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Hormone Replacement Therapy |
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Resources: North Carolina Hospitals Breast Cancer Services
Making the Diagnosis After the Diagnosis Managing Side Effects Post-Treatment Issues Lymphedema Therapists Advanced Breast Cancer Clinical Trials Genetic Testing, Counseling Bone Marrow Transplants Home Health Care Hospice and End of Life Financial, Other Assistance Insurance, Legal, Employment Mastectomy & lymphedema products, wigs N.C. Support Groups Complementary Therapies Ethnicity-Specific Resources Young Women Lesbian Resources Male Breast Cancer Advocacy Women Building Bridges Web sites |
You have to accept whatever comes, Once you have completed your treatments for breast cancer (including surgeries, chemotherapy, radiation therapy, etc.), you will naturally want to "get on with your life." Although each of us goes through the experience of being diagnosed with and treated for breast cancer differently, there may be some common issues that you will need to deal with either immediately or long after our treatment is over. Having an awareness of the possibilities puts you in a better position to know how to deal with them or where to turn for help if one arrives in your life. In this section, as in the previous one, we have chosen to address some of the more common "post-treatment" issues which many breast cancer survivors may be concerned with. Along with the resources we list at the end of this section, you should talk with your doctor about any health situation that gives you concern. I have breast cancer and had been taking hormone replacement therapy. Should I continue to take it? Your doctor should advise you about whether to continue HRT (hormone replacement therapy) at the time you are diagnosed with breast cancer. Generally, hormone replacement therapy is not recommended for women who have been diagnosed with breast cancer. Why would hormone therapy be given to women with breast cancer? Researchers have found a way to use hormones as therapy against breast cancer. This is different than HRT (hormone replacement therapy), which is given to imcrease levels of hormones (such as estrogen and progesterone) that are decreased in the body due to menopause. One hormone therapy drug for breast cancer is Tamoxifen. By blocking estrogen, Tamoxifen can block the growth of cancer cells. If your tumor is estrogen receptor positive (called "ER positive") this may be a good treatment for your breast cancer. (Estrogen receptors are found in the nucleus or center of the tumor cell. The ER allows cells to use estrogen to grow). Tamoxifen can be used alone, with chemotherapy, or following chemotherapy. Tamoxifen is also being used to prevent breast cancers from developing. You may want to ask your doctor about this. LYMPHEDEMA
What is lymphedema? Lymphedema is the collection of lymph fluid that can occur in your arm and hand after your lymph nodes have been removed or damaged from your underarm area (axilla) during breast cancer surgery. What is lymph fluid? Lymph fluid is a colorless fluid containing the white blood cells that fight infection and disease. Lymph fluid travels through channels of the lymph system throughout your body much like blood travels through arteries and veins. What are lymph nodes? Lymph nodes are small, pea-sized organs located along the lymph channels. They are grouped in clusters. Their job is to trap foreign bodies such as bacteria or cancer cells to keep them from spreading throughout the body. The nodes are clustered in areas throughout your body such as underams (axilla), groin, neck, chest and abdomen. The ones in your chest and underarm are the ones that collect the lymph fluid from your breast. This is why they are often removed at the time of surgery. What causes the arm to swell after surgery? Not every woman's arm swells after surgery. It swells because the number of pathways for the lymph to drain from the arm are reduced by the removal of or damage to the lymph tissue during surgery or radiation therapy. Fewer channels to drain the fluid can result in collection of fluid in the arm (or swelling). The extent of lymph tissue removed or damaged relates to how much swelling you may experience. Swelling may occur weeks, months or even years after treatment. Are there any safety precautions I should be aware of? Yes. Because the lymph channels and nodes have been removed (or decreased) on the side of your surgery, you must take extra caution to protect your hand and arm from injury, cuts, scrapes and insect bites. You may have less protection against infection in that arm. Some people wear a medical alert bracelet with this information on it. It is important to remind healthcare workers to avoid drawing blood and measuring your blood pressure on that arm. It is also recommended that you wear gloves while doing housework, gardening and other activities that may put your arm or hand at risk for injury. In addition, it is possible for lymphedema to occur years after you have finished your treatment; therefore, taking care and being aware are your two best keys to avoiding or managing lymphedema. What about using antiperspirant or deodorant under my arm? You should not use deodorants or antiperspirants while you are healing from surgery on the armpit on the side of your surgery. Once you are healed, you may use either antiperspirants or deodorants. Some doctors may recommend use of deodorants only. You should talk about this with your healthcare team. What can I do about the swelling? Is it permanent? You should talk with your doctor about this. Sometimes, elevation of the arm for brief periods throughout the day is adequate to promote fluid drainage. Other methods to reduce swelling include arm exercises and gentle massage that specifically promote lymph drainage. Your doctor should refer you to a practitioner who specializes in lymphedema treatment if you have a persistent problem with this. More severe cases may require use of pressure sleeves to compress the arm. Lymphedema can be a permanent condition in some cases. How do I choose a lymphedema therapist? Lymphedema therapists have a range of training options. The programs they attend vary in length. When you are choosing a therapist, you might want to consider how much training he or she has. The programs include: LeDuc (6 days of
training), Lerner (14 days), Casley-Smith(14 days), Academy of Lymphatic Studies (ALS; 14
days), Klose-Norton (15 days), Foldi (20 days), and Vodder (20 days; some programs teach
Vodder "techniques", but only therapists who Also, see the listing of lymphedema therapists in North Carolina in this directory.
What is Manual Lymph Drainage? Manual Lymph Drainage is a massage technique used to improve the flow of lymph using light, rhythmic strokes. This therapy may be effective for the lymphedema that sometimes follows breast surgery.
MENOPAUSE
What is menopause? Menopause is the absence of menstrual periods due to reduced function of the ovaries. This can occur naturally with aging, or from damage to the ovaries. This naturally occurs in women beginning in their 40s and 50s. Will chemotherapy cause me to experience menopause? Before menopause, your ovaries produce estrogen. Estrogen is responsible for your monthly menstrual cycle and reproduction. Some chemotherapy drugs interrupt (temporarily or permanently) ovarian function, which can result in early (or chemotherapy-induced) menopause. This type of menopause can be permanent and has the same effect on your body as naturally-occurring menopause. What are some of the typical side effects of menopause? Hot flashes, night sweats, vaginal dryness, and irregularity or absence of monthly menstrual periods are the most common effects of menopause. Menopause is also associated with bone loss due to reduced calcium stores in the bone. After chemotherapy treatment, some women resume their menstrual cycle. If you do not, you should seek advice about calcium replacement and exercise to promote bone health. What can I do to manage side effects of menopause, such as hot flashes and vaginal dryness? You should discuss menopause management strategies with your doctor or nurse. For hot flashes, there are medications available; also, many people are beginning to explore the use of alternative therapies, such as soy products or herbs. You should check with your doctor before proceeding with this approach. You must always be cautious about the possibility of drug interactions when taking supplements or herbals in addition to medications. Other considerations include choosing loose-fitting, comfortable clothing and regulating the temperature control to suit your preference. Vaginal dryness can be addressed through the use of lubricants prior to sexual activity. There are many products available without prescription to remedy this problem. Persistent vaginal itching should be investigated to rule out the possibility of infection (see also the section below on Sexuality).
What is osteoporosis? Osteoporosis or "porous bones" is a condition of decreased bone mass. Bone is living tissue that continuously undergoes breakdown and rebuilding (at a cellular level) as a normal body process. Peak bone mass is usually reached by age 38. After that, bone begins to lose mass as part of the aging process. As bone mass is lost, bones become brittle. Men generally lose 20-30% of their bone mass over their lifetime, and women generally lose 45-50% of their bone mass. Decreased bone mass can lead to an increased risk of bone breakage and disability. Why is this important to me now, and what are the risk factors? As a person receiving cancer treatment, you are at increased risk for osteoporosis. Risk factors for osteoporosis include:
Chemotherapy can interfere with your normal production of hormones due to its effect on ovarian function. Reduction or failure of ovarian function automatically places you at increased risk for osteoporosis. It is important that you discuss prevention and treatment strategies with your doctor or nurse. Would I know if I had osteoporosis? Can I be tested for it? Early changes in bone density are usually painless. Most people dont know they have osteoporosis until they break a bone. That is why it is important to know the risk factors and to learn what you can do to prevent bone deterioration. Testing can be done for osteoporosis. First, you should have a thorough health history and physical exam to determine your risk factors for osteoporosis. Then, your doctor will discuss or recommend your having a bone mineral density test if you are considered to be at high risk. It is a safe, painless and non-invasive test. This establishes your baseline bone density and provides useful information in determining the best course of action for you. In North Carolina, bone mineral density (BMD) tests are available in some pharmacies. The cost of measuring the BMD in the heel is generally around $30, and this correlates well with the trabicular (spine) bone. This test reveals very little about the cortical (hip) bones, so you will not get the whole picture. However, the test will give you a reasonable assessment and baseline information that you can take to your doctor to see if further testing is needed. The test takes about five minutes or less and is pain free. You can have this test done without a referral from your doctor. Can I help prevent osteoporosis from happening to me? Yes. There are a number of prevention strategies that are recommended to reduce your risk for osteoporosis:
Again, your healthcare team should advise
you in regard to these strategies, but you should not hesitate to initiate this discussion
with them. Every womans image of their body and sexuality is unique. No two people have exactly the same response or feelings when they learn they have breast cancer. If a mastectomy is performed, this can be overwhelming and emotionally difficult for some women. For others, it is a relief to have the cancer removed. Treatment for cancer, such as chemotherapy, can cause physical changes that may interfere with a woman's sexuality. In addition, breasts are a part of many womens' sexual identity. Breasts are symbolic of nurturing, sustaining new life and intimacy. The loss of a breast can be threatening to body image and sense of self. If I have a mastectomy, will I be disfigured? Mastectomies today are done to preserve muscle, so there is much less disfigurement than there used to be. It is very important that you discuss this topic fully with your surgeons. If you are interested in reconstruction, you may want to consider options regarding breast reconstruction at the time of your initial surgery. If so, you should be referred to a plastic surgeon for a full discussion of your options. In some situations, reconstruction is not advised at the time of your initial surgery, but can be done at a later date after all of your cancer treatment has been completed. Reconstruction can also be chosen years down the road. What if I choose not to have reconstruction? If you wish to use one, external breast prosthetics (breast forms) are available to help minimize the visual alteration of losing a breast. There are many different options available to you. You might want to consider this, too, when deciding about surgery and potential reconstruction options. (Also see the section on Reconstruction in After the Diagnosis in this directory). Will my sex life be different after breast cancer? Chemotherapy for breast cancer can sometime cause a woman to go into premature, or early, menopause. This can be difficult for a woman physically, emotionally and sexually. The symptoms of early menopause are sometime more severe than those that occur with natural menopause. These symptoms can include hot flashes, vaginal dryness, and low sexual desire, as well as depression, anxiety and increased irritability. Other menopausal issues include increased risk of heart disease and osteoporosis. Are there solutions to the sexual problems I might face? The good news is that there are solutions for these problems. Hot flashes can be treated with specific drugs prescribed by a doctor. Some women also have found Vitamin E or soy products to be helpful. Vaginal dryness can be improved by the liberal use of a lubricant such as Lubrin, K-Y Jelly, Ortho Personal Lubricant, Surgilube, Today Personal Lubricant or Astroglide. Replens, a vaginal moisturizer, can be used three times a week. Recent studies have found that both Estrace, a estrogen cream used vaginally, or Estring, a vaginal ring with slow release of estrogen, restore the vaginal tissues without increasing estrogen in the rest of the body. Ask your doctor about these options. Persistent, low sexual desire is sometimes treated with androgens. You can have your hormone levels checked and discuss this option with a doctor. Other ways of increasing desire are reading erotic literature or watching erotic videos. Almost all women who were orgasmic before cancer treatment can be so again although sometimes it takes relearning and practice. If needed, doctors can also prescribe therapies that address other menopausal issues (depression, anxiety, irritability, increased risk of heart disease and osteoporosis). Several new, improved therapies are now available. See the publications and organizations in Resources below for more help with managing menopausal symptoms. How will my spouse or lover feel about me after surgery? It is very important that you discuss this with your partner. Open, honest communication about your feelings and theirs is very beneficial to your overall sense of well being and the intimacy you experience before and after treatment. Your healthcare team may include a social worker or psychologist who can specifically help you to address your feelings and fears regarding sexuality and intimacy. Your acceptance of your body changes will affect how others react to you. It is important for you to be open about your feelings to yourself and to your spouse, lover or partner. Always remember that who you are has nothing to do with your breasts (although perhaps they may have played a part in your self-esteem or sexual identity prior to your surgery). You are special no matter what the size of shape of your body, and you deserve to be in an open, honest and loving relationship with someone who cares about you--and accepts you--because of who you are in your heart, mind and soul. I'm single and not in a relationship. How and when do I tell someone new in my life about my breast cancer and surgery? This is not a question with any easy answers, but there are some things you can consider when you find yourself in a new relationship:
RESOURCES American Cancer Society, Inc. (ACS) American Menopause Foundation The Breast Cancer Fund Cancer Care, Inc. The Hormone Foundation Lilly Center for Womens Health National Alliance of Breast Cancer Organizations
(NABCO) National Lymphedema Network, Inc. National Osteoporosis Foundation (NOF) National Womens Health Network National Womens Health Resource Center North American Menopause Society Osteoporosis and Related Bone Diseases-- National
Resource Center (ORBD-NRC) Osteoporosis Coalition in North Carolina Resolve: National Infertility Association Sexuality Information & Education Council After Cancer: A Guide to Your New Life, by Wendy Schlessel Harpham, MD (HarperCollins, Inc., 1995). A warm, informative overview written by a physician and cancer survivor. She discusses sexuality in the chapter "Where did my Libido Go?" and offers practical advice. Coping With Lymphedema: A Practical Guide to Understanding, Treating and Living with Lymphedema, by Joan Swirsky, RN, and Diane Sacket Nannery (Avery Publishing Group, 1998). A practical guide to understanding, treating and living with lymphedema caused by treatment for breast cancer. Can be ordered by calling 800-548-5757, Ext. 123. Dr. Susan Loves Hormone Book: Making Informed Choices About Menopause by Susan M. Love, MD, with Karen Lindsey (Random House, 1997). Offers comprehensive information on menopause and coping with symptoms, and addresses concerns about breast cancer. Also includes a listing of resources. Living in the Post-Mastectomy Body: Learning to Live in and Love Your Body Again by Becky Zuckweiler, MS, RN, CS (Hartley & Marks, 1998). As a nurse, psychotherapist and breast cancer survivor (who had a double mastectomy), Zuckweiler guides women through all aspects of recovery, focusing on regaining confidence in your body and developing a comfortable self-image and intimate relationships. Lymphedema, by Jeanne Petrek, MD, Peter I. Pressman, MD, Robert A. Smith, PhD (1998). Results from a workshop on breast cancer treatment-related lymphedema and lymphedema resource guide. A bit technical and scientific; useful for health professionals. Order online at American Cancer Societys web site at http://www.cancer.org/bookstore/lym_pub.html or call toll-free 888-227-5552. Lymphedema: A Breast Cancer Patients Guide to Prevention and Healing, by Jeannie Burt and Gwen White, PT (Hunter House, 2000). Provides clear information on what lymphedema is and why it occurs. Describes treatment procedures to suit a range of needs and emphasizes that lymphedema can be treated successfully. Covers preventing lymphedema, reducing lymphedema through professional therapy and self-massage and more. Managing Menopause (magazine) Includes helpful information on dealing and living with symptoms of menopause and other interesting articles regarding womens health. Published biannually (free in OB-GYN offices) by American College of Obstetricians and Gynecologists. Contact 202-484-3321. See also http://www.acog.org Sexuality and Cancer: For the Woman Who Has Cancer and Her Partner (# 4657), by American Cancer Society. (FREE) A brochure available from the ACS. Call 800-ACS-2345 or see their web site at http://www.cancer.org Sexuality and Fertility After Cancer by Leslie R. Schover, Ph.D. (John Wiley and Sons, 1997). Addresses how treatment may interfere emotionally and physically with male and female sexual function and fertility. Offers help for survivors and their partners learn to enjoy sex again and make informed choices about having children. (Schover also wrote the influential 1988 book, Sexuality and Cancer: For the Woman Who Has Cancer and Her Partner.) On American Cancer Societys booklist. Strong Women, Strong Bones: Everything You Need to Know to Prevent, Treat and Beat Osteoporosis, by Miriam Nelson, Ph.D., with Sara Wernick, PhD. (Putnam Publishing Group, 2000). This book teaches women how to recognize, prevent and treat osteoporosis through exercise (strength training, weight-bearing aerobic exercise, stretching and balance) and nutrition. Tufts University nutrition researcher, Miriam Nelson, and award-winning health writer, Sarah Wernick team up on their third "Strong Women" book to bring you the latest science about osteoporosis. What Every Woman Facing Breast Cancer Should Know About Lymphedema: Hand and Arm Care Following Surgery or Radiation Therapy for Breast Cancer, by American Cancer Society (ACS). (FREE) A brochure available from the American Cancer Society. Call 800-ACS-2345 or see http://www.cancer.org Without Estrogen: Natural Remedies for Menopause and Beyond by Dee Ito & Barbara Herbert (Crown Publishing, 1995). Offers options for managing the symptoms of menopause for women who cannot or choose not to rely on hormone replacement therapy. Lymphedema Bosom Buddies: Breast Cancer and Lymphedema
Support Group http://www.go-icons.com/bosombuddies.htm Circle of Hope Lymphedema Foundation National Lymphedema Network Sexuality, Premature Menopause, HRT Breast Cancer and Sexuality: Surviving and
Thriving Menopause From Breast Cancer, from INFO Breast
Cancer Oncolinks Page About Cancer and Sexuality Power Surge: A warm and caring community for
women in menopause Questions and Answers About Hormone Replacement
Therapy, from the National Cancer Institute Sexuality from the American Cancer Society Sexuality from the National Cancer Institute Online Support
Groups CANCER-FERTILITY CANCER-SEXUALITY LYMPHEDEMA OSTEO-P |