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TREATMENT

the doctor  we have just been informed that we have breast cancer. Our mind  is invaded by disparate thoughts: !! Can not be !!, ! Why me!! What will happen to my family if I die?! This storm of negative thoughts gives way to another phase of  thoughts of acceptance of reality, and finally  to the fight phase. "Well, it's my turn, and I'm going to fight to be one of the many (90%) who survive this disease!!

What do I have to face?

1.- Surgery: Usually  to a conservative intervention (removal of the tumor and removal of the sentinel node) and on rare occasions, complete removal of the breast (mastectomy) must be resorted to.

2.- Oncology: Once we have the final report from the pathologist, we must go to the oncologist who, from this moment on, becomes the director of all treatment. The  WHAT, THE HOW  AND THE WHEN will be determined by HIM.

The pathological report is thoroughly studied to assess the immunohistochemical study which will predict the greater or lesser risk of tumor recurrence. Tumors are classified as Luminal A, Luminal B, Her 2, and basal like .

The Luminal have positive hormone receptors, the HER 2 have the expression  HER2, and the basal like or triple negative, do not have  no hormone receptors  nor HER 2. Luminal A has the best prognosis and basal like has the worst prognosis.

Then the oncologist will study the stage of the tumor, considering that there are 5 stages:

Stage 0: Lobular carcinomas in situ and ductal carcinoma in situ. They are tumors that have not yet passed into the blood but may or may not do so throughout the life of the patient.

Stage I: Tumors smaller than 2 cm and without lymph node involvement.

Stage II: Tumor from 2 to 5 cm with lymph node involvement

Stage III: Tumor of   more than 5 cm with extension to axillary/mammary nodes This group also includes tumors that infiltrate the skin of the breast

Stage IV: Tumor of any size with spread to other parts of the body

Once the oncologist has assessed these data, he also has the information that the genetic tests performed on the tumor can provide. Today several of them are marketed (Oncotype DX, MammaPrint, and Prosigna) with all of this having an assessment of the risk of recurrence as well as the benefit of giving chemotherapy. This type of test is ideal for patients with tumors smaller than 2 cm  , without lymph node involvement, with positive receptors and her2 negative, but they are also used in stages II and III (tumors 2.5 cm and with positive lymph nodes).

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Once the need for treatment has been decided, it can be  before the operation (Neo-adjuvant) or after the operation (Adjuvant). The first is used to improve the conditions of the tumor in order to later perform a more conservative surgery, and the second is used to help the organism in the destruction of some possible cells that could have passed into the blood.

Adjuvant treatment can be: Chemotherapy (4-6 months), Hormone therapy (patients with positive hormone receptors for 5 to 10 years), and targeted therapies (patients with HER2 positive for 1 year).

THE FINAL QUESTION YOU WILL ASK AND ALL THIS FOR WHAT?

The answer is to be able to heal you.

Patients in stage I survival at 5 years is 99%. Patients with stage II and III survival reaches 87%. . Stage IV patients drop to 27%.

These are overwhelming figures of the need for early diagnosis.

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