In most cases, you do not have to decide immediately on a treatment plan. You can take at least a few days and perhaps, a few weeks to consider your options and think about which treatment is best for you, both medically and personally. Ask your doctor how long you can safely review your choices.
Your doctor will advise you on what he or she believes is the best option for you, based on the biopsy results and your pathology report. But it is likely that you will have to make some choices.
You may be asked to decide on a method of local control -- how the tumor in the breast will be removed. One option is a mastectomy, a surgical procedure in which the entire breast is removed. Another option is a lumpectomy (also called a wide local excision), a surgical procedure in which only the tumor and the tissue immediately surrounding it are removed. Whether or not you can undergo a lumpectomy is determined by the size of the tumor, the size of your breast, and how advanced the cancer is, among other factors. If you choose lumpectomy, you will likely be advised to have radiation therapy to the breast area as well. Some women will be advised to undergo radiation therapy after a mastectomy as well.
Your doctor may also talk to you about treatment or surgical removal of the lymph nodes closest to the breast. A discussion of lymph node dissection can be found under "Lymph Node Surgery."
Another decision you may need to make concerns systemic control -- treatment for any cancer cells that might have moved beyond the breast. Options here include chemotherapy, hormone therapy, and biologic therapy. Whether or not you need any systemic treatment (also called adjuvant therapy), and which type best suits your condition, depends on a number of factors such as: whether or not any lymph nodes or other parts of the body are involved, the size of the tumor, your menopausal status, and the results of various cellular tests, such as your hormone-receptor status (information that is found in your pathology report). Chemotherapy is usually given over several months and hormonal therapy is given over several years.
If you decide to have a mastectomy, you will also need to think about whether you want reconstruction, and which type of reconstruction will work best for you. (However, if you are not ready to make that decision, you can wait.)
Clinical Trials
You may be offered the chance to take part in a clinical trial at some time during your treatment. Clinical trials are research studies that help evaluate treatments and may give you access to new therapies not yet readily available. Clinical trials are done in several stages. A phase I clinical trial aims to find the best and safest way to give a new treatment. Patients are closely watched for side effects. Once the phase I trial is completed, the new treatment may be evaluated in a phase II clinical trial. At this stage the doctors are looking for significant anti-cancer activity, as well as side effects. After that, a phase III clinical trial will compare the new treatment to a standard treatment, randomly assigning patients to either group. Random assignment means assignment is based on chance, similar to flipping a coin. This makes the results of the trial more scientifically sound. You may be asked to take part in any of the three types of clinical trials. Some people worry that they will receive only a placebo, such as an ineffective sugar pill, in a clinical trial, but that is very rarely done in cancer treatment clinical trials.
In general, a clinical trial is a research program that compares the effectiveness of one treatment, such as a type of surgery or chemotherapy agent, to the standard. In many cases, one is a standard treatment that has been in use for some time, while the other is a newer treatment that has shown promise in earlier studies.
Clinical trials may also be used to compare diagnostic tests, prevention strategies, or other aspects of caring for cancer patients.
If you are asked to participate in a clinical trial, your doctor or nurse will explain exactly what is involved and any possible benefits or drawbacks posed by the trial. However, be aware that unexpected side effects may also occur. You will need to sign an informed consent agreement.
You are not required to participate in a clinical trial and if you refuse, this will not jeopardize your relationship with your physician. You may leave a trial at any time, for any reason, even after signing the agreement. If you do choose to participate, however, you can help to evaluate new treatments, and may also have access to new therapies that are not yet available to the general public.
