Frequently Asked Questions
Are breast changes normal?
Yes. Every woman's breasts change during the course of her menstrual cycle, pregnancy, breast-feeding and menopause. Sometimes, however, breast changes such as a change in the size, appearance or feel of your breasts indicates a more serious problem, one requiring a physician's attention.
What kind of breast problems can occur?
The most common breast problems are the presence of benign (non-cancerous) cysts in the breast. Cysts are small, fluid-filled lumps, ranging in size from very tiny to the size of a golf ball. Fibrocystic change, which most often affects women between 25 and 50 years old, may cause your breasts to feel tender and heavy. Medical research links fibrocystic breasts to changes in diet. For some women, caffeine stimulates the formation of cysts. Cutting down on the consumption of coffee, tea, cola beverages and chocolate may help to improve breast symptoms.
Approximately one in eight women will develop breast cancer during their lifetime. The word cancer refers to a group of diseases, all involving the rapid growth of abnormal cells somewhere in the body. Fortunately, breast cancer can be successfully treated when detected early. Yearly physical examinations, monthly breast self-examinations and mammography, if your doctor recommends it, greatly increase your chance to detect breast cancer early.
What if I found a lump?
A breast lump is the first noticeable sign of a breast problem. A lump in the breast can be detected by both you and your doctor by doing a physical exam. The earlier you find a lump, the more successful the treatment of the disease. Because of this, you should get into the habit of performing routine breast self-examination. Women practicing regular breast self-exams discover many of their own breast lumps. During your regular visit, your gynecologist or gynecological nurse practitioner (gyn np) will also examine your breasts for any abnormalities.
How do I perform a breast self-examination?
Make a commitment to do a self-breast examination routinely, every month. Do the exam on the same day each month so that you won't forget. The best time to perform a breast self-exam is 7-14 days after your menstrual period, when your breasts are no longer swollen or tender. If you do not get a menstrual period, then pick a time every month to exam your breasts. Regular self-breast exams will familiarize you with the way your breasts normally look and feel. The following guidelines can be used to help learn how to do a breast exam:
1. Sit or stand in front of a mirror, and examine the way your breasts look. Has either of your breasts changed in appearance or in size or shape? Look for puckering or dimpling of the breast skin, and retraction (pushing in) of your nipples. Then, lift your arms and place your hands on your head, and check the appearance of your breasts again. Finally, press your hands firmly against your hips and inspect your breasts a third time.
2. Now, lie down. Flatten your right breast by placing a pillow under your right shoulder. Place your right arm behind your head.
3. Use the sensitive finger pads (where your fingerprints are, not the tips) of the middle three fingers on your left hand. When doing a breast exam, feel for lumps using a circular, rubbing motion in small, dime-sized circles without lifting the fingers. Powder, oil or lotion can be applied to the breast to make it easier for the fingers to glide over the surface and feel changes to your breast.
4. Press firmly enough to feel different breast tissues, using three different pressures. First, light pressure to just move the skin without jostling the tissue beneath; then, medium pressure pressing midway into the tissue; and finally, deep pressure to probe more deeply down to the ribs or to the point just short of discomfort.
5. Completely feel all of the breast and chest area up under your armpit, up to the collarbone and all the way over to your shoulder and down to your bra line.
6. Use the same pattern to feel every part of the breast tissue. Choose the method easiest for you:
Circles - Beginning at the outer edge of your breast, move your fingers slowly around the breast in a circle. Move around the breast in smaller and smaller circles, gradually working toward the nipple. Don't forget to check the underarm and upper chest areas too.
Lines - Start in the underarm area and move your fingers downward little by little until they are below the breast. Then, move your fingers slightly toward the middle and slowly move back up. Go up and down until you cover the whole area.
Wedges - Starting at the outer edge of the breast, move your fingers toward the nipple and back to the edge. Check your whole breast, covering one small wedge-shaped section at a time. Be sure to check the underarm area and the upper chest when doing a breast exam. After you have completed a breast self-examination of your right breast, examine your left breast using the same method, and your right hand with a pillow under your left shoulder. You may want to examine your breasts or do an extra exam while showering. It's easy to slide soapy hands over your skin and feel anything unusual.
What should I look for when doing a breast self-examination?
Many breasts feel naturally lumpy. This is no cause for alarm. Pay attention to anything that seems new or unusual - new lumps, puckering, dimpling, a thickening or hardening under the skin, a retraction of the nipple, or any other change in the way your breasts or nipples look. Discharge or bleeding from your nipple also signals a problem which needs to be evaluated by a physician.
What if I find something abnormal when doing my self-examination?
If anything abnormal is found after performing your self breast examination, or you notice a change in your breasts, see your doctor immediately to evaluate. If you do not have cancer, you will feel reassured. If you do have cancer, the earlier your doctor can begin treating it, the better your chances for cure.
Your doctor will perform a thorough breast examination, similar to the one you do at home. Based on that exam, and on your medical history, your doctor may recommend further tests to determine the cause of your breast abnormalities found during the exam. These tests include mammography, breast ultrasound, breast MRI or a biopsy.
What is hereditary cancer?
All cancers are due to changes in genes. The majority of cancer is due to gene changes acquired during a person's lifetime and is not considered to be inherited or hereditary. But in some cases, a change in a specific gene may have been inherited (hereditary) and can predispose a person to a particular type of cancer. In these cases, cancer is linked to an inherited trait which can be passed on to a person's children, grandchildren and other extended family members.
Cancer due to an inherited trait results from a change in at least one gene that occurred before conception, and at least one additional change in a gene occurring after conception. A change that occurs before conception can be passed from one generation to the next. Cancers that are not due to an inherited trait are brought about by changes in the genes that occur after conception.
How many cancers are due to inherited traits?
One in every three people will develop cancer in their lifetime. While the majority of cancer is not due to a specific inherited trait, hereditary cancers account for approximately 5 to 10 percent of all cancer cases.
If an individual inherits a specific, altered cancer susceptibility gene, his or her lifetime risk for a particular type or types of cancer is significantly increased. Some cancer types, which are known to cluster in families and may be due to an inherited trait, include breast, ovarian, colon and other cancers.
Who may be at risk for a hereditary cancer?
Analyzing a family history can help to determine if a person may be at increased risk for a hereditary cancer. Family histories that may indicate hereditary cancer tend to have certain features in common. These include:
- Cancer in two or more close relatives, on the same side of the family.
- Individuals diagnosed with cancer before the age of 50.
- The presence of the same or associated cancers that comprise a syndrome. For example, breast and ovarian cancers in the same family is suggestive of hereditary breast-ovarian cancer syndrome.
- Bilateral cancer in paired organs, which is cancer in both organs where the body has more than one of a particular organ. For example, cancer in both breasts or ovarian cancer in both ovaries.
- Two or more separate tumors in the same individual.
- Two or more generations affected on the same side of the family.
- Presence of a rare cancer (for example, male breast cancer).
If any one of these circumstances describes your family, you may be at increased risk for cancer due to an inherited trait.
How is an individual's risk for hereditary cancer determined?
A person's cancer risk may be derived in a number of different ways. Typically, however, it begins with obtaining a pedigree, or a three-generation family history. This involves collecting information about first, second and third-degree relatives on both the mother's and father's side of the family. First-degree relatives include the mother/father, brothers/sisters and children. Second-degree relatives include grandparents, aunts/uncles, nieces/nephews and grandchildren.
Cousins, who are third-degree relatives, help complete the full picture. Ethnicity and race are also important because of the higher prevalence of certain gene changes in specific populations. A family history questionnaire is usually distributed and completed prior to an individual's office visit. Completing a family history questionnaire gives a person the opportunity to contact relatives and gather more detailed information before speaking with a genetic counselor who will analyze the family history.
Can several family members have cancer without it being hereditary?
Non-hereditary or non-genetic factors may also increase a person's risk to develop cancer. For example, cancer may occur in a family at a higher than expected rate due to hormonal or reproductive factors, lifestyle or environmental exposures, such as smoking cigarettes.
What is genetic counseling?
During genetic counseling, a genetic specialist educates families about their risk of having an inherited disorder, as well as the testing, management and screening options available for at-risk individuals. The process includes:
- Careful review of a patient’s medical history, family history and other risk factors
- Estimating the likelihood that cancers in the family are hereditary, and the patient’s individual risk of developing specific cancers
- Discussion of the benefits, limitations and implications of genetic testing
- When appropriate, facilitating genetic testing for at risk individuals and providing a detailed explanation of the results and their meaning
- Review of cancer screening and risk reduction recommendations tailored to the patient’s level of risk
- Opportunity for enrolling in unique clinical trials, genetic testing studies and cancer registries to further understand the genetics of cancer
Is gene testing available for certain types of cancer? Who are candidates for gene testing?
Over the past decade, research advances have led to the identification of many genes responsible for hereditary cancer syndromes. Currently, testing is available for breast, ovarian, colon and medullary cancers, retinoblastoma and other, more rare cancer types. In many cases, gene testing involves a simple blood test after a person receives genetic counseling. Although genetic testing is available for a number of hereditary cancers, it is not practical or appropriate to screen everyone, since only 5 to 10 percent of all cancers is due to an inherited risk.
Who should have genetic testing for hereditary cancer?
Analysis of a person's medical and family history is used to determine whether genetic counseling and genetic testing are necessary. Genetic testing may be considered in the following situation(s):
- When an individual has a reasonable likelihood of carrying a cancer predisposing gene change.
- When a genetic test is available that can be adequately interpreted.
- When results of testing will influence medical management.
- When the information revealed from testing will be meaningful and empowering to the person.
Genetic testing is always voluntary and is a decision to be made only after the risks, benefits and limitations have been presented by a trained genetic counselor.
What are the benefits of genetic testing for hereditary cancers?
For people in higher risk families with a known change in a cancer susceptibility gene, a negative test can provide a sense of relief. Additionally, unaffected family members of patients with identified gene changes who test negative can be spared the need for intensive cancer screening and intervention.
A positive test can help individuals make decisions about follow-up care. Some individuals may choose to have surgeries such as a prophylactic mastectomy or oophorectomy. These surgeries can reduce the risk of developing cancer in a particular organ. Additionally, patients may feel empowered by detecting cancer early through intensified screening or reducing their risk for cancer by altering their lifestyle. Results of gene testing in some families may also guide family planning.
Genetic testing involves complex issues that should be discussed with the individual considering testing. For this reason and others, genetic counseling is an important component of the process – both before testing is considered and after a test is ordered.
Is genetic testing covered by insurance?
Some genetics tests for well-defined hereditary cancers where a positive or negative result will change medical care are considered part of standard management. Other genetic tests for hereditary syndromes where the medical benefit of identifying a mutation carrier is not yet established are not considered standard medical practice. Recently, there has been a trend among the larger insurance companies to recognize the importance of testing and provide coverage for genetic counseling and testing.
Genetic testing raises ethical, legal and social questions; therefore, some individuals do not want their health insurance company to know if they carry a cancer predisposing gene change. Some fear that the company may use this information to raise premiums or cancel coverage. The extent to which this type of discrimination may occur is unknown. Applicable federal and state laws are explained to individuals considering genetic testing by a genetic counselor.
Can you tell me a little about the Infusion Center?
The Center features spacious, light-filled treatment bays, individual flat-screen TVs and relaxing décor. There are 20 reclining chairs in the unit along with chairs for anyone who may have accompanied you. There are curtains around each unit that can be used for privacy.
The Infusion Center tends to be cold. We can provide blankets if you are feeling chilly or feel free to bring a blanket from home if it will make you feel more comfortable.
Laptops and cell phones are permitted and can provide instructions on how to connect to the Internet through our Hospital Wi-Fi system, Jeff Guest.
Can I bring a family member with me?
On the day of treatment, we encourage you to bring one family member or friend with you. Depending on the length of treatment and medication administered, you may be too tired to drive home. Please understand that many of our patients are at an increased risk for infection from viruses due to compromised immune systems. It is for this reason that a strict policy has been implemented that no children under the age of 16 may be permitted in the Infusion Center unless they are receiving treatment themselves.
Am I allowed to eat before treatment?
There are no restrictions on what you can eat on the day of treatment and you can eat anything during the treatment process. You can bring in your own food or eat what is provided by the Infusion Center. We have snacks, juices, coffee, tea and sodas available at all times and sandwiches are available at lunchtime.
There are also many places outside of the Infusion Center where you may purchase food.
Am I allowed to take my medications on the day of treatment?
If you are taking any prescription medications for any conditions, you are permitted to take those on the day of treatment unless your oncologist has instructed otherwise. If you are unsure, contact your doctor.
Where can I park?
Valet parking is available on 10th street between Market and Chestnut Streets in the Rothman Building. The cost of parking is dependent upon the length of stay. Your parking ticket will be validated at the end of your stay and costs can range anywhere from $2.00 to $4.00. You may also self-park in the Laz Parking Garage on 10th and Chestnut Streets.
What is the check-in process at the Infusion Center?
Upon arrival you will check in on the 2nd floor. At the reception desk, you will see a computer monitor and you need to enter your name in the computer and take a seat in the waiting room. If you have any questions on how to do this, one of the receptionists can help you.
Within a short time, someone will call your name and you will be asked to verify your identity and contact information some questions and asked to provide copies of insurance cards, referrals if needed and any co-pays to complete your registration. Once you have completed the registration process, you take a seat in the waiting room until your name is called to have your lab work done. If you do not have a port, you will be brought back to have a phlebotomist or nurse draw your blood.
If you do have a port, you will be taken into the Infusion Center to have your labs done via your port by an assigned registered nurse.
If you are seeing your physician on the same day of your treatment, you will do that after your labs have been drawn. The physician offices are located on the 3rd or 4th floors.
Once you have completed your physician visit, you will come back to the Infusion Center where you will be seated and treatment will begin.
What lab work will I need done?
Your physician will order blood work to be drawn prior to each treatment to ensure that your lab values are within range to proceed with treatment. Labs will either be drawn from our highly skilled phlebotomists or by a registered nurse if you have an infusaport.
Once the labs are drawn and sent to the lab, it will take approximately 60 to 90 minutes for your physician to get the results. We encourage: You can ask your doctor to have your lab work done several days prior to treatment to avoid the wait time and to speed up your treatment process.
How long can I expect my treatment to take?
The length of your treatment is dependent on the type of chemotherapy your physician has ordered based on your type of cancer.
On your first visit, your chemotherapy is mixed specifically for you and your type of cancer at our onsite pharmacy. The pharmacist does not start mixing the chemotherapy until they receive a checklist from your assigned nurse.
This checklist contains your lab results and weight, which needs to be a certain range for you to receive treatment. If the lab values and weight are acceptable, the pharmacist will mix the therapy. This process can take approximately 30-60 minutes depending upon the type of chemotherapy you are receiving.
Overall you can expect to be there anywhere from an hour to several hours.
Will I need an IV to receive treatment?
When you come in for your treatment a registered nurse will be assigned to you. They will determine whether you require an IV or if you have a port that needs to be accessed.
What happens if I miss my appointment?
If you miss your appointment, please be sure to notify your physician so you can be rescheduled for another time. Please contact your physician’s office directly to reschedule.
What if I am running late for my appointment?
If you are running late, please notify the front desk. The telephone number is 215-955-8874. You will not be cancelled but you may be delayed in being seated.
How many times will I need to receive chemotherapy treatments?
Your physician will discuss your treatment and determine how often you will need to receive treatment. Depending upon your type of cancer, a chemo cycle could be every week, every two weeks or every three weeks.
What is a Complete Blood Count (CBC)?
This is a lab value that helps your physician determine if you are able to receive treatment. It looks at your white blood count, hemoglobin (the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs.) and platelets (important for blood clotting). If any of these values are extremely low, treatment may be delayed and you will be rescheduled in a week or so to give your counts time to recover.
If your white blood count is too low, you may receive an injection that will boost your count to prevent you from developing an infection or your physician may put you on antibiotics. If your hemoglobin level or platelet count are too low, you may require a blood transfusion.
Where do I go for blood transfusions if I need one?
If you need a blood transfusion because of a low hemoglobin level or platelet count, a blood specimen is drawn and sent to the Blood Bank so that they can match your blood type.
Once your blood type is matched, a bag is prepared and we are notified that it’s ready. Your physician may order pre-medication (Tylenol or Benadryl) prior to the infusion to avoid a possible blood transfusion reaction. Typically the doctor will order 2 units.
This entire process can take up to 4 hours.
What if I have a problem after I get home?
If you have any issues after you receive your treatment please call 215-955-8874 and you will be directed on what to do.
If it is an emergency, please call 911 immediately or go to the nearest hospital.
What are the side effects of chemotherapy?
You may experience some side effects after receiving your treatment. The most commonly reported symptoms are nausea, vomiting, diarrhea, hair loss, peripheral neuropathies, and fatigue. Before your treatment begins, you will be given anti-nausea medications, which will help you during your stay.
It’s important to remember that everyone is different and you may experience none of these effects, some or all. It’s important to share the side effects with your physician who may be able to help you manage the side effects with medications. If your symptoms are severe, please contact your physician immediately.
Also, the Jefferson-Myrna Brind Center of Integrative Medicine offers an Integrative Cancer Care Program that provides complementary therapies such as vitamins, special diets, herbs and acupuncture that may help with some of your symptoms.
You also have access to oncology social workers who are trained in individual and family therapy and are available to meet with you to assist with the psychosocial impact of cancer treatment, and can provide a valuable link to available community resources.
I understand I may lose my hair after treatment. Where can I purchase a wig?
Jefferson's Wig Program for Cancer Patients was created to help ease the stress and/or embarrassment of sudden hair loss experienced by our patients. If you are being treated for cancer, either as an inpatient or an outpatient at Jefferson, and you have hair loss, we are happy to provide you with a free synthetic wig, turban or hat.
To make an appointment, place call Patient Services at 215-955-7777 or 5-7777 (from inside the Hospital).
Here at Jefferson, we want our patients to be as educated and informed as possible when it comes to their cancer care. We suggest you bring a list of questions and a notepad to ensure you get the most information possible during your visit with us. Some frequent questions asked of our radiation oncologists about cancer include:
- What type and stage of cancer do I have?
- How will radiation therapy help me?
- How does radiation therapy work? Is it internal or external?
- How many and how long will I receive radiation treatments?
- What are the chances that radiation therapy will work?
- What is the chance that the cancer will spread or come back if I do not have radiation therapy?
- Will I need chemotherapy, surgery or other treatments?
- How can I expect to feel during treatment and in the weeks following radiation therapy?
- Can I drive myself to and from the treatment facility?
- Will I be able to continue my normal activities?
- What side effects may occur from the radiation?
- Will radiation therapy affect my ability to have children?
- What are some of the support groups I can turn to during treatment?