Emerson Hospital is proud to offer a breast nurse navigator to guide patients on their journey by providing support and answering questions during a very difficult and unsure time. Her primary role and focus is on the patient, as well as family and support members. Our breast nurse navigator, Kerin Malley, BSN, RN, is the central point of contact for each patient with their physicians, in addition to connecting with supportive community groups.
The breast nurse navigator meets with patients during the initial cancer diagnosis and throughout the cancer care continuum as necessary. She is knowledgeable of the various treatment options and learns the physical, psychological, and social needs of her patients. By fostering a relationship with her patients and their families, she assists with offering interventions and referrals as needed.
The goals of the breast nurse navigator are:
- To provide information and education, thus reducing a portion of stress
- To improve patients’ understanding of treatment options and plans
- To empower patients to participate in their own care, treatment, and decision making
- To ensure patients complete all treatments as prescribed
Please utilize our breast nurse navigator as a resource, a liaison, an advocate, and a friend throughout your cancer journey. Our breast nurse navigator, Kerin Malley, BSN, RN, can be reached at 978-287-8173. Funding for the oncology patient navigator is provided in part by the Hans and Mavis Lopater Foundation.
What to Expect
Step 1 — Testing and Consultation
You feel a lump in your breast or you are told you have a suspicious finding on a routine mammogram.
You are referred to a breast surgeon who will do a clinical breast examination, order imaging such as a mammogram and ultrasound if necessary, and order a breast biopsy. The surgeon will discuss four possible pathology findings with you, including:
- Benign breast disease — Cells appear normal and do not contain cancer
- A subtype with atypia — Cells appear different than normal cells but do not contain cancer. Close follow-up with your breast surgeon is recommended.
- Ductal carcinoma in situ (DCIS) — Cancer cells that do not have the capacity to invade into the normal tissue or to spread through the body
- Invasive carcinoma — Cancer cells that invade the surrounding tissues
You will receive biopsy results from your breast surgeon three to five days following your biopsy, results are usually given over the phone.
If positive for cancer, your breast surgeon will schedule a follow-up appointment to further discuss your results in person and to determine a treatment plan and schedule surgery. We encourage you to bring someone with you to this appointment.
- Pre-surgical testing will be ordered by your breast surgeon, this includes blood work, a chest x-ray, and an electrocardiogram (ECG). Additional imaging such as a CT, MRI, or bone scan may be necessary as well.
Step 2 — Meeting with Medical and Radiation Oncologists
Part of your treatment plan will be referrals to both a medical oncologist and a radiation oncologist; usually a patient is seen by both specialties prior to surgery.
- A medical oncologist prescribes chemotherapy, immunotherapy, and hormonal therapy, and closely follows patients from diagnosis into survivorship. Depending on course of treatment, chemotherapy/immunotherapy takes five to twelve months to complete. Hormonal therapy is taken for five to ten years.
- A radiation oncologist specializes in radiation therapy to cure or reduce symptoms of cancer. Radiation therapy is typically given daily (Monday through Friday) for four to six weeks.
Step 3 — Surgery
Surgery is completed and surgical samples are sent to pathology for further testing. You will again receive a call from your breast surgeon three to five days following surgery once results are available. Based on surgical pathology findings, a small percentage of patients will need additional surgery to ensure all cancer has been removed.
Your surgical pathology report will describe several features, including the type of cancer, tumor grade, the stage (tumor size and lymph node involvement), and the margin status (whether or not the cancer was removed entirely). Pathologists also perform additional tests on invasive cancers to determine prognostic and predictive markers such as ER and PR expression of the tumor, and the HER2 status of the tumor.
- ER (Estrogen Receptor) — A protein responsible for binding to and detecting estrogen in the body
- PR (Progesterone Receptor) — A protein responsible for binding to and detecting progesterone in the body
*Tumors that are ER and PR positive are much more likely to respond to hormone therapy.
- HER2 (Human Epidermal growth factor Receptor 2) — A protein which promotes the growth of cancer cells
*There are several types of drugs that directly target the HER2 protein on cancer cells.
Step 4 — Post-surgery Care
Your breast surgeon will communicate surgical findings to your care team to coordinate next steps as return to medical oncology and radiation oncology for treatment.
Order of treatment: Surgery → Chemotherapy → Radiation therapy → Hormonal therapy
The order of these therapies may be switched or eliminated altogether depending on the type of cancer you have. The therapy is tailored to you, and a multidisciplinary team of specialists will guide you through the complex process.