Stage 3 Breast Cancer Treatment Timeline

Stage 3 Breast Cancer Treatment Timeline. hi in this video i'll be talking about stage 3 breast cancer what is stage 3 breast cancer what are some of your treatment options what should you expect as you go through different treatments and i'll address a little bit the cost of treatment as well [Music] what is stage 3 breast cancer you'll often hear stage 3 breast cancer referred to as locally advanced breast cancer and that's because there's more disease in the breast or lymph nodes or involving the skin or the chest wall you can also have stage 3 breast cancer if the primary tumor in the breast is more than five centimeters and there are little lymph nodes involved with just tiny microscopic areas of lymph nodes so just tumor size alone if they're only what are called micro metastases in the lymph nodes can actually make this stage 3 breast cancer stage 3 breast cancer can also be used as a term for what stage you have if the tumor involves the skin or the chest wall that is the back of the chest inflammatory breast cancer is usually considered stage 3 breast cancer as well if the cancer is spread to distant parts of the body other parts of the body away from the breast chest wall or the lymph nodes.

This is metastatic breast cancer and that's no longer stage three breast cancer although the breast cancer is more advanced than stages one or two our goal of treatment is to cure you so all the treatments are given with the intent to cure you although you might hear that the chances of the coming cancer coming back are a little bit higher it doesn't mean we can't cure stage 3 disease if you want to learn more about the risk of recurrence and long-term prognosis of stage 3 breast cancer you can look at our video linked below it's important to know that you can be told going into surgery that you have stage two breast cancer and then if more than four of the lymph nodes are involved this would be stage three breast cancer so it can be a little confusing because you go into the operating room thinking you have one stage and you come out having another stage that's because we know more not because the cancer has changed between your pre-operative or before surgery period to the post-operative period so how will your treatment go how do we treat stage 3 breast cancer i'm going to cover chemotherapy radiation therapy surgery targeted therapy and hormonal therapy and i'll keep reminding you where we are as i go through now in general because the cancer is more locally advanced there's more of the disease you will hear about getting treatment through your whole system before you go to surgery sometimes that's called preoperative chemotherapy primary chemotherapy or neoadjuvant chemotherapy all of those refer to chemotherapy given before surgery.

Read also: Stage-1-breast-cancer-treatment

So what we do is give treatment that goes through your whole system before you have surgery and the treatment if effective which it usually is will also of course treat the cancer in the breast skin shrink it near the chest wall etc and the lymph nodes as well so we'll give you not additional therapy we're just switching the order of the therapy so for most people with breast cancer if they get chemotherapy the chemotherapy is given after surgery but if you have stage 3 breast cancer or locally advanced breast cancer we'll often give you treatment with chemotherapy first again we're just switching the order the reason we do this is because we're more likely to be able to have what's called a favorable surgical outcome we're more likely to be able to get all of the cancer confined to the breast and make the surgery easier on you and technically less challenging for the surgeon if your lymph nodes are stuck together under the armpit or over the collarbone the clavicle we can shrink the lymph nodes and make them easier to remove some people can even go from needing a mastectomy as a type of operation to being able to have breast conserving therapy where we can actually keep the breast so that's another reason to give it first sometimes it's actually even easier to get chemotherapy started than it is to plan time in the operating room especially if you want surgical reconstruction that's another type of surgery after mastectomy that can take a while to orchestrate and arrange with your schedule and the different surgeons who are involved if we give chemotherapy first we have longer to plan your surgery and the type of surgery you're going to have now if you hear that your tumor is inoperable that doesn't mean that it's not curable what that means is that we can't get negative or clean surgical margins without shrinking the tumor ahead of time or decreasing the extent of the tumor in the skin or the lymph nodes so we'll give chemotherapy first to make the cancer then operable so chemotherapy can make an inoperable tumor operable [Music] let's talk about how chemotherapy is given chemotherapy is given. 

When you're an outpatient usually in a cancer treatment center a cancer center or a place called an infusion center chemotherapy is given in general by vein so when you go in to get chemotherapy you'll have an iv started in your arm or sometimes in a semi-permanent iv under the skin that's called a port you don't absolutely have to have a port some people want to avoid it because it's an additional surgery and some people find that their veins are kind of difficult to get an iv in so the port might be easier another thing to know is you can start getting chemotherapy in the vein of your arm and then it can be switched over to a port if your veins become challenging to get an iv into after chemotherapy which takes up to six hours but usually less the iv comes out and you go home a couple things to know your chemotherapy doses are picked and prescribed specifically for you based on both the medication and how it's given and also your body size so it's not made up ahead of time the day before or even before you come to the infusion center it'll be made up after you've seen your doctor or your nurse practitioner or physician assistant the pharmacy is told everything's good to go and then they start assembling your chemotherapy we also want you to know that you get chemotherapy anti-nausea meds and other side effect prevention medications before you get your chemotherapy those are usually given by mouth sometimes by vein and those will help prevent those side effects especially nausea or vomiting which we're very good at preventing but we can always do better so work with your medical team if you're particularly concerned about this which most people are surgery for stage 3 breast cancer will depend on the size of the tumor relative to the size of your breast and also the lymph nodes status so first of all if you have a very large breast and it will still look good to you after the surgery then we can often do breast conserving surgery where you keep the breast and just the tumor and the normal rim of tissue is taken around the tumor that's often called a lumpectomy if you prefer or if there are reasons for you to have a mastectomy that's removal of the whole breast that's an equally good effective and safe option the decision about the type of surgery you have will be made between you and your surgeon and the recommendation can change if the chemotherapy is effective in shrinking the tumor the decision about the lymph nodes is completely different and independent of the surgery you have on the breast so just because you need a mastectomy to remove the whole breast doesn't mean that you need to have all the lymph nodes removed and just because you need to have all the lymph nodes removed doesn't mean you have to have the whole breast removed so again these are really independent decisions one decision made about the surgery on the breast and another made about the lymph nodes if your lymph nodes are clearly positive on ultrasound or a mammogram or on physical exam. 

If they're abnormal at the time the surgeon goes into the area under the armpit you'll have more lymph nodes removed it's important to know we don't actually know how many lymph nodes are in the armpit we can't see the lymph nodes we remove the area of tissue or fat that's marked by the different landmarks in your armpit for example the pectoralis muscles so you can learn more about the type of surgery to expect on your lymph nodes in our other video what happens after you've had surgery will depend on the treatment you had before surgery and also what we know about the tumor nearly every single person will have radiation therapy after stage 3 breast cancer there are very few exceptions so it's helpful to know that this will most likely be part of your treatment plan if the side effects of radiation therapy in particular the long-term side effects if those benefits are lower than the risks radiation therapy may not be part of your treatment plan for example if you've had previous radiation therapy to that area pretty recently we really try to avoid radiation therapy unless it's absolutely necessary also if you have serious medical problems radiation therapy may not help you and your doctor will go over that with you but most people should expect to have radiation therapy if you want to learn more about this visit yerba.com if you get radiation treatment radiation is given every day it's a short treatment monday through friday radiation starts with something we call treatment planning or you might hear the term simulation or sometimes it's nicknamed sim and this is done to avoid radiating tissues that don't need radiating and also to make sure that all the areas that need radiation therapy will get it that treatment planning takes a while the radiation oncologist and the physicists who are experts in radiation therapy will make sure that we don't radiate the heart or the lungs or the bones unless they're exactly within the radiation field so you can imagine this takes a while this will actually take up to two hours sometimes a little bit more and then after that's done the treatment team comes up with a treatment plan that can also take a few days before you actually start radiation once you start radiation like i said it's in and out 20 minutes you come in change into a gown get your radiation treatment on a different machine from the one where the planning was done then you get dressed and go home again you can drive yourself to and from radiation treatment side effects of radiation therapy include some redness or darkening of the skin if you have darker skin you may get redness and some increase in pigmentation or color of the skin this will gradually go away over time if this becomes severe you may actually have some peeling of the skin and the skin underneath may actually be moist your radiation therapy nurse radiation oncologist and other members of the team can help you manage that sloughing of the skin or shedding of the skin any discomfort you may have let them know that you're uncomfortable other side effects of radiation therapy include fatigue or tiredness that actually gets worse over the radiation treatment other side effects tend to be later like skin tags those can come off they just come off on their own and like i said you can get a mark where you have the radiation treatment this will actually be sort of a square mark you'll be able to see the edges of it and that will that will fade and get better over time additional chemotherapy after surgery may be recommended if there's a lot of cancer seen after the chemotherapy before surgery in other words you have chemotherapy then you have surgery and we see a lot of cancer left in the tumor chemotherapy after surgery will also be part of your treatment plan that's particularly the case if the tumor is negative for the hormone receptors if you want to learn more about your tumor and the hormone receptor status of your tumor. 

To see your personalized report we have specific chemotherapy that's recommended after surgery assuming you had chemotherapy first and that's based on what the tumor looks like under the microscope in terms of the hormone receptors and the her2 status and also what treatment you had in particular before surgery i'm going to talk now about targeted therapy for stage 3 breast cancer targeted therapy is given only in the tumors only for people with tumors that are her2-positive targeted therapy can be given along with chemotherapy before surgery and then because most targeted therapy goes for a whole year even when you've had your surgery and you're done with all chemotherapy you'll finish out what we call a course of targeted therapy up to a year we try to give up to a year unless you have side effects that mean we need to stop it in particular any evidence that your heart is not tolerating therapy as well targeted therapy is given by vein and if you're going to get targeted therapy i would recommend that you consider a porch that's the semi-permanent iv that goes out under your skin on your chest that comes out after all the treatment is over that's why i call it semi-permanent it doesn't stay with you forever hormonal therapy is given if the tumor is or was hormone receptor positive hormonal therapy is given to decrease the amount of estrogen in your body even if you're done menstruating and your ovaries are done working we still make estrogen even men have estrogen so no matter what if the tumor is hormone receptor positive you'll get some form of hormonal therapy to decrease the amount of estrogen in your body getting to the tumor.

Usually we give hormonal therapy for up to 10 years in people who have had stage 3 breast cancer it's really important that you work with your medical team to make sure then that you can tolerate it a lot of people think after chemotherapy and targeted therapy and hormone and chemotherapy radiation therapy targeted therapy and surgery why do i need hormonal therapy hormonal therapy is actually one of the most effective treatments in breast cancer in tumors that are hormone receptor positive that means they have the estrogen or the progesterone receptor or both and it's so powerful that we say if you're not tolerating it well we're going to switch you to a different hormonal therapy and for most people we can actually help you stay on your hormonal therapy you have to let your medical team know if you're having side effects that make you think you don't want to stay on it you know hold us to task we have to help you get through this if costs are concerned with your hormonal therapy let us know there are ways we can help with the cost of hormonal therapy another thing to know about hormonal therapy is that if you have functioning ovaries we will recommend that we shut those ovaries down either temporarily with medicine or permanently with surgery or even radiation therapy if your ovaries are no longer making estrogen we don't need to do this but if your ovaries are we need to decrease estrogen in your body if you're close to natural menopause then you can have your ovaries shut down permanently if you're younger we may want to just do this temporarily and then your periods your ovaries will start to work again after we stop the medications that would suppress the ovaries if you want to learn more about this see your personalized report at yerba.com side effects of hormone treatment depend on which medication you get with tamoxifen we see hot flashes night sweats vaginal dryness or discharge and leg cramps the aromatase inhibitors are the other main class of hormonal therapy and they can also cause hot flashes and night sweats unlike lead cramps with tamoxifen they can cause joint or muscle aches and pains we also see vaginal dryness with the aromatise inhibitors make sure you let your medical team know what side effects you're having because we can help with most of these and if your side effects can't be managed we can switch you to the other type of hormonal treatment i'm going to talk briefly about the cost of each of these treatments i would recommend that you learn about the cost of chemotherapy surgery radiation treatment targeted therapy and hormonal therapy as you get to each step or even better before the whole thing i think the worst thing is not being prepared for the cost of treatment for the most part insurance will cover a big part of the cost but if you have a high deductible plan or high out of pocket costs it's good to know what those are let your medical team know that this is a concern for you and that you'd like to do anything you can to decrease the cost of therapy what do i mean by this well if you're treated towards the end of the year it's possible you could have all your radiation treatment completed before the new year starts and that new deductible kicks in it's also important to know that we use generic medications that are just as good as brand name medications whenever possible and you can you know ask your team are am i getting the generic forms is there anything i can do to offset the cost of treatment and also let me know what their costs are going to be before i start treatment so i can prepare these costs aren't trivial and they can certainly affect a lot of people going through cancer treatment we don't want the cost of course to decrease or interfere with the quality of your treatment if this video was helpful to you