FAQ

Breast cancer is the collective term for all the cancers that originate in breast tissue. Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

Breast cancer cells can break away from the original, or primary, cancer and move around the body to form secondary breast cancer. Lymph nodes in the armpit are a usual place for breast cancer to spread to. Examining the lymph nodes helps doctors predict the likelihood of breast cancer returning.

If you are referred to a specialist breast centre, a number of tests, as well as physical examination, will be organised to determine if you have breast cancer.

• Mammogram: This is an X-ray of the breast.

• Ultrasound: In some patients, most commonly younger women, ultrasound is used instead of – or alongside – a mammogram to image the breast.

• Biopsy: A small sample of breast tissue is removed using a needle that is normally guided with ultrasound or X-ray. This is performed on an outpatient basis, and the results of the biopsy are usually available within one or two weeks.

If you are diagnosed with breast cancer, your doctor may order a number of additional tests to determine the best course of treatment. These may include:

• Blood tests.
• Chest X-ray.
• Bone scan.
• CT scan.
• MRI scan.

Not everyone will have all these investigations, as the tests required for you will be determined by the specialist team in charge of your care.

Two main types of surgery are used in the treatment of breast cancer:

1. Lumpectomy: sometimes called breast-conserving surgery or wide local excision, this is where the breast cancer and a small amount of surrounding normal tissue is removed.

2. Mastectomy: this is an operation to remove the whole of the affected breast.

What type of surgery is most suitable for you will be decided in discussion with your breast surgeon, who will take a number of factors into consideration including the size and location of the tumour within the breast.

Women who undergo lumpectomy will require radiation therapy after surgery as large studies have shown that this reduces the chances of the tumour recurring to the same degree as removing all of the breast.

The most common site for breast cancer cells to spread to is to small glands, called lymph nodes, just under the armpit. This area is referred to as the ‘axilla’. To check if breast cancer cells have spread to this area, your breast surgeon has to remove a sample of these glands.

In most cases this is through a procedure known as sentinel lymph node biopsy. Normally performed at the same time as removal of the breast tumour, this identifies the gland most likely to be affected. This gland is then removed through a small scar and sent to the laboratory for analysis. If no tumour cells are identified, no further surgery is required. However, in 25%-30% of patients, cancer cells are identified in this gland and a further operation is necessary to remove all of the lymph nodes in the axilla. This operation will normally take place within one month of your initial surgery.

In some cases, women will undergo chemotherapy or hormone therapy for a period before surgery. These treatments, known as neoadjuvant therapy, are aimed at shrinking the size of the tumour prior to surgery. If this is not required, your operation for breast cancer is generally scheduled within a few weeks of your diagnosis.

The length of in-hospital stay following surgery for breast cancer varies depending on the type of surgery. In most cases, lumpectomy combined with sentinel lymph node biopsy is performed on a day case basis, meaning you go home the same day as your surgery. Patients requiring mastectomy and/or axillary lymph node dissection will be admitted for one or two days following surgery, but most breast surgeons aim to get patients discharged as soon as they are ready. Depending on your other pre-existing medical conditions, a longer hospital stay may be required.

As with all operations, it is highly advisable that if you smoke, you should stop prior to surgery as there is a higher rate of complications following surgery in patients who smoke.

Breast reconstruction is an operation that uses a breast implant or tissue from elsewhere in your body to create a new breast that looks as much as possible like your other breast. Reconstruction can be an important part of treatment that helps emotional recovery and wellbeing. You can discuss your options for reconstruction with your surgeon or breast care nurse. You can have your reconstruction at the same time as your breast cancer surgery or at a later date.

Some benefits of immediate reconstruction:

• You will have fewer operations.

• Your reconstructed breast will be created at the time of your initial surgery – some women find this helps them cope better with any feelings associated with breast loss.

Some of the reasons why women opt for a delayed reconstruction include:

• More time to decide on the type of reconstruction.

• If you are having radiotherapy after surgery, the radiotherapy can, in some cases, damage the reconstruction.

• If you have any complications with the surgery it may delay the start of chemotherapy (if that is required).

These are only some of the factors to take into consideration. It is important that you discuss your options for reconstruction with your breast surgeon and breast care nurse. Further information on breast reconstruction is available at:

Breast Cancer Care UK:
http://www.breastcancercare.org.uk/breast-cancer-breast-health/treatment-sideeffects/surgery/reconstruction/

American Cancer Society:
http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Breast_Reconstruction_After_Mastectomy

Lymphoedema is a long-term swelling of the arm caused by poor drainage of excess fluid. It can appear on the same side as the breast treated for cancer and can occur any time after surgery or radiotherapy. The more lymph nodes you have removed as part of your breast cancer treatment, the more likely you are to develop lymphoedema.

Symptoms associated with lymphoedema are often mild. However, some people experience discomfort or pain. The skin on your arm may become dry and tight and your arm may feel heavy, restricting its mobility.
Although lymphoedema can’t yet be cured, there are exercises and specialist massages that can help reduce the swelling. More information on these exercises is available at:

Lymphoedema Support Network

http://www.lymphoedema.org/lsn/index.html

No. In some cases following mastectomy it may still be necessary to undergo radiotherapy depending on the extent of the cancer removed. In addition to radiotherapy, chemotherapy and hormonal therapy are often used, depending on the type of tumour. All of these options will be discussed with your cancer specialist and breast care nurse.

Radiotherapy, or radiation therapy, uses X-ray beams to kill cancer cells. It is carried out in specialist hospitals over a period of time for optimal effect to reduce the chances of cancer recurring. In most cases, radiotherapy is given five days a week for between three and six weeks with each session lasting only a few minutes. Prior to the start of treatment, you will meet with the oncologist and radiotherapist, who will plan your treatment with the help of special scans, and decide exactly on the area to be treated. Side effects of radiotherapy are often mild and include skin reactions, fatigue and lymphoedema.

All treatments are aimed at reducing the chances of your tumour returning. Improvements in diagnosis and treatment have seen survival rates from breast cancer increase in recent years.

What constitutes best treatment differs markedly between women and takes into account many factors of both the woman and the type of breast tumour that was removed. As outlined previously, some of the factors to be considered include:

• The type of breast cancer.
• How fast the tumour is growing.
• The woman’s age and whether or not she has gone through the menopause.
• The size of the tumour.
• Whether or not the tumour has spread to the lymph nodes under the arm.
• The presence or not of a number of proteins, namely the estrogen receptor, the progesterone receptor and human epidermal growth factor type 2 receptor.

Treatment will include any combination of surgery, chemotherapy, radiotherapy and hormonal therapy. Be sure to discuss the full range of options available with your cancer specialist and breast care nurse.

Different drugs cause different side effects, and not everyone will experience all side effects. It is important that you discuss potential side effects of your specific treatment drugs with your doctor or nurse. Some common short-term side effects of chemotherapy include:

• Nausea and vomiting.
• Diarrhoea.
• Hair loss.
• Mouth ulcers.
• Tiredness, which may get worse through treatment and may continue for a period after treatment.

Short-term side effects of hormonal therapies are similar to symptoms experienced by women who are going through the menopause. These include hot flushes, night sweats, vaginal dryness or discharge, irregular periods, lighter periods or stoppage of periods. Joint pain is a common side effect of the aromatase inhibitors.

There are a number of potential long-term side effects that are specific to each treatment:

• Radiotherapy: Fibrosis or scarring of the remaining breast tissue may occur following radiotherapy. If severe, the breast can become noticeably smaller as well as harder. Fibrosis can also block lymph drainage of the arm and cause lymphoedema.

• Chemotherapy: Some younger women may find that their periods become irregular or stop temporarily while they’re having chemotherapy. Others may find that they stop completely, which may indicate permanent infertility. This often depends on your age. Women around the age of 40 and above are less likely to get their periods back after completing chemotherapy than women under this age. If you’re concerned about your fertility, it’s important to talk to your specialist team before treatment begins.

• Tamoxifen: With tamoxifen treatment, there is a very slight increase risk of developing a cancer of the womb. If you have any abnormal bleeding, or other symptoms that concern you, tell your doctor so you can have a check-up.

• Aromatase inhibitors: Treatment with an aromatase inhibitor reduces the amount of oestrogen in your body. A lack of oestrogen over a long period of time can increase the risk of osteoporosis (thinning of the bone).

• Herceptin: There’s a small chance that heart problems may occur in patients who receive Herceptin, and so tests of heart function are carried out before and during treatment. Heart problems are most often seen when Herceptin is given at the same time as chemotherapy (especially with a group of drugs called anthracylines) or if the patient already has heart problems before starting Herceptin. Only a very small number of patients who receive Herceptin experience heart problems, and these are usually not serious.

Clinical trials are designed to investigate new treatments that may improve survival from breast cancer. They test new therapies in a controlled way to compare them to what is currently available. More information on whether there are clinical trials for which you may be eligible will be available from your cancer specialist and breast care nurse.