Managing A Breast Cancer Diagnosis
- Stephanie Rifici Thorkelson was a 32-year-old mother of one when she was diagnosed with breast cancer. Two days prior, she learned she was having another baby boy.
- Thankfully, Rifici Thorkelson was able to safely undergo surgery and chemotherapy during her pregnancy, and she successfully delivered her baby post-chemo.
- There are many treatment options for people with breast cancer, but treatment depends greatly on the specifics of each case. Identifying these specifics means looking into whether the cancerous cells have certain receptors – the estrogen receptor, the progesterone receptor and the HER2 receptor.
- Fertility preservation practices for women can include egg and embryo freezing, ovarian tissue freezing, ovarian suppression and ovarian transposition.
- According to our experts, people with breast cancer face unique challenges when it comes to fertility. If they need chemotherapy, their eggs could be damaged. Also, if a women’s treatment calls for medication to stop specific hormones, they might not be able to get pregnant for several years or, in some instances, 10.
Stephanie Rifici Thorkelson was nursing her then-13-month-old baby boy, Luka, when she felt a lump in her breast. Assuming it was a cyst or a clogged milk duct, Rifici Thorkelson didn’t give the lump much thought – until it never went away.
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“Your world just comes crashing down… Like why, why?” Rifici Thorkelson said. “We were so happy and excited because we had been trying for a baby—and getting that news you have cancer; All the thoughts go to your head. How is this gonna be safe?”
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Chemotherapy could’ve been harmful to the baby during the first trimester, so doctors began treatment during the second semester starting with a lumpectomy followed by chemo every three weeks.
“It was truly a miracle. I didn’t get sick at all,” Rifici Thorkelson said of chemo while pregnant. “I did not throw up. Not even once.”
Rifici Thorkelson successfully gave birth to her son, Leo, after completing chemo treatments. Today, he’s a healthy 1 year old who turns 2 in April.
“He is my little miracle angel,” she said. “We have a special bond.”
Understanding Breast Cancer
Breast cancer is a common cancer that has been the subject of much research. Many women develop breast cancer every year, but men can develop this cancer too – though it is much more rare, in part, due to the simple fact that they have less breast tissue.
Signs and symptoms of breast cancer may include:
- A breast lump or thickening that feels different from the surrounding tissue
- Change in the size, shape or appearance of a breast
- Changes to the skin over the breast, such as dimpling
- A newly inverted nipple
- Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
- Redness or pitting of the skin over your breast, like the skin of an orange
It’s important to keep an eye out for these symptoms while remembering that having one or many of them does not necessarily mean you have breast cancer. Regardless, you should always speak with a doctor promptly if anything ever feels off or you’re experiencing one or more of the signs listed above. You never know when speaking up about your health can lead to a very important diagnosis.
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Screening for breast cancer is typically done via mammogram, which looks for lumps in the breast tissue and signs of cancer. The American Cancer Society (ACS) says women should begin yearly mammogram screening for breast cancer at age 45 if they are at average risk for breast cancer. The ACS also says those aged 40-44 have the option to start screening with a mammogram every year, and women age 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms.
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It’s also important to be on top of self breast exams. If you ever feel a lump in your breast, you should be vigilant and speak with your doctor right away. Voicing your concerns as soon as you have them can lead to earlier cancer detection which, in turn, can lead to better outcomes.
There are many treatment options for people with this disease including surgery, radiation therapy, chemotherapy, hormonal therapy, targeted therapy and immunotherapy.
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Appropriate treatments depend greatly on the specifics of each case. Identifying these specifics means looking into whether the cancerous cells have certain receptors. These receptors – the estrogen receptor, the progesterone receptor and the HER2 receptor – can help identify the unique features of the cancer and help personalize treatment.
“These receptors, I like to imagine them like little hands on the outside of the cell, they can grab hold of what we call ligands, and these ligands are essentially the hormones that may be circulating in the bloodstream that can then be pulled into this cancer cell and used as a fertilizer, as growth support for the cells,” Dr. Elizabeth Comen, a SurvivorNet advisor and medical oncologist at Memorial Sloan Kettering Cancer Center, previously told SurvivorNet.
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One example of a type of ligand that can stimulate a cancer cell is the hormone estrogen, hence why an estrogen receptor positive breast cancer will grow when stimulated by estrogen. For these cases, your doctor may offer treatment that specifically targets the estrogen receptor. But for HER2 positive breast cancers, therapies that uniquely target the HER2 receptor may be the most beneficial.
Fertility and Cancer Treatment
Infertility can be a side effect of some cancer treatments, but there are options to consider. Fertility preservation, for example, is available to women of childbearing age. Options for women include:
- Egg and embryo freezing (the most common practice)
- Ovarian tissue freezing
- Ovarian suppression to prevent the eggs from maturing so that they cannot be damaged during treatment.
- Ovarian transposition, for women getting radiation to the pelvis, to move the ovaries out of the line of treatment.
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No matter what course of action you choose to take, it is important that all women feel comfortable discussing their options prior to cancer treatment.
In a previous conversation with SurvivorNet, Dr. Jaime Knopman said time was precious when dealing with fertility preservation for women with cancer. In other words, the sooner the better when it comes to having these important fertility conversations with your doctor.
“The sooner we start, the sooner that patient can then go on and do their treatment,” Dr. Knopman said. “A lot of the success comes down to how old you are at the time you froze and the quality of the lab in which your eggs or embryos are frozen in.”
Can I Have A Baby After Breast Cancer?
When it comes to breast cancer patients specifically, there are some unique challenges for women with the disease. Dr. Elizabeth Comen outlined them for us in a previous interview:
- Young women who need chemotherapy could have their fertility significantly affected because many chemotherapy drugs can damage a woman’s eggs.
- If women are on a medication to stop the hormones which feed their specific kind of breast cancer, they may not be able to get pregnant for several years – in some instances 10 years.
- Many stage four breast cancers need estrogen to grow. Pregnancy is a very, very high hormonal state, so it’s not recommended in these cases.
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