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Health knowledge made personal
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Health knowledge made personal
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Treatment for breast cancer is usually carried out using a combination of surgery, chemotherapy, radiotherapy and, in some cases, hormone, or biological therapies. The amount and type of treatment that you receive will depend on the type of breast cancer that you have, as well as its stage and grade, and your overall health.
You will receive treatment from a team of healthcare professionals headed by an oncologist (a specialist in cancer). Do not be afraid to discuss any fears and concerns that you have with your oncologist; they will be able to explain each phase of your treatment.
Most women who have breast cancer will need surgery and this is often the first form of treatment that you will receive. There are two types of surgery for breast cancer; surgery to remove just the cancerous lump (tumor), which is known as breast-conserving surgery, and surgery to remove a whole breast, which is called a mastectomy. In many cases, a mastectomy can be followed by reconstructive surgery to recreate the removed breast.
In some cases, particularly if the cancer is detected in its early stages, you may be able to choose which type of surgery you would prefer. This is a big decision, and you should be able to discuss your options fully with your surgeon and oncologist (specialist in cancer). Some women may decide that they want to keep their breast if at all possible, while others may feel more comfortable having their breast removed.
The two different types of surgery are outlined in more detail below.
Breast-conserving surgery
The aim of breast-conserving surgery is to save as much of your breast as possible, while removing as much of the cancer as possible in order to prevent it from recurring. You may be able to have breast-conserving surgery if the cancer is in its early stages, or has not spread beyond your breast.
Breast-conserving surgery ranges from a lumpectomy, or wide local excision, in which just the tumor and a little surrounding breast tissue is removed, to a partial mastectomy, or quadrantectomy, in which up to a quarter of your whole breast is removed.
If you have breast-conserving surgery, the amount of breast tissue you have removed will depend on:
Your surgeon will always remove an area of healthy breast tissue around the cancer, which will then be tested for traces of cancer. If there is no cancer present in the healthy tissue, there is less chance that the cancer will recur. However, if cancer cells are found in the surrounding tissue, you may need to have more tissue surgically removed from your breast.
After breast-conserving surgery, you will need to have radiotherapy in order to destroy any remaining cancer cells.
Mastectomy
A mastectomy removes all of your breast tissue, including your nipple. You may need to have a mastectomy if the tumor is large or very central in your breast, or if the cancer has spread beyond your breast to other parts of your body.
The type of mastectomy that you have will depend on whether or not the cancer has spread to your lymph nodes (small glands under your breast and in your armpit that filter bacteria from the body), or to your chest wall muscles.
If the cancer has not spread to your lymph nodes, you may have a simple mastectomy, in which only your breast will be removed. However, if the cancer has spread to your lymph nodes, you may need to have a modified or radical mastectomy, in which your breast will be removed, along with lymph nodes under your arm or your chest wall muscles.
If you have lymph nodes removed from your armpit during a mastectomy, it is possible for the scarring to block the filtering action of the lymph nodes. This is known as lymphedema, and can cause excess fluid to build up in your arm. Lymphedema can also be caused by radiotherapy.
If it occurs, lymphedema can be treated through exercise, massage, and using compression sleeves (tightly fitting bandages which push excess fluid out of your arm), but it is a long-term (chronic) condition. Lymphedema can develop months, or sometimes even years, after surgery, so you should see your breast care nurse or doctor if you notice any swelling in your arm or hand on the side of your operation.
Breast reconstruction and prostheses
If you have a mastectomy, you may be able to have reconstructive surgery at the same time, or later, in order to recreate your breast. This may be done either by inserting a breast implant, or by using tissue from another part of your body to create a new breast.
It is your decision as to whether or not you have reconstructive surgery following a mastectomy, and when you wish to have it, as long as there is no medical reason for delaying the surgery. It is a good idea to discuss your options fully with your surgeon and breast nurse before making a decision.
Women who decide against breast reconstruction can wear a false breast, or breast prosthesi. After having a mastectomy, you may have both a temporary fiber-filled prosthesis and a permanent prosthesis made from silicone.
Chemotherapy is a specialist treatment for cancer which uses medicines that can stop the growth of cancer cells. These medicines are known as ">cytotoxic, which means that they target rapidly growing cancer cells, stopping them from dividing and multiplying.
Chemotherapy is usually used before radiotherapy to destroy any cancer cells that cannot be removed by surgery, although in some cases, you may have it before surgery to shrink a large tumor. It can also be used to treat breast cancer that has recurred (come back).
If you need to have chemotherapy, it is likely that you will be given the medicine intravenously (by injection through a vein, directly into your bloodstream). However, in some cases, you may need to take tablets. There are many different ">cytotoxic medicines for breast cancer, and it is likely that you will be given a combination of three at the same time. As it circulates through your blood, the medicine targets cancer cells in your breast, as well as any that may have spread elsewhere in your body.
Chemotherapy for breast cancer also works in another way. If you have not yet been through the menopause, chemotherapy can stop the production of estrogen in your body, which can encourage the growth of some breast cancers. Your ovaries should start producing estrogen again once your chemotherapy is over, but unfortunately in a small number of cases, this does not happen and it is possible for chemotherapy to make you enter early menopause.
It is not possible to predict whether or not this will happen, but it is more likely to occur in women who are over the age of 40 because they are closer to menopausal age. If you do enter menopause as a result of chemotherapy, you will no longer be able to conceive.
You may receive chemotherapy sessions 3-4 times a week, over a period of 4-8 months. Your sessions will be 3-4 weeks apart to give your body a rest in between treatments. The medicine is usually injected over a period of three hours, although in some cases, this may be extended to 24 hours. If this is the case, you will need to stay in hospital overnight.
Side effects of chemotherapy
Chemotherapy works by preventing cells, such as those that are cancerous, from growing rapidly. However, there are other cells that occur naturally in your body which also divide and multiply rapidly, including hair follicles, and red and white blood cells. As a result, chemotherapy also destroys these non-cancerous cells, which can cause many different side effects including:
If you need to have chemotherapy, the side effects that you experience will depend on the type of ">cytotoxic medicine that you take, the number of treatment sessions you need to have, and your individual reaction to the treatment.
If you experience nausea and vomiting as a result of chemotherapy, you may be able to take anti-sickness medication to counter it. This may be given intravenously (by injection directly into your bloodstream) at the same time as your chemotherapy.
The side effects of chemotherapy will only last for as long as your course of treatment lasts. Once your treatment is over, the rapidly growing cells that occur naturally in your body will repair themselves. This means that your hair will grow back, although it might look or feel different to how it did before your chemotherapy. For example, it may be a slightly different color, or be softer, or curlier, than before.
Radiation therapy uses high energy X-rays and, like chemotherapy, works by targeting rapidly growing cancer cells. Radiation therapy is usually given after chemotherapy in order to minimize the risk of the cancer recurring after breast-conserving surgery, or to destroy any remaining cancer cells in your lymph nodes under your arm after a mastectomy. It may also be given without chemotherapy if the cancer is detected in its early stages.
If you need to have radiotherapy, your treatment will begin about a month after your surgery or chemotherapy in order to give your body a chance to recover. It is a painless procedure in which you lie under a radiotherapy machine while it directs radiation at your affected breast. You will be positioned by your radiographer (a specialist in radiotherapy) so that the machine targets only the cancer cells and avoids as much of your healthy tissue as possible.
It is likely that you will have radiotherapy sessions five days a week, for 3-6 weeks. Each session will only last a few minutes. The radiation does not stay in your system afterwards, and it is perfectly safe to be around others in between your treatments.
Side effects of radiotherapy
As radiotherapy works by targeting rapidly growing cancer cells, like chemotherapy, it can have several side effects. Other rapidly growing cells that occur naturally in your body are also damaged by radiotherapy, including the skin cells and the cells that line your digestive system. The side effects of radiotherapy may include:
It is possible for lymphedema to develop months, or years, after radiotherapy, so you should see your breast care nurse or doctor if you notice any swelling in your arm or hand on the side of your treatment.
If your breast cancer was found to be hormone receptor positive at the time of diagnosis, you may be able to have hormone therapy to further minimize the risk of your breast cancer recurring.
Breast cancers which are hormone receptor positive are stimulated to grow by the hormones estrogen or progesterone, which are found naturally in your body. Hormone therapy works by lowering the levels of hormones in your body, or by stopping their effects. It may be used as the only treatment for breast cancer if your general health prevents you from having surgery, chemotherapy, or radiotherapy.
If hormone therapy is suitable for you, it is likely that your treatment will be given after surgery or chemotherapy although, in some cases, it may be given before surgery to help shrink a large tumor. There are several different hormone therapy medicines, including tamoxifen, aromatase inhibitors, and pituitary downregulators. In most cases, you will need to take hormone therapy for up to five years after your breast cancer surgery.
Tamoxifen
Tamoxifen is the most common type of hormone therapy. It is most effective for treating cancers that are estrogen receptor positive, although you may still be prescribed tamoxifen if you have cancer that is progesterone receptor positive. If you are prescribed taximofen, you will need to take it every day by mouth (orally) as either a tablet or a liquid. Tamoxifen can cause several side effects including:
Aromatase inhibitors
Aromatase inhibitors come in brands called Arimidex, Aromasin, and Femara. They are only suitable for women who have been through the menopause because they block the estrogen that is made after menopause by the adrenal glands. If you are prescribed an aromatase inhibitor, you will need to take it as a tablet once a day. Aromatase inhibitors can cause side effects, including:
Pituitary downregulators
Pituitary downregulators are most commonly available in a brand called Zoladex. They are prescribed for women who are still having periods, as they prevent the ovaries from producing hormones.
If you are prescribed a pituitary downregulator, your periods will stop while you are taking it, although they should start again once your treatment is complete. However, if you are close to approaching menopause (around the age of 50), you may find that your periods do not start again once you stop taking the pituitary downregulator.
This type of hormone therapy is taken as an injection once a month, and can cause menopausal side effects, including:
If your breast cancer was found to be HER2 positive at the time of diagnosis, you may be able to have biological therapy to further minimize the risk of your breast cancer recurring. Biological therapy can also increase the effects of chemotherapy on breast cancer cells. For more information about HER2 testing, see the 'diagnosis' section.
Breast cancers which are HER2 positive are stimulated to grow by the protein HER2. Biological therapy works by stopping the effects of HER2, and by helping your immune system to fight off cancer cells.
If you are able to have biological therapy, it is likely that you will be prescribed a medicine called Herceptin. Herceptin is usually used following chemotherapy.
Herceptin
Herceptin is a type of biological therapy known as a monoclonal antibody. Antibodies are molecules that occur naturally in your body, and are made by your immune system to destroy harmful cells, such as viruses and bacteria. Herceptin works by targeting and destroying cancer cells that are HER2 positive.
If you are prescribed Herceptin, you will need to have your treatment in hospital, as it is given intravenously (an injection directly into your vein). Each treatment session takes up to one hour, and the number of sessions that you need will depend on whether you have early breast cancer, or cancer that is more advanced. On average, you will need a session once every three weeks for early breast cancer, and weekly sessions if your cancer is more advanced.
Herceptin can cause side effects, including heart problems. This means that it is not suitable if you have existing heart problems, such as angina, uncontrolled high blood pressure (hypertension), or heart valve disease. If you need to take Herceptin, you will need to have regular tests on your heart to make sure it is not causing any problems. Other side effects of Herceptin may include:
