OK, I Have Breast Cancer. Now What? A Step-by-Step Guide to Treatment

Patient Expert

You had a "bad" mammogram. You thought, OK, it's probably nothing, even though they want me to have a biopsy.

You had a biopsy, and waited for the results. You thought, lots of people have breast lumps, and they always turn out to be nothing.

Then you got the call. And heard the words.

You have breast cancer.

That was a few days ago. Maybe a week. Since then, you've been convinced you were going to die. Then certain you'd be fine. Then found yourself sobbing because you'd never see your grandchildren. Your family's in a (shocked) uproar; you're gradually figuring out how to tell people; you're trying to plan your next steps.

But it's hard to plan if you don't know what comes next, isn't it? I mean, how debilitating is this breast cancer thing? How much time will you have to take off from work? Will you be in bed? Feel fine? Be able to drive, pick your 1-year-old up out of his crib, make love?

Breast cancer has as many different incarnations as there are women who deal with it; we all experience our own personal journey. But thankfully, there's a common path we follow, a treatment sequence that usually varies only in its details.

I can't tell you how you'll react to chemo, how much pain you'll have after your mastectomy, or whether or not radiation will exhaust you. But I can at least help you plan out the next chunk of your life by sharing with you a general timeline of events for the next few months.

Ready? Let's begin.

First step: the surgeon
The first thing you'll do is simple: wait. For an appointment with either a breast surgeon, or an oncologist. (Since most women see a surgeon first, that's the path we'll follow here.)

Although you probably want that tumor removed from your breast RIGHT NOW, doctors know that breast cancer isn't a medical emergency. Except in rare cases, it's slow growing, and waiting several weeks for surgery isn't a deal-breaker. Really. It'll make you crazy, but you're not the only patient at the hospital, and you simply have to wait your turn to see a surgeon.

Surgery options
When you finally meet your surgeon, (s)he will probably offer you two options: breast conservation surgery, a.k.a. lumpectomy. Or mastectomy - total removal of your breast. The surgeon may have a recommendation; or the decision may be left entirely up to you.

If you decide on mastectomy, you'll also have to decide whether you want reconstructive surgery. If you opt for reconstruction, you need to decide on the timeframe, and the type.

WHEW Once you get past all the decisions, your surgery will be scheduled. And then you'll wait again; possibly for weeks. Surgeons are busy; your cancer isn't an emergency. Patience is a virtue" and oh so difficult.

The amount of time it takes to remove a tumor from your breast, and possibly harvest a few underarm lymph nodes at the same time, can vary from about an hour, to upwards of 8 to 9 hours (f you have reconstructive surgery at the same time).

After surgery, you'll need to take it easy for awhile. For a lumpectomy, plan a couple of days, maybe a bit more. For mastectomy, plan on a week, maybe two. For mastectomy with reconstruction, you'll probably be out of work (or at least not doing any heavy lifting) for 3 to 6 weeks.

Second step: the pathologist and oncologist
After surgery, the tumor and surrounding tissue is sent to a pathologist, along with any lymph nodes you had removed. (S)he will examine all the tissue in detail, and compile a thorough report: the pathology report.

This report will be sent to your oncologist. Your oncologist will be the contractor overseeing this project. (S)he will use the pathology report to make decisions about your treatment. You'll meet with your oncologist once the pathology report is ready (within about a week of surgery), and as soon as (s)he's able to work you into the schedule. Remember - patience!

Treatment options
If you had a lumpectomy, your oncologist will probably refer you to a radiation oncologist. This is the doctor who'll oversee your radiation.

If you had a mastectomy, it usually signals more serious cancer. Your oncologist may recommend chemotherapy alone; or both radiation and chemotherapy, with chemotherapy first.

Third step, radiation: the radiation oncologist
Let's assume you've had a lumpectomy, and the pathology report shows no evidence of lymph node involvement. Next stop: the radiation oncologist, who'll determine the strength and duration of your radiation.

First, you'll be scheduled for a simulation. During this visit, you'll lie on the radiation table without getting treatment; it's a dry run. The technicians will use tiny tattoos to mark the spots where they'll aim their linear accelerator, the machine that delivers the radiation. This simulation may take an hour or so.

Standard radiation is delivered 5 days a week for a total of 5 to 7 weeks. While the treatment itself only takes 15 or 20 minutes, factor in the drive to the hospital and yes, hanging out in the waiting room.

Newer types of radiation (e.g., MammoSite), which may or may not be an option for you, take only a week. The treatment lasts a good part of each day, so you'll be pretty much out of commission the entire week.

Third step, chemotherapy
If you don't have radiation, your oncologist will probably recommend chemotherapy. If that's the case, it'll probably start within a month of your surgery. Prior to your first treatment (called an infusion), you'll undergo cardiac testing, to make sure your heart is strong enough to withstand treatment.

The oncologist will supervise your chemo; (s)he'll examine you before each treatment to make sure you're healthy enough to have the infusion. Since chemo lowers your resistance to infections, it's necessary to keep a close eye on your overall health.

Expect chemo to last for months, rather than weeks. A typical course will run 3 to 6 months, with treatments every 2 to 3 weeks. Each treatment will last 2 to 4 or 5 hours, sometimes longer. You'll have side effects, but many women find they're able to work during chemo, if their job isn't physically stressful.

Fourth step: the end of active treatment
After chemo, you may have radiation; see above. And that's it; you're ready to take your life back.


You may take hormone therapy drugs for up to 10 years or more. And you'll see the oncologist regularly; first every 3 or 4 months, then every 6 months, and then once a year. But as far as active treatment goes - you're done.

So how long does a typical breast cancer treatment take, start to finish?

It can vary widely, woman to woman and hospital to hospital. I had fairly typical treatment, including a lumpectomy followed by a mastectomy; chemo, and radiation. I was diagnosed on May 10, and finished on Valentine's Day. Which made it 9 months, start to finish.

Your treatment may be shorter. It may be longer. It may be simpler, or more involved. If you have advanced, inflammatory, or triple-negative breast cancer, the sequence outlined above may be quite different.

Only one thing is for sure: it'll be unique to YOU. And YOU are the only one who can make the many, many decisions that direct your personal treatment.

Daunting, isn't it? In my next post, I'll offer you some good decision-making tools.