There is nothing more stressful and intimidating than your first appointment after receiving your diagnosis. It was overwhelming, emotional and scary. It was difficult to retain important information provided, while trying to process that I had been diagnosed with cancer.

Here’s what you can expect to discuss at your first meeting with your team.

• Information collected from your biopsy results
• Physical exam
• Synthesizing the information
• Developing your treatment plan
• Important considerations

For more information on what to expect during your first appointment Visit: https://blog.dana-farber.org/insight/2019/04/what-to-expect-in-your-first-meeting-with-your-oncologist/

Below is the list of questions I developed.  This list allowed me to stay focused and ask the appropriate questions while taking notes. Email team Pink Dove if you need assistance with your questions at [email protected]

Questions to Ask:

Size of mass:

Exact location on breast:

Do you agree with the report from the imaging? Would you recommend getting another biopsy?

Besides getting Genetic testing, would you recommend any other tests?

MRI?

Who will be part of my care team? (*You should be able to meet w/ your entire care team before your surgery/treatment)

Nurse case manager:

Social Worker:

Radiation Oncologist:

Medical Oncologist (For hormone therapy):

Breast Surgeon:

Plastic Surgeon:

Genetic Counselor:

Surgical nurse Navigator:

•  What’s the hormone receptor status of my cancer?
• Should we know this before proceeding with surgery, if we don’t already?
• Test used to find the receptor status: Immunohistochemistry (IHC)

Notes: 

ER+ = Breast cancer with estrogen receptors 

PR+ = Breast cancer with progesterone receptors

Keeping these receptors from attaching by hormone therapy can help keep the cancer from growing/spreading

1 or both of the receptors, hormone therapy drugs can be used

What’s the HER2 Status of my cancer? (*Her2 is A protein involved in normal cell growth. They can be made in larger than normal amounts by some types of cancer cells, causing cancer cells to grow more quickly. Checking the amount of HER2/neu on may help plan treatment)

Am I Her2- or Her2+?

How do these (above) factors affect treatment options and long-term outlook (prognosis)?

How much experience do you have with treating cancer?

What are my treatment options?

Mastectomy with Reconstruction:

Single or Bilateral:

Removal of almost all of the breast tissue

Reconstruction with implant or flap

Strengths:

Decreases possibility for needing radiation in certain cases

No repeated surgeries for positive margins

No mammograms needed (if bilateral)

If Single mastectomy, mammogram will be done on other breast

The way to screen for cancer w/ single or bilateral mastectomy is by doing the self-check exam & during follow-up appointments. If cancer did come back, it would be felt superficially.

Weaknesses:

Longest surgery (6-14 hours)

Longest recovery

More post-op complications relative to other surgical options

Implant complications

50/50 % chance of it being a same day (mastectomy & reconstruction) surgery or a 2-Part surgery

Same day: reconstruction will be done right after mastectomy. This is dependent on how the skin separates from the breast. If it looks healthy or not.

2-Part Surgery: Mastectomy is performed & an expander is placed. 3 months to 1 year + after surgery (after treatment is complete & once healed), 2^nd surgery for reconstruction will be done.

Breast Conservation Options (Both Options need Radiation after):

Partial Mastectomy (Standard Lumpectomy)

Remove part of breast that has the cancer & sew up skin over the defect

Strengths: 

Shorter surgery (45 mins)

If cancer is small, reasonable cosmetic results

Quick recovery

Day / outpatient surgery

Weaknesses:

Pretty high rate of positive margins (20% or 1 in 5), needing further surgery

Not an option for large cancers

Defect after radiation can scar & lead to possible nipple retraction

Will have a divot in area cancer was removed

Oncoplastic Surgery (not many perform this type of surgery)

Remove part of breast w/ cancer

Fill defect created with some sort of breast lift or reduction technique

Perform symmetry on other breast (pseudo lift will be done to healthy breast)

Strengths:

Low positive margin rate (10%)

Allows breast conservation for larger cancers

Fills in cancer defect region w/ breast tissue, decreasing chances of scarring & nipple retraction

Creates a symmetrically aesthetic breast form that patients benefit from – similar to a breast lift or reduction

Quick recovery

Weaknesses:

longer surgery (2-4 hours)

Which treatment/surgery would you recommend and why?

Do you have pictures / evidence of your work?

What would the goal of the treatment be?

How soon would I start treatment?

How long will it last?

What will it be like?

What should I do to get ready?

What risks or side effects are there to the treatments you suggest?

How will treatment affect my daily activities?

My husband and I have been trying to get pregnant. Can you explain what impact treatment/surgery will have on our current goal or future fertility? 

Can I still get pregnant during this process?

Can I breastfeed?

What are the chances of recurrence?

What would we do if the treatment doesn’t work or if the cancer comes back?