Health Guide

Breast Cancer Treatment

Breast cancer is treated by several different methods: surgery, radiotherapy, chemotherapy and hormone therapy.

The treatment choice, using one or a combination of therapies depends on:

* The type and size of the breast cancer and whether it has spread or not.
* The individual woman: her age, general health and personal preferences.

Women should discuss with the specialist the treatment options before a final decision is made. Some women prefer to have their partner, family member or friend with them when discussing treatment with the specialist.

Surgery

The initial treatment for breast cancer is usually surgery - removing breast tissue to a varying degree.

* Lumpectomy is less extensive breast surgery involving the removal of a lump and a small amount of surrounding breast tissue.
* Partial Mastectomy involves the removal of part of the breast. A subcutaneous mastectomy allows for later insertion of an implant to restore the breast contour.
* Mastectomy is the removal of all the breast tissue including the skin and the nipple but without removal of the chest muscles. This allows for easier breast reconstruction.
* Removal of the Lymph Glands. Usually some of the lymph glands in the axilla (armpit) are removed and tested microscopically to determine if the cancer has spread.
* Radical Mastectomy, involving the removal of the chest muscle along with all the breast tissue.

Breast-conserving operations are newer than the mastectomy procedure. Studies on the treatment of early breast cancer have shown so far that there is no difference in survival between women who have undergone mastectomy and those who have had a lumpectomy followed by radiotherapy. Whilst many women might wish for the breast conserving procedure, the outcome depends on the size, position and type of breast cancer, as well as the size of the breast and the woman's personal preference.

Reconstruction

Breast reconstruction is performed by specialist breast surgeons. Some surgeons perform reconstruction immediately after mastectomy, whilst others prefer to wait for several months or longer. The type of breast reconstruction should be discussed fully with the specialist.

Radiotherapy

This is the use of x-ray beams to kill cancer cells. Treatment is carefully planned to minimise the effect on normal cells.

With early breast cancer, radiotherapy is used commonly after a lumpectomy or partial mastectomy, to destroy any remaining cancer cells in the breast or lymph gland areas. It is used less commonly after mastectomy.

Treatment, which is given five days a week over five to six weeks, is painless and only takes a few minutes. An extra radiation boost may be given to the area where the breast cancer was located. This may require two to three days in hospital. Another hospital treatment used less frequently is the temporary placement of radioactive wires within the breast after initial surgery.

Side effects of radiotherapy may include general tiredness, and some inflammation [like sunburn] of the skin. Women receiving radiotherapy are encouraged to rest and to wear loose cotton clothing whenever possible.

Following radiotherapy the breast sometimes feels firmer and may change a little in size or shape.

Chemotherapy

This is the treatment of cancer by drugs; the aim is to kill cancer cells whilst doing the least damage to normal cells.

Chemotherapy may be offered to some women with breast cancer as a supplement to surgery, radiotherapy or both; this is called adjuvant chemotherapy. Adjuvant chemotherapy aims to kill undetected cancer cells [occult metastases].

This treatment can reduce the chance of breast cancer recurrence especially in pre-menopausal women.

Chemotherapy side effects vary according to the particular drugs used. Side effects are temporary and can be controlled by medications and adjusting treatment. The effects of the conventional chemotherapy drugs used to treat breast cancers are usually not as severe as those experienced with other chemotherapy treatments. It is important to ask the specialist about all the types of side effects likely to occur.

Hormonal Therapy

Many breast cancers appear to be influenced by the female hormones, oestrogen and progesterone. Some breast cancers can be treated by changing these hormones, either by adding other hormones or by blocking the action of the body's own hormones.

In selected women with breast cancer, hormone treatment may be used as adjuvant treatment to reduce the chances of breast cancer recurrence.

Summary

Most women with early breast cancer are successfully treated by surgery and/or radiotherapy, sometimes combined with chemotherapy and/or hormone therapy.


Following Treatment

Lymphoedema

Following treatment for breast cancer, a small number of women may experience swelling of the arm on the affected side. This condition is called lymphoedema. It is more likely to occur if you have had lymph glands removed from under your arm or a course of radiotherapy to the gland area under the arm after surgery. This can happen quite soon after treatment or it can occur months or years afterwards. Women may discuss with their doctor some simple measures to minimise swelling in their arm and hand.

On-going care

Following treatment, most women find they can do most physical things within a few weeks. Instructions will be given by the doctor or physiotherapist on exercises that will help the woman gain strength and movement in her arm. Advice is given on both temporary and permanent breast prostheses. Some women find it takes them a few months to feel both physically and emotionally well again.

Many women find the threat of cancer and fear of its recurrence can make them upset and anxious; these fears will gradually subside. Some women are concerned about the change in their appearance and how it will affect their lives and relationships. They should be encouraged to talk over these feelings with the doctor, nurse and their family. The Cancer Helpline or Cancer Connect are also available through The Cancer Council South Australia.

About 30% of Australian women who develop breast cancer live in regional, rural or remote areas. Women living in regional towns generally have good access to a range of services. Yet women living far from urban centres may have limited access to services and information. These women can talk this over with their family, friends, General Practitioner, Breast Cancer Contact Worker, Cancer Connect volunteer or the Cancer Helpline staff.

Younger women with breast cancer may be concerned about pregnancy and breast feeding following treatment. This should be discussed with the doctor.


Recurrent breast cancer

Recurrent breast cancer is best treated if detected early. Most recurrences appear within the first five years after initial treatment. Regular check-ups are necessary during this period. Women should be encouraged to examine their remaining breast and mastectomy area and to report unusual breast changes or general symptoms to the doctor.

Breast information on the web

National Breast Cancer Centre
www.nbcc.org.au

Information and support for men
http://www.breasthealth.com.au/boysdocry/

An interactive website for 13-19 year olds
www.myparentscancer.com.au

BreastScreen SA
www.breastscreensa.sa.gov.au

Breast Cancer Network Australia (a support network)
www.bcna.org.au