Breast Cancer's Confusing Vocabulary: The Follow-Up Visit
Once you’ve started breast cancer treatment–with a lumpectomy or mastectomy, or maybe you’re starting with chemotherapy–the vocabulary seems to expand like weeds in a garden. You understand what chemotherapy is, but what’s this neutropenic fever they’re warning you about? You had a lymph node out–and now you’re at risk for lymphedema. What’s that? The following terms are some you may hear during a visit or visits following your initial treatment.
Adjuvant therapies: This is a catchall term for the various things that you do after your tumor is surgically removed. Chemotherapy, radiation, hormones, and drugs (e.g., tamoxifen) are all considered adjuvant therapies.
Bone density test: This is also known as a DEXA scan. Some long-term post-treatment drugs tend to lower your bone density, i.e., they make your bones more porous. Denser bones are stronger bones, and as we age our risk for osteoporosis and hip fractures increases. So if you’re taking drugs that may reduce bone density, you’ll probably be asked to take a calcium supplement and have regular bone density tests, to make sure that your bones are maintaining sufficient density. A bone density test is just like having an X-ray; it’s usually done in a couple of areas, including your hips.
Bone scan: Sometimes, if there’s reason to suspect cancer has spread, the oncologist will ask you to get a bone scan, to rule out (or discover) whether it’s moved into your bones. When you have a bone scan, you’ll be injected with a small amount of radioactive material, then lie on a table as a camera moves over your body from one end to the other. The camera will pick up any areas with a concentration of radioactive material, which signals an abnormality.
Chemo-brain: An all-purpose, non-medical term that describes thinking and memory skills disrupted by chemotherapy. Researchers are just beginning to study the causes and possible treatments for chemo-brain, a side effect that about 20%-30% of women who’ve had chemotherapy develop post-treatment. Typically, chemo-brain symptoms include short-term memory loss, inability to remember words, a slowdown in your ability to learn new things, and impaired ability to multitask. Hey, sounds like menopause, doesn’t it?!
DCIS: Ductal carcinoma in situ (DCIS) is the most common form of non-invasive breast cancer. Sometimes referred to as “pre-cancer,” it’s cancer that’s contained in the milk ducts, and hasn’t spread into any surrounding tissue. A diagnosis of DCIS usually means a lumpectomy, followed by radiation, and a course of tamoxifen (or a similar drug).
Invasive/infiltrating: These two words mean the same thing: cancer cells that are capable of growing into surrounding non-cancerous tissue. This doesn’t mean that they HAVE “invaded” anywhere else; it just means they can.
Lobular cancer: Most commonly invasive, lobular cancer occurs in the breast’s lobules, where milk is made. About 10-15 percent of women have this kind of cancer.
Lymph nodes (and axillary lymph nodes): Lymph nodes are located in various parts of the body and serve as filters, collecting and destroying bacteria and viruses, as well as cancer cells. (When the doctor talks about your axillary lymph nodes, he or she is referring to the ones in your armpit next to the affected breast.) Generally, if any of your lymph nodes show cancer cells, that signals it’s traveled out of the breast tissue. This in turn generally means different treatment than if the lymph nodes showed no sign of cancer. The “sentinel lymph node” is the one closest to your tumor, and the one most likely to contain cancer cells, if cancer has spread.
Lymphedema: If you have a lymph nodes or nodes removed (or sometimes as a result of radiation), you may notice at some point that the arm on the side the lymph nodes were removed has swelled up. This doesn’t have to happen immediately; it can occur months or even years later. Don’t ignore this swelling, even if it’s only very slight; it can lead to serious problems with your arm. Go see your doctor, who will probably recommend lymphedema therapy, which can include massage, and the use of a tight elastic sleeve to reduce and prevent further swelling.
Metastasize: Cancer that has spread out of the breast into other parts of the body is said to have metastasized.
Neutropenic fever: This is a fever that may develop during chemotherapy, when your white blood cell count is very low and it’s difficult to fight off infections. Neutropenic fever is the reason your doctor tells you to rest, avoid crowds, and be good to yourself while you’re having chemo.
Remission and recurrence: The yin and yang of cancer. Remission is when all signs of cancer have disappeared. Recurrence is what happens if that cancer, which had been in remission, reappears. We all know which “r word” we prefer.
See my September 5, 2006 SharePost for Part I: The Initial Visit.