There are several indications of a locally advanced breast cancer: a stage 3 cancer, with a size larger than two inches and lymph node metastasis; swelling of the skin, or a big, matted cluster of lymph nodes in the armpit; or it might be stuck to the chest muscle, or ulcerating through the skin.

These are all indications that the breast cancer is likely to have spread to elsewhere in the body, at least microscopically and so when they are discovered, surgery isn't always the first step taken. Lymph node sampling isn't necessary. There is frequently a question whether a wide excision is even possible. If you've got very large breasts, it might be, but if your breasts are small, surgeons may not be able to get enough surrounding tissue out without a mastectomy. It the tumor is stuck to the chest muscle or ulcerating through the breast skin, an immediate local treatment might not be feasible at all; removing the muscle or all the skin that is ulcerated might not leave sufficient tissue to sew back together again.

All this generally suggests that it would be wise to start a systemic rather than local treatment, usually in the form of chemotherapy and this is now fairly generally agreed on in the medical community. Normally, the drugs used are Adriamycin and Cytoxan and/or Taxol or Taxotere. This may not eradicate the whole tumor, but if it doesn't, it can still do two things: it can destroy the cancer cells that have spread to various organs and it can shrink the tumor size to a size that can be more easily managed with surgery or radiation. Oftentimes, chemotherapy is continued for three to four cycles and then the situation is re-evaluated. If the tumor has shrunk, a lumpectomy (the surgical removal of a small tumor or a lump); if there is no change, surgeons resort to a surgical technique known as mastectomy, or surgical removal of the breast. Even when the tumor seems to have disappeared, there may still be some cancer cells present. Most doctors always want to at least a lumpectomy on the spot where the tumor where the tumor had been to see what's actually left. If the lumpectomy is clear or shows clean margins, you are a candidate for radiotherapy. Similarly, if doctors can do a lumpectomy and clear margins because the lump is small, that in addition to radiation is a sensible treatment. If there is still a large lump or a lot of cancer at the margins, the best option might be to do a mastectomy with or without immediate breast reconstruction. In the case of an ulceration that doesn't have enough skin to sew back together, breast reconstruction has not only a cosmetic but also a medical advantage: reconstruction provides skin from another part of the body.

After lumpectomy or mastectomy, some women with stage 3 breast cancer receive high-dose chemotherapy and stem cell rescue (bone marrow transplantation). Knowing that many of these locally advanced cancers are very aggressive, many doctors feel that a higher dose of chemotherapy is advisable. Different hospitals have different preferences in treatment order and combinations. Most centers do chemotherapy first and many of them will then do a mastectomy. Some of them will consider breast conservation surgery, if the lump becomes small enough and they usually follow up with radiation therapy. Combinations of treatments in this kind of breast cancer produce better response rates.

Inflammatory breast cancer is a special kind of advanced breast cancer and it's a serious one. Though we see an increasing number of cases, it is rare, accounting for only 1 to 4 percent of all breast cancers. Overall survival is worse in women with this kind of breast cancer than in other forms of breast cancer. It is inflammatory because its initial manifestations are usually redness and warmth in the skin of the breast, often without a palpable lump. Oftentimes, the patient and even the doctor will mistake it for a simple infection and she'll be put on antibiotics. But it doesn't get better. It also doesn't get worse and that's the tip-off: an infection will always get better or worse within a week or two - it rarely stays the same. If no change seems to be evident, the doctor should perform a biopsy of the underlying tissue to see if it is cancer.

An asymptomatic breast cancer patient was breast-feeding and developed what her doctor thought was lactational mastitis or inflammation of the breast brought about by breast-feeding. It never cleared up and did not hurt much - there was no fever sign of infection. It hadn't gone away or gotten worse in six months. Another patient, not breast-feeding, noticed that one breast had suddenly become larger than the other; there was also redness and swelling. In both cases, the doctors at first thought the women had breast infections. So if the symptoms continue after treatment, you should ask to have a biopsy done of the breast tissue and of the skin itself. With inflammatory breast cancer, you have cancer in the lymph vessels of your skin, which makes the skin red. An internet survey done on women with the disease by a man whose wife had died of inflammatory breast cancer showed that most women said they wished they had known that when there is redness of the breast skin unresponsive to antibiotic therapy, this is indicative of inflammatory breast cancer. Probably their doctors were not breast specialists and did not know about this unusual type of breast cancer.

Inflammatory breast cancer is the only kind of breast cancer that virtually everyone agrees doesn't call for mastectomy as its sole primary treatment. Because it involves the lymphatic vessels of the skin as well as of the breast tissue and the skin is sewn back after mastectomy (surgical removal of the breast), doing a mastectomy will leave a great chance of recurrence in the skin. Chemotherapy would be treatment of choice for this type of breast cancer before any local treatment can be entertained.

The incidence of inflammatory breast cancer is quite variable. Women with this cancer tend to be significantly younger than those with other breast cancers and African Americans with this type of cancer tend to be younger than Caucasians.

As with all advanced cancers, chemotherapy is started with three or four cycles of Adriamycin and Cytoxan with or without Taxol or Taxotere. After which local treatment can be done - usually in the form of mastectomy. After mastectomy, most women will receive four more cycles of chemotherapy followed by radiation therapy to the chest wall. Serious though it can be, inflammatory breast cancer is still an extremely variable disease.

Sometimes a cancer is unusual, not in itself, but in the situation which it occurs. Breast cancer is most common in women over 50; there are several cases in women in their 40s. It is far rarer in women under 40, but it does occur. We tend to be particularly shocked when it occurs in a young woman. In this situation it is detected as a lump, since generally, breast cancer screening through mammography is not done in young women.

Very often, a young woman gets misdiagnosed. She detects a lump and she is told it is just lumpy breasts and it is followed for a while until doctors realize it's something serious. Although this can be horrifying, in fact, it's quite understandable, since the vast majority of lumps in women under 35 are totally benign and the risk of cancer is very low. The fact that cancer is not diagnosed immediately doesn't mean that the young patient will die; since most breast cancers have been around 8 to 10 years, and whether it is diagnosed the minute you find it or six months later isn't the critical factor. We're so horrified when a young woman gets breast cancer that there's a disappointing number of lawsuits against doctors failing to find breast cancer in this population, because they're often misdiagnosed and because it's such a gut-wrenching situation. However, in most cases the doctors are not negligent. Still, doctors should be taught that young women can develop breast cancer and that doctors should remain vigilant.

Many doctors believe that breast cancer in a young woman is more aggressive than in older ones. Two studies have recently shed some light on this theory. Both studies showed that the mortality from breast cancer was higher in women who had been pregnant in the past four years. Risk was assessed to be higher right after pregnancy and decreased with each year, going back to normal after four years. Since young women are more likely to have been recently pregnant, they will show more of this effect. This suggests that it may not be the woman's age itself that affects aggressiveness but the changes in her immune system and hormones that go with pregnancy.

Breast cancer in young women is more likely to be hereditary. That makes sense - if you've inherited a gene mutation and you will only need one or two more mutations to get cancer, you're one step closer and you're likely to get there faster, whereas if you "acquire" breast cancer, you still need to get all the genetic mutations. That doesn't work all the time. Like older women, the majority of younger women with breast cancer have no family history. Nevertheless, if you have breast cancer in your family you are more likely to get it at a younger age than if you don't.

Overall, there is no evidence that breast cancer under 35 matched for prognostic features is any more aggressive than a cancer in an older woman. Younger women do, on the other hand, have a higher incidence of poor prognostic features. Still, a young woman and an older woman with the same tumors will have the same general prognosis.

In recent years, much research has been done on ways to prevent breast cancer and other disease. Much of the research has focused on green tea, which has been shown in many studies to have cancer preventing qualities. So much research has been done, in fact, that Japan’s medical community now calls green tea a known cancer preventative, and other medical communities are expected to follow suit.

One recent study, however, suggests that herbal teas may be effective in preventing breast cancer, too. The UK Tea Council reported on a study conducted on over 4000 French women with no history of cancer. The women were studied over a 6 year period, and received a mammogram and other cancer screening tests every two years during the period. In addition, the women were evaluated based on the particular beverages they consumed, including herbal tea, regular tea, coffee, fruit juices and wine.

By the end of the six year period, 95 of the participants had developed breast cancer. However, the study could not find any link between any of the beverages consumed and an increased risk of breast cancer. Surprisingly, however, they did find that the women that consumed herbal teas had a slightly lower risk of developing breast cancer than those women who consumed other beverages.

Herbal tea, of course, is not really tea at all. Rather herbal teas, also known as tisanes, are really infusions of one or more herbs. They are made with hot water and taken like tea, hence the name; but true herbal teas contain no leaves from the Camilla sinensis plant, the tea tree. However, herbal teas can have many useful purposes, and are used to treat many discomforts naturally.

Just as they are thought to have discovered traditional tea, it is believed that the Chinese discovered herbal teas, too. Herbs were widely used in ancient medicines, and the Chinese, were the first to combine the healing properties of herbs with the enjoyment of tea. Brewing a tea from the correct combination of herbs may simply have been the easiest way to administer the medicine.

Herbal teas were not widely used in the Western world until the last 20 years, though Asian cultures have continued to use them in conjunction with modern medicine. However, in the last few years, herbs have become popular in the rest of the world for relaxation and as alternative medical treatments.

Statistics show that today consumers spend about $120 million on herbal teas at major supermarkets, and that figure is growing at a rate of about 10% per year. So, you can see that herbal teas make up a significant portion of the beverages consumed in the Western world. Most people who drink herbal teas buy commercially produced loose teas or tea bags. And, this is considered the safest way to consume herbal teas. Making your own brew from plants you’ve picked in the wild is risky, at best.

If you’re taking prescription medication, be sure to consult with your doctor before making herbal teas part of your regular routine. Some herbs have been known to have interactions with medications. But, as long as your doctor approves, there’s no reason to avoid herbal teas, whether for health protection or just for pleasure.

There are dozens of different types of herbal teas available. In fact, one of the pieces of information not noted in the study mentioned above was what kind of herbal teas the study participants drank. But, if you’re interested in trying them, here are some of the most popular varieties.

Rooibos - This is an herbal tea whose base is the South African Rooibos herb –it’s often referred to as red tea. You’ll find this tea delicious and sweet on its own, but it can also be found flavored with other fruits.

Yerba Mate Herbal Tea – This tea is made from the South American herb Yerba Mate. It is very healthy; full of anti-oxidants and vitamins and is said to give energy.

Chamomile – This is a traditional herbal tea made from the chamomile plant. Chamomile has been used for centuries to induce sleep and relieve upset stomachs.

Ginger Tea – Spicy ginger has been used for centuries to make tea. It’s delicious and also highly regarded as a treatment for nausea. Ginger tea is an especially good natural treatment for morning sickness.

Lavender Tea – Tea made from the lavender plant has been used for many years to help calm the soul and induce sleep. A weak brew of lavender can be used to calm a colicky baby, too.

Herbal teas can be a wonderful addition to your diet. They can be used to treat minor ailments and provide a feeling of calm. And, now that there’s evidence that herbal teas may help prevent breast cancer, they can become part of your regular health protecting routine.

Protecting yourself from cancer includes living an overall healthy lifestyle. This includes getting regular exercise, eating a diet that is low in saturated fat and rich in fresh fruits and vegetables and not smoking.

Be sure to include the most potent anti-oxidants in your diet too, like those found in blueberries, artichokes, pomegranates and green tea. Following these guidelines and adding a cup or two of herbal tea, as well, can help you protect your health for years to come.

We all know that doctors are busy, pulled in many directions and pressed for time. As a breast cancer patient, when you are dealing with people you might otherwise find intimidating, you may be a bit reluctant to make demands. But remember, they are people just like you and you can bet they'd want someone to pay close attention if you were in their shoes. Never lose sight of this fact - and never chose a doctor who has. You should expect doctors to hear you. As a way of showing they are listening and caring, it is not unusual for doctors to pull up a chair and sit face-to-face while discussing your diagnosis and options for treatment of your breast cancer. You need to feel your doctor sees you as a person. If only one of you is talking, there's a problem. You will want to make certain that your doctor not only answers any questions you may have, but also provides you with information that will allow you to make decisions, or know where to look for answers.

Each of us has a comfort level when it comes to facing what will lie ahead in terms of breast surgery, cancer adjuvant therapies, prognosis and possibilities. You may want to know every detail. If this is the case, you should expect the doctor you select to explain tests and procedures you will be undergoing. On the other hand, you should decide in advance how much you really want to know. Some of us need the hard, fast facts of breast cancer; others just want a broad overview; still other want only the information they will need to take their first step. One size does not fit all, so feel free to ask about anything that comes to mind.

Because you may be nervous or frightened - or simply because you may be asking questions that require lengthy or complicated answers - you may want to tape-record conversations with your doctor. Don't be afraid to ask. This is a great way to make sure you aren't missing anything important. It provides you with the opportunity to review what you discussed and also allows you to absorb what was said at your own pace, in your own time. If you run into a doctor who doesn't want to be taped, you should seriously consider whether this is someone you will feel safe and confident with, or if it's time to move on.

In this day and age, it is not uncommon for women with breast cancer to seek out therapies that may be considered outside the realm of Western medicine. A growing number of patients feel they need to approach breast cancer on more than one level. You may try acupuncture, massage, Chinese herbs, vitamins, or many other therapies currently classified alternative or complementary medicine. Your doctor should want to know about these and you will want to pay close attention to reactions when you discuss other therapies you may be trying or want to try. If your doctor dismisses these therapies without evidence that a specific therapy is harmful or ineffective, you may want to leave that doctor and find one who acknowledges that alternative treatments can help you to improve you physical and emotional well-being.

One of the hardest parts about being diagnosed with breast cancer is how to tell your children about it. Generally speaking, the best thing to do is to be honest with them. If they don't hear it from you now, they're bound to find out some other way - they'll overhear a conversation when you assume they're out of the room, or a friend or neighbor will inadvertently say something. And when they hear it that way, in the form of a terrible secret they were never supposed to know, it will be a lot more horrifying for them. By talking about it openly with them, you can demystify it. In addition, if all goes well your children gain an opportunity to learn about survival after breast cancer. Kids need to know they can trust you - you don't want to do anything to violate that trust. It's a two-way communication; remember also to listen to their fears. If you find it difficult to bring up the subject, there are children's books you can get that can give you a place to begin.

How you tell them about your breast cancer diagnosis, of course, will depend on the ages of your children and their own emotional vulnerability. They must be told very directly that they did not cause the cancer by thoughts, words, anger, dreams, wishes, etc. Your children will also be affected in other ways; you may be gone for a few days in the hospital and will need to rest when you come home; you may be getting daily radiation therapy, which will consume a lot of your time and leave you tired and lethargic afterwards. You may be having chemotherapy treatments that make you violently sick and make you lose your hair as well. Your children need to know that the alteration in your behavior and the decrease in your accessibility to them isn't happening because you don't love them or because they've been bad and this is their punishment.

Some surgeons encourage breast cancer patients to bring young children to the examining room with them. It could be very helpful for a daughter in particular to see her mother being examined. If you are being treated with radiation or chemotherapy in a center where your children are permitted to see the treatment areas, it's a good idea to bring them along once or twice a week. The environments aren't intimidating and a child who doesn't know what's happening to you in the hospital can conjure up awful images of what "those people" are doing to mom.

Breast cancer has particularly complex ramifications for a mother and her daughter. Aside from all the normal fears any child has to deal with, a daughter might worry about whether this will happen to her, too. It's not a wholly unfounded fear, since there is a genetic component to breast cancer. You need to reassure your daughter, explain to her that it is not inevitable but as she gets older she should learn about her breasts and be very conscious of the need for monitoring.

Many women are hesitant to take hormone replacement because they fear that it will increase their chances of developing breast cancer. Up to this time, after so much medical research, this remains a complicated and controversial issue, especially as we are talking about the most common cancer in the Western world. Statistical data shows that breast cancer affects one in every thirteen women by the age of seventy-five and one in eight women who have a family history of this disease. In some cancerous tumors, a substance known as estrogen receptor is present, which means the possibility that cancer may be promoted by estrogen therapy.

The incidence of breast cancer continues to rise progressively throughout life, so one certainly would not want to do anything during midlife that might further increase this risk. Women who are most at risk of developing breast cancer include those who have never given birth or who are over thirty when they had their first children, obese women, women who went through puberty early, or went through menopause late (after the age of forty-four) and those with a family history of breast cancer. A common feature among these factors is a prolonged and constant exposure to estrogen from the ovaries. Women who consume high fat and low fiber diets have high blood levels of estrogen than women on low-fat, high-fiber diets and they also have much higher incidence of breast cancer, so it seems that we have yet another possible link between estrogen and breast cancer.

Notwithstanding these theoretical indications, however, of almost thirty studies determining the correlation between estrogen replacement and breast cancer, the majority have failed to indicate a definitive for or against this form of treatment. Data is contradictory in that studies linking estrogen therapy to breast cancer also show that women on estrogen who developed breast cancer had survival rates that were significantly better than that of women not on estrogen.

Although studies that show an increased risk of breast cancer are only population studies that surveyed women on hormone replacement therapy, rather than rigorously designed clinical trials comparing the experience of a group of women taking this treatment than a group taking a placebo, they still should make a doctor cautious about prescribing a high dose or prolonged use of estrogen replacement therapy to a woman with a known high risk of breast cancer. In such a case, if estrogen therapy is deemed extremely necessary, it is wise to use smaller or intermittent doses of estrogen replacement therapy. This is reassuring for women who want to take estrogen replacement for only a short time.

All in all, with hormone replacement therapy of less than five years' duration, there is no increase in the incidence of breast cancer. The incidence may increase after ten to fifteen years of hormone replacement and this increase appears to be approximately 30 percent. Furthermore, while it appears that the incidence of breast cancer may increase with long term hormone substitution, women who get breast cancer while on hormone therapy are less likely to die from the disease.

How does an average woman react to the terrifying diagnosis of breast cancer? Many women go through several psychological steps in learning how to deal with breast cancer.

First, there is shock. Particularly when you're relatively young and have never had a life-threatening illness before; it's hard to believe you have something as serious as cancer. It's all the more difficult to believe because, in most cases, your body hasn't given you any warning at all. Unlike, for example, appendicitis or a heart attack, there's no pain or fever or nausea - no symptom that tells you something is going wrong inside. You or your doctor have found this painless little lump, or your routine mammogram shows something peculiar - and the next thing you know, your doctor is telling you you've got breast cancer. Many women say this is the worst part of the journey. The initial shock can leave you feeling confused and not sure how to proceed. Along with the shock, there's a feeling of anger at your body, which has betrayed you in such an underhanded fashion. In spite of the horror that you feel at the thought of losing your breast, often your first reaction is a desire to get rid of it.

While this is a perfectly understandable emotional response, it's not one you should act on. Getting your breast cut off will not make things go back to normal; your life has been changed and it will never be the same again. You need time to let this sink in, to face the implications cancer has for you and to make a rational, informed decision about what treatment will be best for you both physically and emotionally.

Today there's much more emphasis on doctor and patient sharing the decision making process and there are more options to choose from. There's also a lot more knowledge available - there are manuscripts about breast cancer and its survival rates in both the medical and the popular press and on the internet.

So if the first stage is shock, the second is investigating your options. It is very important to reflect seriously on what the possibility of losing a breast would mean to you. Its importance varies from woman to woman, but there is no woman for whom it doesn't have some significance. Although many women will say, "I don't care about my breast", deep down this is probably not true for most of us. A mastectomy may be the best choice for you, but it will still have a powerful effect on how you feel about yourself. For many women, the loss of a breast can mean feelings of inadequacy.

Several studies have been done comparing conservative surgery and mastectomy with or without immediate breast reconstruction, looking for differences in psychological adjustment. Interesting enough, the important factor often appears to be the match between the woman and her treatment. That is, the way she feels about her body, about surgery, about radiotherapy, about having a part in the decision making process of her treatment and about a multitude of factors affects how she reacts to this new and enormous stress.

Along with the fears and stages of recovery, there are also a number of related issues that come up for people with cancer. One of these is the tendency to feel quilt for having cancer - a sense that you've somehow done something wrong. People have a tendency to blame themselves for being ill anyway and a woman will often feel she's betrayed her function as a caregiver by getting breast cancer.

For many women breast cancer never returns and they begin gradually to rebuild their lives. But sometimes, cancer does return. The emotional issues of breast cancer recurrence are so profound and complex that, if you do have a reappearance of the cancer, you may need the help of a mental health professional.