After confirming a breast cancer diagnosis, it could get difficult to focus on what to do next. You are understandably scared and confused, most likely because you’re not prepared—no one is—to discuss about prognosis and medication for cancer.
According to the best oncologist in Singapore, here are 10 questions you should ask your doctor. The answers of your specialist will help better understand your case and treatment choices.
1. “What type of breast cancer I am diagnosed with?”
Doctors classify breast cancers in various ways. The most common way is to locate where the cancer cells originate, which will determine whether the disease will spread and the kind of treatment to perform.
Most breast cancers, however, start in the milk ducts. They are known as invasive ductal carcinomas, meaning that they have penetrated the milk duct’s wall and propagated into the breast’s fatty tissues. Once the cancer is there, it’s possible for the cells to further spread to other parts of the body.
Rarer types of breast cancer diagnosed by an oncologist from Singapore may involve the breast’s connective tissues, the nipple, or the linings of the lymph or blood vessels. Some are also non-invasive, meaning they have not spread. They are contained within the milk ducts and are called ductal carcinoma in situ (DCIS).
2. “Has the cancer spread to my lymph nodes?”
Whether your cancer has infected your lymph nodes—or elsewhere in your body that are part of the immune system—is among the important predictors of the severity of the disease. Once the lymph nodes are involved, it changes the treatment plan—more aggressive approaches, like chemotherapy, are considered.
3. “How big is the tumour?”
The size of the tumour is another vital indicator that will help determine your treatment plan. Your Singapore oncologist uses the size of the tumour to identify the ‘Stage’ and further categorize your cancer. The size will be estimated through physical examination, ultrasound, mammogram, or MRI of the breast. The accurate size of the tumour won’t be known until a pathologist has examined the tumour after it is surgically removed.
4. “What stage is my cancer?”
Staging of cancer is a way of classifying the severity of a patient’s case. You may have heard of Stages 0 to IV, which reflects the size of the tumour and the severity of the metastasis. The higher the stage, the bigger the tumour is. Your oncologist uses staging to create a treatment plan, gauge prognosis, and communicate with other Singapore oncology consultants.
5. “Do I need to undergo a surgery, and if so what kind?
The answer for this question varies from patient to patient, and may change over time as the tumour grows. Some cases cannot initially be removed through surgery. In other instances, whether or not to operate and the type of surgery depends on the stage of the disease, the location and size of the tumour, and the size of the breast. If your cancer is operable, your choices would be breast-conserving surgery or mastectomy. Within each of the two broad treatment categories lie more surgical options. Discuss with your Singapore oncologist, and if in doubt, you can certainly seek for second opinion.
6. “Do I need radiation?”
In general, Singapore oncologists recommend radiation therapy for breast cancer patients who undergo surgery for removal of cancer tumour (lumpectomy). For patients who undergo whole-breast removal, radiation therapy may be recommended for those who are at higher risk of re-growing cancer cells again—those with tumours larger than five centimetres and with over four cancer-affected lymph nodes.
7. “Do I need chemotherapy?”
Typically, this cancer treatment is a must for women with high-risk cases. Some factors that may indicate that you need chemotherapy are cancer-infected lymph nodes, higher-grade tumours, HER2-positive tumours, and breast cancer cases in patients below 40 years old. If you need chemo, it will be provided as an outpatient treatment every two to three weeks, delivered through a port of directly into your vein.
8. “Do I long-term medication?”
If you have ER/PR-positive tumour, meaning your tumour can detect estrogen and use it to fuel its growth, your oncologist will likely recommend to continue getting an anti-estrogen therapy for up to 10 years after cancer treatment. Anti-estrogen treatment is usually a once-daily pill. For women in premenopausal stage, tamoxifen is the commonly prescribed medication; postmenopausal women have more options.
9. “Should I undergo breast reconstruction?
The answer for this involves medical and personal considerations. Some patients prefer not have breast reconstruction, while others believe that it benefits their physical appearance and psychological recovery. As for when the right time is for breast reconstruction, this depends on the stage of your cancer. Women with early-stage cancer and have been treated can have immediate reconstruction. But for those with Stage III cancer, discuss with your oncologist the right timing for a reconstruction surgery.
10. “Should I consider clinical trials?”
Treatments for breast cancer have improved tremendously over the years, and the reason for that significant progress is because patients have been willing to try the newer treatment options. For any stage of cancer, a well-thought clinical trial could be the best option you have. If you’re willing to consider this option, your oncologist Singapore can answer the questions about clinical trials you may have in mind.
Any cancer is a critical threat to your health, but being diagnosed with one doesn’t mean it’s going to bring you to a terrible end. Get up and fight for a better health. With the right knowledge about your situation, it’s easier to look for ways on how to counteract this highly treatable disease.