Treatment for Breast Cancer
For many
women with breast cancer, treatment may remove or destroy the cancer.
Completing treatment can be both stressful and exciting. You may be relieved to
finish treatment, but find it hard not to worry about cancer coming back. This
is a very common concern in people who have had cancer.
It
may take a while before your fears lessen. But it may help to know that many
cancer survivors have learned to live with this uncertainty and are leading
full lives. For other people, the cancer may never go away completely. These
people may get regular treatments with chemotherapy, radiation therapy, or
other treatments to try to help keep the cancer in check. Learning to live with
cancer that does not go away can be difficult and very stressful. It has its
own type of uncertainty.
When treatment ends, your doctors will
still want to watch you closely. It is very important to go to all of your
follow-up appointments. During these visits, your doctors will ask questions
about any problems you may have and may do exams and lab tests or x-rays and
scans to look for signs of cancer or treatment side effects.
Almost any cancer treatment can have side
effects. Some may last for a few weeks to months, but others can last the rest
of your life. This is the time for you to talk to your cancer care team about
any changes or problems you notice and any questions or concerns you have.
At first, your follow-up appointments will
probably be scheduled for every 3 to 6 months. The longer you have been free of
cancer, the less often the appointments are needed. After 5 years, they are
typically done about once a year. If you had breast-conserving surgery, you
will get a mammogram about 6 months after surgery and radiation are completed,
and then at least every year. Women who had a mastectomy should continue to
have yearly mammograms on the remaining breast.
You should have pelvic exams every year because these drugs can increase your
risk of uterine cancer. This risk is highest in women who have gone through
menopause. Be sure to tell your doctor right away about any abnormal vaginal
bleeding, such as vaginal bleeding or spotting after menopause, bleeding or
spotting between periods, or a change in your periods. Although this is usually
caused by a non-cancerous condition, it can also be the first sign of uterine
cancer.
Other tests such as blood tumor marker
studies, blood tests of liver function, CTs, bone scans, and chest x-rays are
not a standard part of follow-up. Getting these tests won’t help a woman
treated with breast cancer live longer. They will be done (as indicated) if you
have symptoms or physical exam findings that suggest that the cancer has
recurred. These and other tests may be done as part of evaluating new
treatments by clinical trials.
If
symptoms, exams, or tests suggest a recurrence, imaging tests such as an x-ray, CT scan, PET scan,
MRI scan, bone scan, and/or a biopsy may be done. Your doctor may also measure
levels of blood tumor markers such as CA-15-3, CA 27-29, or CEA. The blood
levels of these substances go up in some women if their cancer has spread to
bones or other organs such as the liver. They are not elevated in all women
with recurrence, so they aren't always helpful. If they are elevated, your
doctor might use them to monitor the results of therapy.
If
cancer does recur, your treatment will depend on the location of the cancer and
what treatments you've had before. It may mean surgery, radiation
therapy, hormone
therapy, chemotherapy, targeted therapy, or some combination of
these. For more information on how recurrent cancer is treated
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