Treatment - Breast cancer in women

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 have experienced the menopause

You should be able to discuss your treatment with your care team at any time and ask questions.

Treatment overview

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. But 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.

Surgery

There are 2 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.

Radiotherapy

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 3 to 5 days a week, for 3 to 6 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)

Chemotherapy

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 3 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 2 to 3 weeks, over a period of 4 to 8 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 have finished the course of chemotherapy, your ovaries should start producing oestrogen again.
But 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.