The treatment of breast cancer depends on many factors. These include the stage of the cancer; your age; whether or not you have had the menopause (change of life); and the grade of the cancer. Whether the cancer cells have receptors for certain hormones on their surface is also important. Receptors are proteins which particular hormones attach to, in order to enter the cancer cell. Surgery, radiotherapy, hormonal therapy and chemotherapy may be used to treat cancer of the breast. Usually, more than one type of treatment is used. It is important to discuss any treatment fully with your doctor, so that you understand what it involves. It is a good idea to take some one with you who can speak English as well as your language. You can also ask for an interpreter to be present when you speak to the doctor to help you understand. Remember, no treatment will be given without your consent. You will be asked to sign a consent form to show that you understand and agree to the treatment. Consent forms should be available written in your language.
Surgery is used to remove the cancer and an area of healthy cells all around the cancer. Sometimes the whole breast may need to be removed (mastectomy) and sometimes just the cancer may be removed (lumpectomy). If you have a lumpectomy, you will usually be advised to have radiotherapy to the remaining breast tissue afterwards. If you have a mastectomy you will sometimes not need to have radiotherapy. Research has shown that in early breast cancer a lumpectomy followed by radiotherapy is as effective at curing the cancer as mastectomy. You may be offered the opportunity to choose which of these treatments suits you best. The different treatments have different benefits and side effects and this can be a difficult decision to make. To help you make the decision you may want to discuss both options fully with your doctor, breast care nurse, or people at Cancer Jagriti. This can help you to feel confident that you have made the choice that is right for you. It is often possible for women who have had a mastectomy to have their breast reconstructed. This involves making a new breast using either an implant, or fat and muscle from another part of your body. Sometimes this is done at the same time as the mastectomy. It can also be done some months, or even years, after the original operation. There are several different methods of breast reconstruction and your surgeon can discuss the different options that may be suitable for you. If you would like to consider breast reconstruction, discuss it with your doctor at the beginning of your treatment so that they can tell you about the different methods available.
As well as removing the breast cancer, the surgeon will usually take out some, or all, of the lymph glands from under your arm on the same side of the body. This is known as lymph gland sampling. There are approximately 20 lymph glands in the armpit (axilla), although the exact number varies from person to person. The lymph glands are examined to check whether any cancer cells have spread into them from the breast. This helps doctors decide what other treatment is needed. Removing the lymph glands can sometimes lead to the development of swelling of the arm on the affected side. This is called lymphoedema. After a mastectomy you will be given an artificial breast made of lightweight foam which you can put inside your bra. This is sometimes called a cumfie. It is specially designed to be worn immediately after the operation when the area will be feeling tender. When your wound has fully healed you will be fitted with a permanent prosthesis (false breast). Several types of prosthesis are available on the NHS.
Radiotherapy treats cancer by using high-energy rays that destroy the cancer cells, while doing as little harm as possible to normal cells. In breast cancer, radiotherapy is usually given to the remaining breast tissue after lumpectomy. If the cancer has spread to the bones, radiotherapy may also be very effective in relieving symptoms, such as pain. Radiotherapy is usually given as a series of short daily treatments in the hospital radiotherapy department. The treatments are normally given from Monday to Friday with a rest at the weekend. The number of treatments will depend on the size and position of the cancer, but the whole course of treatment will generally last from three to six weeks. Each treatment takes from 10 to 15 minutes. Your doctor will discuss the possible side effects with you. Possible side effects include soreness of the skin in the radiotherapy area, tiredness and feeling slightly sick. It is important to get plenty of rest during your treatment. The side effects can usually be well controlled with medicines.
Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. Chemotherapy may be used to shrink a tumour before surgery. It may also be used after surgery to reduce the chance of the cancer coming back. It can also be used if the cancer has spread to another part of the body, or if it comes back in the future. The drugs are sometimes given as tablets or, more usually, by injections into a vein. Two or three chemotherapy drugs are usually given together. The drugs will be injected, or given slowly through a drip. As well as the chemotherapy you will be given injections to stop you feeling sick. Most patients are usually able to go home on the same day. This is followed by a rest period of three to four weeks. This rest
allows your body to recover from any side effects of the treatment. The number of sessions of chemotherapy can vary from four to eight. Some people will have their chemotherapy given through a central line or a PICC line. These are long plastic tubes that are placed into a vein either in your chest or the crook of your arm. The lines can stay in place for the whole of your treatment. It is important that the line is kept clean and dry to prevent infection. You will be taught how to look after the line before you go home. A few chemotherapy drugs may contain very small amounts of alcohol. The alcohol is used to stabilize the drug to make it safe to give. If you are concerned about having these drugs because of your religious or cultural beliefs, it may help to discuss this with your religious leader, your doctor or nurse. Chemotherapy is usually given to you as an outpatient, but occasionally it will mean spending a few days in hospital. Chemotherapy can cause unpleasant side effects. Many people have just a few side effects and those that occur can often be well controlled with medicines. It is helpful to let your doctor or chemotherapy nurse know about any side effects immediately, so that they can find ways of controlling them. The main side effects are a lowered resistance to infection, anaemia, tiredness, feeling sick, a sore mouth, and loss of appetite. Some of the chemotherapy drugs can cause hair loss.
Hormonal therapies can slow or stop the growth of breast cancer cells. They work either by altering the levels of particular female hormones which are naturally produced in the body, or by preventing the hormones from being taken up by the cancer cells. There are many different types of hormonal therapy and they work in slightly different ways. Hormonal therapy may also be given before or after chemotherapy. Commonly used hormonal therapies, which are given as tablets, include tamoxifen, arimidex, artificial progesterones (megace and provera), letrozole, anastrozole, exemestane, and formestane. Zoladex may be given to women who have not had their menopause and is given as an injection once a month. Hormonal therapies can cause side effects. These include hot flushes and sweats, feeling sick, putting on weight, dryness of the vagina and an increased discharge from the vagina. These side effects are usually mild. Some women may be advised to have their ovaries removed to reduce the level of oestrogen in the body. The ovaries can be removed by an operation. They can also be stopped from working by giving a low dose of radiotherapy to the area. Unfortunately, this brings on an early menopause which can be distressing, especially for a woman who was hoping to have children or complete her family. It also causes menopausal side effects such as hot flushes, dry skin, emotional changes and depression. However, these symptoms can be effectively treated.
It is generally advised that you do not get pregnant for two years after treatment for breast cancer. As there is a risk that the hormones (oestrogen and progesterone) in the contraceptive pill may affect breast cancer cells, women who have had breast cancer are usually advised not to take the pill. Barrier methods of contraception such as condoms or the cap are more suitable. Lubricating jelly (available without prescription from the chemist) is completely safe to use with barrier contraceptives if extra moisture is needed during sex. Your GP, hospital doctor or breast care nurse can give you advice about contraception. Your GP can also fit you with a cap if this is the method of contraception you choose. Coils (IUDs) can be an effective method of contraception and your GP can fit you with a coil if you wish. Some women choose to be sterilized to prevent the risk of pregnancy. The choice of an effective contraceptive is largely a personal one. Your likes and dislikes, and those of your partner, are obviously important. Some women also have religious and moral implications to consider. Unfortunately, the withdrawal and rhythm methods of contraception are not safe enough to be effective as protection against pregnancy. Some women find that talking through their situation with their religious leader, the Family Planning Association or a trained family planning counsellor helps them to find acceptable alternatives.
Hormone replacement therapy (HRT)
Women who have had breast cancer are usually advised not to take hormone replacement therapy as there is a risk that the oestrogen could stimulate a recurrence of the cancer. However, if you have troublesome menopausal symptoms there are drugs which can be used to treat them. If the menopausal symptoms continue despite the drugs, your doctor may wish to prescribe a short course of low-dose HRT to deal with these. Research trials are being carried out to find the risks and benefits of taking HRT for menopausal symptoms. If you take HRT, it is important that you should be very carefully monitored.