Questions about Breast Cancer

After hearing your diagnosis “You’ve got breast cancer,” it’s hard to focus on what comes next. You’re understandably scared, and your mind probably is reeling. You’re not prepared to have a conversation about your prognosis and medical choices.

From oncologist Jame Abraham, MD, Director of Cleveland Clinic’s Breast Medical Oncology Program, here are 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. 

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. Rarer, breast cancers may involve the nipple or the breast’s connective tissue. 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. The tumor’s dimensions are estimated by a physical exam, a mammogram, an ultrasound or an MRI of the breast. 

3. Is the cancer in my lymph nodes?

''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?

There are various systems that use number or letter codes to designate the cancer’s status and how far it may have spread. You may have heard of Stages 0 through IV, which reflect a tumor’s size and the extent of metastasis. A higher stage means a larger tumor and wider distribution of cancer cells. 

5. What is the grade of my tumor?

Grading is not the same as staging. Both are indicators of a cancer’s severity and prognosis, but using different criteria. While staging deals with tumor size, location and cancer cell distribution, grading is based on the cancer cells’ appearance under a microscope. 

6. What is my estrogen receptor and progesterone receptor status?

Your body’s hormones, such as estrogen and progesterone, may play a role in how your breast cancer progresses. 

7. Will I need surgery, and what kind should I have?

This is an important question, but the answer may be less than definitive, will vary from patient to patient, and you may have more than one choice. According to the American Cancer Society, most women with breast cancer have some type of surgery. Some breast cancers can’t initially be surgically removed.

8. Should I have breast reconstruction, and when?

This is another question whose answer is multi-layered, and which involves both medical and personal considerations. Some women opt not to have reconstruction. Others believe it benefits their appearance and psychological recovery. 

9.  Will I need radiation?

In general, Cleveland Clinic oncologists recommend radiation treatment for all breast cancer patients who undergo only removal of the tumor (lumpectomy). For women who undergo whole-breast removal, radiation may be recommended for those who are considered high-risk, especially those with tumors larger than 5 centimeters and with more than four cancerous lymph nodes.

10. Will I need chemotherapy?

Typically, chemotherapy is a consideration for patients with high-risk breast cancers. 

11. What long-term medications should I take?

If you have an ER/PR-positive breast tumor, Cleveland Clinic oncologists strongly recommend continuing anti-estrogen therapy for five to 10 years after your cancer treatment, unless there are medical contraindications. 

12. Should I consider participating in a clinical trial?

Breast cancer treatment has improved tremendously, and the reason for that progress is because patients have been willing to take part in tests of newer treatment options. For any stage of breast cancer, a well done clinical trial could be your best treatment option.