What treatment is there for breast cancer?
There are four main areas of possible treatment for breast cancer, namely surgery, radiotherapy, chemotherapy and hormone therapy (more information on these below). These can be used alone or in combination with each other, and the treatment plan you have will depend on many factors including the type and size of cancer.
What are the surgical options for breast cancer?
Lumpectomy - if the cancer is single and small, then this may be suitable. The lump is removed with a margin of normal tissue around it. The armpit glands may also be sampled to check for any evidence of spread. Occasionally further surgery may be required depending on lab findings.
Simple mastectomy - this operation removes the breast, but leaves the underlying muscles in place. The armpit glands may also be sampled at the same time.
Modified radical mastectomy - this is similar to a simple mastectomy, but the armpit glands are removed. One of the smaller chest muscles may also be removed.
Radical mastectomy - this involves removing all the breast, the armpit glands and the underlying major chest muscles. This is quite an extreme operation and rarely performed, although it was commonly performed many years ago.
Reconstruction - this may be performed at the same time as, or after, treatment. Please click here for information on breast reconstruction.
Taking samples of the armpit glands will help tell if the cancer has spread. If the sample shows evidence of tumour, then all the glands are usually removed. The sampling of the gland may be performed by 'sentinel node biopsy' - this uses radioactive dye to show the surgeon the most likely affected gland if spread has occurred.
Removing all the glands can leave a patch of numbness on the inner arm and may lead to bothersome arm swelling, called lymphoedema, which can be difficult to treat. This procedure may, however, be necessary to reduce risks of future recurrence. The arm may also feel stiff or weak, which can be helped with physiotherapy.
How does radiotherapy treat breast cancer?
Radiotherapy is used to deliver high-energy beams (similar to x-rays) to the breast and/or armpit area, usually after surgery. This helps to 'mop up' any residual cancer cells, reducing risks of recurrence.
A number of treatment sessions are usually required, and can last for 5-6 weeks. The treatment itself is usually painless, although it is common to get side effects such as tiredness or skin reactions similar to sunburn. It can also sometimes cause, or worsen, lymphoedema (arm swelling). Long-term effects may include skin ulceration, scarring and prominent blood vessels in the treated area. Hair loss and sickness are not usual side-effects.
How does chemotherapy treat breast cancer?
Chemotherapy uses medication that circulates through the body and specifically 'hunts out' cancer cells, destroying them when located. The treatment may be given before or after other treatment, and often lasts for 4-6 weeks.
As well as clearing breast cancer cells, though, a number of normal cells may also be destroyed in the process. This can lead to side effects such as hair loss and suppression of the immune system (which can lead to greater susceptibility to infections). Other side effects include nausea, vomiting, loss of energy and anaemia. Periods may become irregular or even stop, and may lead to infertility.
How does hormone therapy treat breast cancer?
Breast cancer growth may be stimulated by hormones, in particular oestrogen. When the tumour is removed, the lab tests for receptors in the cancer for the two main hormones - oestrogen and progesterone. If receptors are present, then the tumour may be affected by the hormones and is termed 'receptor positive'. If there are no receptors then it is termed 'receptor negative' and is unaffected by the hormones.
A 'receptor positive' cancer may be suitable for hormone therapy, such as tamoxifen, which blocks oestrogen and its growth effects on any residual cancer cells.
Which treatment is right for me?
This is a very difficult question that can only be answered by both you and your specialist. Once all the information is gained, your specialist can discuss further options with you, and possible treatment plans. The decision making process often involves many members of a team, including radiologists (for scans and radiotherapy) and oncologists (for hormone and chemotherapy). There may be more than one possible option and you should carefully weigh up the pros and cons of each option.
Never be afraid to ask more questions, and always be sure that you are clear about what treatment you are having and what to expect from it. If you are unsure about your treatment, you are always entitled to ask for a second opinion.
To learn about causes of breast cancer, tests and scans, please click here
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You may also be interested to read our article on breast reconstruction
Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.
The information provided is for guidance only and you should discuss matters fully with your specialist before deciding if this is the right procedure for you. Please also read our disclaimer