FREE ESSAY ON A JOURNEY WITH BREAST CANCER

A JOURNEY WITH BREAST CANCER

A Journey with Breast Cancer
What is Cancer?
The body is made up of many types of cells. Normally, cells grow and divide to produce
more cells only when the body needs them. This is an orderly process which keeps the body
healthy. Sometimes cells keep dividing when new cells are not needed. They may form a
mass of extra tissue called a growth or tumor. Benign tumors are not a threat to life but
malignant tumors are cancer. Cells in these tumors can invade and damage nearby tissues
and organs. The fear is that cancer cells can break away from a malignant tumor and enter
the bloodstream or lymphatic system. That is how breast cancer spreads and forms other
tumors in the body. The spread of cancer is called metastisis. (Dollinger, Rosenbaum and
Cable, 1991).
Understanding the breasts
Each breast has 15 to 20 overlapping sections called lobes. There are many smaller
lobules, which end in dozens of tiny bulbs that can produce milk. The lobes, lobules and
bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the
center of a dark area of skin called the areola. Fat fills the spaces around the lobules
and ducts. The breast does not have muscles tissue but muscles lie under each breast and
cover the ribs. Each breast contains blood vessels and vessels that contain lymph. The
lymph vessels lead to small bean shaped organs called lymph nodes. Clusters of lymph
nodes are found near the breast under the arm, above the collarbone and in the chest.
They are also found in other parts of the body. (Dollinger, Rosenbaum and Cable, 1991).
Types of breast cancer
According to Dollinger, Rosenbaum and Cable (1991), the most common type of breast cancer
begins in the lining of the ducts It is called ductal carcinoma. Lobular carcinoma arises
in the lobules. They explain that when breast cancer spreads outside of the breast,
cancer cells are often found in the lymph nodes under the arm. If it reaches these nodes
it may mean that cancer cells have spread to other parts of the body, other lymph nodes
or other organs. It may have spread to the bones, liver or lungs. 
When cancer spreads, it is called metastatic breast cancer. The median duration of
survival for women with metastatic disease is two to three years. Malignant cells are
transported via the lymphatic system. Distant metastasis occurs when the cancerous tumor
cells break away from the primary tumor and spread to other sites in the body. (McEvilly
and Hassey, 1998).
Risk factors for breast cancer
According to the National Cancer Institute (1999), research has shown that the following
conditions place a woman at increased risk for breast cancer:
Personal history of breast cancer - Women who have had breast cancer face an increased
risk of getting breast cancer again.
Genetic alterations - Changes in certain genes (BRCA1, BRCA2, and others) make women more
susceptible to breast cancer. In families in which many women have had the disease, gene
testing can show whether a woman has specific genetic changes known to increase the
susceptibility to breast cancer. 
Family history- A woman's risk for developing breast cancer increases if her mother,
sister, daughter or two or more other close relatives, such as cousins, have a history of
breast cancer, especially at a young age.
Certain breast changes - Having a diagnosis of atypical hyerplasia or lobular carcinoma
in situ (LCIS) or having had two or more breast biopsies for benign conditions may
increase a woman's risk for developing cancer. 
Breast density - Women age 45 and older whose mammograms show at least 75 per cent dense
tissue are at increased risk. Dense breasts contain many glands and ligaments, which
makes breast tumors difficult to see and the dense tissue itself is associated with
developing breast cancer.
Radiation therapy - Women whose breasts were exposed to radiation during their childhood,
especially those who were treated with radiation for Hodgkin's disease, are at an
increased risk. 
Late childbearing - Women who had their first child after the age of 30 have a greater
chance of developing breast cancer than women who had their children at a younger age.
Early menstruation - Women who started menstruating at an early age (before age 12),
experienced menopause late (after age 55), never had children, or took hormone
replacement therapy or birth control pills for long periods of time. Each of these
factors increases the amount of time a woman's body is exposed to estrogen. The longer
this exposure, the more likely she is to develop breast cancer. 
In most cases, doctors cannot explain why a woman develops breast cancer. Studies show
that most women who develop breast cancer have none of the risk factors listed above.
Also, women with known risk factors may never develop breast cancer (Dollinger, Rosenbaum
and Cable, 1991).
Early detection
When breast cancer is found and treated early, the chances for survival are better. Women
can take an active part in the early detection by having regular mammograms and breast
exams. Self examination is also very important. Mammograms can often detect cancer before
it is felt. It can also show calcium deposits which may be an early sign of cancer. There
are some limitations because a mammogram may miss some cancers or may find things that
turn out not to be cancer at all. Detecting a tumor early does not guarantee that a
woman's life will be saved. Some fast growing cancers may have already spread to other
parts of the body before being detected. (Dollinger, Rosenbaum and Cable, 1991). The
National Cancer Institute recommends that women in their forties and older have
mammograms on a regular basis, every one to two years.
Symptoms
Early breast cancer does not cause pain as a rule. In fact, when breast cancer first
develops, there may be no symptoms at all. According to Dollinger, Rosenbaum and Cable,
1991), as cancer grows it can cause many changes that women should watch for: 
A lump or thickening in or near the breast or in the underarm area;
A change in the size or shape of the breast;
Nipple discharge or tenderness, or the nipple pulled back into the breast;
Ridges or pitting of the breast (looks the skin of an orange);
A change in the way the skin of the breast, areola or nipple looks or feels.
Diagnosis
The physician is able to tell a lot about a lump by its size, texture and whether is
moves easily. He/she does this by feeling the lump and the tissues around it. Apparently,
benign tumors have a different feel. The physician finds out a lot of information by
reading the mammogram. Ultrasonography is also used to tell whether a lump is solid or
fluid filled. The following procedures may be performed to make a diagnosis according to
Dollinger, Rosenbaum and Cable, (1991):
Fine needle aspiration. A thin needle is used to remove fluid from a lump. If it is fluid
filled it is not cancer. If it is solid it may or may not be cancer.
Needle biopsy. Tissue can be removed with a needle from an area that is suspicious on a
mammogram and cannot be felt. 
Surgical biopsy. The surgeon cuts out part or all of a lump or suspicious area. 
When cancer is found
The pathologist can tell what kind of cancer it is, if it is invasive, whether the cancer
is sensitive to hormones, if it grows slowly or rapidly. The patient will be referred to
an oncologist who specializes in the treatment of cancer. Generally, treatment will begin
within a few weeks after diagnosis. This is the time to get a second opinion, prepare
self and loved ones.
Treatment
There are more treatment options and hope for survival than ever before. The options
depend on the size and location of the tumor, the results of lab test and hormone
receptor tests, and the stage of the disease. The women's age, menopausal status, general
health and size of her breasts are considered. This is the time to learn all that is
possible about the disease, the treatment choices and to take an active part in decisions
about medical care and options.
There are many resources where a patient can learn about breast cancer. Calling the
National Cancer Institute's Cancer Information Service a 1-800-4-CANCER is a great way to
gather the most current up to date treatment information, including information about
current clinical trials. A cancer specialist can provide answers to questions about
breast cancer treatment. They can also make referrals to other resources. There is so
much to learn about breast cancer and its treatment. As I described in my personal
journey, this is a very difficult time to remember all of the information heard and
understand all of the answers at once. I suggest keeping a journal to refer to when
things seem a lot clearer.
Planning treatment
Methods of treatment are local or systemic. Local treatments are used to remove, destroy,
or control the cancer cells in a specific area. Surgery and radiation therapy are local
treatments. Systemic treatments are used to destroy or control cancer cells throughout
the body. Chemotherapy and hormonal therapy are systemic treatments. A patient may have
one form of treatment or both (McEvilly and Hassey, 1998). 
Surgery is the most common treatment for breast cancer. An operation to remove the breast
or as much of the breast as possible, is a mastectomy. Breast reconstruction is often an
option at the same time as the mastectomy, or later on. An operation to remove the cancer
but not the breast is called breast sparing surgery. They usually are followed by
radiation therapy to destroy any cancer cells that may remain in the area. In most cases,
the lymph nodes under the arm are removed to help determine whether cancer cells have
entered the lymphatic system (Dollinger, Rosenbaum and Cable, 1991).
In lumpectomy, the breast cancer and surrounding tissue is removed. Some of the lymph
nodes under the arm are removed. 
In segmental mastectomy, the surgeon removes the cancer and a larger area of normal
breast tissue around it. Occasionally, some of the lining over the chest muscles below
the tumor is removed as well. Some of the lymph nodes under the arm may also be removed.
(Dollinger, Rosenbaum and Cable, 1991).
In total (simple) mastectomy, the whole breast is removed with some of the lymph nodes.
In modified radical mastectomy, the whole breast is removed, the lymph nodes under arm
and often the lining over the chest muscles. The smaller of the two chest muscles is also
taken out to help in removing the lymph nodes (Dollinger, Rosenbaum and Cable, 1991)..
In radical mastectomy, also called Halsted radical mastectomy, the breast is removed, the
chest muscles, all of the lymph nodes under the arm and some additional fat and skin.
This operation was considered standard procedure for many, many years. Thank goodness, it
is only used rarely these days and only in cases where the cancer has spread to the chest
muscles. (Dollinger, Rosenbaum and Cable, 1991).
Breast reconstruction is surgery to rebuild a breast's shape. This option should be
discussed with a plastic surgeon prior to having a mastectomy (Fraker and Edwards,
1998).
Radiation therapy is the use of high energy rays to kill cancer cells and stop them from
growing . These rays can come from radioactive material outside the body and be directed
at the breast by a machine. It can also come from radioactive material placed directly in
the breast in thin plastic tubes. Some women receive both kinds (McEvilly and Hassey,
1998). 
Chemotherapy is the use of drugs to kill cancer cells. It is usually in a combination of
drugs. They may be given orally or by injection. Either way, it is a systemic therapy
because the drugs enter the blood stream and travel throughout the body.
Treatment Choices
Treatment choices depend on a number of factors. These include age, menopausal status,
general health, the size, location, stage of the tumor, lymph node involvement and size
of the breast. Certain features of the tumor cells, such as whether or not they depend on
hormones to grow are considered. But, the most important consideration is the stage of
the disease. The stage is based on the size of the tumor and whether the cancer has
spread. 
The following is a brief description of the stages of breast cancer and the treatments
often used at each stage according to (Dollinger, Rosenbaum and Cable, 1991):
Stage 0 is sometimes called noninvasive carcinoma or carcinoma in situ. Lobular carcinoma
in situ, or LCIS, refers to abnormal cells in the lining of the lobule These abnormal
cells seldom become invasive cancer. They mean there is an increased risk for developing
breast cancer. The risk is increased for both breasts. Some women with LCIS may choose to
take a medication called tamoxifen in an attempt to prevent cancer or may do nothing at
all and have regular check ups.
Ductal carcinoma in situ is called intraductal carcinoma or DCIS. This refers to the
cancer cells in an area of abnormal tissue in the lining of a duct that have not invaded
the surrounding breast tissue. If DCIS lesions are left untreated, over time cancer cells
may break through the duct and spread to nearby tissue. Patient with DCIS may have a
mastectomy or breast sparing surgery followed by radiation therapy. Underarm lymph nodes
are not usually removed. 
Stage I , the cancer cells have not spread beyond the breast and the tumor is no more
than an inch across.
Stage II, the tumor in the breast is less than one inch across and the cancer has
spread to the lymph nodes under the arms, the tumor is between 1 and 2 inches with or
without spread to the lymph nodes under the arms or the tumor is larger than 2 inches but
has not spread to the lymph nodes under the arm. 
Stage III is called locally advanced cancer. The tumor is large, more than 2 inches
across and the cancer is extensive in the underarm lymph nodes or it has spread to other
lymph nodes or issues near the breast. Inflammatory breast cancer is this type. Usually
local and systemic treatment are given to stop the disease from spreading. 
Stage IV is metastatic cancer. The cancer has spread from the breast to other parts of
the body. Chemotherapy and/or hormonal therapy is given to destroy the cancer cells and
control the disease. Recurrent cancer means it has come back in spite of the initial
treatment. Even when a tumor seems to have been completely removed or destroyed, the
disease sometimes returns because undetected cancer cells remained in the area after
treatment or the disease had already spread before treatment. Most recurrences appear
within the first 2 to 3 years after treatment, but breast cancer can recur many years
later. Side effects of treatment
The side effects are different for each person or even one treatment to the next. It is
hard to limit the effects so that only the cancer cells are removed. Healthy cells and
tissues are both damaged and the treatment can cause many side effects.
The most common side effect of radiation is fatigue. Resting is important. The skin in
the treated area becomes red, dry, tender and itchy. Toward the end of treatment the skin
may become moist and weepy. Exposing the area to air helps aid healing. There may be a
permanent change in the skin color (Dollinger, Rosenbaum and Cable, 1991).
Chemotherapy has many side effects but vary from person to person. In general, anti-
cancer drugs affect rapidly dividing cells. These include blood cells, which fight
infection, cause the blood to clot and carry oxygen to all parts of the body. When these
cells are affected the patient is more prone to infections, bruising and bleeding easily,
and my have less energy during treatment. Patients may lose their hair, have loss of
appetite, nausea, vomiting, diarrhea or mouth sores. These side effects are generally
short term problems and go away after treatment is over (Dollinger, Rosenbaum and Cable,
1991).
Tamoxifen is a form of hormonal therapy. This drug blocks the body's use of estrogen but
does not stop estrogen production. It may cause hot flashes, vaginal discharge and
irritation, and irregular periods in some women. Serious side effects are rare but are
noted to be blood clots in the veins, especially in the legs and sometimes causes cancer
in the lining of the uterus (McEvilly and Hassey, 1998). 
Surgery
Surgery causes short term pain and tenderness in the area of the operation. Any surgery
carries a risk of infection, poor wound healing, bleeding or reactions to medications and
anesthesia according to Fraker and Edwards, (1998). Removal of a breast can cause a
woman's weight to shift and be out of balance. This can cause discomfort in a woman's
neck and back. The skin in the breast area may be tight and the muscles of the arm and
shoulder may feel stiff. After a mastectomy, some women have some permanent loss of
strength in these muscles, but for most, reduced strength and limited movement are
temporary. Exercises are of benefit to improve and maintain range of motion. Nerves may
be injured or cut during surgery and they may be a numbness and tingling in the chest,
underarm, shoulder and arm. These feelings usually go away within a few months but some
women have permanent numbness (Fraker and Edwards, 1998). 
Nutrition for cancer patients
Loss of appetite can be a problem when feeling uncomfortable or tired. Nausea, vomiting
and mouth sores can make it hard to eat. However, good nutrition is important. Getting
enough calories and protein helps to prevent weight loss, regain strength and rebuild
normal tissues (Monson and Harwood, 1998).
Breast reconstruction
After mastectomy a woman may decide to wear a breast form (prosthesis). Others may prefer
breast reconstruction. What is right for one woman may not be right for another. There
are many choices to be considered. Various procedures are used to reconstruct the breast.
Some use implants or tissue moved from another part of the body. A woman's age, body and
type of cancer treatment will all play a role in deciding what treatment would be best.
According to Fraker and Murray (1998), some women think the reconstructed breast may
improve marital or sexual relations. It may make a woman feel more feminine and I
described earlier, whole again. There is more freedom in wearing clothing. The prosthesis
is difficult to wear at times. Other factors play a role in choosing reconstruction or
not. Such as, age, fear of more surgery, fear of the outcome, more pain and fear of not
finding a local recurrence. Some reconstruction takes place right away, others are
delayed because of the type of procedure. The reconstruction process can be long and
grueling according to my own experience but it can be one of the most important parts of
the rehabilitation process if a woman chooses this option.
Rehabilitation
Recovery will be different for every woman, depending on the extent of the disease, the
type of treatment and other factors.
Exercising after surgery helps to regain motion and strength in the arm and shoulder. It
can also reduce pain and stiffness in the neck and back. Gradually, exercising can be
more active and regular exercise should become part of the daily routine (Fraker and
Edwards, 1998). 
Often, lymphedema after surgery can be prevented or reduced with certain exercises and
resting the arm on a pillow. An elastic sleeve can be worn, medication prescribed or
manual lymph drainage (massage) can be tried. A physical therapist may be a helpful
referral (Dollinger, Rosenbaum and Cable, 1991).
Follow up care
Regular follow up care is important after breast cancer treatment. A woman will have
regular checkups to be sure that the cancer has not returned. This includes examinations
of the breasts, chest, underarm and neck. From time to time there will be a complete
physical examination and additional tests. Any unusual symptoms should be reported to the
doctor such as pain, loss of appetite or weight changes, unusual vaginal bleeding or
blurred vision. A woman should be alert to signs of dizziness, coughing or hoarseness,
headaches, backaches or digestive problems that are unusual and do not go away. These
symptoms may be a sign that cancer has returned but could be a lot of other things
(Dollinger, Rosenbaum and Cable, 1991).
Living with cancer
This diagnosis can change a woman's life and the lives of people close to her. These
changes can be very hard to handle. There are feelings of fright, anger and depression.
These are normal reactions when someone faces a serious health problem. It helps to share
thoughts and feelings with others. It can open the way for others to show their concern
and offer support. 
Sometimes women who have had breast cancer are afraid that changes to their body affect
not only how they look but how other people feel about them. They may be concerned that
breast cancer and its treatment will affect their sexual relationships. It is helpful to
seek counseling or a couple's support group (Monson and Harwood, 1998).
Cancer patients may worry about holding a job, caring for their families or starting new
relationships. Worries about tests, treatments, hospital stays and medical bills are
common. Doctors, nurses, members of the health care team and the rehabilitation counselor
can help calm fears and ease confusion about these issues. The patient should be provided
with information and resources (Monson and Harwood, 1998).
Employers must be educated to understand breast cancer and its treatment. Flexible work
schedules, rest periods, time off for doctor appointments and treatments will be
necessary. Depending on the extent of the disease, an employer may need to make
reasonable accommodations for the returning employee. If the patient, for example is
suffering from lymphedema, it may be necessary to adapt the work station or place the
worker in a different position where no lifting is involved. Since cancer is a disease
outlined in the American Disabilities Act, it may be necessary for the rehabilitation
counselor to discuss making reasonable accommodations and review the laws with the
employer.
Support
In conclusion, it can be very helpful to talk with others who are facing similar
problems. It is beneficial to get together in support groups and self help groups to
share what has been learned about cancer, its treatment and coping with the disease.
Several organizations have trained volunteers who have had breast cancer themselves, such
as Kaiser Permanente's Breast Buddy program or The American Cancer Society's, Reach for
Recovery program. Volunteers may telephone or visit patients, provide information and
lend emotional support before and after the treatment. Their own experiences are often
shared with the patient which helps to put things into perspective during a very
confusing, lonely and frightening time.
Bibliography
Ault, Susan R., BSN, OCN and Ferrell, Betty R., Ph.D., FAAN (1999). From victim to
victor: Taking control of breast cancer, The American Journal of Nursing, 46-51
Dollinger, Malin, M.D., Rosenbaum, Ernest N., M.D., and Cable, Greg (1991). Everyone's
guide to breast cancer therapy, New York; Universal Press
Fraker, Teresa R., BSN, RN, OCN and Murray Edwards, Denise, MA, MED, RNCS, NTS (1998).
After mastectomy: Restoring cosmesis via breast reconstruction, The American Journal of
Nursing, (Suppl. 6), 40-45.
McEvilly, Jan Marie, MS, RN and Hassey Dow, Karen, Ph.D., RN, FAAN (1998). Treating
metastatic breast cancer; Principles on current practice, The American Journal of
Nursing, (Suppl. 6), 26-29.
Moffa Barse, Patty, MSN, OACN, RN and Masney, Agnes, MPH, MSN (1990). Adjuvent therapy
and breast cancer treatment, The American Journal of Nursing, (Suppl. 6), 21-25. 
Monson, Mary Ann, MSN, RN and Harwood, Kerry, MSN, RN, (1998). Helping women select
primary breast care treatment, The American Journal of Nursing,, 3-7.
The National Cancer Institute, (1999). Understanding breast cancer treatment; A guide for
patients, Chicago: Author.