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Breast Cancer

Breast Cancer General Info

Explore the basics of breast cancer, staging, treatment. Also hear from breast cancer patients, survivors, and medical experts.

Breast Cancer General Info

Breast cancer is the second most common cancer for women in the U.S. (after skin cancer). Below is information we’ve aggregated from multiple leading sources of breast cancer information, including the National Cancer Institute, along with supporting stories from our breast cancer patients, caregivers, and medical experts.


What are the different types of breast cancer?

The type of breast cancer is dependent on several factors, including where in the breast the cancer started. Most cases are carcinomas. Less common types of breast cancer include Paget’s disease, inflammatory, and connective tissue. There can be a combination of different tumors in one tumor. Then there’s staging which helps determine how serious the cancer is and the best treatment.

According to the National Institutes of Health:

Carcinomas
  • General: Tumors that start in the epithelial cells that line organs and tissues throughout the body.
  • Statistics: Most of the breast malignancies are adenocarcinomas, which make up more than 95% of breast cancers.
  • Main types:
  • Ductal carcinomas. These form in the lining of a milk duct in your breast.
    • Invasive ductal carcinoma (IDC). This type breaks out of the milk ducts. It’s the most common form of invasive breast cancer, making up 55% of breast cancer incidence upon diagnosis
    • Ductal carcinoma in situ (DCIS). This type stays within the milk ducts.
  • Lobular carcinomas. These form in the lobules of the breast (where the milk is produced).
    • Invasive lobular carcinoma. This is when the cancer breaks out of the lobules.
Paget’s Disease
  • General:
    • A rare type of cancer involving the skin of the nipple and, usually, the darker circle of skin around (areola).
    • Most people with Paget disease of the breast are women older than 30.
    • They usually have ductal breast cancer (in situ or invasive).
    • Rare for Paget’s to be only in the nipple.
  • Statistics: Approximately 1-4%of all cases of breast cancer also involve Paget disease of the breast
  • Average age of diagnosis: 57 years, but the disease has been found in adolescents and in people in their late 80s
  • Usual Treatment: Mastectomy (surgery)

Read Margaret’s Paget disease breast cancer story →

Inflammatory
  • General: An uncommon type of invasive breast cancer.
  • Statistics: It accounts for about 1% to 5% of all breast cancers. (American Cancer Society)
Connective Tissues

These begin in the connective tissues composed of fat, muscles, and blood vessels. This is also called sarcoma. Two main types are angiosarcoma and phyllodes tumor.

Angiosarcomas
  • General: rare cancer that starts in the cells that line blood vessels or lymph vessels. It can involve the breast tissue or the skin of the breast. Some may be related to prior radiation therapy in that area. 
  • Statistics: are making up less than 1% of all breast cancers
Phyllodes
  • General: Rare breast tumors. They develop in the connective tissue (stroma) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Most are benign, but there are others that are malignant (cancer). (ACS)
  • Statistics: Most phyllodes tumors are benign (not cancer), but about 1 out of 4 of these tumors are malignant (cancer).
  • Average age of diagnosis: 40 (in women)

Can men get breast cancer?

Breast cancer can occur in men, but it is more than 100 times more common in women than in men. (National Institutes of Health)

How is breast cancer staged?

The American Joint Committee on Cancer (AJCC) updated breast cancer staging guidelines in 2018. According to BreastCancer.org:

  • “Tumor grade”: a measurement of how much the cancer cells look like normal cells
  • Estrogen- and progesterone-receptor status: do the cancer cells have receptors for the hormones estrogen and progesterone?
  • HER2 status: are the cancer cells making too much of the HER2 protein?
  • Oncotype DX score, if the cancer is estrogen-receptor-positive, HER2-negative, and there is no cancer in the lymph nodes

What are the different types of breast cancer treatment?

It usually involves surgery, chemotherapy, radiation, and if a mastectomy is involved, a decision on whether the patient wants to pursue reconstructive surgery.  No two patients go through the very same experience but the stories of these women who’ve lived through their breast cancer diagnoses may give people in similar situations a good understanding of what life will be like in the coming months.

Hormone status of the breast cancer

According to the Mayo Clinic:

  • Estrogen receptor (ER) positive. The cells of this type of breast cancer have receptors that allow them to use the hormone estrogen to grow. Treatment with anti-estrogen hormone (endocrine) therapy can block the growth of the cancer cells.
  • Progesterone receptor (PR) positive. This type of breast cancer is sensitive to progesterone, and the cells have receptors that allow them to use this hormone to grow. Treatment with endocrine therapy blocks the growth of the cancer cells.
  • Hormone receptor (HR) negative. This type of cancer doesn’t have hormone receptors, so it won’t be affected by endocrine treatments aimed at blocking hormones in the body.

Genetic makeup of breast cancer cells

According to the Mayo Clinic: Doctors are just beginning to understand how the individual DNA changes within cancer cells might one day be used to determine treatment options. By analyzing the genes of cancer cells, doctors hope to find ways to target specific aspects of the cancer cells to kill them.

A sample of your tumor tissue from a biopsy procedure may be tested in a laboratory to look for:

  • HER2 gene. Cancer cells that have too many copies of the HER2 gene (HER2-positive cancers) produce too much of the growth-promoting protein called HER2. Targeted therapy drugs are available to shut down the HER2 protein, thus slowing the growth and killing these cancer cells.
  • Other tumor markers. Researchers are studying ways to interpret the genetic makeup of tumor cells. Doctors hope this information can be used to predict which cancers will spread and which may need aggressive treatments. That way, women with relatively low-risk breast cancers may avoid aggressive treatments.

    Tests that analyze the genetic makeup of breast cancers are available but aren’t recommended in all situations. Ask your doctor whether this type of test might be helpful in your case.

Doctors are increasingly using genetic information about breast cancer cells to categorize breast cancers. These groups help guide decisions about which treatments are best. Breast cancer groups include:

  • Group 1 (luminal A). This group includes tumors that are ER positive and PR positive, but negative for HER2. Luminal A breast cancers are likely to benefit from hormone therapy and may also benefit from chemotherapy.
  • Group 2 (luminal B). This type includes tumors that are ER positive, PR negative and HER2 positive. Luminal B breast cancers are likely to benefit from chemotherapy and may benefit from hormone therapy and treatment targeted to HER2.
  • Group 3 (HER2 positive). This type includes tumors that are ER negative and PR negative, but HER2 positive. HER2 breast cancers are likely to benefit from chemotherapy and treatment targeted to HER2.
  • Group 4 (basal-like). This type, which is also called triple-negative breast cancer, includes tumors that are ER negative, PR negative and HER2 negative. Basal-like breast cancers are likely to benefit from chemotherapy.

Understanding more about the chemical and genetic makeup of your cancer may help doctors choose the most effective treatment for your specific cancer.

What is the 5-year survival rate for female breast cancer?

According to the National Cancer Institute (NCI): 89.7% (2008-2014)

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What is Non Hodgkin’s Lymphoma | NHL General Information

What is Non Hodgkin’s Lymphoma?
Non-Hodgkin Lymphoma: General Info

What is non-Hodgkin’s lymphoma? Below we feature some of the basic background of NHL, including common symptoms, diagnostic and staging tests, as well as treatment.

Diagnosis

What is non-Hodgkin’s lymphoma?

Non-Hodgkin’s Lymphoma is a cancer that develops in the body’s lymphatic system, which is part of our immune system.  It’s one of two main types of lymphoma (the other is Hodgkin’s lymphoma).

  • Lymphatic system: network of lymph vessels (also covers thymus, tonsils, spleen, stomach, small intestine, skin)
  • Lymph: clear fluid that carries white blood cells, particularly lymphocytes like your B-cells and T-cells
  • Lymph vessels: these cover all tissues of our body
  • Lymph nodes: store white blood cells; filter out and remove foreign cells and organisms, get rid of waste products and fluids from the body (usually in neck, chest, underarms, chest, and groin)
  • Lymphocytes: one type of white blood cell geared toward fighting infections started by viruses, bacteria, or fungi

Lymphoma happens when the lymphocytes start to multiply out-of-control. This usually means that lymphoma can start essentially anywhere but typically is found first in a lymph node (swollen). That indicates that your lymphatic system is fighting an infection.  

Non-Hodgkin’s lymphoma types & subtypes

Here is a chart created by TPS to give a general picture of the different types of non-Hodgkin’s lymphoma and subtypes. 

Of these, the largest subtype of non-Hodgkin lymphoma is diffuse large B-cell lymphoma (DLBCL) which tends to grow quickly. 

What are the most common symptoms?

Note: these are the most common symptoms of Non-Hodgkin Lymphoma, but there will be differences person to person. These may also be caused by many other reasons other than cancer, especially if they’re short-lived.

  • Swollen, painless lymph nodes (neck, armpits, or groin)
  • Unexplained weight loss
  • Fever
  • Soaking night sweats
  • Coughing
  • Trouble breathing
  • Chest pain
  • Weakness and tiredness that don’t go away
  • Pain, swelling, or a feeling of fullness in the abdomen

    *Source: National Institutes of Health

What tests do I have to undergo pre-diagnosis?

This can also range depending on where you are and/or what doctor you go to. Here are some general guidelines.

  • Physical Exam: The first step is usually having a doctor check for swollen lymph nodes in your neck, underarms, and groin. The doctor will usually also feel around for a swollen spleen or liver.
  • Blood tests: If the doctor suspects swollen lymph nodes or wants to be extremely thorough even without them, s/he may order blood tests in the lab. Unless your doctor’s office has a lab on-site, this will mean going to another location to draw and test the blood. The lab is checking for the number of white blood cells, an indicator of lymphoma. It would also check for other substances like lactate dehydrogenase (LDH) which tends to be high when lymphoma is present.
  • Chest x-rays: A doctor will order this to see whether there are swollen lymph nodes and/or other signs of disesase.
  • Biopsy: This usually requires surgery and is the most surefire way of diagnosing lymphoma. There are different kinds.
    • Excisional: removing the entire lymph node; usually involves general anesthesia (going under), performed by Ear Nose Throat surgeon
    • Incisional: removing part of a lymph node; usually involves general anesthesia (going under), performed by Ear Nose Throat surgeon
    • Fine Needle Aspiration: getting a small sample of the lymph node; usually involves local anesthesia, performed by doctor
What tests do I have to undergo for staging?

Your doctor needs to know the extent (stage) of nonHodgkin lymphoma to plan the best treatment. Staging is a careful attempt to find out what parts of the body are affected by the disease. Lymphoma usually starts in a lymph node. It can spread to nearly any other part of the body. For example, it can spread to the liver, lungs, bone, and bone marrow.

Staging may involve some of these tests:

  • Bone marrow biopsy: The doctor uses a thick needle to remove a small sample of bone and bone marrow from your hipbone or another large bone. Local anesthesia can help control pain. A pathologist looks for lymphoma cells in the sample.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your head, neck, chest, abdomen, or pelvis. You may receive an injection of contrast material. Also, you may be asked to drink another type of contrast material. The contrast material makes it easier for the doctor to see swollen lymph nodes and other abnormal areas on the x-ray.
What are the different types?

There are main ways of categorizing types of Non-Hodgkin Lymphoma:

  • Origin of the cancer
    • B-Cell is most common, making up around 85% of all Non-Hodgkin Lymphoma cases in the U.S.
    • T-Cell makes up less than 15% of the rest of cases in the U.S.
  • Pace of growth
    • Indolent (low-grade) lymphomas grow slowly. They tend to cause few symptoms.
    • Aggressive (also called intermediate-grade and high-grade) lymphomas grow and spread more quickly. They tend to cause severe symptoms. Over time, many indolent lymphomas become aggressive lymphomas.

(Check chart at top of page for complete visual.)

How common is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma makes up an estimated 4.3% of all new cancer cases in the U.S. According to the same data, the number of people dying from NHL is going down while the five-year survival rate has been on the rise since 1975.

YEAR          5-YEAR SURVIVAL RATE (%)

1975             45.7
1980            49.1
1985             52.4
1990             49.7
1995             51.9
2000            63.8
2005            71.6
2010             74.1

*National Cancer Institute

Treatment

What is the standard treatment?

According to the National Cancer Institute, there are nine different kinds of standard treatment used for non-Hodgkin’s lymphoma, including:

  • Radiation therapy
  • Chemotherapy
  • Immunotherapy
  • Targeted therapy
  • Plasmapheresis
  • Watchful waiting
  • Antibiotic therapy
  • Surgery
  • Stem cell transplant

There are also promising new developments in clinical trials and CAR T-cell therapies, especially for refractory/relapsed non-Hodgkin’s lymphoma.

What is a PICC line?
What is a port?
  • A port is like an artificial vein that will allow your healthcare team to give you continuous chemo for multiple days. It can also:
    • draw blood for tests
    • give you intravenous (IV) medication
    • give you IV fluids
  • It’s about the size of a quarter with varying shapes. It is most commonly called a Port-A-Cath®, PowerPort®, BardPort®, or a Mediport®.
  • This can be done outpatient in a hospital’s interventional radiology department
  • Usually requires more anesthesia so you can sleep through the procedure.
  • Total surgery time: under 1 hour

“The port is usually placed about an inch below the center of your right collarbone (see Figure 2). If you wear a bra, the port will usually be about 1 inch from where your bra strap lies.” – Memorial Sloan Kettering Cancer Center

“Your port may raise your skin about ½ inch above normal. You will most likely be able to feel it through your skin. It will probably not be seen when you wear a V-neck sweater. Most people will not know that you have a port. Implanted ports can stay in place for years. Once you no longer need the port, it will be removed.” -Memorial Sloan Kettering Cancer Center


Non-Hodgkin’s Lymphoma Patient Stories

B-Cell Stories
Burkitt Lymphoma

Erin R., DLBCL & Burkitt Lymphoma, Stage 4



Cancer details: Characteristics of both subtypes
1st Symptoms: Lower abdominal pain, blood in stool, loss of appetite
Treatment: Chemotherapy (Part A: R-CHOP, HCVAD, Part B: Methotrexate, Rituxan, Cytarabine)
Diffuse Large b-cell lymphoma (dlbcl)

Luis V., Diffuse Large B-Cell (DLBCL), Stage 4



1st Symptoms: Persistent cough, fatigue, unexplained weight loss



Treatment: Chemotherapy R-CHOP and methotrexate

Nina L., Diffuse Large B-Cell (DLBCL), Stage 4



1st Symptoms: Hip and lower extremities pain, night sweats
Treatment: Chemotherapy R-CHOP

Richard P., Relapsed/Refractory Follicular Lymphoma & DLBCL



1st Symptoms of relapse: Swelling in leg, leg edema Treatment:1st line - R-CHOP chemotherapy, 2nd line - clinical trial of venetoclax-selinexor

Shahzad's CAR T Story



Cancer details: Refractory non-Hodgkin lymphoma, stage 4
1st Symptoms: Extreme fatigue
Treatment: R&B, R-ICE, R-EPOCH, CAR T-cell therapy (cell-based gene therapy)
FDA approved: October 2017

Erin R., DLBCL & Burkitt Lymphoma, Stage 4



Cancer details: Characteristics of both subtypes
1st Symptoms: Lower abdominal pain, blood in stool, loss of appetite
Treatment: Chemotherapy (Part A: R-CHOP, HCVAD, Part B: Methotrexate, Rituxan, Cytarabine)

Emily G., Diffuse Large B-Cell (DLBCL), Stage 4



1st Symptoms: Pain in left knee
Treatment: R-CHOP chemo (6 cycles), high-dose methotrexate chemo (3 cycles)
mantle cell lymphoma (mcl)

Tim H., Mantle Cell Lymphoma (MCL), Stage 3/2



1st Symptoms: Lump on left-side of neck that grew bigger over a couple years, new lump on right side
Treatment: 6 cycles Nordic chemo protocol, alternating cycles of R-CHOP and rituximab + high-dose cytarabine, autologous stem cell transplant

Sheryl B., Mantle Cell Lymphoma (MCL), Stage 4



1st Symptoms: (Over 15 years) Skin irritation from temperature changes, rising WBC levels, unexplained fatigue, retinal hemorrhage, hardened abdomen (from enlarged spleen)
Treatment: 6 cycles Hyper-CVAD chemotherapy

Shari B., Mantle Cell Lymphoma (MCL), Stage 4



1st Symptoms: None, lymphoma discovered at unrelated doctor appointment
Treatment: 6 cycles R-CHOP, 5 cycles Phase 3 trial of Velcade + Rituxan (normally for multiple myeloma), allogeneic bone marrow transplant (BMT)

Bobby J., Mantle Cell Lymphoma (MCL), Stage 4



1st Symptoms: Fatigue, enlarged lymph nodes
Treatment: Clinical trial of ibrutinib + rituximab, consolidated chemo of 4 cycles of Hyper-CVAD

Jason W., Mantle Cell Lymphoma (MCL), Stage 4



1st Symptoms: Hives, inflamed arms



Treatment: Calabrutinib, Lenalidomide, Rituxan
marginal zone lymphoma (mzl)

Kimberly O., Marginal Zone Lymphoma



1st Symptoms:None at first, routine blood work showed suspicious results, bad nosebleed
Treatment: Chemotherapy (bendamustine & rituximab)

Rachel P., Marginal Zone Lymphoma, Gastric MALT



1st Symptoms: Fatigue, bloating, stomach pain
Treatment:
Chemotherapy, targeted therapy, surgery
primary mediastinal b-cell lymphoma (pmbcl)

Arielle R., Primary Mediastinal (PMBCL)



1st Symptoms: Swollen neck lymph nodes, fever, appetite loss, weight loss, fatigue, night sweats, coughing, itchy skin, trouble breathing
Treatment: R-EPOCH (dose-adjusted) chemotherapy, 6 cycles

Keyla S., Primary Mediastinal (PMBCL), Stage 1



1st Symptoms: Bad cough, slight trouble breathing
Treatment: R-EPOCH (dose-adjusted) chemotherapy, 6 cycles

Donna S., Primary Mediastinal (PMBCL), Stage 1-2



1st Symptoms: Visible lump in center of throat, itchy legs, trouble swallowing
Treatment: R-EPOCH (dose-adjusted) chemotherapy, 6 cycles

Patrick M., Primary Mediastinal (PMBCL), Stage 2



1st Symptoms: Bump pushing up into sternum
Treatment: 6 cycles of DA-EPOCH-R (dose-adjusted) chemotherapy at 100+ hours each

Crystal Z., Primary Mediastinal (PMBCL), Stage 2



1st Symptoms: Chest pain
Treatment: 6 cycles of R-CHOP chemotherapy

Stephanie C., Primary Mediastinal (PMBCL), Stage 3

1st Symptoms: Visible swelling around the jaw and neck area, major fatigue
Treatment: R-EPOCH (dose-adjusted) chemotherapy, 6 cycles

Sonia S., Primary Mediastinal (PMBCL), Relapse, CAR T-Cell Therapy



1st Symptoms: Chest pain, superior vena cava syndrome (SVCS); persistent, dry coughs, headaches
Treatment: (1st Line) R-CHOP chemotherapy, 6 cycles (2nd Line) R-ICE Chemotherapy (3rd Line) CAR T-cell therapy

Mags B., Primary Mediastinal (PMBCL), Stage 4



1st Symptoms: Exhaustion, migraines, persistent coughs, swelling and discoloration in left arm
Treatment:(1st Line) R-CHOP chemotherapy, 6 cycles
small lymphocytic lymphoma/chronic lymphocytic leukemia (sll/cll)

Sean R.



1st symptoms: No apparent symptoms; went to ER for unrelated shoulder pain
Treatment: Clinical trial, Ibrutinib & Venetoclax

Lacey B.




1st symptoms: Extreme fatigue and elevated WBCs
Treatment: FCR chemo and Venetoclax+R

Tony D.



1st Symptoms: Lump in back of neck that got bigger in a couple weeks
Treatment: Targeted therapy - orall pill (Imbruvica), takes 3 pills a night
waldenstrom Macroglobulinemia
Sheree

Sheree N., Waldenstrom Macroglobulinemia



Cancer details: Only ~1000-1500 new cases in the US each year
1st Symptoms: Feeling anemic
Treatment: Chemotherapy (bendamustine and rituximab)
...

Cindy S., Waldenstrom Macroglobulinemia



Cancer details: Only ~1000-1500 new cases in the US each year
1st Symptoms: Hyperproteinemia
Treatment: Chemotherapy
...

*A lot of information on this page came from the National Cancer Institute, under the U.S. Department of Health and Human Services.