I'm done with treatment. What happens now?
As your doctor may have told you, once you have had breast cancer, you have a higher risk for developing a new breast cancer than someone who has never had breast cancer before. That is why it is so important to get the follow-up treatment and care your doctor recommends. With proper follow-up, your doctor can keep track of how you are recovering - including taking care of side effects. In addition, if there is a local (in the breast, chest wall, or lymph nodes) recurrence of breast cancer, it can be detected early on when treatment has the best chance to succeed.
What are the recommendations for follow-up care?
The American Society of Clinical Oncology has established the following guidelines for the follow-up of breast cancer treatment:
1. Have a physical examination performed by a doctor every 4 to 6 months for 5 years.
2. Have a mammogram every 12 months. For women treated with breast conserving surgery and radiation therapy, have a mammogram 6 months after radiation therapy ends, then of both breasts every 12 months.
3. Understand which symptoms should be reported immediately.
4. Have a pelvic exam every 12 months if taking tamoxifen and have not had the uterus removed.
What symptoms should be reported to your doctor?
You should report any changes in the remaining breast(s) and chest area, unusual pain, loss of appetite or weight, changes in menstrual periods, unusual vaginal bleeding or blurred vision. It is also important to let your doctor know if you are experiencing dizziness, coughing that does not go away, hoarseness, shortness of breath, headaches, backaches or digestive problems that are unusual or that do not go away. Your doctor will examine you and determine the nature of the symptoms and discuss what to do next.
How will I know if the cancer returns?
Before you complete your cancer treatments, set up follow-up visits with your doctor. Follow-up appointments and monthly breast self-exams will help find recurrent or new breast cancer. For step-by-step breast self-exam instructions, please click here.
What are the different types of recurrence?
There are three different types of recurrence: local, regional and distant.
Local — A recurrence of the cancer in the same breast or same side of the chest wall.
Regional — A recurrence of the cancer in the axillary lymph nodes or nodes around the collar bone.
Distant — A recurrence of the cancer in other places of the body. This means the cancer has metastasized outside the breast and the surrounding lymph nodes. Even if the cancer spreads to other places, it is still considered breast cancer because the breast is where the cancer began.
Am I going to feel sick from now on?
No. As you finish your treatment, you may still be tired. Do not fight that — your body needs the rest. Aerobic exercise can help hasten the recovery process following chemotherapy.
Should I re-establish my usual routine?
Getting back to all the things you used to do - even if it takes some time — will help you feel better. Adding preventive health activities like physical activity, a healthy diet, and regular tests — such as a bone-density test and a colon exam — may also help you have peace of mind.
Will it ever be over?
Believe it or not, there may come a day when you stop worrying about cancer and live your life without fear. You can always get support from groups of women who have gone through what you have, and some who are in the same place as you are now.
What is lymphedema?
Lymphedema [lim-fa-DEE-ma] is a build-up of lymphatic fluid, which causes swelling in the arm and hand, and occasionally in the chest/breast/back on the side of surgery. When the lymphatic system is damaged, fluid collects in the tissue of the affected area causing swelling. The surgical removal of the lymph nodes in the underarm area and/or radiation therapy to the affected area can interfere with normal lymph drainage
What are the signs of lymphedema?
Let your doctor know if you experience any of these symptoms:
- a heavy feeling in your arm
- tight sensation in your arm or hand
- swelling in your arm or hand
- decreased flexibility in your hand or wrist
- shirt sleeves or jewelry that feel tight
- skin that may "pit" with any finger pressure
Call your doctor if your affected arm or hand is warm, red, or swollen, or if you have a fever. These symptoms could indicate an infection and may require antibiotics.
Who is at risk for lymphedema?
Any woman who has had some of her axillary lymph nodes removed or has undergone radiation therapy to this area is at risk for lymphedema. It can occur weeks after surgery, within a few months, after a couple of years or even as long as 20 years after treatment. As long as proper precautions are taken, lymphedema can be avoided by most women.
What should you do to reduce your risk of developing lymphedema?
To reduce your risk, follow these recommendations:
1. Have injections or blood drawn from the unaffected arm.
2. Have your blood pressure taken from the unaffected arm.
3. Wear gloves when doing house or yard work.
4. Keep your arm clean and dry. Moisturize your skin after bathing.
5. Protect your skin from the sun with sunscreen (at least SPF 15) and protective clothing.
6. Avoid lifting or carrying heavy bags, purses, or other objects with your at-risk arm.
7. Avoid wearing tight jewelry or clothing.
8. Avoid cutting your cuticles during manicures.
9. Use an electric razor, not a blade, to shave your underarm.
10. Use insect repellent when outdoors, but wash it off when inside.
11. Avoid any type of injury, including scratches and bruises, to the at-risk arm.
12. When flying in an airplane, wear a compression sleeve and drink lots of fluids during the flight.
13. Rest your arm in an elevated position (above your heart or shoulder).
Can lymphedema be treated?
Lymphedema can be kept under control with a variety of treatments. Tell your doctor about any changes in your arm as soon as you notice them. Check with your insurance company to see if your treatment choice is covered.
Arm elevation — Keeping your hand and arm higher than your heart and shoulder can help increase the flow of lymphatic fluid.
Compression sleeve — This device is an elastic, custom-fit sleeve that applies pressure to help fluid drain. It can be used alone or with manual lymphatic drainage.
Manual lymphatic drainage — This procedure consists of a gentle arm massage to stimulate movement of lymphatic fluid. Wrapping the arm and hand is also included to reduce the swelling. It is done by a trained, certified therapist.
Mild exercise — Staying active will also increase the flow of lymph fluid. Arm stretches will help you maintain range of motion. Activities like swimming and walking will help with circulation. Avoid strenuous and repetitive exercises, and check with your doctor or physical therapist about which exercises are right for you.
Weight loss — Maintaining a healthy weight can also help reduce lymphedema.