therapy, you must understand that chemotherapies may differ very widely from each other just like food, where a T-bone steak is very different from a twinkie.  Do not assume that because you may have heard of someone else getting sick with chemotherapy, that you will experience the same thing.  Every chemotherapy is unique.  There are also a large variety of supportive care options that can help lessen the side effects of various therapies. There is no one correct way to manage breast cancer, there are many ways.  Every breast cancer is unique. You and your doctor will determine which is the most suitable way to manage your particular situation.  We will consider many things including your disease characteristics, extent of disease (stage), your overall health status and other medical conditions, your degree of risk, your personality, lifestyle, family situation and philosophy.  You will work as a team with your doctor and other healthcare professionals.

Doctors have many treatment styles. Some doctors are very high tech, some like more aggressive treatments than others, some like to limit toxicity at the expense of response rates for some patients.  The doctors in our practice have different treatment styles and are all skilled in the management of breast cancer. It is very important that your doctor and you are well matched because you will be working together very closely in a long-term relationship.  No matter which doctor you are paired with we will be here to guide you through every step of your journey. If you would like to explore this condition in more depth we have provided several links at the right to authoritative sources about the disease, treatments and support.

Doctor Ratner was recently interviewed on channel 11 and on channel 2 about the need for genetic testing in breast cancer and the heightened interest in preventative mastectomy.

© Lynn Herbert Ratner MD

Breast Cancer Basics disclaimer

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You have just been diagnosed with breast cancer and your emotions may feel out of control... fear, sadness, anger. And so many questions: What is going to happen to me? What do I do? Where do I go? Am I going to die? What about my family?

The first thing to do is stop and take a deep breath. You are not alone. We are here to help you get through this and one of the best ways is to learn about your disease. In order to make sense of everything happening, you will need to understand breast cancer. You need to understand how it grows and where it goes. If you can understand that, you can understand the various treatment options.

The following is an oversimplification constructed to help you understand your disease. Imagine the breast is a clump of grapes dipped in a bowl of jello. The 'jello' is the fat and connective tissue that holds everything together. The grapes are the internal structure of the breast called the lobule. The grape stem represents the structure of the breast called the duct. Cancers arise either inside the lobule (grapes) or in the duct (stem). If they remain confined to the inside of these structures, they are considered in situ or noninvasive. If they penetrate the outer skin of these structures, they are considered invasive or infiltrating. It is the invasive or infiltrating cancers which present a more complex management problem because they are the ones that have the capability of spreading to other parts of the body.  Noninvasive or in situ cancers do not usually spread and are usually treated with only local modalities. You will hear many terms used like DCIS, LCIS, IDC and ILC and we will help you understand the one that relates to you.

When you are initially diagnosed with this disease, your doctors will need to establish whether your tumor is invasive or not and whether it has spread from its original site and, if so, to what extent. This process is called staging. This is done with various lab tests and imaging studies.   You may hear the term TNM used in staging discussions. The T refers to the size of the tumor, N refers to the number of lymph nodes involved, and M refers to metastases (whether or not the tumor has spread to other areas of the body).

In addition, your physician will examine several characteristics of your tumor to determine how best to treat it. Other characteristics which will be important to know include: estrogen and progesterone receptor status (this will determine whether your particular tumor is sensitive to treatment with different hormonal agents) and also Her-2 neu status, which will help determine whether certain targeted agents will be useful to treat your tumor.

Once staging is complete we can consider treatment options. Many modalities can be used to manage your disease. They include surgery, radiation therapy, and systemic therapy which may include chemotherapy, hormonal therapy, or biologic therapy.  Surgery and radiation therapy are local modalities.  Systemic therapies work throughout the body. The modalities may be used singly or in combination.  If your doctor recommends systemic

Valuable Breast Cancer Resources

The National Cancer Institute information for patients about breast cancer

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The National Library of Medicine
X-Plain teaching module for patients about breast cancer

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The American Cancer Society patient information about breast cancer

Lynn H Ratner MD
Dialecti Voudouris MD
Paul A C Greenberg MD

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