Frequently Asked Questions about Oncology

When it comes to knowing which are the best treatment options, it is very important that each particular case be studied by a multidisciplinary team of experts who will contribute their knowledge and opinions on the best path to follow.

At the Breast Pathology Center, we have the most important experts in each of the areas involved in the diagnosis and treatment of breast cancer: radiology, pathological anatomy, oncological surgery, plastic and reconstructive surgery, medical oncology, and radiotherapy. There are also different professionals in other areas, such as physical therapy or psycho-oncology, who are an important part of a personalized and comprehensive treatment aimed at obtaining the best results for each patient.

Treatment will generally combine procedure methods that attack the cancer locally, such as surgery or radiation therapy, with others that destroy cancer cells throughout the body through systemic treatments such as chemotherapy, hormone therapy, and targeted treatments.

The duration of treatment will depend on the characteristics of the tumor cells and the stage of the cancer, as well as age, menopausal status, and patient comorbidities.

Tumor stage is a form of disease staging to assess the risks and prognosis associated with the specific characteristics of the tumor type and its status at the time of diagnosis.

The TNM staging system is widely used and combines tumor size (T), invasion of surrounding tissue, lymph node involvement (N), and distant metastasis (M).

The stage is important when considering treatment. The less advanced the stage, the better the prognosis. Radiological examinations, such as chest x-rays, abdominal ultrasound, or even CT or bone scintigraphy, are necessary to ensure that there are no metastases and to be able to safely establish the stage.

Adjuvant treatment is a treatment given after surgery. This treatment may include radiation therapy, chemotherapy, hormone therapy, and/or targeted therapy.

In this setting, radiation therapy is a local treatment, while chemotherapy, hormone therapy, and targeted therapy can reach tumor cells that may have spread to other parts of the body; that is why they are called “systemic” treatments.

Neoadjuvant treatment is given as the first step to reduce the size of a tumor before administration of the main treatment, which is usually surgery, and to control the disease systemically from the outset.

Some cases of neoadjuvant treatment include chemotherapy, biological treatments, and hormone therapy.

Not all treatments are the same for all breast cancer patients. Nor are all breast cancers the same, nor are they in the same clinical situation, just as each patient presents some particularities that make them different and special from the rest.

It is very important to consider all these factors before indicating a type of treatment.

The most important experts in each of the areas involved in the diagnosis and treatment of breast cancer meet at the Tumor Committee of the Breast Pathology Center: radiology, pathological anatomy, oncological surgery, plastic and reconstructive surgery, medical oncology, and radiotherapy, to decide the best treatment in each case.

There are different chemotherapy schemes that can be indicated in different situations. Today, we carry out genetic tests that analyze the mutations present in each tumor, in order to determinewhich ones will obtain the best results by directly attacking those mutations among all the possible drugs. In this way, a “à la carte” treatment scheme can be designed for each patient,which takes into account the particularities of both the tumor and the individual who suffers from it.

It is a breast tumor with cells that do not have estrogen receptors, progesterone receptors, or a sufficient amount of HER2 protein.

This type of tumor lacks a specific target on which to act at present, so chemotherapy is a fundamental tool in its treatment.

When analyzing the tumor in the pathology laboratory, it is very important to know the status of the hormone, estrogen, and progesterone receptors.

Tumor cells can have high levels of estrogen receptors and/or progesterone receptors on their surface or within the cell. This means that their growth and multiplication are stimulated by these hormones. Tumors with a high concentration of estrogen receptors (ER +) and/or progesterone (PR +) respond to hormone therapy. This data is essential in order to select the best treatment in the different stages of the disease.

Approximately 70 percent of breast cancers have estrogen receptors, and most ER-positives are also PR-positive.

HER2 is a cell surface protein found in approximately 20 percent of breast cancer cases and is involved in cell growth and migration. It is studied in the pathological anatomy laboratory, through various tests, to determine whether or not the tumor shows the expression of this protein.
A cancer is HER2 positive when the result of the IHC test is 3+, or the result of a FISH or CISH test is positive, according to the pathology report. Otherwise, the HER2 status is negative.
Once this data is established, it is time to propose biological treatments aimed at blocking the action of this protein. The discovery of this tumor growth pathway and the drugs that block it has been one of the most important advances in recent years in the treatment and prognosis of breast cancer.
HER2 status can also be determined by studying gene expression using molecular biology techniques, such as “expression arrays”.

Thanks to modern imaging techniques and women’s awareness of the importance of regular check-ups, tumors are increasingly detected sooner. When detection is early and the tumor can be surgically removed, the chances that complementary chemotherapy treatment may not be necessary increase.

In recent past, many women underwent chemotherapy to reduce the chancesof the cancer reproducing, although in the vast majority the cancer would not reproduce regardless of whether they received chemotherapy or not. Therefore, they were unnecessarily exposed to a treatment that can lead to nausea, hair loss, vulnerability to infection and, less frequently, heart problems, or leukemia.

Currently, there are genetic tests that can predict a tumor’s risk of relapse over the years and its sensitivity to chemotherapy treatment. In this way, it is possible to select only those women who are going to benefit from an adjuvant treatment with chemotherapy, avoiding unnecessary treatment for the rest. Only those patients with a sufficiently high risk of relapse in genetic tests will receive treatment.

Tumor cells can grow and divide faster than normal cells, which is why many drugs have been developed to destroy growing cells. However, certain normal cells in our body grow rapidly and chemotherapy can affect them as well.

This damage to normal cells can cause side effects. As a result of chemotherapy, patients may lose their hair and may experience other side effects, such as poor appetite, nausea, vomiting, diarrhea, constipation, or changes in the lining of the mouth.

These side effects are very important for patients’ quality of life, which is why they are always one of our biggest concerns. In this sense, we are pioneers in Spain in the use of a hair loss prevention system from patients receiving chemotherapy.

Although most anticancer drugs have side effects, not all patients experience them. Some people may not experience chemotherapy side effects or may experience only a few.

Alopecia is one of the most frequent side effects produced by chemotherapy and the one that most alters patients’ daily lives.

Thus, our interest in researching in this area led us to conduct a pioneering clinical study in Spain which has demonstrated the usefulness of a hair loss prevent system for patients receiving chemotherapy.

Thanks to this, many of our patients go onwith their lives without having to go through the undesirable effect of alopecia. We have also verified how hair grows faster and more uniformly after treatments with the prevention system than without it.

During cancer treatments, you should take special care of your nails and avoid cutting cuticles to avoid possible injury. Likewise, the use of nail polish and nail polish remover is not recommended, as they can damage your nails.

Yes, pregnancies after breast cancer are possible and many women who have overcome their disease are currently mothers of one or more children, leading a normal life like any other woman with the same condition. This should be discussed openly and ahead of time with young women who want to preserve their fertility before starting treatment, especially if the ovaries may be damaged by certain drugs. Neither pregnancy nor subsequent lactation increases the likelihood of a relapse in women who become pregnant after completing therapy for breast cancer.

We often cannot know immediately what the response to treatment is. In general, it is necessary to wait two or three months with hormone treatment and two or three cycles of chemotherapy for us to find any answer in the analytical or imaging tests. There are times when clinical symptoms disappear, or the tumor becomes smaller upon palpation. This provides us faster with information that our treatment is working.

The response to treatment must be evaluated to find the balance between the benefit and adverse effects it produces. For this reason, at the Breast Pathology Center, we are always attentive to changes or symptoms that may appear during treatment, by following up on the progressduring consultations and by performing blood tests and/or radiological examinations that compare the initial alterations with progression during treatment.

The discovery of this tumor growth pathway and the drugs that block it has been one of the most important advances in recent years in the treatment and prognosis of breast cancer.