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Guidline Suggestions after Breast Cancer Diagnosis
judyfams posted:


I. Diagnosis
II. Find a Breast Surgeon and/or Plastic Surgeon, and/or Radiation Oncologist
A. Mastectomy (skin and/or nipple sparing mastectomies)
with possible reconstruction at the time of surgery or post operative.
There are different kinds of breast reconstruction using your own
muscles, tissue and skin such as TRAM flap, DIEP flap, SIEA flap,
and Latissimus dorsal with an implant. Reconstruction can also be
done using implants. If that is what you are considering you
might also want to consult with a plastic surgeon prior to surgery to
know your options.
B. Lumpectomy is another option and with this option you have radiation. You might want to consult a Radiation Oncologist prior to surgery to know your options.
1. One option is known as internal radiation (also called brachytherapy) and can be done at the time of the lumpectomy or within a few weeks of the surgery. This is also known as Accelerated Partial Breast Radiation. This is done using a balloon type device that is put in the lumpectomy cavity which allows the radiation to be delivered to the site within catheters. This usually is done twice a day for 5 days. Even though radiation takes place after chemo (should you need chemo), if you wait to consult the radiation oncologist after you finish chemo, you will probably not have the option of doing brachytherapy and will only have the option of external beam radiation.
2. External Beam radiation includes IMRT — Intensity Modulated Radiation Therapy and 3D-CRT — 3 dimensional conformal radiotherapy.
3. The standard external beam radiation is the one that takes place every weekday for five to seven weeks. Most external beam radiation is done in the supine (face up) position. Definitely ask about having radiation possibly done in the prone (face down) position.
III. Find a Medical Oncologist
A. Chemotherapy is usually done (if needed) after surgery and prior to radiation (adjuvant), sometimes it can be done first (neo-adjuvant) to shrink the tumor. The oncologist might recommend a DNA test be done on the tissue from the tumor to see if you would benefit from chemotherapy. The name of that test is the ONCOTYPE DX test and it determines the % chance of recurrence of your specific type of breast cancer over the next 10 years. You should discuss this with your oncologist to see if this test is feasible for you and if your insurance company will pay for it.
B. Hormone Therapy is prescribed by a medical oncologist if your breast cancer is estrogen/progesterone positive or HERS2 positive
IV. There are many decisions and choices that you may have to consider if you have been diagnosed with breast cancer. I would strongly recommend that you discuss these options with your surgeon, plastic surgeon and radiation oncologist prior to your surgery, to help you make the right decision for you. Not all breast cancer patients are candidates for each of the above mentioned options, and not all surgeons are trained to perform these new procedures. So you need to educate yourself so you can ask your doctor questions about these procedures and their ability to perform them. Also these are the treatment procedures as of 2010 and are always changing - so do research to remain up to date on new breast cancer treatments.

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For more information, visit the Duke Health Breast Cancer Center