital? If so, forhow long?

• What is the treatment likely to cost? Will myinsurance cover the cost?

• How will treatment affect my normalactivities?

• Would a clinical trial be appropriate for me?

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Surgery

Surgery is the most common treatment for breastcancer. There are several types of surgery. (See pictureson pages 27 and 28.) Your doctor can explain eachtype, discuss and compare the benefits and risks, anddescribe how each will change the way you look.

• Breast-sparing surgery: An operation to remove thecancer but not the breast is breast-sparing surgery. Itis also called breast-conserving surgery,lumpectomy, segmental mastectomy, and partialmastectomy. Sometimes an excisional biopsy servesas a lumpectomy because the surgeon removes thewhole lump.

The surgeon often removes the underarm lymphnodes as well. A separate incision is made. Thisprocedure is called an axillary lymph nodedissection. It shows whether cancer cells haveentered the lymphatic system.

After breast-sparing surgery, most women receiveradiation therapy to the breast. This treatmentdestroys cancer cells that may remain in the breast.

• Mastectomy: An operation to remove the breast (oras much of the breast tissue as possible) is amastectomy. In most cases, the surgeon alsoremoves lymph nodes under the arm. Some womenhave radiation therapy after surgery.

Studies have found equal survival rates for breast-sparing surgery (with radiation therapy) andmastectomy for Stage I and Stage II breast cancer.

Sentinel lymph node biopsy is a new method ofchecking for cancer cells in the lymph nodes. Asurgeon removes fewer lymph nodes, which causesfewer side effects. (If the doctor finds cancer cells inthe axillary lymph nodes, an axillary lymph nodedissection usually is done.) Information about ongoingstudies of sentinel lymph node biopsy is on page 53 in

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the section on “The Promise of Cancer Research.”These studies will learn the lasting effects of removingfewer lymph nodes.

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In breast-sparing surgery, the surgeon removes thetumor in the breast and some tissue around it. Thesurgeon may also remove lymph nodes under thearm. The surgeon sometimes removes some of thelining over the chest muscles below the tumor.

In total (simple) mastectomy, the surgeon removes thewhole breast. Some lymph nodes under the arm mayalso be removed.

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You may choose to have breast reconstruction. Thisis plastic surgery to rebuild the shape of the breast. Itmay be done at the same time as a mastectomy or later.If you are considering reconstruction, you may wish totalk with a plastic surgeon before having a mastectomy.More information is on page 43 in the “BreastReconstruction” section.

The time it takes to heal after surgery is different foreach woman. Surgery causes pain and tenderness.Medicine can help control the pain. Before surgery,you should discuss the plan for pain relief with yourdoctor or nurse. After surgery, your doctor can adjustthe plan if you need more relief. Any kind of surgeryalso carries a risk of infection, bleeding, or otherproblems. You should tell your health care providerright away if you develop any problems.

You may feel off balance if you’ve had one or bothbreasts removed. You may feel more off balance if youhave large breasts. This imbalance can cause

In modified radical mastectomy, the surgeon removesthe whole breast, and most or all of the lymph nodesunder the arm. Often, the lining over the chest musclesis removed. A small chest muscle also may be takenout to make it easier to remove the lymph nodes.

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discomfort in your neck and back. Also, the skin whereyour breast was removed may feel tight. Your arm andshoulder muscles may feel stiff and weak. Theseproblems usually go away. The doctor, nurse, orphysical therapist can suggest exercises to help youregain movement and strength in your arm andshoulder. Exercise can also reduce stiffness and pain.You may be able to begin gentle exercises within daysof surgery.

Because nerves may be injured or cut duringsurgery, you may have numbness and tingling in yourchest, underarm, shoulder, and upper arm. Thesefeelings usually go away within a few weeks ormonths. But for some women, numbness does not goaway.

Removing the lymph nodes under the arm slows theflow of lymph fluid. The fluid may build up in yourarm and hand and cause swelling. This swelling islymphedema. Lymphedema can develop right aftersurgery or months to years later.

You will need to protect your arm and hand on thetreated side for the rest of your life:

• Avoid wearing tight clothing or jewelry on youraffected arm

• Carry your purse or luggage with the other arm

• Use an electric razor to avoid cuts when shavingunder your arm

• Have shots, blood tests, and blood pressuremeasurements on the other arm

• Wear gloves to protect your hands when gardeningand when using strong detergents

• Have careful manicures and avoid cutting yourcuticles

• Avoid burns or sunburns to your affected arm andhand

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You should ask your doctor how to handle any cuts,insect bites, sunburn, or other injuries to your arm orhand. Also, you should contact the doctor if your armor hand is injured, swells, or becomes red and warm.

If lymphedema occurs, the doctor may suggestraising your arm above your heart whenever you can.The doctor may show you hand and arm exercises.Some women with lymphedema wear an elastic sleeveto improve lymph circulation. Medication, manuallymph drainage (massage), or use of a machine thatgently compresses the arm may also help. You may bereferred to a physical therapist or another specialist.

More information about lymphedema is available onNCI’s Web site at http://www.cancer.gov and fromInformation Specialists at 1–800–4–CANCER orLiveHelp.

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You may want to ask your doctor thesequestions before having surgery:

• What kinds of surgery can I consider? Isbreast-sparing surgery an option for me?Which operation do you recommend for me?Why?

• Will my lymph nodes be removed? Howmany? Why?

• How will I feel after the operation? Will I haveto stay in the hospital?

• Will I need to learn how to take care of myselfor my incision when I get home?

• Where will the scars be? What will they looklike?

• If I decide to have plastic surgery to rebuildmy breast, how and when can that be done?Can you suggest a plastic surgeon for me tocontact?

• Will I have to do special exercises to helpregain motion and strength in my arm andshoulder? Will a physical therapist or nurseshow me how to do the exercises?

• Is there someone I can talk with who has hadthe same surgery I'll be having?

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Radiation Therapy

Radiation therapy (also called radiotherapy) useshigh-energy rays to kill cancer cells. Most womenreceive radiation therapy after breast-sparing surgery.Some women receive radiation therapy after amastectomy. Treatment depends on the size of thetumor and other factors. The radiation destroys breastcancer cells that may remain in the area.

Some women have radiation therapy before surgeryto destroy cancer cells and shrink the tumor. Doctorsuse this approach when the tumor is large or may behard to remove. Some women have chemotherapy orhormone therapy before surgery.

Doctors use two types of radiation therapy to treatbreast cancer. Some women receive both types:

• External radiation: The radiation comes from alarge machine outside the body. Most women go toa hospital or clinic for treatment. Treatments areusually 5 days a week for several weeks.

• Internal radiation (implant radiation): Thin plastictubes (implants) that hold a radioactive substanceare put directly in the breast. The implants stay inplace for several days. A woman stays in thehospital while she has implants. Doctors remove theimplants before she goes home.

Side effects depend mainly on the dose and type ofradiation and the part of your body that is treated.

It is common for the skin in the treated area tobecome red, dry, tender, and itchy. Your breast mayfeel heavy and tight. These problems will go away overtime. Toward the end of treatment, your skin maybecome moist and “weepy.” Exposing this area to airas much as possible can help the skin heal.

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Bras and some other types of clothing may rub yourskin and cause soreness. You may want to wear loose-fitting cotton clothes during this time. Gentle skin carealso is important. You should check with your doctorbefore using any deodorants, lotions, or creams on thetreated area. These effects of radiation therapy on theskin will go away. The area gradually heals oncetreatment is over. However, there may be a lastingchange in the color of your skin.

You are likely to become very tired during radiationtherapy, especially in the later weeks of treatment.Resting is important, but doctors usually advisepatients to try to stay as active as they can.

Although the side effects of radiation therapy can bedistressing, your doctor can usually relieve them.

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You may want to ask your doctor thesequestions before having radiation therapy:

• How will radiation be given?

• When will treatment start? When will it end?How often will I have treatments?

• How will I feel during treatment? Will I beable to drive myself to and from treatment?

• How will we know the treatment is working?

• What can I do to take care of myself before,during, and after treatment?

• Will treatment affect my skin?

• How will my chest look afterward?

• Are there any long-term effects?

• What is the chance that the cancer will comeback in my breast?

• How often will I need checkups?

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Chemotherapy

Chemotherapy uses anticancer drugs to kill cancercells. Chemotherapy for breast cancer is usually acombination of drugs. The drugs may be given as a pillor by injection into a vein (IV). Either way, the drugsenter the bloodstream and travel throughout the body.

Women with breast cancer can have chemotherapyin an outpatient part of the hospital, at the doctor’soffice, or at home. Some women need to stay in thehospital during treatment.

Side effects depend mainly on the specific drugs andthe dose. The drugs affect cancer cells and other cellsthat divide rapidly:

• Blood cells: These cells fight infection, help yourblood to clot, and carry oxygen to all parts of thebody. When drugs affect your blood cells, you aremore likely to get infections, bruise or bleed easily,and feel very weak and tired. Years afterchemotherapy, some women have developedleukemia (cancer of the blood cells).

• Cells in hair roots: Chemotherapy can cause hairloss. Your hair will grow back, but it may besomewhat different in color and texture.

• Cells that line the digestive tract: Chemotherapycan cause poor appetite, nausea and vomiting,diarrhea, or mouth and lip sores.

Your doctor can suggest ways to control many ofthese side effects.

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Some drugs used for breast cancer can causetingling or numbness in the hands or feet. This problemusually goes away after treatment is over. Otherproblems may not go away. In some women, the drugsused for breast cancer may weaken the heart.

Some anticancer drugs can damage the ovaries. Theovaries may stop making hormones. You may havesymptoms of menopause such as hot flashes andvaginal dryness. Your menstrual periods may no longerbe regular or may stop. Some women become infertile(unable to become pregnant). For women over the ageof 35, infertility is likely to be permanent.

On the other hand, you may remain fertile duringchemotherapy and be able to become pregnant. Theeffects of chemotherapy on an unborn child are notknown. You should talk to your doctor about birthcontrol before treatment begins.

Hormone Therapy

Some breast tumors need hormones to grow.Hormone therapy keeps cancer cells from getting orusing the natural hormones they need. These hormonesare estrogen and progesterone. Lab tests can show if abreast tumor has hormone receptors. If you have thiskind of tumor, you may have hormone therapy.

This treatment uses drugs or surgery:

• Drugs: Your doctor may suggest a drug that canblock the natural hormone. One drug is tamoxifen,which blocks estrogen. A drug called an aromataseinhibitor prevents the body from making the femalehormone estradiol. Estradiol is a form of estrogen.If you have not gone through menopause, yourdoctor may give you a drug that stops the ovariesfrom making estrogen.

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• Surgery: If you have not gone through menopause,you may have surgery to remove your ovaries. Theovaries are the main source of the body’s estrogen.A woman who has gone through menopause doesnot need surgery. (The ovaries produce less estrogenafter menopause.)

The side effects of hormone therapy depend largelyon the specific drug or type of treatment. Tamoxifen isthe most common hormone treatment. In general, theside effects of tamoxifen are similar to some of thesymptoms of menopause. The most common are hotflashes and vaginal discharge. Other side effects areirregular menstrual periods, headaches, fatigue, nausea,vomiting, vaginal dryness or itching, irritation of theskin around the vagina, and skin rash. Not all womenwho take tamoxifen have side effects.

It is possible to become pregnant when takingtamoxifen. Tamoxifen may harm the unborn baby. Ifyou are still menstruating, you should discuss birthcontrol methods with your doctor.

Serious side effects of tamoxifen are rare. However,it can cause blood clots in the veins. Blood clots formmost often in the legs and in the lungs. Women have aslight increase in their risk of stroke.

Tamoxifen can cause cancer of the uterus. Yourdoctor should perform regular pelvic exams. Youshould tell your doctor about any unusual vaginalbleeding between exams.

When the ovaries are removed, menopause occurs atonce. The side effects are often more severe than thosecaused by natural menopause. Your health careprovider can suggest ways to cope with these sideeffects.

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Biological Therapy

Biological therapy helps the immune system fightcancer. The immune system is the body’s naturaldefense against disease.

Some women with breast cancer that has spreadreceive a biological therapy called Herceptin®

(trastuzumab). It is a monoclonal antibody. It is madein the laboratory and binds to cancer cells.

Herceptin is given to women whose lab tests showthat a breast tumor has too much of a specific proteinknown as HER2. By blocking HER2, it can slow orstop the growth of the cancer cells.

Herceptin is given by vein. It may be given alone orwith chemotherapy.

The first time a woman receives Herceptin, the mostcommon side effects are fever and chills. Some womenalso have pain, weakness, nausea, vomiting, diarrhea,headaches, difficulty breathing, or rashes. Side effectsusually become milder after the first treatment.

Herceptin also may cause heart damage. This maylead to heart failure. Herceptin can also affect thelungs. It can cause breathing problems that require adoctor at once. Before you receive Herceptin, yourdoctor will check your heart and lungs. Duringtreatment, your doctor will watch for signs of lungproblems.

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Treatment Choices by StageYour treatment options depend on the stage of your

disease and these factors:

• The size of the tumor in relation to the size of yourbreast

• The results of lab tests (such as whether the breastcancer cells need hormones to grow)

• Whether you have gone through menopause

• Your general health

On the following pages are brief descriptions ofcommon treatments for each stage. Other treatmentsmay be appropriate for some women. Clinical trials

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You may want to ask your doctor thesequestions before having chemotherapy, hormonetherapy, or biological therapy:

• What drugs will I be taking? What will theydo?

• If I need hormone treatment, would yourecommend drugs or surgery to remove myovaries?

• When will treatment start? When will it end?How often will I have treatments?

• Where will I go for treatment? Will I be able todrive home afterward?

• What can I do to take care of myself duringtreatment?

• How will we know the treatment is working?

• Which side effects should I tell you about?

• Will there be long-term effects?

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can be an option at all stages of breast cancer. “ThePromise of Cancer Research” section on page 50 hasinformation about clinical trials.

Stage 0

Stage 0 breast cancer refers to lobular carcinoma insitu (LCIS) or ductal carcinoma in situ (DCIS):

• LCIS: Most women with LCIS do not havetreatment. Instead, the doctor may suggest regularcheckups to watch for signs of breast cancer.

Some women take tamoxifen to reduce the risk ofdeveloping breast cancer. Others may take part instudies of promising new preventive treatments.

Having LCIS in one breast increases the risk ofcancer for both breasts. A very small number ofwomen with LCIS try to prevent cancer withsurgery to remove both breasts. This is a bilateralprophylactic mastectomy. The surgeon usually doesnot remove the underarm lymph nodes.

• DCIS: Most women with DCIS have breast-sparingsurgery followed by radiation therapy. Some womenchoose to have a total mastectomy. Underarm lymphnodes are not usually removed. Women with DCISmay take tamoxifen to reduce the risk of developinginvasive breast cancer.

Stages I, II, IIIA, and Operable IIIC

Women with Stages I, II, IIIA, and operable (cantreat with surgery) IIIC breast cancer may have acombination of treatments. Some may have breast-sparing surgery followed by radiation therapy to thebreast. This choice is common for women with Stage Ior II breast cancer. Others decide to have amastectomy.

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With either approach, women (especially those withStage II or IIIA breast cancer) often have lymph nodesunder the arm removed. The doctor may suggestradiation therapy after mastectomy if cancer cells arefound in 1 to 3 lymph nodes under the arm, or if thetumor in the breast is large. If cancer cells are found inmore than 3 lymph nodes under the arm, the doctorusually will suggest radiation therapy aftermastectomy.

The choice between breast-sparing surgery(followed by radiation therapy) and mastectomydepends on many factors:

• The size, location, and stage of the tumor

• The size of the woman’s breast

• Certain features of the cancer

• How the woman feels about saving her breast

• How the woman feels about radiation therapy

• The woman’s ability to travel to a radiationtreatment center

Some women have chemotherapy before surgery.This is neoadjuvant therapy (treatment before the maintreatment). Chemotherapy before surgery may shrink alarge tumor so that breast-sparing surgery is possible.Women with large Stage II or IIIA breast tumors oftenchoose this treatment.

After surgery, many women receive adjuvanttherapy. Adjuvant therapy is treatment given after themain treatment to increase the chances of a cure.Radiation treatment can kill cancer cells in and near thebreast. Women also may have systemic treatment suchas chemotherapy, hormone therapy, or both. Thistreatment can destroy cancer cells that remainanywhere in the body. It can prevent the cancer fromcoming back in the breast or elsewhere.

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Stages IIIB and Inoperable IIIC

Women with Stage IIIB (including inflammatorybreast cancer) or inoperable Stage IIIC breast cancerusually have chemotherapy. (Inoperable cancer meansit cannot be treated with surgery.)

If the chemotherapy shrinks the tumor, the doctorthen may suggest further treatment:

• Mastectomy: The surgeon removes the breast. Inmost cases, the lymph nodes under the arm areremoved. After surgery, a woman may receiveradiation therapy to the chest and underarm area.

• Breast-sparing surgery: The surgeon removes thecancer but not the breast. In most cases, the lymphnodes under the arm are removed. After surgery, awoman may receive radiation therapy to the breastand underarm area.

• Radiation therapy instead of surgery: Somewomen have radiation therapy but no surgery. Thedoctor also may recommend more chemotherapy,hormone therapy, or both. This therapy may helpprevent the disease from coming back in the breastor elsewhere.

Stage IV

In most cases, women with Stage IV breast cancerhave hormone therapy, chemotherapy, or both. Somealso may have biological therapy. Radiation may beused to control tumors in certain parts of the body.These treatments are not likely to cure the disease, butthey may help a woman live longer.

Many women have supportive care along withanticancer treatments. Anticancer treatments are givento slow the progress of the disease. Supportive carehelps manage pain, other symptoms, or side effects(such as nausea). It does not aim to extend a woman’s

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life. Supportive care can help a woman feel betterphysically and emotionally. Some women withadvanced cancer decide to have only supportive care.

Recurrent Breast Cancer

Recurrent cancer is cancer that has come back afterit seemed to be gone. Treatment for the recurrentdisease depends mainly on the location and extent ofthe cancer. Another main factor is the type of treatmentthe woman had before.

If breast cancer comes back only in the breast afterbreast-sparing surgery, the woman may have amastectomy. Chances are good that the disease will notcome back again.

If breast cancer recurs in other parts of the body,treatment may involve chemotherapy, hormonetherapy, or biological therapy. Radiation therapy mayhelp control cancer that recurs in the chest muscles orin certain other areas of the body.

Treatment can seldom cure cancer that recursoutside the breast. Supportive care is often animportant part of the treatment plan. Many patientshave supportive care to ease their symptoms andanticancer treatments to slow the progress of thedisease. Some receive only supportive care to improvetheir quality of life.

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Breast Reconstruction

ome women who plan to have a mastectomydecide to have breast reconstruction. Other

women prefer to wear a breast form (prosthesis).Others decide to do nothing. All of these options havepros and cons. What is right for one woman may notbe right for another. What is important is that nearlyevery woman treated for breast cancer has choices.

Breast reconstruction may be done at the same timeas the mastectomy, or later on. If you are thinkingabout breast reconstruction, you should talk to a plasticsurgeon before the mastectomy, even if you plan tohave your reconstruction later on.

There are many ways to reconstruct the breast.Some women choose to have implants. Implants maybe made of saline or silicone. The safety of siliconebreast implants has been under review by the Foodand Drug Administration (FDA) for several years.If you are thinking about having silicone implants,you may want to talk with your doctor about theFDA findings. Your doctor can tell you ifsilicone implants are an option. You also can readinformation from the FDA on breast implants athttp://www.fda.gov/cdrh/breastimplants.

You also may have breast reconstruction with tissuethat the plastic surgeon moves from another part ofyour body. Skin, muscle, and fat can come from yourlower abdomen, back, or buttocks. The surgeon usesthis tissue to create a breast shape.

Which type of reconstruction is best depends onyour age, body type, and the type of surgery you had.The plastic surgeon can explain the risks and benefitsof each type of reconstruction.

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You may want to ask your doctor thesequestions about breast reconstruction:

• What is the latest information about the safetyof silicone breast implants?

• Which type of surgery would give me the bestresults? How will I look afterward?

• When can my reconstruction begin?

• How many surgeries will I need?

• What are the risks at the time of surgery?Later?

• Will I have scars? Where? What will they looklike?

• If tissue from another part of my body is used,will there be any permanent changes where thetissue was removed?

• What activities should I avoid? When can Ireturn to my normal activities?

• Will I need follow-up care?

• How much will reconstruction cost? Will myhealth insurance pay for it?

Complementary and Alternative Medicine

ome women with breast cancer usecomplementary and alternative medicine (CAM):

• An approach is generally called complementarymedicine when it is used along with standardtreatment.

• An approach is called alternative medicine when it isused instead of standard treatment.

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Acupuncture, massage therapy, herbal products,vitamins or special diets, visualization, meditation, andspiritual healing are types of CAM.

Many women say that CAM helps them feel better.However, some types of CAM may change the waystandard treatment works. These changes could beharmful. And some types of CAM could be harmfuleven if used alone.

Some types of CAM are expensive. Healthinsurance may not cover the cost.

NCI offers a fact sheet called “Complementary andAlternative Medicine in Cancer Treatment: Questionsand Answers.”

You also may request materials from the FederalGovernment’s National Center for Complementary andAlternative Medicine. You can reach their clearing-house toll-free at 1–888–644–6226 (voice) and1–866–464–3615 (TTY). In addition, you can visit theCenter’s Web site at http://www.nccam.nih.gov, orsend an email to info@nccam.nih.gov.

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You may want to ask the doctor thesequestions before you decide to use CAM:

• What benefits can I expect from this therapy?

• What are its risks?

• Do the expected benefits outweigh the risks?

• What side effects should I watch for?

• Will the therapy change the way my cancertreatment works? Could this be harmful?

• Is this therapy under study in a clinical trial?If so, who sponsors the trial?

• Will my health insurance pay for this therapy?

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Nutrition and Physical Activity

t is important for women with breast cancer totake care of themselves. Taking care of yourself

includes eating well and staying as active as you can.

You need the right amount of calories to maintain agood weight. You also need enough protein to keep upyour strength. Eating well may help you feel better andhave more energy.

Sometimes, especially during or soon aftertreatment, you may not feel like eating. You may beuncomfortable or tired. You may find that foods do nottaste as good as they used to. In addition, the sideeffects of treatment (such as poor appetite, nausea,vomiting, or mouth sores) can make it hard to eat well.Your doctor, dietitian, or other health care provider cansuggest ways to deal with these problems. Also, theNCI booklet Eating Hints for Cancer Patients hasmany useful ideas and recipes.

Many women find they feel better when they stayactive. Walking, yoga, swimming, and other activitiescan keep you strong and increase your energy. Exercisemay reduce nausea and pain and make treatment easierto handle. It also can help relieve stress.

Whatever physical activity you choose, be sure totalk to your doctor before you start. If your activitycauses you pain or other problems, be sure to let yourdoctor or nurse know. You may want to try a differentexercise instead.

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Follow-up Care

ollow-up care after treatment for breast cancer isimportant. Recovery is different for each woman.

Your recovery depends on your treatment, whether thedisease has spread, and other factors.

Even when the cancer seems to have beencompletely removed or destroyed, the diseasesometimes returns because undetected cancer cellsremained somewhere in the body after treatment. Yourdoctor will monitor your recovery and check forrecurrence of the cancer.

You should report any changes in the treated area orin your other breast to the doctor right away. Tell yourdoctor about any health problems, such as pain, loss ofappetite or weight, changes in menstrual cycles,unusual vaginal bleeding, or blurred vision. Also talkto your doctor about headaches, dizziness, shortness ofbreath, coughing or hoarseness, backaches, or digestiveproblems that seem unusual or that don’t go away.Such problems may arise months or years aftertreatment. They may suggest that the cancer hasreturned, but they can also be symptoms of other healthproblems. It is important to share your concerns withyour doctor so problems can be diagnosed and treatedas soon as possible.

Follow-up exams usually include the breasts, chest,neck, and underarm areas. Since you are at risk ofgetting cancer again, you should have mammograms ofyour preserved breast and your other breast. Youprobably will not need a mammogram of areconstructed breast or if you had a mastectomywithout reconstruction. Your doctor may order otherimaging procedures or lab tests.

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Facing Forward Series: Life After Cancer Treatmentis an NCI booklet for people who have completed theirtreatment. It answers questions about follow-up careand other concerns. It has tips for making the best useof medical visits. It also suggests ways to talk with thedoctor about creating a plan of action for recovery andfuture health.

Sources of Support

earning you have breast cancer can change yourlife and the lives of those close to you. These

changes can be hard to handle. It is normal for you,your family, and your friends to have many differentand sometimes confusing feelings.

You may worry about caring for your family,keeping your job, or continuing daily activities.Concerns about treatments and managing side effects,hospital stays, and medical bills are also common.Doctors, nurses, and other members of the health careteam can answer questions about treatment, working,or other activities. Meeting with a social worker,counselor, or member of the clergy can be helpful ifyou want to talk about your feelings or concerns.Often, a social worker can suggest resources forfinancial aid, transportation, home care, or emotionalsupport.

Friends and relatives can be very supportive. Also,you may find it helps to discuss your concerns withothers who have cancer. Women with breast canceroften get together in support groups to share what theyhave learned about coping with their disease and theeffects of their treatment. It is important to keep inmind, however, that each woman is different. Waysthat one woman deals with cancer may not be right for

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another. You may want to ask your health care providerabout advice you receive from other women withbreast cancer.

Several organizations offer special programs forwomen with breast cancer. Women who have had thedisease serve as trained volunteers. They may talk withor visit women with breast cancer, provide information,and lend emotional support. They often share theirexperiences with breast cancer treatment, breastreconstruction, and recovery.

You may be afraid that changes to your body willaffect not only how you look but also how other peoplefeel about you. You may worry that breast cancer andits treatment will affect your sexual relationships.Many couples find it helps to talk about their concerns.Some find that counseling or a couples’ support groupcan be helpful.

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Information Specialists at 1–800–4–CANCER andat LiveHelp (http://www.cancer.gov) can help youlocate programs, services, and publications. Also, youmay want to read the NCI fact sheets “NationalOrganizations That Offer Services to People WithCancer and Their Families.”

The Promise of Cancer Research

octors all over the country are conducting manytypes of clinical trials (research studies in which

people volunteer to take part). They are studying newways to prevent, detect, diagnose, and treat breastcancer. Some are also studying therapies that mayimprove the quality of life for women during or aftercancer treatment.

Clinical trials are designed to answer importantquestions and to find out whether new approaches aresafe and effective. Research already has led toadvances and researchers continue to search for moreeffective methods for dealing with cancer.

Women who join clinical trials may be among thefirst to benefit if a new approach is effective. And evenif people in a trial do not benefit directly, they stillmake an important contribution by helping doctorslearn more about breast cancer and how to control it.Although clinical trials may pose some risks,researchers do all they can to protect their patients.

If you are interested in being part of a clinical trial,talk with your doctor. Trials are available for all stagesof breast cancer. You may want to read the NCIbooklet Taking Part in Clinical Trials: What CancerPatients Need To Know or Taking Part in ClinicalTrials: Cancer Prevention Studies. NCI also offers an

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easy-to-read brochure called If You Have Cancer…What You Should Know About Clinical Trials. TheseNCI publications describe how clinical trials arecarried out and explain their possible benefits andrisks.

NCI’s Web site includes a section on clinical trials athttp://www.cancer.gov/clinical_trials. It has generalinformation about clinical trials as well as detailedinformation about specific ongoing studies of breastcancer. Information Specialists at 1–800–4–CANCERor at LiveHelp at http://www.cancer.gov can answerquestions and provide information about clinical trials.

Research on PreventionScientists are looking for drugs that may prevent

breast cancer. For example, they are testing severaldifferent drugs that lower hormone levels or prevent ahormone’s effect on breast cells.

In one large study, the drug tamoxifen reduced thenumber of new cases of breast cancer among womenwho were at an increased risk of the disease. Doctorsare studying whether the drug raloxifene is as effectiveas tamoxifen. This study is called STAR (Study ofTamoxifen and Raloxifene). Results will be availablein late 2006.

Research on Detection, Diagnosis, and StagingAt this time, mammograms are the most effective

tool we have to detect changes in the breast that maybe cancer. In women at high risk of breast cancer,researchers are studying the combination ofmammograms and ultrasound. Researchers are alsoexploring positron emission tomography (PET) andother ways to make detailed pictures of breast tissue.

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In addition, researchers are studying tumor markers.Tumor markers may be found in blood, in urine, or influid from the breast (nipple aspirate). High amountsof these substances may be a sign of cancer. Somemarkers may be used to check breast cancer patientsfor signs of disease after treatment. At this time,however, no tumor marker test is reliable enough to beused routinely to detect breast cancer.

Ductal lavage also is under study. This techniquecollects cells from breast ducts. A liquid flows througha catheter (very thin, flexible tube) into the opening ofa milk duct on the nipple. The liquid and breast cellsare withdrawn through the tube. A pathologist checksthe cells for cancer or changes that may suggest anincreased risk of cancer.

Research on TreatmentResearchers are studying many types of treatment

and their combinations:

• Surgery: Different types of surgery are beingcombined with other treatments.

• Radiation therapy: Doctors are studying whetherradiation therapy can be used instead of surgery totreat cancer in lymph nodes. They are looking at theeffectiveness of radiation therapy to a larger areaaround the breast. In women with early breastcancer, doctors are studying whether radiationtherapy to a smaller part of the breast may behelpful.

• Chemotherapy: Researchers are testing newanticancer drugs and doses. They are working withdrugs and combinations of drugs. They are lookingat new drug combinations before surgery. They arealso looking at new ways of combining chemo-therapy with hormone therapy or radiation therapy.

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• Hormone therapy: Researchers are testing severaltypes of hormone therapy, including aromataseinhibitors.

• Biological therapy: New biological treatments alsoare under study. For example, researchers arestudying cancer vaccines that help the immunesystem kill cancer cells.

In addition, researchers are looking at ways to lessenthe side effects from treatment, such as lymphedemafrom surgery. They are looking at ways to reduce painand improve quality of life. One method under study issentinel lymph node biopsy. Today, surgeons have toremove many lymph nodes under the arm and checkeach of them for cancer. Researchers are studyingwhether checking only the node to which cancer ismost likely to spread (sentinel lymph node) will allowthem to predict whether cancer has spread to othernodes. If this new procedure works as well as standardtreatment, surgeons may be able to remove fewerlymph nodes. This could reduce lymphedema for manypatients.

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Dictionary

Acupuncture (AK-yoo-PUNK-cher): The technique ofinserting thin needles through the skin at specificpoints on the body to control pain and other symptoms.It is a type of complementary and alternative medicine.

Adjuvant therapy (AD-joo-vant): Treatment given afterthe primary treatment to increase the chances of a cure.Adjuvant therapy may include chemotherapy, radiationtherapy, hormone therapy, or biological therapy.

Anesthesia (an-es-THEE-zha): Drugs or substancesthat cause loss of feeling or awareness. Localanesthetics cause loss of feeling in a part of the body.General anesthetics put the person to sleep.

Areola (a-REE-o-la): The area of dark-colored skin onthe breast that surrounds the nipple.

Aromatase inhibitor (a-ROW-ma-tays in-HIB-it-er): A drug that prevents the formation of estradiol, afemale hormone, by interfering with an aromataseenzyme. Aromatase inhibitors are used as a type ofhormone therapy for postmenopausal women who havehormone-dependent breast cancer.

Aspirate (AS-pi-rit): Fluid withdrawn from a lump(often a cyst) or a nipple.

Atypical hyperplasia (AY-TIP-i-kul hy-per-PLAY-zha):A benign (noncancerous) condition in which cells lookabnormal under a microscope and are increased innumber.

Axilla (ak-SIL-a): The underarm or armpit.

Axillary lymph node (AK-suh-LAIR-ee): A lymphnode in the armpit region that drains lymph channelsfrom the breast.

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Axillary lymph node dissection (AK-suh-LAIR-ee…dis-EK-shun): Surgery to remove lymph nodes foundin the armpit region. Also called axillary dissection.

Bacteria (bak-TEER-ee-uh): A large group of single-cell microorganisms. Some cause infections anddisease in animals and humans. The singular ofbacteria is bacterium.

Benign (beh-NINE): Not cancerous. Benign tumors donot spread to tissues around them or to other parts ofthe body.

Bilateral prophylactic mastectomy (by-LAT-uh-ralpro-fi-LAK-tik mas-TEK-tuh-mee): Surgery to removeboth breasts in order to reduce the risk of developingbreast cancer. Also called preventive mastectomy.

Biological therapy (by-oh-LAH-jih-kul THER-ah-pee):Treatment to stimulate or restore the ability of theimmune system to fight infections and other diseases.Also used to lessen certain side effects that may becaused by some cancer treatments. Also calledimmunotherapy, biotherapy, or biological responsemodifier (BRM) therapy.

Biopsy (BY-op-see): The removal of cells or tissues forexamination by a pathologist. The pathologist maystudy the tissue under a microscope or perform othertests on the cells or tissue. When only a sample oftissue is removed, the procedure is called an incisionalbiopsy. When an entire lump or suspicious area isremoved, the procedure is called an excisional biopsy.When a sample of tissue or fluid is removed with aneedle, the procedure is called a needle biopsy, corebiopsy, or fine-needle aspiration.

BRCA1: A gene on chromosome 17 that normallyhelps to suppress cell growth. A person who inherits analtered version of the BRCA1 gene has a higher risk ofgetting breast, ovarian, or prostate cancer.

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BRCA2: A gene on chromosome 13 that normallyhelps to suppress cell growth. A person who inherits analtered version of the BRCA2 gene has a higher risk ofgetting breast, ovarian, or prostate cancer.

Breast: Glandular organ located on the chest. Thebreast is made up of connective tissue, fat, and breasttissue that contains the glands that can make milk. Alsocalled mammary gland.

Breast reconstruction: Surgery to rebuild the shape ofthe breast after a mastectomy.

Breast self-exam: An exam by a woman of her breaststo check for lumps or other changes.

Breast-conserving surgery or breast-sparing surgery:An operation to remove the breast cancer but not thebreast itself. Types of breast-conserving and breast-sparing surgery include lumpectomy (removal of thelump), quadrantectomy (removal of one quarter, orquadrant, of the breast), and segmental mastectomy(removal of the cancer as well as some of the breasttissue around the tumor and the lining over the chestmuscles below the tumor).

Calcium (KAL-see-um): A mineral found in teeth,bones, and other body tissues.

Cancer: A term for diseases in which abnormal cellsdivide without control. Cancer cells can invade nearbytissues and can spread through the bloodstream andlymphatic system to other parts of the body. There areseveral main types of cancer. Carcinoma is cancer thatbegins in the skin or in tissues that line or coverinternal organs. Sarcoma is cancer that begins in bone,cartilage, fat, muscle, blood vessels, or otherconnective or supportive tissue. Leukemia is cancerthat starts in blood-forming tissue such as the bonemarrow, and causes large numbers of abnormal blood

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cells to be produced and enter the bloodstream.Lymphoma and multiple myeloma are cancers thatbegin in the cells of the immune system.

Carcinoma (KAR-si-NO-ma): Cancer that begins inthe skin or in tissues that line or cover internal organs.

Carcinoma in situ (KAR-si-NO-ma in SYE-too):Cancer that involves only cells in the tissue in which itbegan and that has not spread to nearby tissues.

Cell: The individual unit that makes up the tissues ofthe body. All living things are made up of one or morecells.

Chemotherapy (kee-moh-THER-ah-pee): Treatmentwith drugs that kill cancer cells.

Clinical breast exam: An exam of the breast performedby a health care provider to check for lumps or otherchanges.

Clinical trial: A type of research study that usesvolunteers to test new methods of screening,prevention, diagnosis, or treatment of a disease. Alsocalled a clinical study.

Complementary and alternative medicine: CAM.Forms of treatment that are used in addition to(complementary) or instead of (alternative) standardtreatments. These practices generally are notconsidered standard medical approaches. CAM mayinclude dietary supplements, megadose vitamins,herbal preparations, special teas, acupuncture, massagetherapy, magnet therapy, spiritual healing, andmeditation.

Core biopsy: The removal of a tissue sample with aneedle for examination under a microscope.

Cyst (sist): A sac or capsule in the body. It may befilled with fluid or other material.

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DES: Diethylstilbestrol (dye-ETH-ul-stil-BES-trol).A synthetic form of the hormone estrogen that wasprescribed to pregnant women between about 1940 and1971 because it was thought to prevent miscarriages.DES may increase the risk of uterine, ovarian, or breastcancer in women who took it. DES also has beenlinked to an increased risk of clear cell carcinoma ofthe vagina or cervix in daughters exposed to DESbefore birth.

Diagnostic mammogram: X-ray of the breasts used tocheck for breast cancer after a lump or other sign orsymptom of breast cancer has been found.

Digestive tract (dy-JES-tiv): The organs through whichfood and liquids pass when they are swallowed,digested, and eliminated. These organs are the mouth,esophagus, stomach, small and large intestines, andrectum and anus.

Duct (dukt): In medicine, a tube or vessel of the bodythrough which fluids pass.

Ductal carcinoma in situ (DUK-tal KAR-si-NO-main SYE-too): DCIS. A noninvasive, precancerouscondition in which abnormal cells are found in thelining of a breast duct. The abnormal cells have notspread outside the duct to other tissues in the breast. Insome cases, ductal carcinoma in situ may becomeinvasive cancer and spread to other tissues, although itis not known at this time how to predict which lesionswill become invasive. Also called intraductalcarcinoma.

Ductal lavage (DUK-tal luh-VAHZ): A method used tocollect cells from milk ducts in the breast. A hair-sizecatheter (tube) is inserted into the nipple, and a smallamount of salt water is released into the duct. Thewater picks up breast cells, and is removed. The cells

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are checked under a microscope. Ductal lavage may beused in addition to clinical breast examination andmammography to detect breast cancer.

Estradiol (es-trah-DIE-awl): A form of the hormoneestrogen.

Estrogen (ES-tro-jin): A hormone that promotes thedevelopment and maintenance of female sexcharacteristics.

Excisional biopsy (ek-SI-zhun-al BY-op-see): A surgical procedure in which an entire lump orsuspicious area is removed for diagnosis. The tissue isthen examined under a microscope.

External radiation (ray-dee-AY-shun): Radiationtherapy that uses a machine to aim high-energy rays atthe cancer. Also called external-beam radiation.

Fertile (FER-tul): Able to produce children.

Fine-needle aspiration (as-per-AY-shun): The removalof tissue or fluid with a needle for examination under amicroscope. Also called needle biopsy.

Gene: The functional and physical unit of hereditypassed from parent to offspring. Genes are pieces ofDNA, and most genes contain the information formaking a specific protein.

Gland: An organ that makes one or more substances,such as hormones, digestive juices, sweat, tears, saliva,or milk. Endocrine glands release the substancesdirectly into the bloodstream. Exocrine glands releasethe substances into a duct or opening to the inside oroutside of the body.

HER2: Human epidermal growth factor receptor 2.The HER2/neu protein is involved in the growth ofsome cancer cells. Also called c-erbB-2.

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HER2/neu gene: The gene that makes the humanepidermal growth factor receptor 2. The proteinproduced is HER2/neu, which is involved in thegrowth of some cancer cells. Also called c-erbB-2.

Hodgkin’s lymphoma: A malignant disease of thelymphatic system that is characterized by painlessenlargement of lymph nodes, the spleen, or otherlymphatic tissue. Other symptoms may include fever,weight loss, fatigue, or night sweats. Also calledHodgkin’s disease.

Hormone: A chemical made by glands in the body.Hormones circulate in the bloodstream and control theactions of certain cells or organs. Some hormones canalso be made in a laboratory.

Hormone receptor test: A test to measure the amountof certain proteins, called hormone receptors, in cancertissue. Hormones can attach to these proteins. A highlevel of hormone receptors may mean that hormoneshelp the cancer grow.

Hormone therapy: Treatment that adds, blocks, orremoves hormones. For certain conditions (such asdiabetes or menopause), hormones are given to adjustlow hormone levels. To slow or stop the growth ofcertain cancers (such as prostate and breast cancer),synthetic hormones or other drugs may be given toblock the body’s natural hormones. Sometimes surgeryis needed to remove the gland that makes hormones.Also called hormonal therapy, hormone treatment, orendocrine therapy.

Imaging procedure: A method of producing pictures ofareas inside the body.

Immune system (im-YOON): The complex group oforgans and cells that defends the body againstinfections and other diseases.

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Implant radiation (ray-dee-AY-shun): A procedure inwhich radioactive material sealed in needles, seeds,wires, or catheters is placed directly into or near atumor. Also called brachytherapy, internal radiation, orinterstitial radiation.

Incisional biopsy (in-SIH-zhun-al BY-op-see): Asurgical procedure in which a portion of a lump orsuspicious area is removed for diagnosis. The tissue isthen examined under a microscope.

Infertile: Unable to produce children.

Infertility: The inability to produce children.

Inflammatory breast cancer: A type of breast cancer inwhich the breast looks red and swollen and feels warm.The skin of the breast may also show the pittedappearance called peau d’orange (like the skin of anorange). The redness and warmth occur because thecancer cells block the lymph vessels in the skin.

Injection: Use of a syringe and needle to push fluids ordrugs into the body; often called a “shot.”

Internal radiation (ray-dee-AY-shun): A procedure inwhich radioactive material sealed in needles, seeds,wires, or catheters is placed directly into or near atumor. Also called brachytherapy, implant radiation, orinterstitial radiation therapy.

Intraductal carcinoma (in-tra-DUK-tal KAR-si-NO-ma): A noninvasive, precancerous condition in whichabnormal cells are found in the lining of a breast duct.The abnormal cells have not spread outside the duct toother tissues in the breast. In some cases, intraductalcarcinoma may become invasive cancer and spread toother tissues, although it is not known at this time howto predict which lesions will become invasive. Alsocalled ductal carcinoma in situ.

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Invasive cancer: Cancer that has spread beyond thelayer of tissue in which it developed and is growinginto surrounding, healthy tissues. Also calledinfiltrating cancer.

IV: Intravenous (in-tra-VEE-nus). Injected into a bloodvessel.

Lobe: A portion of an organ, such as the liver, lung,breast, thyroid, or brain.

Lobular carcinoma in situ (LOB-yoo-lar KAR-si-NO-ma in SYE-too): LCIS. A condition in which abnormalcells are found in the lobules of the breast. LCISseldom becomes invasive cancer; however, havinglobular carcinoma in situ in one breast increases therisk of developing breast cancer in either breast.

Lobule (LOB-yule): A small lobe or a subdivision of alobe.

Local therapy: Treatment that affects cells in the tumorand the area close to it.

Locally advanced cancer: Cancer that has spread onlyto nearby tissues or lymph nodes.

Lumpectomy (lump-EK-toe-mee): Surgery to removethe tumor and a small amount of normal tissue aroundit.

Lymph (limf): The clear fluid that travels through thelymphatic system and carries cells that help fightinfections and other diseases. Also called lymphaticfluid.

Lymph node (limf node): A rounded mass of lymphatictissue that is surrounded by a capsule of connectivetissue. Lymph nodes filter lymph (lymphatic fluid), andthey store lymphocytes (white blood cells). They arelocated along lymphatic vessels. Also called a lymphgland.

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Lymph vessel (limf): A thin tube that carries lymph(lymphatic fluid) and white blood cells through thelymphatic system. Also called lymphatic vessel.

Lymphatic system (lim-FAT-ik SIS-tem): The tissuesand organs that produce, store, and carry white bloodcells that fight infections and other diseases. Thissystem includes the bone marrow, spleen, thymus,lymph nodes, and lymphatic vessels (a network of thintubes that carry lymph and white blood cells).Lymphatic vessels branch, like blood vessels, into allthe tissues of the body.

Lymphedema (LIMF-eh-DEE-ma): A condition inwhich excess fluid collects in tissue and causesswelling. It may occur in the arm or leg after lymphvessels or lymph nodes in the underarm or groin areremoved or treated with radiation.

Magnetic resonance imaging (mag-NET-ik REZ-o-nans IM-a-jing): MRI. A procedure in which radiowaves and a powerful magnet linked to a computer areused to create detailed pictures of areas inside thebody. These pictures can show the difference betweennormal and diseased tissue. MRI makes better imagesof organs and soft tissue than other scanningtechniques, such as CT or x-ray. MRI is especiallyuseful for imaging the brain, spine, the soft tissue ofjoints, and the inside of bones. Also called nuclearmagnetic resonance imaging.

Malignant (ma-LIG-nant): Cancerous. Malignanttumors can invade and destroy nearby tissue andspread to other parts of the body.

Mammogram (MAM-o-gram): An x-ray of the breast.

Mastectomy (mas-TEK-toe-mee): Surgery to removethe breast (or as much of the breast tissue as possible).

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Medical oncologist (MEH-dih-kul on-KOL-oh-jist):A doctor who specializes in diagnosing and treatingcancer using chemotherapy, hormonal therapy, andbiological therapy. A medical oncologist often is themain health care provider for someone who has cancer.A medical oncologist also gives supportive care andmay coordinate treatment given by other specialists.

Menopausal hormone therapy: Hormones (estrogen,progesterone, or both) given to women aftermenopause to replace the hormones no longerproduced by the ovaries. Also called hormonereplacement therapy or HRT.

Menopause (MEN-o-pawz): The time of life when awoman’s menstrual periods stop. A woman is inmenopause when she has not had a period for 12months in a row. Also called “change of life.”

Menstrual cycle (MEN-stroo-al): The monthly cycle ofhormonal changes from the beginning of one menstrualperiod to the beginning of the next.

Menstrual period (MEN-stroo-al PEER-ee-od): Theperiodic discharge of blood and tissue from the uterus.From puberty until menopause, menstruation occursabout every 28 days, but does not occur duringpregnancy.

Metastasis (meh-TAS-ta-sis): The spread of cancerfrom one part of the body to another. A tumor formedby cells that have spread is called a “metastatic tumor”or a “metastasis.” The metastatic tumor contains cellsthat are like those in the original (primary) tumor. Theplural form of metastasis is metastases (meh-TAS-ta-seez).

Metastasize (meh-TAS-ta-size): To spread from onepart of the body to another. When cancer cellsmetastasize and form secondary tumors, the cells in themetastatic tumor are like those in the original (primary)tumor.

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Microcalcification (MY-krow-kal-si-fi-KAY-shun): A tiny deposit of calcium in the breast that cannot befelt but can be detected on a mammogram. A cluster ofthese very small specks of calcium may indicate thatcancer is present.

Modified radical mastectomy (mas-TEK-toe-mee):Surgery for breast cancer in which the breast, most orall of the lymph nodes under the arm, and the liningover the chest muscles are removed. Sometimes thesurgeon also removes part of the chest wall muscles.

Monoclonal antibody (MAH-no-KLO-nul AN-tih-BAH-dee): A laboratory-produced substance that canlocate and bind to cancer cells wherever they are in thebody. Many monoclonal antibodies are used in cancerdetection or therapy; each one recognizes a differentprotein on certain cancer cells. Monoclonal antibodiescan be used alone, or they can be used to deliver drugs,toxins, or radioactive material directly to a tumor.

Needle-localized biopsy: A procedure that uses verythin needles or guide wires to mark the location of anabnormal area of tissue so it can be surgicallyremoved. An imaging device is used to place the wirein or around the abnormal area. Needle localization isused when the doctor cannot feel the mass of abnormaltissue.

Neoadjuvant therapy (NEE-o-AD-joo-vant):Treatment given before the primary treatment.Examples of neoadjuvant therapy include chemo-therapy, radiation therapy, and hormone therapy.

Nipple: In anatomy, the small raised area in the centerof the breast through which milk can flow to theoutside.

Nipple discharge: Fluid coming from the nipple.

Obese: Having an abnormally high, unhealthy amountof body fat.

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Organ: A part of the body that performs a specificfunction. For example, the heart is an organ.

Ovary (O-va-ree): One of a pair of female reproductiveglands in which the ova, or eggs, are formed. Theovaries are located in the pelvis, one on each side ofthe uterus.

Overweight: Being too heavy for one’s height. Excessbody weight can come from fat, muscle, bone, and/orwater retention. Being overweight does not alwaysmean being obese.

Partial mastectomy (mas-TEK-toe-mee): The removalof cancer as well as some of the breast tissue aroundthe tumor and the lining over the chest muscles belowthe tumor. Usually some of the lymph nodes under thearm are also taken out. Also called segmentalmastectomy.

Pathologist (pa-THOL-o-jist): A doctor who identifiesdiseases by studying cells and tissues under amicroscope.

Physical therapist: A health professional who teachesexercises and physical activities that help conditionmuscles and restore strength and movement.

Plastic surgeon: A surgeon who specializes in reducingscarring or disfigurement that may occur as a result ofaccidents, birth defects, or treatment for diseases.

Plastic surgery: An operation that restores or improvesthe appearance of body structures.

Positron emission tomography scan: PET scan. Aprocedure in which a small amount of radioactiveglucose (sugar) is injected into a vein and a scanner isused to make detailed, computerized pictures of areasinside the body where the glucose is used. Becausecancer cells often use more glucose than normal cells,the pictures can be used to find cancer cells in thebody.

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Precancerous (pre-KAN-ser-us): A term used todescribe a condition that may (or is likely to) becomecancer. Also called premalignant.

Primary tumor: The original tumor.

Progesterone (pro-JES-ter-own): A female hormone.

Progestin (pro-JES-tin): Any natural or laboratory-made substance that has some or all of the biologiceffects of progesterone, a female hormone.

Prosthesis (pros-THEE-sis): A device, such as anartificial leg, that replaces a part of the body.

Quality of life: The overall enjoyment of life. Manyclinical trials assess the effects of cancer and itstreatment on the quality of life. These studies measureaspects of an individual’s sense of well-being andability to carry out various activities.

Radiation oncologist (ray-dee-AY-shun on-KOL-o-jist): A doctor who specializes in using radiation totreat cancer.

Radiation therapy (ray-dee-AY-shun THER-ah-pee):The use of high-energy radiation from x-rays, gammarays, neutrons, and other sources to kill cancer cellsand shrink tumors. Radiation may come from amachine outside the body (external-beam radiationtherapy), or it may come from radioactive materialplaced in the body near cancer cells (internal radiationtherapy, implant radiation, or brachytherapy). Systemicradiation therapy uses a radioactive substance, such asa radiolabeled monoclonal antibody, that circulatesthroughout the body. Also called radiotherapy.

Radioactive (RAY-dee-o-AK-tiv): Giving off radiation.

Recurrent cancer: Cancer that has returned after aperiod of time during which the cancer could not bedetected. The cancer may come back to the same placeas the original (primary) tumor or to another place inthe body. Also called recurrence.

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Risk factor: Something that may increase the chance ofdeveloping a disease. Some examples of risk factorsfor cancer include age, a family history of certaincancers, use of tobacco products, certain eating habits,obesity, exposure to radiation or other cancer-causingagents, and certain genetic changes.

Screening: Checking for disease when there are nosymptoms.

Screening mammogram: X-rays of the breasts taken tocheck for breast cancer in the absence of signs orsymptoms.

Segmental mastectomy (mas-TEK-toe-mee): Theremoval of cancer as well as some of the breast tissuearound the tumor and the lining over the chest musclesbelow the tumor. Usually some of the lymph nodesunder the arm are also taken out. Also called partialmastectomy.

Sentinel lymph node biopsy: Removal andexamination of the sentinel node(s) (the first lymphnode[s] to which cancer cells are likely to spread froma primary tumor). To identify the sentinel lymphnode(s), the surgeon injects a radioactive substance,blue dye, or both near the tumor. The surgeon then usesa scanner to find the sentinel lymph node(s) containingthe radioactive substance or looks for the lymphnode(s) stained with dye. The surgeon then removesthe sentinel node(s) to check for the presence of cancercells.

Side effect: A problem that occurs when treatmentaffects healthy tissues or organs. Some common sideeffects of cancer treatment are fatigue, pain, nausea,vomiting, decreased blood cell counts, hair loss, andmouth sores.

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Stage: The extent of a cancer within the body. If thecancer has spread, the stage describes how far it hasspread from the original site to other parts of the body.

Staging (STAY-jing): Performing exams and tests tolearn the extent of the cancer within the body,especially whether the disease has spread from theoriginal site to other parts of the body. It is important toknow the stage of the disease in order to plan the besttreatment.

Stereotactic biopsy (STAYR-ee-oh-TAK-tik BY-op-see): A biopsy procedure that uses a computer and a 3-dimensional scanning device to find a tumor site andguide the removal of tissue for examination under amicroscope.

Supportive care: Care given to improve the quality oflife of patients who have a serious or life-threateningdisease. The goal of supportive care is to prevent ortreat as early as possible the symptoms of the disease,side effects caused by treatment of the disease, andpsychological, social, and spiritual problems related tothe disease or its treatment. Also called palliative care,comfort care, and symptom management.

Surgeon: A doctor who removes or repairs a part of thebody by operating on the patient.

Surgery (SER-juh-ree): A procedure to remove orrepair a part of the body or to find out whether diseaseis present. An operation.

Symptom: An indication that a person has a conditionor disease. Some examples of symptoms are headache,fever, fatigue, nausea, vomiting, and pain.

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Systemic therapy (sis-TEM-ik THER-ah-pee):Treatment using substances that travel through thebloodstream, reaching and affecting cells all over thebody.

Tamoxifen (ta-MOK-si-FEN): A drug used to treatbreast cancer, and to try to prevent it in women whoare at a high risk of developing breast cancer.Tamoxifen blocks the effects of the hormone estrogenin the breast. It belongs to the family of drugs calledantiestrogens.

Tissue (TISH-oo): A group or layer of cells that workstogether to perform a specific function.

Total mastectomy (mas-TEK-toe-mee): Removal of thebreast. Also called simple mastectomy.

Trastuzumab (tras-TOO-zuh-mab): A type ofmonoclonal antibody used to detect or treat some typesof cancer. Monoclonal antibodies are laboratory-produced substances that can locate and bind to cancercells. Trastuzumab blocks the effects of the growthfactor protein HER2, which transmits growth signals tobreast cancer cells. Also called Herceptin.

Tumor (TOO-mer): An abnormal mass of tissue thatresults when cells divide more than they should or donot die when they should. Tumors may be benign (notcancerous), or malignant (cancerous). Also calledneoplasm.

Tumor marker: A substance sometimes found in theblood, other body fluids, or tissues. A high level oftumor marker may mean that a certain type of cancer isin the body. Examples of tumor markers include CA125 (ovarian cancer), CA 15-3 (breast cancer), CEA(ovarian, lung, breast, pancreas, and gastrointestinaltract cancers), and PSA (prostate cancer). Also calledbiomarker.

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Ultrasound: A procedure in which high-energy soundwaves (ultrasound) are bounced off internal tissues ororgans and make echoes. The echo patterns are shownon the screen of an ultrasound machine, forming apicture of body tissues called a sonogram. Also calledultrasonography.

Ultrasound-guided biopsy (BY-op-see): A biopsyprocedure that uses an ultrasound imaging device tofind an abnormal area of tissue and guide its removalfor examination under a microscope.

Vaccine: A substance or group of substances meant tocause the immune system to respond to a tumor or tomicroorganisms, such as bacteria or viruses. A vaccinecan help the body recognize and destroy cancer cells ormicroorganisms.

X-ray: A type of high-energy radiation. In low doses,x-rays are used to diagnose diseases by makingpictures of the inside of the body. In high doses, x-raysare used to treat cancer.

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National Cancer Institute InformationResources

ou may want more information for yourself, yourfamily, and your health care provider. The

following National Cancer Institute (NCI) services areavailable to help you.

TelephoneThe NCI’s Cancer Information Service (CIS)

provides accurate, up-to-date information on cancer topatients and their families, health professionals, and thegeneral public. Information Specialists translate thelatest scientific information into understandablelanguage and respond in English, Spanish, or on TTYequipment. Calls to the CIS are free.

Telephone: 1–800–4–CANCER (1–800–422–6237)

TTY: 1–800–332–8615

InternetThe NCI’s Web site (http://www.cancer.gov)

provides information from numerous NCI sources. Itoffers current information on cancer prevention,screening, diagnosis, treatment, genetics, supportivecare, and ongoing clinical trials. It has informationabout NCI’s research programs and fundingopportunities, cancer statistics, and the Institute itself.Information Specialists provide live, online assistancethrough LiveHelp. (Click on “Need Help?” Then clickon “Connect to LiveHelp.”)

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National Cancer Institute Publications

ational Cancer Institute (NCI) publications can beordered by writing to the address below:

Publications Ordering ServiceNational Cancer InstituteSuite 3035A6116 Executive Boulevard, MSC 8322Bethesda, MD 20892–8322

Many NCI publications can be viewed, downloaded,and ordered from http://www.cancer.gov/publicationson the Internet. In addition, people in the United Statesand its territories may order these and other NCIpublications by calling the NCI’s Cancer InformationService at 1–800–4–CANCER.

Publications About Breast Changes and BreastCancer• What You Need To Know About™ Breast Cancer

(also available in Spanish: Lo que usted necesitasaber sobre™ el cáncer de seno)

• Understanding Breast Changes: A Health Guide forWomen

• “Cambios en el seno y el riesgo de desarrollarcancer”

Publications About Cancer Treatment andSupport• Surgery Choices for Women with Early-Stage Breast

Cancer

• Radiation Therapy and You: A Guide to Self-HelpDuring Cancer Treatment (also available in Spanish:La radioterapia y usted: Una guía de autoayudadurante el tratamiento del cáncer)

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• Chemotherapy and You: A Guide to Self-HelpDuring Cancer Treatment (also available in Spanish:La quimioterapia y usted: Una guía de autoayudadurante el tratamiento del cáncer)

• Helping Yourself During Chemotherapy: 4 Steps forPatients

• Biological Therapy: Treatments That Use YourImmune System to Fight Cancer

• Eating Hints for Cancer Patients: Before, During &After Treatment (also available in Spanish: Consejosde alimentación para pacientes con cáncer: Antes,durante y después del tratamiento)

• Understanding Cancer Pain (also available inSpanish: El dolor relacionado con el cáncer)

• Pain Control: A Guide for People with Cancer andTheir Families (also available in Spanish: Controldel dolor: Guía para las personas con cáncer y susfamilias)

• Get Relief from Cancer Pain

• “Complementary and Alternative Medicine inCancer Treatment: Questions and Answers” (alsoavailable in Spanish: “La medicina complementariay alternativa en el tratamiento del cáncer: preguntasy respuestas”)

• “Biological Therapies for Cancer: Questions andAnswers” (also available in Spanish: “Terapiasbiológicas: el uso del sistema inmune para tratar elcáncer”)

• “How To Find a Doctor or Treatment Facility If YouHave Cancer” (also available in Spanish: “Cómoencontrar a un doctor o un establecimiento detratamiento si usted tiene cáncer”)

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• “National Organizations That Offer Services toPeople With Cancer and Their Families” (alsoavailable in Spanish: “Organizaciones nacionalesque brindan servicios a las personas con cáncer y asus familias”)

Publications About Living With Cancer• Advanced Cancer: Living Each Day

• Facing Forward Series: Life After Cancer Treatment(also available in Spanish: Siga adelante: la vidadespués del tratamiento del cáncer)

• Facing Forward Series: Ways You Can Make aDifference in Cancer

• Taking Time: Support for People with Cancer andthe People Who Care About Them

• When Cancer Recurs: Meeting the Challenge

Publications About Clinical Trials• Taking Part in Clinical Trials: What Cancer

Patients Need To Know (also available in Spanish:La participación en los estudios clínicos: Lo que lospacientes de cáncer deben saber)

• If You Have Cancer...What You Should Know AboutClinical Trials (also available in Spanish: Si tienecáncer...lo que debería saber sobre estudiosclínicos)

• Taking Part in Clinical Trials: Cancer PreventionStudies: What Participants Need To Know (alsoavailable in Spanish: La participación en losestudios clínicos: estudios para la prevención delcáncer)

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The National Cancer Institute (NCI) is part of theNational Institutes of Health. NCI conducts and supportsbasic and clinical research in the search for better ways toprevent, diagnose, and treat cancer. NCI also supports thetraining of scientists and is responsible for communicatingits research findings to the medical community and thepublic.

The written text of NCI material is in the public domain.It is not subject to copyright restrictions. You do not needour permission to reproduce or translate NCI written text.However, we would appreciate a credit line and a copy ofyour translations.

Private sector designers, photographers, and illustratorsretain copyrights to artwork they develop under contract toNCI. You must have permission to use or reproduce thesematerials. In many cases, artists will grant permission, butthey may require a credit line and/or usage fees. To inquireabout permission to reproduce NCI artwork, please write to:Office of Communications, Communication ServicesBranch, National Cancer Institute, 6116 ExecutiveBoulevard, Room 3066, MSC 8323, Rockville, MD20892–8323.

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NIH Publication No. 05–1556Revised May 2005

Printed September 2005

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