Making Choices for Treatment

Surgery

The aim of surgery is to remove the cancer from the breast. Surgery is usually but not always performed first and can be combined with reconstruction of the breast if a mastectomy is required. Breast reconstruction can take place immediately at the time of mastectomy, or a later date, usually 12 months following the initial surgery and after other treatments have finished.

Chemotherapy

This form of treatment involves powerful (cytotoxic) drugs by mouth or by injection. This form of treatment treats cancerous cells throughout the body and is given under the care of a medical oncologist.

Chemotherapy is usually given after surgery and before radiotherapy, but can be given initially to shrink tumours prior to surgery to improve the cosmetic outcome and reduce the amount of surgery required (e.g to convert a mastectomy into a breast conserving operation). We are increasingly using chemotherapy first in selected patients with sometimes dramatic reductions in tumour size allow us to achieve much better cosmetic outcomes as well as knowing the chemotherapy has been an effective therapy. Side effects include sickness, tiredness, hair loss and mouth ulcers. Chemotherapy treatments vary widely in strength, type and duration of treatment. Not all patients require chemotherapy as part of their breast cancer treatments.

Radiotherapy

This form of treatment is a local x-ray treatment aimed at reducing the chances of breast cancer returning after surgical removal of the tumour. Patients who require a mastectomy usually (but not always) avoid the need for radiotherapy to the breast as it has been removed. Radiotherapy is usually given after surgery, or after chemotherapy if it required. The treatment of breast cancer is directed at removing or destroying all of these cancerous cells, whether by cutting them out at an operation, or by destroying them with radiotherapy and chemotherapy.

Which treatments will I need?

Which of these types of treatment you require depends on the type of breast cancer, whether the cells have spread outside their normal position within the breast, or whether they have spread outside the breast. Your breast surgeon and breast care nurse will discuss the options available for you and help guide your decision.

Modern breast cancer treatments do not always follow the traditional pathway of surgery first followed by chemotherapy and then radiotherapy. Increasingly, particularly in younger patients chemotherapy can be given first to allow shrinkage of the tumour to make surgery easier or even convert the surgery from a mastectomy to a smaller operation.

The surgery for breast cancer can include procedures that are traditionally thought of as cosmetic procedures such as breast reduction to remove large volumes of tissue (including the cancer) without a mastectomy. The time spent considering the order and type of treatment is time very well spent. Written information, photographs and the support of an experienced specialist nurse will help you at this time make the right choice for you.

Increasingly we are using sophisticated tests (Commercial tests such as Onctoype DX and Endopredict) to look in detail at the exact molecular "signature" of an individuals cancer. These signatures can allow very accurate assessments of future risk and provide the information (e.g low or high risk of recurrence) to allow patients to safely avoid chemotherapy or to choose to have chemotherapy without relying on old fashioned methods such as the size of the cancer for example.