14 Questions About Your Breast Cancer Diagnosis
prognosis and medical choices.
From oncologist Jame Abraham, MD, Director of Cleveland Clinic’s Breast Medical Oncology Program, here are 14 questions you should ask your doctor. The answers you get will help you better understand your breast cancer diagnosis and treatment options. Your doctor may not have all the answers immediately, but don’t be afraid to ask, and to follow up. The more informed you are as a patient, the more you can actively and confidently participate in your care decisions.
1. What type of breast cancer do I have?
Breast cancers aren’t all the same. Doctors classify them in a number of different ways. Probably the most basic is where the cancer cells originate. Their origin is a factor in whether your cancer may spread, and helps dictate the kind of treatment you’ll get. Most breast cancers – 70 to 80 percent – start in the milk ducts. They’re known as infiltrating or invasive ductal carcinomas, meaning that they’ve broken through the milk duct’s wall and have proliferated into the breast’s fatty tissue. Once there, it’s possible for the cancer cells to further spread, or metastasize, to other parts of the body. Ten percent of breast cancers start in the milk-producing glands, or lobules, and are called invasive lobular carcinomas. They’re also capable of spreading. Other rarer breast cancers may involve the nipple, the breast’s connective tissue, or the linings of blood vessels or lymph vessels. Some breast cancers are non-invasive. They haven’t spread. They’re contained within the milk ducts and are called ductal carcinoma in situ (DCIS). Generally, the prognosis for patients with DCIS is very good, Dr. Abraham says.
2. How big is my tumor?
Tumor size is another factor that will determine your course of treatment. Your doctor uses the size of your tumor to “stage,” or further categorize, your cancer, which you’ll read more about in a minute. The tumor’s dimensions are estimated by a physical exam, a mammogram, an ultrasound or an MRI of the breast. The precise size won’t be known until a pathologist studies the tumor after surgical removal.
3. Is the cancer in my lymph nodes?
Whether your breast cancer has spread to your lymph nodes – the filtering mechanisms in your armpits and elsewhere in the body that are part of the immune system – is one of the most important predictors of the severity of your disease. “Involvement of the lymph nodes changes the treatment plan,” says Dr. Abraham. “When breast cancer cells have spread to the lymph nodes, we tend to discuss more aggressive treatment options, such as chemotherapy.”
4. What is the stage of my cancer?