General information
Breast cancer is the most common type of cancer in women. It ranks second in cancer-related deaths in women after lung cancer.
The mammary gland consists of 15-20 lobes located around the nipple. The units called lobules, formed by the cells that secrete milk in the breast, combine to form lobes. The lobules are connected to each other by the milk ducts and the milk ducts unite towards the nipple.
Each breast has blood and lymph vessels. Lymph vessels carry a colorless liquid called lymph, containing cells that allow us to fight infections and diseases, and empty into the lymph nodes. There are many lymph nodes in the armpit, around the breastbone and in the neck.
Breast tissue develops under the influence of hormones. The main ones of these hormones are estrogen and progesterone. Milk ducts and lobules grow and develop with the effect of secreted hormones. In order to show the effects of hormones on the breast, it is necessary to bind to special places (receptors) on the breast cells.
If breast cancer, which develops with the uncontrolled proliferation of cells forming the lobules or milk ducts, originates from the milk ducts, it is called ductal carcinoma. Lobular cancer is less common, but the risk of having lobular cancer in both breasts at the same time is higher than other types of breast cancer.
In inflammatory cancer type, the breast is hot, red and sensitive. In this type of cancer, the breast is large and edematous, and may look like an orange peel, as cancer cells cause obstruction in the lymphatic vessels. Inflammatory cancer is less common but spreads quickly.
Breast cancer primarily spreads to lymphatic vessels and axillary lymph nodes. The spread of cancer to organs other than the breast is called metastasis. Breast cancer most commonly metastasizes to the bone, lung and liver.
Is early diagnosis possible in breast cancer and is there a screening test?
Every woman should play an active role in the early diagnosis and screening of breast cancer by asking her doctor what the symptoms of breast cancer might be or learning what kind of tests she should have at what age. The procedures performed to detect a possible cancer early when there is no complaint are called screening tests. Thus, breast cancer can be caught in the very early stages without causing any complaints in the patient. It should be noted that; Early stage breast cancer is a curable disease with treatment.
Although it cannot detect every breast cancer, mammography is the best method used for screening today. Mammography is a special kind of X-ray, it gives a small amount of radiation and is taken by compressing the breast between two plates. It can detect non-palpable breast tumors that have not yet caused complaints. After the age of 50, every woman should have a mammogram every year. Women who have a family history of breast cancer and are in the risk group for developing breast cancer are recommended to have annual mammography after the age of 40.
Another screening method is breast examination by a doctor at regular intervals. Women between the ages of 20 and 40 should have a breast examination by a doctor every 3 years, and those aged 40 and over every year.
In addition to these screening methods, it is recommended that women over the age of 20 should examine their breasts every month, preferably while they are in the bathroom with soap, and check whether there is an image that did not exist before in front of the mirror in both breasts. It should be noted that not everyone’s breast tissue is the same, and the same person’s breast tissue may have a different structure at different times. During menopause, pregnancy, taking birth control pills or during menstruation, the breast has a different structure. It is natural to have tenderness and tension in the breasts before menstruation.
What can be the symptoms of breast cancer?
In early stage breast cancer, the patient may not have any complaints. Breast cancer usually does not cause pain. Often there is one or more of the following symptoms.
* A palpable mass in the breast is the most common symptom.
* Discharge from the breast (blurred or bloody)
* Retraction on the nipple or breast skin
* Breast enlargement, edema, redness, orange skin of the breast
having the appearance of a shell
* Non-healing wound on the nipple, ulcer
* If the disease has spread to organs other than the breast (metastasized), complaints occur depending on the organ to which it has spread. For example, if it has spread to the bone, bone pain, if bone fractures have spread to the brain, complaints such as headache, nausea, vomiting, dizziness, visual impairment and even paralysis may develop.
What are the conditions that increase the risk of developing breast cancer?
The most important risk factor is age. The risk of developing breast cancer increases with age. Most breast cancers occur over the age of 50. Family history is important. Those who have breast cancer in their first degree relatives (such as mother, sister, etc.) have a higher risk of developing breast cancer. This risk is even higher if the relative has breast cancer before menopause. It is recommended that women in this group start screening tests earlier than those who do not.
The risk of developing new breast cancer increases by 1% each year in those with previous breast cancer. The risk of developing breast cancer is also higher in patients with bowel, ovarian and uterine cancer. The risk increases in those who have their first menstruation at an early age (before 12 years old). The risk increases in late menopause (after 55 years of age). The later the first gestational age (especially over 30 years of age), the higher the risk of breast cancer. It is thought that terminating pregnancies without giving birth due to abortion or miscarriage increases the risk of breast cancer. It is more common in women who have never been married. Women with better socioeconomic status have a higher risk of breast cancer due to changing living conditions (for reasons such as late marriage and late childbearing). It is known that the risk of developing breast cancer is slightly increased in those who use birth control pills and those who have taken estrogen therapy for long-term menopause.
Lifestyle can also affect the chance of developing breast cancer. Gaining excess weight in the postmenopausal period increases the risk of breast cancer. It is thought that insufficient physical activity and being overweight at an advanced age increase the risk of breast cancer. recommends a balanced diet that keeps you at your ideal weight. It is known that regular physical activity during adolescence reduces the development of breast cancer. Alcohol intake (too much) increases the risk of developing breast cancer.
Breast cancer is more common in Caucasians. Radiation exposure increases the risk of breast cancer.
Breastfeeding for a long time is thought to be protective against breast cancer.
Is breast cancer hereditary?
5-10% of all breast cancers are hereditary. The genes in our cells carry the hereditary information we receive from the genes of our parents. Some genes of those with breast cancer have been found to be damaged. Relatives of breast cancer patients carrying these damaged genes have a higher risk of developing breast cancer and ovarian cancer. Breast cancer genes are known to cause breast cancer in some ethnic groups, such as Jews and Icelanders.
How is the diagnosis made?
Patients with the above-mentioned symptoms or complaints should definitely consult a doctor. If the doctor notices a breast mass or any suspicious condition after his examination, he will order a mammogram and send the patient to a general surgeon. Mammography is the filming of the breast by giving X-rays. It can show masses that are too small to be noticed by hand. Generally, if there are suspicious findings in mammography, breast ultrasound is also performed. Ultrasound provides the understanding of structures with different consistency in the breast tissue with high-frequency sound waves that people cannot hear, and gives an image to a screen such as a TV screen. With ultrasound, it can be understood whether the mass in the breast is full of liquid or solid. If there is a mass with liquid inside, it is called a cyst. A sample is taken from the cyst with an injector and examined under the microscope. When a solid mass is detected in the breast, your doctor enters it with a needle and requests a piece of this mass to be removed. This process is called biopsy, sometimes it can be done by pulling a piece of breast tissue into the injector with a needle (aspiration biopsy) and sometimes by removing a small piece from the mass in the breast with a special needle (trucut biopsy). There is no need for general anesthesia for both procedures, it can be easily performed on an outpatient basis with local anesthesia, it does not require hospitalization.
How is the treatment plan determined after breast cancer is diagnosed?
Treatment of breast cancer primarily depends on how advanced the disease is, namely its stage. The stage of the disease is determined after the operation by investigating the size of the tumor, whether it has spread to the lymph nodes, and whether there is disease in other parts of the body other than the breast. Generally, after breast cancer is diagnosed by biopsy, most patients need to have the cancer surgically removed. In this surgery, the armpit glands on the side of the cancer are often also removed. A report is written by examining the surgically removed tumor and lymph nodes under the microscope. The department that wrote this report is the pathology department and the report they wrote is called the pathology report. Estrogen and progesterone receptors are detected in surgically removed cancerous tissue because this test shows whether the patient can benefit from hormone therapy. Tumor-related features (such as the size of the tumor, the appearance of cancer cells under the microscope, whether the lymph nodes are involved by cancer cells, the presence of estrogen and progesterone receptors) written in the pathology report play an important role in determining the treatment plan. Considering the patient’s characteristics in the pathology report, age, whether he has entered menopause and his general condition, medical oncologists, general surgeons and radiation oncologists decide together whether additional treatment is needed after the operation, and if so, which treatment should be given and in what order.
Before starting treatment, a chest X-ray, bone scintigraphy, abdominal ultrasound and blood tests may be requested by the doctor to see if the disease has spread to other organs. Considering all these features, the doctor tells the patient how the most appropriate treatment will be. The duration of this decision-making period for a few weeks does not have a negative effect on the disease.
Stages of the Disease
In the early stages (Stages 1 and 2), the tumor is small in size and sometimes may not even have spread to the axillary lymph nodes. As the stage increases (Stage 3), the size of the tumor, the number of lymph nodes and the area it has spread increase. It can also spread to the lymph nodes near the neck and breastbone. If it progresses a little further, the cancer spreads to the chest muscles and ribs. In the advanced stage (Stage 4, metastatic disease), the disease spreads to other organs such as bone, liver, lung, brain.
Recurrent disease: It is the return of the disease after treatment. If the disease has come back in the area where the surgery was performed, it is called local recurrence, and if it has come back in other organs, it is called metastatic disease. Most recurrences develop in the first 2 years after treatment, but breast cancer can come back years later. The cause of recurrence is cancer cells that remain behind despite treatment and cannot be detected.
What are the treatment options in breast cancer?
The treatment of breast cancer can be divided into two parts. Effective treatment for the area of the disease is called local treatment. Radiotherapy and surgical treatment are this group of treatments. The treatment to destroy cancer cells in any part of the body is called systemic therapy. Chemotherapy and hormone therapy are in this group. Patients may need both systemic and local treatment. Surgical treatment is the surgical removal of cancerous tissue. Radiation therapy is the killing of cancer cells with high-dose X-rays. Chemotherapy is the killing of cancer cells, mostly with intravenous drugs. The administration of drugs that disrupt the functioning of hormones, reduce their production or render the glands that secrete hormones inoperable in order to destroy the effects of hormones that cause cancer cells to multiply is called hormone therapy. For this purpose, the ovaries can be surgically removed and the production of the estrogen hormone, which allows cancer cells to multiply, can be stopped.
Surgical Treatment
The size of the patient’s breast, the size of the tumor, the general condition of the patient and wishes determine which type of surgery will be performed. Two types of surgery are performed in breast cancer. The first group is breast-conserving surgeries, in which the entire breast is not removed, only the tumor is removed. These are:
*Lumpectomy: It refers to the removal of only the tumor and surrounding breast tissue. Usually, the remaining breast tissue is irradiated and the axillary lymph nodes on the same side are removed.
*Segmental Mastectomy: It means the removal of the breast mass together with the surrounding breast tissue and the thin membrane surrounding the chest muscles under the tumor. Usually, the axillary lymph nodes on the same side are also removed and postoperative radiation therapy is required.
The second group is surgeries that involve removing the entire breast. The decision whether to give radiation therapy following these surgeries is determined by the characteristics of the tumor in the pathology report. This group of surgeries can be listed as follows:
*Simple Mastectomy: It refers to the removal of the breast along with the surrounding fat tissue and the skin on it, usually the armpit lymph nodes are also removed in the same session.
*Modified Radical Mastectomy: It is the most common surgery in breast cancer. It means the removal of the entire breast, along with the axillary lymph nodes on the same side, the thin membrane surrounding the chest muscles, and sometimes a part of the chest wall muscles. The decision whether to give radiotherapy after the surgery is determined according to the characteristics of the tumor in the pathology report.
*Radical Mastectomy: Chest muscles and axillary lymph nodes of the breast. Today, this surgery is performed only when the tumor spreads to the chest muscles. It used to be the most common surgery.
Radiation (radiation therapy or radiotherapy) Treatment
Radiation therapy, which prevents the death of tumor cells and the growth of tumor by using high-energy X-rays, is done by a machine outside the body or by materials (radioisotope) placed in cancerous tissue. can be given. Patients receiving this treatment do not emit radiation to the people they live with.
Patients undergoing breast-conserving surgery definitely receive radiotherapy. Depending on the characteristics of the patient and the tumor, sometimes radiotherapy and sometimes chemotherapy are the first treatment to be given after surgery. Radiotherapy can be given after chemotherapy is completed or between chemotherapy cycles. Radiotherapy lasts for 5-6 weeks in total, patients can come to the hospital 5 days a week to receive their treatment and return to their homes. Patients who have completed their radiotherapy are monitored periodically by the doctors of this department in terms of possible side effects due to radiotherapy.
Chemotherapy
Chemotherapy is the killing of cancer cells with drugs. It usually consists of more than one drug. Only nurses with special training in this field give chemotherapy. The number of chemotherapy is expressed as a cure (such as the 1st cycle, the 2nd cycle) and usually the same drugs are given by repeating every 21 or 28 days. Chemotherapy is most often given in the form of intravenous fluids in outpatient centers or as an oral pill. Sometimes, depending on the general condition of the patient, the drugs given or the way the drugs are given, patients may need to receive their treatment in the hospital. After each cure, patients are checked in the medical oncology outpatient clinic. In these controls, patients are examined, their complaints are listened to, the side effects of drugs are questioned, and some blood tests are requested to investigate whether they cause any harm to other organs in the body. Before each cycle, blood count should be done and this count should be shown to authorized nurses giving chemotherapy. The characteristics of the tumor in the pathology report determine whether a patient will receive chemotherapy after surgery and, if so, how many cures he will receive. However, the age, general condition and menopausal status of the patient also play an important role in making these decisions.
Chemotherapy is not suitable for patients whose general condition is poor enough to spend more than 12 hours in a day, as they cannot tolerate side effects. In patients who are scheduled to undergo chemotherapy, it is preferred to start chemotherapy within 3 weeks after surgery.
Hormone Therapy
Hormone therapy is given to prevent the hormones that cancer cells need to grow. Most hormone therapy drugs are given by mouth as pills. These drugs act either by preventing the functioning of hormones in the body, by reducing their production or by making the ovaries that produce these hormones inoperative. Whether a patient will benefit from hormone therapy or not is decided after the estrogen and progesterone receptors have been identified. Patients receiving adjuvant chemotherapy are recommended to use tamoxifen for 5 years following chemotherapy if their receptors are positive. In advanced ages, patients who are thought to be unable to remove the side effects of chemotherapy can be offered only hormone therapy after surgery without chemotherapy.
How to determine the most appropriate treatment option?
The first treatment in breast cancers that have not spread to another organ other than the breast is surgical removal of the tumor. The additional treatment given to patients who have no visible, detectable cancer after surgery is called adjuvant therapy. Adjuvant therapy is given after surgery to kill a small number of cancer cells that are not visible to the naked eye but are likely to be left behind. The decision whether to give adjuvant treatment is determined by the characteristics in the pathology report, the age of the patient, menopausal status and general condition. Patients can receive only chemotherapy or only radiotherapy or both chemotherapy and radiotherapy or only hormone therapy as adjuvant treatment after surgery. Sometimes, very early stage patients may not require post-operative adjuvant therapy. All patients undergoing breast-conserving surgery should receive postoperative radiation therapy. If estrogen and progesterone receptors are positive in the surgically removed breast tissue, this finding indicates that the patient’s tumor may grow under the influence of the naturally occurring estrogen hormone in his body. Hormone therapy is given to reduce or eliminate the hormones that cancer cells need for proliferation.
In some cases, for example, if the tumor is too large to be surgically removed, preoperative chemotherapy is given to reduce the tumor size (neoadjuvant therapy) and thus breast-conserving surgery can be performed on the patient. The patient receives the necessary adjuvant treatment after surgery.
In metastatic disease, hormone therapy or chemotherapy can be given to stop the progression of the disease. If only bone metastases are present, hormone therapy can be given. If there is spread to the liver, lungs or other organs other than the bone, chemotherapy can be given. In order to receive chemotherapy, the general condition of the patients must be good. If the disease has spread to the brain, radiation therapy is preferred. Radiation therapy can be given to bone metastases to reduce bone pain. In patients with a single metastasis in the lung or liver, these metastases can be surgically removed if the patient’s general condition is suitable. Today, it is accepted that the patient receives a systemic treatment after the metastasis is surgically removed. Patients with metastases can be included in ongoing clinical trials that try new promising drugs for treatment.
What are the side effects of treatment?
1.Surgical Treatment
There may be temporary weakness in the arm and chest muscles on that side after the surgery. Complaints such as burning, stinging, tingling, numbness in the surgery area because nerve cells are cut or damaged during the surgery. can develop. These complaints may go away within months or may be permanent in some patients.
Lymph circulation in that arm is insufficient because the armpit lymph nodes are removed. For this reason, any possible injury to that arm and hand should be more protected against accident. Suggested exercises should be done and the doctor should be informed in cases such as a wound, insect bite or cut that may occur on that arm. Carrying heavy loads with that side arm should be avoided, and tiring work such as handwork and typing for a long time should be avoided.
2.Radiotherapy
Dose calculations are made in order to prevent damage to the organs, heart and lungs just behind the breast, from the radiation, and plates that act as protective shields for the necessary areas are used. During the period of radiotherapy, patients should rest as much as possible. .
The skin in the treated area may become red, dry, sensitive and itchy. Towards the end of the treatment, the same area becomes more wet and runny. This is a reaction of the skin to the light. This area should be in contact with the air as much as possible, tight underwear and clothes should be avoided during this period. During the period of radiation therapy, this area should not come into contact with water. No lotion or cream should be used for this area without asking the doctor. The effects of radiation therapy on the skin are temporary. But the degree of influence varies from patient to patient. Sometimes, the skin color in the area that has received radiation treatment may remain darker than normal.
In metastatic disease, especially in brain metastases, brain irradiation is performed. This process lasts for 1 week or 10 days, and side effects such as nausea and vomiting due to radiation therapy may develop. For these situations, the radiotherapist prescribes the drugs to be taken before and during the treatment. tells.
3. Chemotherapy
Patients receiving chemotherapy should go through a doctor’s control in the medical oncology outpatient clinic approximately one week after each chemotherapy. In this control, the patients are examined, their complaints are listened, the side effects of chemotherapy are evaluated and the dose of the drug is adjusted if necessary.
The side effects of chemotherapy vary according to the drug given. As a general rule, chemotherapy affects rapidly proliferating cells. Blood cells that provide coagulation during bleeding, make our defense against diseases and carry oxygen to the organs in our body are cells that multiply rapidly. These blood cells decrease in number about 1 week and 10 days after receiving chemotherapy, and therefore there may be rapid bruising or bleeding after minor procedures such as tooth brushing. Normally, since our defense system is strong when they enter our body, microbes that do not cause disease can easily cause us to catch febrile diseases as the cells that provide our defense are reduced after chemotherapy. During this period, you should avoid eating raw vegetables and fruits (such as salad) that we wash and eat for at least 10 days. During this period, you should avoid being infected by the people around you and avoid being in crowded environments
Do not forget that this forbidden fruit and vegetables are not due to any effect on your disease, but to avoid possible microbes that may remain on the vegetable or fruit you eat, no matter how clean you wash them. Make sure your food is cooked within this time frame. If you have a fever that exceeds 38.50C for more than an hour, you should definitely contact your doctor. If you have a fever and your blood cells are found to be low in the blood count, you will need to be treated with antibiotics. This decrease in the number of your blood cells will go away on its own within a week to 10 days and the cells will reach their normal numbers.
Another group of rapidly proliferating cells are digestive system cells and hair root cells. For this reason, after chemotherapy, hair usually falls out after the first week. Loss of appetite, nausea, vomiting, diarrhea and mouth sores may develop in patients, almost all of these side effects can be controlled with medication. These side effects are short-lived, the complaints of the patients disappear before the next chemotherapy starts. The severity of these side effects of chemotherapy varies from patient to patient.
Long, persistent side effects are rare today with modern chemotherapy. However, some chemotherapy drugs can have negative effects on the heart, and in those who use such drugs, the doctor periodically asks for tests to see if your heart is affected. The chemotherapy drug doses and chemotherapy cycle numbers used today are not large enough to have a negative effect on the heart. There is a risk of developing blood cancer, or leukemia, years after taking certain chemotherapy drugs. In addition, some cancer drugs affect the ovaries and kill the egg cells, so the ovaries cannot produce the female hormone estrogen and patients enter menopause. Menstruation may become infrequent or stop, and in this case, women cannot become pregnant. Especially over the age of 35-40, infertility caused by chemotherapy is permanent. In younger patients, periods that are interrupted during chemotherapy may return to normal after a while.
Chemotherapy drugs are mostly given intravenously and they can damage the vein they are given over time, causing the vein to harden and become visible when viewed from the outside. You should inform your doctor immediately if redness, swelling and burning occur in the arm that you take the drug while you are receiving chemotherapy or the day after you take it. Generally, the arm on the side from which the breast is taken is not preferred for intravenous drug administration. Again, you should avoid having an injection for any reason other than your arm on that side.
If you need to use painkillers for any reason while receiving chemotherapy, consult your doctor. Because some painkillers can cause a decrease in the number or function of blood cells in the body. Apart from this, you can continue with your medicines that you use for your heart, lung and kidney disease and which are of vital importance during chemotherapy. It would be appropriate to show your doctor about these drugs that you have to use during your visits and ask if there is any harm.
4.Hormone Therapy
Side effects are different compared to the drug given as hormone therapy, but tamoxifen is the most commonly used drug today. This drug prevents the use of estrogen in the body. Therefore, patients develop symptoms related to menopause, such as hot flashes, vaginal dryness, and irregular menstruation. Other drugs, on the other hand, cause menopause in patients receiving hormone therapy, as they act by inhibiting the production of estrogen and rendering the ovaries inoperable. Some of these complaints can be controlled with medication. Serious side effects related to tamoxifen are very rare. One of them is the development of blood clots in our veins carrying dirty blood, especially in the veins of the legs. This can be treated by administering drugs that thin the blood. Yürüyüş yapmak, fazla oturur pozisyonda kalmamak ve gece yatakta ayakların altına bir yastık koyarak yükseltmek pıhtı gelişmesini önlemede faydalı olur. Diğer ciddi yan etki ise tamoksifenin rahim kanseri gelişme riskini arttırmasıdır. Yapılan büyük çalışmalar tamoksifen kullanan her bin kadının 3 ünde rahim kanseri geliştiğini göstermiştir.Bu küçük risk tamoksifenin meme kanserini önlemedeki önemli etkisinin yanında oldukça önemsiz kalabilir ancak yine de tamoksifen kullanırken en az yılda bir kez jinekolojik muayene yaptırılmalıdır. Menopoza girmiş olup tamoksifen kullanan hastalar herhangi bir vajinal kanama durumunda zaman kaybetmeden doktora başvurmalıdırlar.
Adjuvan tedavisini tamamlamış bir meme kanseri hastası nasıl takip edilir?
Meme kanseri olup adjuvan tedavisini tamamlayan hastalar tanı konulduktan sonraki ilk 2 yıl 3 ayda bir, 3. ve 5. yıllar arası 6 ayda bir daha sonra ise yılda bir kez muayene olmalıdır. Meme koruyucu ameliyat yapılan hastalar ameliyattan sonraki ilk 6. ayda , memesinin tümü alınan hastalar ise ameliyattan sonra 12. ayda başlamak üzere yılda bir kez mamografi yaptırmalıdır. Bunların dışında hastanın şikayetlerine göre doktor uygun gördüğü tetkikleri isteyebilir.
Verilen tedavi ile iyileşme şansı nedir?
Bazen hastalar iyileşme şanslarının rakamlarla ifade edilmesini isterler. Aslında yapılan büyük çalışmalarda hangi evredeki hastanın ortalama ne kadar süre yaşayabileceğine dair rakamsal yüzde değerleri mevcuttur. Ancak unutulmamalıdır ki bu istatistiksel değerler binlerce hastaya ait değerlerin bir ortalamasıdır, yani herhangi bir meme kanseri hastasına ne olacağını önceden kestirmek için kullanılması tam olarak doğru olmaz. Meme kanseri olan iki hastanın gelecekte ne olacağı birbirinden farklıdır, tümörün ve hastanın kendisine ait bugün henüz bilemediğimiz pek çok faktör aynı hastalığa yakalanan iki kişinin farklı seyirler göstermesinde etkili olmaktadır. Bu nedenle kendinizi başka hastalarla kıyaslamayınız.
Meme kanseri ve gebelik
Gebelik sırasında da meme kanseri görülebilir. Yaygın inanışın tersine, ne gebeliğin meme kanseri üzerinde ne de meme kanserinin gebelik üzerinde bilnen olumsuz etkisi yoktur. Uygulanacak tedavi gebeliğin dönemine göre belirlenir.
Kemoterapi alan hastalarda verilen ilaçların yumurtalık hücreleri üzerine olan etkileri nedeni ile geçici ya da kalıcı kısırlık gelişme riski vardır. Bu risk, meme kanserinin menopoza yakın yaşlarda geliştiği hastalarda daha belirgindir, daha genç yaştaki hastalarda ise kemoterapi tamamlandıktan bir süre sonra gebelik mümkün olabilir. Kemoterapi ilaçlarının yumurtalıklar üzerindeki etkileri nedeni ile, gebe kalmak isteyen hastaların tedavi sonrası ilk iki yıl doğum kontrol yöntemlerini kullanmaları ve bu süre içinde gebe kalmamaları tavsiye edilmektedir..
Tedavi sonrası yaşam
Adjuvan tedavisini tamamlamış olan hastalar kendilerini iyi hissettikleri andan itibaren iş yaşamlarına geri dönebilirler. Adjuvan tedavi alırken bile ağır olmaması kaydı ile iş yaşamlarına devam edebilen hastalar vardır.
Mastektomi sonrası bazı kadınlar protez takmayı bazıları ise plastik cerrahlar tarafından alınan memenin yerine yenisinin yapılmasını (rekonstrüksiyon) isteyebilirler.Her iki işleminde kendisine göre avantaj ve dezavantajları vardır. Rekonstrüksiyon memenin alındığı ameliyat sırasında yapılabileceği gibi tedavi tamamlandıktan sonra da yapılabilir. Bu ameliyatın risklerini ve yararlarını bir plastik cerrahla konuşarak öğrenebilirsiniz.
Ameliyatla meme ile birlikte o taraftaki koltuk altı lenf bezleri de alındığından zaman içinde o taraf kolda şişlik meydana gelebilir. Lenf bezleri alındığı için o kolun lenf dolaşımı yetersizdir. Bu nedenle kolun şişmesine lenfödem adı verilir. Lenfödemin gelişmemesi için size kolunuzu biraz yüksekte örneğin yastık üzerinde tutmanız ve bir takım egzersizler önerilir. Lenfödem geliştiğinde elastik bandajlar, elle masaj veya bir makine yardımı eli ve kolu sıkıştırarak ödemin azaltılması yöntemlerinden fayda görebilirsiniz.
Tedavi sonrası önerilen özel bir diyet yoktur, dengeli beslenme, fazla yağlı yiyeceklerden kaçınma, düzenli egzersiz yapmak yani normal şartlar altında her sağlıklı insanin uyması gereken kurallar sizin için de geçerlidir.
Kilo kaybı, iştahsızlık, aşırı yorgunluk, bulantı-kusma, baş dönmesi, karın ağrısı ve dolgunluk, kemik ağrısı veya ameliyat olan bölgede yeni bir kitle, yara geliştiğinde, iki haftadan fazla süren öksürük, baş ağrısı olduğunda normal periyodik kontrol zamanınızı beklemeden doktorunuza ulaşmanız gereklidir.
Meme kanseri için tedavi almış ve reseptörleri pozitif olan hastalarda menopoz için estrojen tedavisi verilmesi önerilmemektedir. Estrojen reseptörleri negatif olanlarda ise menopoz için hormon tedavisi verilmesi tartışmalıdır.
Tedavi sırasında ve sonrasında cinsel yaşamınıza eskiden olduğu gibi devam etmenizde bir sakınca yoktur. Kemoterapinin yumurtalık hücreleri üzerinde olan mutajenik (bebekte ciddi anormallikler olabilmesi) etkileri nedeni le tedavi süresince gebeliği önlemek için doğum kontrol yöntemlerinden biri tercih edilmelidir. Verilen kemoterapi ilaçlarının çoğu yumurtalıkların çalışmasını bozar ancak bu etkilenmenin derecesi hastadan hastaya değişir.
Tanı sonrası tedavi planı ile yaşadığınız fiziksel ve ruhsal sıkıntılar, hastalığa veya tedaviye bağlı yorgunluk, halsizlik hissi, cinsel yaşamınızın, istek ve heyecan duyma gibi duygularınızı etkileyebilir. Cinsel yaşamınız ile ilgili bu tür sorunlar , bu dönemde yaşadığınız ve tedavi sonrası geçen diğer sorunlar gibi zaman içinde geçecektir.
Ameliyatla göğüsleri alınan hastaların eşleri tarafından reddedilme ve çekiciliklerini kaybetme endişesi ile kendilerine olan güvenlerinin azalması cinsel yaşamlarında sorunlara neden olabilir. Bu tür fiziksel eksiklik hisseden hastalar için dışarıdan askılı protez meme veya plastik cerrahi bölümüne başvurarak rekonstrüksiyon (yeniden meme yapılması) şansı olduğunu unutmayınız. Buna yönelik planlamalar ameliyat öncesi dönemde de yapılabilir.
Cinsel yaşamınıza yönelik kaygılarınız olduğunu ve bu konuda yardım almak istediğinizi tedavi aldığınız kemoterapi ünitesindeki doktor ve hemşirelere belirtmekten çekinmeyiniz
