Symptoms
The first sign of breast cancer is often a painless lump. But early breast cancer is often found on a mammogram before a lump can be felt. Other symptoms of breast cancer may not appear until the cancer is more advanced. These include:
A thickening in the breast or armpit.
A change in the size or shape of the breast.
Changes in the skin of the breast, such as a dimple or skin that looks like an orange peel.
A change in the nipple, such as scaling of the skin or a nipple that turns in.
A green or bloody fluid that comes from the nipple.
A change in the color or feel of the skin around the nipple (areola).
About 1% of breast cancer occurs in men. Although most men diagnosed with breast cancer are older than 65, the disease can appear in younger men. For this reason, any breast lump in an adult male is considered abnormal.
Inflammatory breast cancer is a specific type of breast cancer that involves the skin of the breast. It occurs when breast cancer cells form "nests" and block the lymphatic drainage from the skin of the breast. Symptoms include redness, tenderness, and warmth. Thickening of the skin of the breast (an orange-peel appearance), rapid breast enlargement, and ridging of the skin of the breast may also be present. Some women may also develop a lump in the breast.
Treatment Overview
Breast cancer is usually treated with surgery, medicine, and radiation therapy. Because of improved screening methods, diagnosis at an early stage, and improved treatment techniques, the number of deaths from breast cancer has been steadily declining over the past few years. Decisions about how to treat breast cancer are based on a combination of factors that include specific information about the cancer, your preferences, and your health.
When making decisions about treatment for your breast cancer, you and your doctor will consider:
The size and location of your breast cancer (stage).
How aggressive the breast cancer is.
Whether your breast cancer has receptors to the hormones estrogen and progesterone, called estrogen receptor/progesterone receptor (ER/PR) status.
Whether your breast cancer cells contain human epidermal growth factor (HER-2/neu).
Whether your breast cancer has spread to the lymph nodes in your underarm area (axilla).
You and your doctor will also consider your personal preferences and health when developing a treatment plan for you. This will include:
Your feelings about keeping your breast.
Your personal and family history of breast cancer.
Your age and whether you have other serious health problems.
Most people with breast cancer have surgery to remove the cancer from the breast. Some or all of the lymph nodes under the arm are also usually removed to find out whether the breast cancer has spread to this area.
Even if your doctor removes all the cancer that can be seen at the time of your surgery, you may be treated with radiation therapy. Chemotherapy or hormone therapy may also be recommended to make sure that the breast cancer cells have been destroyed. You may also be given chemotherapy or hormone therapy to shrink your breast cancer before surgery. This is called neoadjuvant therapy.
Initial treatment
Initial treatment of breast cancer may include:
Surgery to remove the cancer. This may be done by removing the whole breast (mastectomy) or just the part of the breast that contains the breast cancer (breast-conserving surgery, or lumpectomy). Some of the lymph nodes under the arm will also be removed using either axillary lymph node dissection or sentinel node biopsy.
Radiation therapy, which is the use of high-dose X-rays to destroy cancer cells and shrink tumors.
Chemotherapy, which is the use of medicine to destroy cancer cells. Chemotherapy is called a systemic treatment, because the medicines enter the bloodstream, travel through the body, and can destroy cancer cells outside the target area.
Hormone therapy with tamoxifen or an aromatase inhibitor, to change the way hormones in the body cause cancer growth.
Treatment with trastuzumab (Herceptin) if your breast cancer tests positive for human epidermal growth factor (HER-2/neu).
What type of surgery should I have to treat early-stage breast cancer?
Should I use chemotherapy for early-stage breast cancer?
Treatment for women over 70
If you are older than 70, you may be a good candidate for having limited treatment and skipping lymph node biopsy or radiation.19 This depends on your health and what type of breast cancer you have.
Coping with your diagnosis
The diagnosis of breast cancer is devastating and scary. Most women will experience some denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer. There are many steps you can take to help with your emotional reaction to breast cancer. You may find that talking with family and friends helps you with your emotions. Some women find that spending time alone is what they need.
If your reaction interferes with your ability to make decisions about your health, it is important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who may have had similar feelings can be very helpful.20
Nausea and vomiting
One of the biggest concerns about treatment for cancer is managing nausea and vomiting from chemotherapy. Depending on the type of chemotherapy, you may only need home treatment to reduce mild nausea. But for certain types of chemotherapy, it's best to take prescription medicine for nausea and vomiting. In some cases, it's best to take it before the first dose of chemotherapy. Everyone is different. Work with your doctor to develop a plan that works for you.
For more ways to help manage side effects caused by breast cancer or breast cancer treatment, see the Home Treatment section of this topic.
Ongoing treatment
After the initial treatment for breast cancer, you may see your family doctor, general practitioner, medical oncologist, radiation oncologist, or surgeon at regularly scheduled intervals, depending on your individual situation. The length of time between visits will gradually lengthen until at 5 years, if no new problems develop, you are seeing your doctor once each year. As part of your follow-up, you may have:
Physical exams. The frequency of your physical exams depends on your general health and the type of breast cancer you have. In general, you will see your doctor every 3 to 6 months for 3 years and then every 6 months until 5 years have passed since your diagnosis of breast cancer. You may see your doctor once a year at this point.
Mammograms to screen for breast cancer and investigate lumps that can be felt during a breast exam.
After treatment for breast cancer, it is important to do regular self-exams. This may help you detect signs of recurrence. Early signs of recurrence may appear in the incision area itself, the opposite breast, under your arm, or in the area above the collarbone.
If new problems develop, you may have additional tests, such as blood tests, bone scans, chest X-rays, CT scans, or MRI tests.
If your breast cancer cells test positive for estrogen and progesterone receptors (ER/PR+), any remaining cancer cells may grow because of estrogen in your body. Medicine such as an aromatase inhibitor (such as Arimidex, Aromasin, or Femara), or tamoxifen (Nolvadex) may be a good treatment option. These hormone therapies block estrogen's effect on the cancer cells.
Studies show that an aromatase inhibitor works even better than tamoxifen in postmenopausal women who are also estrogen receptor-positive (ER+).21, 22, 23, 24 For women who have taken tamoxifen for a few years, switching to an aromatase inhibitor improves their chances of successful treatment.25 Talk with your doctor about the risks and benefits of these medicines if your breast cancer is ER/PR+.
Treatment if the condition gets worse
For information about the treatment of metastatic or recurrent breast cancer, see the topic Breast Cancer, Metastatic or Recurrent.
What to Think About
Even if your doctor removes all the cancer that can be seen at the time of the operation, you may need additional treatment. Radiation therapy, chemotherapy, hormone therapy, or a combination of the three therapies may be used after surgery to try to destroy any cancer cells that may be left in your body. This is called adjuvant therapy and is used to reduce the chances that your breast cancer will come back. Talk with your doctor about the risks and benefits of each type of treatment. Your personal preferences and considerations are important when choosing a treatment that is right for you.
Should I use chemotherapy for early-stage breast cancer?
You may also make decisions about using chemotherapy or hormone therapy to shrink your breast cancer before surgery (neoadjuvant therapy). Talk with your doctor about the risks and benefits of each type of treatment.
The likelihood that your breast cancer will return after treatment depends on a number of factors, including the size and grade of your breast cancer, whether you had breast cancer cells in your lymph nodes, and how many lymph nodes were involved with breast cancer.
Breast Cancer: Medications
Capecitabine
What is the most important information I should know about capecitabine?
Capecitabine should only be prescribed by a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.Talk to your doctor if you are taking the blood thinner warfarin (Coumadin). In some cases, severe bleeding and death have resulted when these medications were taken together, or when treatment with warfarin (Coumadin) was started in the month following treatment with capecitabine. If treatment with both medications is determined by your doctor to be necessary, special monitoring will be required.If the dose of capecitabine prescribed for you requires a combination of different strength tablets, it is very important that you correctly identify the tablets to ensure the correct dose. Contact your doctor or pharmacist if you have questions regarding a dose.Stop taking capecitabine and notify your doctor immediately if you experience any of the following side effects: more than 4 bowel movements per day or diarrhea at night; vomiting more than once in a 24-hour period; the amount of food you eat each day is much less than usual or if you are only able to eat at certain times; pain, redness, swelling, or sores in or around the mouth; tingling, numbness, pain, swelling, or redness of the hands and/or feet (hand-and-foot syndrome); or fever (temperature greater than 100.5 degrees) or other evidence of infection.
What is capecitabine?
Capecitabine is a cancer (chemotherapeutic) medication. Capecitabine interferes with the growth of cancer cells and slows their growth and spread in the body.
Capecitabine is used in the treatment of some types of breast and colorectal cancers.
Capecitabine may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking capecitabine?
Do not take capecitabine without first talking to your doctor if you are allergic to fluorouracil (Adrucil).
Before taking capecitabine, tell your doctor if you
have liver disease or a history of liver problems;
have kidney disease;
have heart or coronary artery disease; or
are taking any other medicines especially warfarin (Coumadin), phenytoin (Dilantin), folic acid (found in some vitamins), or leucovorin (Wellcovorin).
You may not be able to take capecitabine, or you may require a dosage adjustment or special monitoring during therapy if you have any of the conditions listed above.
Do not take this medication if you are pregnant or could become pregnant during treatment. Capecitabine is in the FDA pregnancy category D. This means that it is known to cause birth defects in an unborn baby. Contraceptive measures are recommended for both men and women during treatment with capecitabine.
It is not known whether capecitabine will harm a nursing infant. Do not take capecitabine without first talking to your doctor if you are breast-feeding.
The safety and effectiveness of capecitabine in patients younger than 18 years of age have not been established.
If you are over the age of 80, you may be more likely to experience side effects from capecitabine.
How should I take capecitabine?
Capecitabine should only be prescribed by a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.
Take capecitabine exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Each dose of capecitabine should be swallowed with water.
Take capecitabine within 30 minutes after the end of a meal (usually breakfast and dinner).
If the dose of capecitabine prescribed for you requires a combination of different strength tablets, it is very important that you correctly identify the tablets to ensure the correct dose. Contact your doctor or pharmacist if you have questions regarding a dose.
Capecitabine is usually taken for 14 days followed by a 7 day rest period (no drug given), in a 21 day cycle. Follow your doctor's instructions.
Take all of the capecitabine that has been prescribed for you.
Store capecitabine at room temperature away from moisture and heat.
What happens if I miss a dose?
If you miss a dose of capecitabine, do not take the missed dose at all and do not double the next one. Instead, continue your regular dosing schedule and check with your doctor.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a capecitabine overdose include nausea, vomiting, diarrhea, stomach upset, and bleeding.
What should I avoid while taking capecitabine?
There are no restrictions on foods, beverages, or activities while taking capecitabine, unless otherwise directed by your doctor.
What are the possible side effects of capecitabine?
If you experience any of the following serious side effects, stop taking capecitabine and seek emergency medical attention or contact your doctor immediately:
an allergic reaction (shortness of breath; closing of your throat; difficulty breathing; swelling of your lips, face, or tongue; or hives);
diarrhea (more than 4 bowel movements each day or any diarrhea at night);
vomiting (more than once in 24 hours);
nausea or a loss of appetite (if the amount of food you eat each day is much less than usual or if you are only able to eat at certain times);
fever (temperature greater than 100.5 degrees) or other signs of infection;
tingling, numbness, pain, swelling, or redness of the hands and/or feet (hand-and-foot syndrome); or
pain, redness, swelling, or sores in or around the mouth.
Other less serious side effects may occur more frequently. Continue to take capecitabine and talk to your doctor if you experience:
dehydration;
a rash or dry or itchy skin;
tiredness;
dizziness;
headache;
constipation;
sleeplessness; or
eye irritation.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect capecitabine?
Talk to your doctor if you are taking the blood thinner warfarin (Coumadin). In some cases, severe bleeding and death have resulted when these medications were taken together, or when treatment with warfarin (Coumadin) was started in the month following treatment with capecitabine. If treatment with both medications is determined by your doctor to be necessary, special monitoring will be required.
Do not take any of the following medicines during treatment with capecitabine without first talking to your doctor:
phenytoin (Dilantin);
leucovorin (Wellcovorin); or
folic acid.
You may not be able to take capecitabine, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with capecitabine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.
Where can I get more information?
Your pharmacist has additional information about capecitabine written for health professionals that you may read.
What does my medication look like?
Capecitabine is available with a prescription under the brand name Xeloda. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.
Xeloda 150 mg--oblong light peach-colored tablets
Xeloda 500 mg-oblong peach-colored tablets
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
