Sexuality after breast cancer

You may have concerns about sexuality after breast cancer. Physical changes (such as those after surgery) make some women less comfortable with their bodies. Some treatments for breast cancer, such as chemotherapy, can change your hormone levels and may negatively affect sexual interest and/or response. For women in their 20s or 30s who may be focused on choosing a partner or having children, a diagnosis of breast cancer can be especially difficult.

Although there may be emotional effects, breast surgery or radiation to the breasts does not physically decrease a woman's sexual desire. Nor does it decrease her ability to have vaginal lubrication or normal genital feelings, or to reach orgasm. And according to recent research, most women with early-stage breast cancer have good emotional adjustment and sexual satisfaction within a year after their surgery .Shawnte’s Sensual Solutions reports a quality of life similar to women who never had cancer.

 It has been quite some time since I have blogged, but know that I will be blogging again more regular. There have been many changes with SSS, and I am very excited to let you all in on all of the secrets and changes that have been made to SSS. I am unable to contain myself with excitment. With that being said, I am praying for each and every one of you regardless of the circumstances that each one of us face. Have a very blessed, and prosperous day!!!! 

Breast Cancer: Stages

Staging is a way of describing where the cancer is located, how much the cancer has grown, and if or where it has spread. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

The most commonly used tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

Tumor (T): How large is the primary tumor? Where is it located?

Node (N): Has the tumor spread to the lymph nodes? If so, where and how many? 

Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

There are 5 stages: stage 0 (zero), which is noninvasive ductal carcinoma in situ (DCIS), and stages I through IV (1 through 4), which are used for invasive breast cancer. The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Staging can be clinical or pathological. Clinical staging is based on the results of tests done before surgery, which may include physical examinations, mammogram, ultrasound, and MRI scans. Pathologic staging is based on what is found during surgery to remove breast tissue and lymph nodes. The results are usually available several days after surgery. In general, pathological staging provides the most information to determine a patient’s prognosis.

Here are more details on each part of the TNM system for breast cancer:

Tumor (T)

Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.

Stage may also be divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information in listed below.

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no evidence of cancer in the breast.

Tis: Refers to carcinoma in situ. The cancer is confined within the ducts or lobules of the breast tissue and has not spread into the surrounding tissue of the breast. There are 2 types of breast carcinoma in situ:

Tis (DCIS): DCIS is a noninvasive cancer, but if not removed it may develop into an invasive breast cancer later. DCIS means that cancer cells have been found in breast ducts and have not spread past the layer of tissue where they began.

Tis (Paget’s): Paget’s disease of the nipple is a rare form of early, noninvasive cancer that is only in the skin cells of the nipple. Sometimes Paget’s disease is associated with another, invasive breast cancer. If there is another invasive breast cancer, it is classified according to the stage of the invasive tumor.

T1: The tumor in the breast is 20 millimeters (mm) or smaller in size at its widest area. This is a little less than an inch. This stage is then broken into 4 substages depending on the size of the tumor:

T1mi is a tumor that is 1 mm or smaller

T1a is a tumor that is larger than 1 mm but 5 mm or smaller

T1b is a tumor that is larger than 5 mm but 10 mm or smaller

T1c is a tumor that is larger than 10 mm but 20 mm or smaller

T2: The tumor is larger than 20 mm but not larger than 50 mm.

T3: The tumor is larger than 50 mm.

T4: The tumor falls into 1 of the following groups:

T4a means the tumor has grown into the chest wall.

T4b is when the tumor has grown into the skin.

T4c is cancer that has grown into the chest wall and the skin.

T4d is inflammatory breast cancer.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. Regional lymph nodes include:

Lymph nodes located under the arm, called the axillary lymph nodes

Above and below the collarbone

Under the breastbone, called the internal mammary lymph nodes

Lymph nodes in other parts of the body are called distant lymph nodes. As explained above, if the doctor evaluates the lymph nodes before surgery, based on other tests and/or a physical examination, a letter “c” for “clinical” staging is placed in front of the “N.” If the doctor evaluates the lymph nodes after surgery, which is a more accurate assessment, a letter “p” for “pathologic” staging is placed in front of the “N.” The information below describes the pathologic staging. 

NX: The lymph nodes were not evaluated.

N0: Either of the following:

No cancer was found in the lymph nodes.

Only areas of cancer smaller than 0.2 mm are in the lymph nodes. 

N1: The cancer has spread to 1 to 3 axillary lymph nodes and/or the internal mammary lymph nodes.

N2: The cancer has spread to 4 to 9 axillary lymph nodes. Or it has spread to the internal mammary lymph nodes, but not the axillary lymph nodes.

N3: The cancer has spread to 10 or more axillary lymph nodes. Or it has spread to the lymph nodes located under the clavicle, or collarbone. It may have also spread to the internal mammary lymph nodes. Cancer that has spread to the lymph nodes above the clavicle, called the supraclavicular lymph nodes, is also described as N3.

If there is cancer in the lymph nodes, knowing how many lymph nodes are involved and where they are helps doctors to plan treatment. The pathologist can find out the number of axillary lymph nodes that contain cancer after they are removed during surgery. It is not common to remove the supraclavicular or internal mammary lymph nodes during surgery. If there is cancer in these lymph nodes, treatment other than surgery, such as radiation therapy, chemotherapy, and hormonal therapy are used first.

Metastasis (M)

The “M” in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis. This is no longer considered early-stage or locally advanced cancer. For more information on metastatic breast cancer, see the Guide to Metastatic Breast Cancer.

MX: Distant spread cannot be evaluated.

M0: The disease has not metastasized.

M0 (i+): There is no clinical or radiographic evidence of distant metastases. Microscopic evidence of tumor cells is found in the blood, bone marrow, or other lymph nodes that are no larger than 0.2 mm.

M1: There is evidence of metastasis to another part of the body, meaning there are breast cancer cells growing in other organs.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications and the tumor grade and the results of ER/PR and HER2 testing. This information is used to help determine your prognosis (see Diagnosis). The simpler approach to explaining the stage of breast cancer is to use the T, N, and M classifications. This is the approach used below to describe the different stages.

Most patients are anxious to learn the exact stage of the cancer. Your doctor will generally confirm the stage of the cancer when the testing after surgery is finalized, usually about 5 to 7 days after surgery. When systemic or whole body treatment is given before surgery, called neoadjuvant therapy, the stage of the cancer is primarily determined clinically. Doctors may refer to stage I to stage IIA cancer as early stage, and stage IIB to stage III as locally advanced.

Stage 0: Stage zero (0) describes disease that is only in the ducts and lobules of the breast tissue and has not spread to the surrounding tissue of the breast. It is also called noninvasive cancer (Tis, N0, M0).

Stage IA: The tumor is small, invasive, and has not spread to the lymph nodes (T1, N0, M0).

Stage IB: Cancer has spread to the lymph nodes and the cancer in the lymph node is larger than 0.2 mm but less than 2 mm in size. There is either no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller (T0 or T1, N1, M0).

Stage IIA: Any 1 of these conditions:

There is no evidence of a tumor in the breast, but the cancer has spread to 1 to 3 axillary lymph nodes. It has not spread to distant parts of the body. (T0, N1, M0). 

The tumor is 20 mm or smaller and has spread to the axillary lymph nodes (T1, N1, M0).

The tumor is larger than 20 mm but not larger than 50 mm and has not spread to the axillary lymph nodes (T2, N0, M0).

Stage IIB: Either of these conditions:

The tumor is larger than 20 mm but not larger than 50 mm and has spread to 1 to 3 axillary lymph nodes (T2, N1, M0).

The tumor is larger than 50 mm but has not spread to the axillary lymph nodes (T3, N0, M0).

Stage IIIA: The cancer of any size has spread to 4 to 9 axillary lymph nodes or to internal mammary lymph nodes. It has not spread to other parts of the body (T0, T1, T2 or T3, N2, M0). Stage IIIA may also be a tumor larger than 50 mm that has spread to 1 to 3 axillary lymph nodes (T3, N1, M0).

Stage IIIB: The tumor has spread to the chest wall or caused swelling or ulceration of the breast or is diagnosed as inflammatory breast cancer. It may or may not have spread to up to 9 axillary or internal mammary lymph nodes. It has not spread to other parts of the body (T4; N0, N1 or N2; M0).

Stage IIIC: A tumor of any size that has spread to 10 or more axillary lymph nodes, the internal mammary lymph nodes, and/or the lymph nodes under the collarbone. It has not spread to other parts of the body (any T, N3, M0).

Stage IV (metastatic): The tumor can be any size and has spread to other organs, such as the bones, lungs, brain, liver, distant lymph nodes, or chest wall (any T, any N, M1). Metastatic cancer found when the cancer is first diagnosed occurs about 5% to 6% of the time. This may be called de novo metastatic breast cancer. Most commonly, metastatic breast cancer is found after a previous diagnosis of early breast cancer. Learn more about metastatic breast cancer.

Recurrent: Recurrent cancer is cancer that has come back after treatment, and can be described as local, regional, and/or distant. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Six Factors Linked to Invasive Breast Cancer Recurrence After DCIS

After being diagnosed and treated for DCIS, six factors seem to be linked to a higher risk of recurrence of invasive breast cancer, according to a study.

 

The factors are:

 

DCIS found by a doctor during a physical exam

being premenopausal

positive margins (DCIS was found at the edge of the removed tissue)

high-grade DCIS

high levels of p16 protein, a protein that helps regulate cell growth

being African American

The research was published online on April 25, 2019, by the journal Cancer Epidemiology, Biomarkers & Prevention. Read the abstract of "Predictors of an Invasive Breast Cancer Recurrence after DCIS: A Systematic Review and Meta-analyses."

 

What is DCIS?

DCIS — ductal carcinoma in situ — is non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means "in its original place." DCIS is called non-invasive because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue. DCIS isn’t life-threatening, but being diagnosed with DCIS increases your risk of developing invasive breast cancer later on.

 

Current DCIS treatment guidelines recommend surgery to remove the DCIS, often followed by radiation therapy and hormonal therapy, if the DCIS is hormone-receptor-positive (most are).

 

Still, the researchers who did this study said most cases of DCIS likely will not progress, so many women are overtreated.

 

"There is a large unmet need to distinguish harmless from potentially hazardous DCIS," said senior author of the study Jelle Wesseling, M.D., professor of breast pathology at the Netherlands Cancer Institute and Leiden University Medical Center, in a statement. "We hope our work will help reduce the burden of intensive treatment that thousands of women with low-risk DCIS undergo annually."

 

How the study was done

This study was a meta-analysis. A meta-analysis combines and analyzes the results of a number of earlier studies. In this case, the researchers analyzed the results of 17 studies published between 1970 and 2018 looking at the risk of invasive breast cancer coming back in the same breast after a diagnosis of DCIS.

 

The number of women in each study ranged from 52 to 37,692, and average follow-up time ranged from 3.2 years to 15.8 years.

 

The researchers found 26 factors that could be linked to invasive breast cancer recurrence after DCIS. Their analysis found that six of those factors were statistically significant, which means the factors were likely linked to a higher risk of invasive breast cancer recurrence rather than it being due to chance.

 

The researchers said that the reason each of the six factors was linked to a higher risk of invasive breast cancer recurrence could be biologically explained.

 

Positive margins: If the DCIS has positive margins, it means that some cancer cells were left behind at the cancer site and could eventually lead to a recurrence.

Being premenopausal: Premenopausal women are younger. Women who are diagnosed at a younger age are more likely to have worse outcomes after being diagnosed with DCIS or breast cancer.

Being African American: Research has shown that black women are more likely to be diagnosed with more aggressive breast cancer than women of other races. This disparity is likely due to several factors, including genetics, the biology of the cancer, and differences in healthcare.

DCIS found by a doctor’s exam is likely to be more aggressive than DCIS found by a regular screening mammogram. According to the researchers, DCIS found by an exam is more often hormone-receptor-negative and HER2-positive.

High-grade DCIS also is likely to be more aggressive than low-grade DCIS.

High p16 levels means that the cells are more likely to grow in an uncontrolled fashion.

The researchers recommended that these six factors be validated in other studies. They also recommended that the type of recurrence after a DCIS diagnosis and treatment be specified in new studies on DCIS.

 

"New studies need to capture information about whether the cancer recurrence was DCIS or a subsequent invasive cancer and whether these are true recurrences or new, primary lesions," Wesseling said.

 

What this means for you

This is one of the first studies to try to identify risk factors for an invasive breast cancer recurrence after a DCIS diagnosis. Although the factors have not been validated by other studies, it makes sense to talk to your doctor about whether you have any of these factors if you’ve been diagnosed with DCIS. It also makes sense to talk to your doctor about calculating your personal risk of invasive breast cancer using one of the assessment tools available.

 

If you have a higher-than-average risk of invasive disease, there are a number of lifestyle choices you can make, including:

 

maintaining a healthy weight

exercising regularly at the highest intensity possible

limiting or avoiding alcohol

limiting processed foods and foods high in sugar

eating healthy, nutrient-dense food

not smoking

There are other, more aggressive risk reduction steps you may want to take, including:

 

a more aggressive screening plan starting at an earlier age

hormonal therapy to block the effect of estrogen on breast tissue or reduce the amount of estrogen in the body

removing the healthy breasts (prophylactic mastectomy)

Together, you and your doctor can figure out a risk-reduction plan for your unique situation