reast cancer (female) - Treatment

If you have cancer, you should be assigned a

multidisciplinary team (MDT) a team of specialists who
work together to provide the best treatment and care.

The main treatments for breast cancer are:

surgery

radiotherapy

chemotherapy

hormone therapy

biological therapy (targeted therapy)

You may have one of these treatments, or a combination. The

type or combination of treatments you have will depend on how
the cancer was diagnosed and the stage it's at.

Breast cancer diagnosed at screening may be at an early stage,

but breast cancer diagnosed when you have symptoms may be at
a later stage and require a different treatment.

Your healthcare team will discuss with you which treatments are
most suitable.

Choosing the right treatment for you

When deciding what treatment is best for you, your doctors will
consider:

the stage and grade of your cancer how big it is and how
far it's spread
 your general health

whether you've experienced the menopause

You should be able to discuss your treatment with your care

team at any time and ask questions.

Want to know more?

National Institute for Health and Care Excellence

(NICE): early and locally advanced breast cancer

Predict: decide on the ideal course of treatment following

breast cancer surgery

Treatment overview hide

Surgery is usually the first type of treatment for breast cancer.

The type of surgery you undergo will depend on the type of
breast cancer you have.

Surgery is usually followed by chemotherapy or radiotherapy or,

in some cases, hormone or biological treatments. Again, the
treatment you'll have will depend on the type of breast cancer.

Your doctor will discuss the most suitable treatment plan with
you. Chemotherapy or hormone therapy will sometimes be the
first treatment.

Secondary breast cancer

Most breast cancers are discovered in the condition's early

stages. However, a small proportion of women discover that they
have breast cancer after it's spread to other parts of the body
(metastasis).
If this is the case, the type of treatment you have may be
different. Secondary cancer, also called "advanced" or
"metastatic" cancer, isn't curable.

Treatment aims to achieve remission, where the cancer shrinks

or disappears, and you feel normal and able to enjoy life to the
full.

Want to know more?

Breast Cancer Care: secondary breast cancer

Breast Cancer Now: controlling secondary breast cancer

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Surgery show

There are two main types of breast cancer surgery:

breast-conserving surgery the cancerous lump (tumour)

is removed

mastectomy surgery to remove the whole breast

In many cases, a mastectomy can be followed by reconstructive

surgery to try to recreate a bulge to replace the breast that was
removed.

Studies have shown that breast-conserving surgery followed by

radiotherapy is as successful as total mastectomy at treating
early-stage breast cancer.

Breast-conserving surgery

Breast-conserving surgery ranges from a lumpectomy or wide

local excision, where just the tumour and a little surrounding
breast tissue is removed, to a partial mastectomy or
quadrantectomy, where up to a quarter of the breast is removed.

If you have breast-conserving surgery, the amount of breast

tissue you have removed will depend on:

the type of cancer you have

the size of the tumour and where it is in your breast

the amount of surrounding tissue that needs to be removed

the size of your breasts

Your surgeon will always remove an area of healthy breast tissue

around the cancer, which will be tested for traces of cancer.

If there's no cancer present in the healthy tissue, there's less

chance that the cancer will return.

If cancer cells are found in the surrounding tissue, more tissue

may need to be removed from your breast.

After having breast-conserving surgery, you'll usually be offered

radiotherapy to destroy any remaining cancer cells.

Mastectomy

A mastectomy is the removal of all the breast tissue, including

the nipple.

If there are no obvious signs that the cancer has spread to your
lymph nodes, you may have a mastectomy, where your breast is
removed, along with a sentinel lymph node biopsy.

If the cancer has spread to your lymph nodes, you'll probably

need more extensive removal (clearance) of lymph nodes from
the axilla under your arm.
Reconstruction

Breast reconstruction is surgery to make a new breast shape

that looks like your other breast as much as possible.

Reconstruction can be carried out at the same time as a

mastectomy (immediate reconstruction), or it can be carried out
later (delayed reconstruction).

It can be done either by inserting a breast implant or by using

tissue from another part of your body to create a new breast.

Lymph node surgery

To find out if the cancer has spread, a procedure called a

sentinel lymph node biopsy may be carried out.

The sentinel lymph nodes are the first lymph nodes that the
cancer cells reach if they spread. They're part of the lymph
nodes under the arm (axillary lymph nodes).

The position of the sentinel lymph nodes varies, so they're

identified using a combination of a radioisotope and a blue dye.

The sentinel lymph nodes are examined in the laboratory to see

if there are any cancer cells present. This provides a good
indicator of whether the cancer has spread.

If there are cancer cells in the sentinel nodes, you may need
further surgery to remove more lymph nodes from under the arm.

Want to know more?

Breast Cancer Care: breast reconstruction: an animated

guide

Cancer Research UK: types of breast cancer surgery

 Predict: decide on the ideal course of treatment following
breast cancer surgery

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Radiotherapy show

Radiotherapy uses controlled doses of radiation to kill cancer

cells. It's usually given after surgery and chemotherapy to kill
any remaining cancer cells.

If you need radiotherapy, your treatment will begin about a

month after your surgery or chemotherapy to give your body a
chance to recover.

You'll probably have radiotherapy sessions three to five days a

week, for three to six weeks. Each session will only last a few
minutes.

The type of radiotherapy you have will depend on your cancer

and the type of surgery you have. Some women may not need to
have radiotherapy at all.

The types available are:

breast radiotherapy after breast-conserving surgery,

radiation is applied to the whole of the remaining breast
tissue

chest wall radiotherapy after a mastectomy,

radiotherapy is applied to the chest wall

breast boost some women may be offered a boost of high-

dose radiotherapy in the area where the cancer was
removed; however, the boost may affect the appearance of
the breast, particularly if you have large breasts, and can
 sometimes have other side effects, including hardening of
the breast tissue (fibrosis)

radiotherapy to the lymph nodes where radiotherapy is

aimed at the armpit (axilla) and the surrounding area to kill
any cancer that may be present in the lymph nodes

The side effects of radiotherapy include:

irritation and darkening of the skin on your breast, which

may lead to sore, red, weepy skin

extreme tiredness (fatigue)

excess fluid build-up in your arm caused by blockage of the

lymph nodes under your arm (lymphoedema)

Want to know more?

Breast Cancer Care: radiotherapy for primary breast cancer

Cancer Research UK: radiotherapy for breast cancer

Macmillan: radiotherapy for breast cancer in women

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Chemotherapy hide

Chemotherapy involves using anti-cancer (cytotoxic) medication

to kill the cancer cells.

It's usually used after surgery to destroy any cancer cells that
haven't been removed. This is called adjuvant chemotherapy.

In some cases, you may have chemotherapy before surgery,

which is often used to shrink a large tumour. This is called neo-
adjuvant chemotherapy.
Several different medications are used for chemotherapy, and
three are often given at once.

The choice of medication and the combination will depend on the

type of breast cancer you have and how much it's spread.

Chemotherapy is usually given as an outpatient treatment, which

means you won't have to stay in hospital overnight. The
medications are usually given through a drip straight into the
blood through a vein.

In some cases, you may be given tablets that you can take at
home. You may have chemotherapy sessions once every two to
three weeks, over a period of four to eight months, to give your
body a rest in between treatments.

The main side effects of chemotherapy are caused by their

influence on normal, healthy cells, such as immune cells.

Side effects include:

infections

loss of appetite

nausea and vomiting

tiredness

hair loss

sore mouth

Many side effects can be prevented or controlled with medicines

that your doctor can prescribe.
Chemotherapy medication can also stop the production of
oestrogen in your body, which is known to encourage the growth
of some breast cancers.

If you haven't experienced the menopause, your periods may stop

while you're undergoing chemotherapy treatment.

After you've finished the course of chemotherapy, your ovaries

should start producing oestrogen again.

However, this doesn't always happen and you may enter an early
menopause. This is more likely in women over 40, as they're
closer to menopausal age.

Your doctor will discuss the impact any treatment will have on
your fertility with you.

Chemotherapy for secondary breast cancer

If your breast cancer has spread beyond the breast and lymph
nodes to other parts of your body, chemotherapy won't cure the
cancer, but it may shrink the tumour, relieve your symptoms and
help lengthen your life.

Want to know more?

Breast Cancer Care: chemotherapy

Cancer Research UK: chemotherapy for breast cancer

Macmillan Cancer Support: chemotherapy for breast cancer

in women

National Institute for Health and Care Excellence (NICE):

advanced breast cancer

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Hormone treatment show

Some breast cancers are stimulated to grow by the hormones

oestrogen or progesterone, which are found naturally in your
body.

These types of cancer are known as hormone receptor-positive

cancers. Hormone therapy works by lowering the levels of
hormones in your body or by stopping their effects.

The type of hormone therapy you'll have will depend on the stage
and grade of your cancer, which hormone it's sensitive to, your
age, whether you've experienced the menopause, and what other
type of treatment you're having.

You'll probably have hormone therapy after surgery and

chemotherapy, but it's sometimes given before surgery to shrink
a tumour, making it easier to remove.

Hormone therapy may be used as the only treatment for breast

cancer if your general health prevents you having surgery,
chemotherapy or radiotherapy.

In most cases, you'll need to take hormone therapy for up to five

years after having surgery. If your breast cancer isn't sensitive to
hormones, hormone therapy will have no effect.

Tamoxifen

Tamoxifen stops oestrogen from binding to oestrogen-receptor-

positive cancer cells. It's taken every day as a tablet or liquid.

It can cause several side effects, including:

tiredness

changes to your periods

 nausea and vomiting

hot flushes

aching joints

headaches

weight gain

Aromatase inhibitors

If you've experienced the menopause, you may be offered an

aromatase inhibitor.

This type of medication works by blocking aromatase, a

substance that helps produce oestrogen in the body after the
menopause. Before the menopause, oestrogen is made by the
ovaries.

Three aromatase inhibitors may be offered. These

are anastrozole, exemestane and letrozole. These are taken as a
tablet once a day.

Side effects include:

hot flushes and sweats

lack of interest in sex (loss of libido)

nausea and vomiting

tiredness

aching joints and bone pain

headaches

skin rashes
Ovarian ablation or suppression

In women who haven't experienced the menopause, oestrogen is

produced by the ovaries. Ovarian ablation or suppression stops
the ovaries working and producing oestrogen.

Ablation can be carried out using surgery or radiotherapy.

It stops the ovaries working permanently and means you'll
experience the menopause early.

Ovarian suppression involves using a medication called

goserelin, which is a luteinising hormone-releasing hormone
agonist (LHRHa).

Your periods will stop while you're taking it, although they should
start again once your treatment is complete.

If you're approaching the menopause (around the age of 50), your

periods may not start again after you stop taking goserelin.

Goserelin is taken as an injection once a month and can cause

menopausal side effects, including:

hot flushes and sweats

mood swings

trouble sleeping

Want to know more?

Breast Cancer Care: hormone therapy

National Institute for Health and Care Excellence (NICE):

hormonal therapies for the adjuvant treatment of early
oestrogen-receptor-positive breast cancer

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Biological therapy (targeted therapy) show

Some breast cancers are stimulated to grow by a protein called

human epidermal growth factor receptor 2 (HER2). These
cancers are called HER2-positive.

Biological therapy works by stopping the effects of HER2 and

helping your immune system to fight off cancer cells.

If you have high levels of the HER2 protein and are able to have
biological therapy, you'll probably be prescribed a medicine
called trastuzumab.

Trastuzumab, also known by the brand name Herceptin, is

usually used after chemotherapy.

Trastuzumab

Trastuzumab is a type of biological therapy known as a

monoclonal antibody.

Antibodies occur naturally in your body and are made by your

immune system to destroy harmful cells, such as viruses and
bacteria.

The trastuzumab antibody targets and destroys cancer cells that

are HER2-positive.

Trastuzumab is usually given intravenously, through a drip. It's

also sometimes available as an injection under the skin (a
subcutaneous injection).

You'll have the treatment in hospital. Each treatment session

takes up to one hour, and the number of sessions you need will
depend on whether you have early or more advanced breast
cancer.
On average, you'll need a session once every three weeks for
early breast cancer, and weekly sessions if your cancer is more
advanced.

Trastuzumab can cause side effects, including heart problems.

This means that it's not suitable if you have a heart problem,
such as angina, uncontrolled high blood pressure (hypertension),
or heart valve disease.

If you need to take trastuzumab, you'll have regular tests on your

heart to make sure it's not causing any problems.

Other side effects of trastuzumab may include:

an initial allergic reaction to the medication, which can

cause nausea, wheezing, chills and fever

diarrhoea

tiredness

aches and pains

Want to know more?

Breast Cancer Care: targeted therapy

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Clinical trials show

A great deal of progress has been made in breast cancer

treatment, and more women now live longer and have fewer side
effects from treatment.

These advances were discovered in clinical trials, where new

treatments and treatment combinations are compared with
standard ones.
All cancer trials in the UK are carefully overseen to ensure
they're worthwhile and safely conducted. In fact, participants in
clinical trials can do better overall than those in routine care.

If you're asked to take part in a trial, you'll be given an

information sheet and, if you want to take part, you'll be asked to
sign a consent form. You can refuse or withdraw from a clinical
trial without it affecting your care.

Want to know more?

Clinical trials and medical research

Against Breast Cancer: our research

Breast Cancer Care: clinical trials

Cancer Research UK: breast cancer research

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Psychological help hide

Dealing with cancer can be a huge challenge for both patients

and their families. It can cause emotional and practical
difficulties.

Many women have to cope with the removal of part or all of a

breast, which can be very upsetting.

It often helps to talk about your feelings or other difficulties with

a trained counsellor or therapist. You can ask for this kind of
help at any stage of your illness.

There are various ways to find help and support. Your hospital
doctor, specialist nurse or GP can refer you to a counsellor.
If you're feeling depressed, talk to your GP. A course of
antidepressant drugs may help, or your GP can arrange for you to
see a counsellor or psychotherapist.

It can help to talk to someone who's been through the same

thing as you. Many organisations have helplines and online
forums. They can also put you in touch with other people who've
had cancer treatment.

Want to know more?

Coping with a cancer diagnosis

Breast Cancer Care: someone to talk to

Macmillan Cancer Support: online community

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Complementary therapies hide

Complementary therapies are holistic therapies that can

promote physical and emotional wellbeing.

They're given alongside conventional treatments and include:

relaxation techniques

massage

aromatherapy

acupuncture

Complementary therapy can help some women cope with

diagnosis and treatment, and provide a break from the treatment
plan.
Your hospital or breast unit may be able to provide access to
complementary therapies or suggest where you can get them.

It's important to speak to your breast cancer specialist nurse

about any complementary therapy you wish to use to make sure
it doesn't interfere with your conventional treatment.