Cancer Articles (Dr. S.N White)

A new major study of over 10,000 women between the ages of 20 and 54 has found that  birth control pills  do not appear to increase a woman's chances of developing  breast cancer , regardless of the type of pill she uses or whether the disease runs in her family. The researchers studied more than 30 forms of oral contraceptives and found no indication that they increased the chances of developing breast cancer even among women who had a previous experience of benign breast disease , had a history of breast cancer in their family or who started using the pill before their first pregnancy. The study involved 5,000 women who had been diagnosed with breast cancer for the first time and compared them with 5,000 women who did not have breast cancer. The women in the study had used contraceptives for up to 15 years. Do oral contraceptives offer protection against any types of cancer?  Some studies have shown that oral contraceptives appear to reduce the risks of can...

Can a woman who has had breast cancer safely have a baby?  Most doctors discourage women from becoming pregnant for from 3 to 5 years following treatment for breast cancer, since recurrences most often happen during this period of time. Recent research has shown that pregnancy after breast cancer has no effect on survival rates. Statistics for women who have had breast cancer and become pregnant are at least as good as those of similar women who do not become pregnant. What is the outlook for women who discover breast cancer during pregnancy?  About 7 percent of women who develop breast cancer happen to be pregnant at the time of diagnosis. The outlook for a pregnant woman is just as favorable as that for a nonpregnant woman of the same age with a similar stage of disease provided that the cancer is diagnosed and treated promptly. When a suspicious lump is found, prompt biopsy is just as appropriate for a pregnant woman as for a nonpregnant woman. Biopsy can usuall...

What drugs are used in adjuvant chemotherapy?  The drugs most commonly used to treat breast cancer include melphalan, cyclophosphamide, methotrexate, 5-fluorouracil, Adriamycin, vincristine, tomaxifen, and prednisone. You may receive two ofthese drugs or as many as five in combination. Why is this adjuvant treatment given? In several research studies, patients who had one or more positive lymph nodes and received chemotherapy after breast cancer surgery, lived longer and had a longer time without disease than those patients with positive nodes who were treated with surgery alone. These studies are continuing, researching many different combinations of drugs. The selection of a specific drug or a combination of drugs is something that will be discussed by your doctor. Is radiation used in treating breast cancer? Yes. Radiation is often advised for lumpectomy or segmental mastectomy as well as when the lymph nodes under the armpit are involved or when the tumor is located i...

Are there some medical reasons why I should wear a prosthesis?  Yes, there are medical reasons why you should wear a form to replace the missing breast. The weight of the remaining breast, particularly for women with medium to large breasts, can cause shoulder, neck, and back pain. You may find that your posture will change, with the affected shoulder rising, if you do not have a prosthesis. The larger the remaining breast, the more vital the need, not only for appearance but also for weight. For your own well being, emotional comfort, and self confidence, you should plan to buy a prosthesis. In many cases, a well fitted prosthetic device means the difference between prompt, cheerful, total recovery and long term personal distress. You will need some device to make your clothing fit well. Can I wear the prosthesis all the time?  Yes. Many patients wear it all the time, around the clock. Some patients start by wearing it a few hours a day and gradually increasing the num...

What size tumors are indicated by the "T" classifications? TO means there is no evidence of primary tumor. Tl refers to a tumor that is 2 centimeters or less in its greatest dimension. T2 refers to a tumor which is more than 2 centimeters but not more than 5 centimeters. T3 means that the tumor is more than 5 centimeters. A T4 designation indicates a tumor of any size with direct extension to the chest wall or skin. Is there more than one kind of breast cancer?  Cancer of the breast is not a single disease. There are at least fifteen distinct varieties. The doctor and the patient need to know which variety they are dealing with before making the decision as to how to proceed. Among the types of breast cancer are intraductal, inflammatory, medulluary, papillary, tubular, lobular and Paget's disease. What is inflammatory breast cancer?  This is a rare type of breast cancer which often spreads rapidly to other parts of the body. In inflammatory breast cancer, the b...

Will my scar be red and swollen? Probably you will see a slight redness and swelling along the incision or find a small amount of pink draining from the scar area. These symptoms are normal. If there is a lot of redness and swelling or pus around the area or if you have heavy bleeding, call the doctor right away. Your scar will be red for a while but will soon fade in color. What if when I ask for a separate procedure for the biopsy, the doctor says that I will be doubling my risk of undergoing general anesthesia twice?  Your doctor, if he uses this argument, has overlooked the fact that a general anesthetic is not usually needed for a biopsy. In most cases, a biopsy can be performed under local anesthesia, with the patient fully conscious or, if she prefers, semiconscious. Most biopsies are now performed on an outpatient basis. What happens next if the pathological report shows that the tumor is cancerous?  Eight out of ten times, the lump will prove to be benign, b...

Won't all this time delay mean that the cancer has more chance to spread? No. Studies have shown that a short delay between biopsy and treatment will not affect the spread of disease or reduce the chances for successful treatment. An interval of 2 days to a week between the two procedures is not a problem. Many medical professionals now agree that this time delay is perfectly acceptable and in most cases is a wise way to proceed. The advantages of getting all of the necessary information about the extent of the cancer far outweigh the advantages of performing a quick, disfiguring operation. I feel I need some time to think, but everybody keeps pushing me to have the biopsy and the operation done right away. What should I do?  It is important to have the time to think and to look at the alternatives. You may want to talk it over with your husband and children, your sisters, your mother, or your friends. You may want to get a second opinion. It is all right to take a few extra d...

In the realities of the bedroom or nursery the size of the breast is only rarely a consideration in sexual attractiveness or nursing function. It is frequently a matter of the changing mode of the era or of ethnic background. The flat, ironing-board style of the current fashion model now competes with her better endowed predecessor on an equal plane. It is the performance, not the size, that counts. Without wanting to offend the plastic surgeon, many physicians believe that augmentation (making little ones big) is rarely indicated. You have to delve deep into your psyche to discover the real reason why you would even consider this. Reduction (making big ones little) mammoplasty is occasionally suggested for the truly heavy breast. Each of these operations leaves scars, so it is hard to conceal the intimate fact that the operation has been done. When a plastic falsie is inserted, the internal prosthesis remains relatively fixed in all positions. Even though the scar may be concealed ...

Yes, but far less frequently. Because the disease is not thought of in the male, men often come for treatment in such an advanced stage that they have a poor outlook. One problem in diagnosis is that men of all ages can develop an enlargement of one or both breasts due to overgrowth of tissues beneath the nipple; some of these breasts are so enlarged that they simulate the small female breast. This conditions is, therefore, called gynecomastia, which means female breast. A benign condition, it is often seen associated with diseases of the liver or thyroid or just advanced age.

The examination of the remaining breast is one of the important reasons for follow-up visits. About 10 percent of women with cancer in one breast have it or will get it on the other side. For a time there was some interest in doing an extensive operation on the involved side and a breast removal of the normal opposite side. The interest in this method has waned. Most surgeons are satisfied that careful repeated examinations of the other breast can be an effective approach to the problem.

The procedure is advised in those women whose vaginal smear examination reveals that the ovaries are still producing hormones (estrogen) that are believed capable of stimulating breast tissue. If the ovaries are not functioning, their removal cannot ordinarily be expected to help arrest cancer growth. This is a relatively simple operation. Removal of the ovaries is not associated with a severe interference with the workings of the body as occurs with removal of the adrenal glands or the pituitary. Many surgeons delay doing this procedure until there is evidence that the tumor has spread. It is a kind of secondary, in reserve, therapeutic modality.

In positive terms, and one would assume that you want to know the truth, it is possible to know this only by seeing what happens in the future. In general, if the tumor is limited to the breast, the chances of cure are excellent. For any single individual, however, the surgeon cannot predict what will happen. If the tumor is small and has not spread to the glands, the cure rate is about 80 percent. That is, 80 percent of such patients are free of the cancer five years later. If it has invaded the glands in the armpit, the cure rate is decreased to 30 percent. If the tumor has already spread to the bones or liver or chest, then the outlook is bad and the patient will die of the disease.

It is not possible to answer that for you as an individual, since there are such marked individual variations in resistance. Each one of us has a somewhat different biology in this regard. In general this condition if untreated is compatible with a life expectancy of two to two and a half years. But be aware that survival does not necessarily mean comfort and tranquillity. Uncontrolled cancer of the breast can be a dreadful experience. The whole purpose of treatment is to avoid the consequences of growth and spread of this tumor.

The surgery of curable breast cancer is controversial principally in regard to whether the breast alone should be removed (a simple mastectomy) or whether the breast should be removed together with the underlying chest wall muscles and the contents of the armpit (a radical mastectomy). The latter has been the procedure advised in most medical centers in this country. In cases of old age or poor general condition, the simpler procedure is always chosen. Sometimes only the tumor is removed, leaving the remainder of the breast intact. This has been termed a lumpectomy. Some surgeons also do more extensive operations that entail removing part of the chest wall (a super radical mastectomy). Others do only a simple breast removal and later give radiation treatments. Each has its place. Just as one size dress does not fit everybody, so the operative procedure is tailored to fit the needs of the individual patient, insofar as we know how to do this.

As a general policy surgeons try to avoid cutting into a suspected cancer for biopsy without having the opportunity immediately to deal with the results of the biopsy. Each time a breast operation for a tumor is to be done, the surgeon discusses with the patient in advance the possibility that, if the biopsy indicates a cancer, the breast may have to be removed. Actually the patient usually gives written consent, in advance, for a breast amputation. Under very special circumstances, where the surgeon can be almost 100 percent certain that the mass is a benign tumor, he will remove it without discussing the possibility of the more radical procedure. This pertains, for example, to breast tumors in teen-age girls. These are so rarely cancerous that it is safe to go with this statistical experience. What you're telling me then is that I will not know in advance, not until I wake up, whether or not my breast has been removed. That's true.

It is usually a very short stay, a day or two or overnight. The sutures can then be removed in the surgeon's office. You can resume full activities almost immediately. Why don't you do the biopsy in your office by removing the tissue under local anesthesia that is, the way a dentist removes a tooth? This is an operative procedure because the tumor may be deep and there may be many blood vessels around it. Is is much safer and technically more appropriate to do it with all the hospital nursing and instrument facilities. In this way one can minimize bleeding and infection. From a practical point of view and in some cases, there is no reason why your suggestion cannot be carried out in a facility specially equipped for that purpose. It would certainly save hospital beds. There is a method of drill biopsy for breast masses that is done on an ambulatory basis, but this approach has not yet found broad acceptance in this country.

This is a general term for poorly understood changes in the ducts of the breast. It is not an infection, although the terminology suggests that it is. Cystic mastitis may occur in both breasts or be dominant in one. The duct leading to the nipple may give out a greenish yellow discharge. The breast lumps may be quite tender, and they usually vary in size and tenderness in relation to the menstrual cycle. It is a completely innocent process. Mastitis: Recognition and Treatment This is also referred to as cystic disease, although in fact it is less a disease than a physiological dysfunction. If the diagnosis can be accurately made in advance, then there is no reason to do anything about it. The injection of hormones is of no help. Surgery is done often for this disease because it can be difficult to differentiate it from a tumor.

One can never be 100 percent positive about what it is until it is examined under the microscope. The removal of a benign tumor is such a safe and simple procedure that it is better to have it removed and know what it is rather than to worry about it, watch it, and still be uncertain. My friend has an ugly scar across the center of the breast. I want to avoid that. This is what makes me hesitant about being operated on. For the removal of a breast cyst or the biopsy or excision of an innocent tumor, the surgeon rarely needs to make an obvious and unsightly incision. The incision can be concealed in the pigmented skin about the nipple or in the lower or outer curve of the breast. These incisions heal so well and fall so well into the natural skin tissues that they are virtually imperceptible after several months. The scar is red at first because it contains blood vessels; as the scar matures, the blood vessels are no longer obvious and the well made scar blends with the normal skin co...

What is the first sign of breast cancer? Many women have no signs at all and are first diagnosed by the alert physician during his breast examination. The patient may first note a lump in the breast or a bloody discharge from the nipple, a change in the appearance of the breast, or a lump in the armpit.  When are breast lumps treated by needling to remove the fluid?  The method of treatment is termed aspiration. It is employed only when the physician is certain that the lump is a cyst. A cyst can be compared to a balloon filled with water. When the fluid is removed, it is hoped that the cyst wall will collapse and be obliterated. If the cyst recurs after aspiration, it then requires surgical removal. Some women are fortunate in that the cyst never reappears. This procedure must be used cautiously and selectively; it is never employed when the nature of the lump is in doubt. Aspiration is particularly suited to the woman who keeps reforming cysts after a biopsy has show...

How doctors detect breast cancer? It is possible to feel 90 to 95 percent of breast tumors.Deciding about the nature of the tumor can be another matter. In about two-thirds of patients it is possible, by feel alone, to make a fairly accurate diagnosis of an innocent breast cyst on the one hand or of a definite cancer on the other. In all instances the nature of the lump can be exactly determined only by taking it out in an operation and having it examined under a microscope. This is not to say that all breast lumps have to be removed. The examiner may be so certain that it is a breast cyst that he may recommend initial observation and removal only if it persists. Breast cancer test at home Do you approve of women examining their own breasts? Yes, indeed. It is an excellent form of self-evaluation. The woman who does this regularly, say, seven days before and seven days after her period, will be able to feel the difference when something new appears. Do not get hysterical and ...