Watch a video of consultant surgeon Clive Griffith talking about breast cancer.
"Treatment is very individual, based on the type, extent and stage of the cancer,” says Maria Leadbeater, clinical nurse specialist at Breast Cancer Care. “A woman’s treatment will be planned so it’s as effective as possible for her.”
Surgery
This is usually the first option and involves removing either the tumour (lumpectomy) or the breast (mastectomy).
“After the diagnosis, surgery will usually occur within weeks,” says Leadbeater.
For some women, surgery is postponed while drugs are used to shrink the tumour. This is called neo-adjuvant chemotherapy.
You could be in hospital for one or more nights, but you need to take time off to recover. “Many women are busy and central to the lives of other people, but this is a time to focus on yourself and your recovery,” says Leadbeater.
Side effects As with any surgery, this depends on how well you recover from anaesthetic and how the wound heals.
It’s important to exercise your arm on the affected side, so that scar tissue doesn’t stop movement of the arm. Your doctor or nurse will advise you on this.
Chemotherapy
This is drug treatment given intravenously (into a vein). Chemotherapy is usually given after surgery, but can be given before surgery to shrink a tumour. It can be given in addition to radiotherapy.
“For primary breast cancer [cancer that started in the breast], chemotherapy will usually be given for a day or two a month,” says Leadbeater. “You’ll have chemotherapy for a couple of days, and then a few weeks off until you have the next one.” It is usually given for four to six months.
Side effects Chemotherapy affects healthy cells as well as cancer cells, and side effects include feeling sick, vomiting, loss of appetite and hair loss or hair thinning. You can also be more likely to pick up an infection.
Anti-sickness drugs can be given before chemotherapy, and patients are given anti-sickness tablets to take home.
“If you still feel sick, talk to your doctor as you might need a change in your anti-sickness medication,” says Leadbeater. “You don't have to feel sick while you're having treatment. There’s always something that can be done to try to improve it.”
What about fertility? Chemotherapy can affect a woman’s fertility, but it’s difficult to know exactly what effect it will have. Not all women lose their fertility.
“The nearer a woman is to her natural menopause, the more likely it is that her periods and fertility won’t return to normal after chemotherapy,” says Leadbeater.
Storing your eggs (having them removed and kept in a laboratory for fertility treatment) might be an option. But this delays treatment and means you have to take hormones that could affect the cancer.
Radiotherapy
Radiotherapy is high-energy radiation given to the breast area to stop recurrence of cancer. Cancer cells are destroyed, but healthy cells recover.
Radiotherapy can be used after surgery, in combination with chemotherapy. It's given at a radiotherapy centre, and involves a few minutes of treatment every day for several weeks.
Side effects Radiotherapy is painless but can cause redness in the skin, and can also make some people feel tired.
Your radiographer or breast care nurse will explain to you how to look after your skin. “This involves very gentle washing and not using any cream unless the radiographer or doctors advise it,” says Leadbeater.
She advises you to accept all practical support you are offered as you’ll have to travel to the radiotherapy centre every day. “When people ask what they can do to help, this is an ideal time to ask them to take you to your radiotherapy."
There might be help available with travel costs or local transport. Ask your breast care nurse for more information.
Hormone treatment
Some breast cancers are hormone-sensitive. This means they grow when oestrogen is released naturally in the body. Hormone therapy involves tablets or injections, and suppresses this hormone stimulation.
“It’s estimated that between 65% and 75% of breast cancers are hormone sensitive, so will be suitable for hormone therapy,” says Leadbeater. It is usually given for around five years, after chemotherapy has finished.
Side effects These can include menopausal symptoms such as hot flushes, night sweats and mood swings. “Usually these will improve as people get used to the drug,” says Leadbeater. Talk to your doctor or nurse if side effects are a problem.
Biological therapies: trastuzumab (Herceptin)
Biological therapies means talking antibodies that can stop cancer cells growing. The most common one used in the UK is trastuzumab, better know by its brand name Herceptin.
“Herceptin is different from chemotherapy as it just affects the breast cancer cells, not the healthy cells,” says Leadbeater.
Herceptin is only effective in breast cancers that have high levels of a protein called HER2 on the surface of their cells. Around 20% of breast cancers (one in five) have HER2. (A test is available to find out which.)
Herceptin is usually given after surgery, chemotherapy and/or radiotherapy, or can be given in combination with chemotherapy. It involves an infusion into a vein once a week or once every three weeks. How long you have the treatment for depends on your cancer.
Side effects These include diarrhoea, flu-like symptoms and pain. Talk to your breast care nurse or doctor, as there are medications that can control these.
Herceptin isn’t suitable for people with heart conditions. You will have tests to check that your heart and blood pressure are healthy before starting the treatment.