Treating breast cancer

How is treatment decided?

Once a thorough assessment has been made of the type and extent of disease it is possible to work out the most appropriate treatment for any individual patient. The most important factor determining treatment is the stage of disease.

Treatment may include:

• Surgery

• Radiotherapy

• Hormone therapy

• Chemotherapy

• Biologic therapy.

Often a combination of these treatments is used. Treatment will be chosen depending on what is best for the patient and best for the particular type and stage of cancer. Treatment is decided only after taking into account each individual woman’s wishes.

Where there are treatment options these will be explained and the patient invited to share in the treatment decision. If you, as the patient, prefer not to be involved in deciding about treatment then tell your doctor and he or she will advise you as to what he or she thinks is the treatment that is most likely to be effective.

In most cases the first treatment will be surgery followed by radiotherapy to deal with the cancer in the breast and the lymph glands under the arm. This is followed by drug treatment aimed at destroying any undetected cells that may have escaped to other parts of the body.

Breast cancer is a very treatable cancer and is associated with a high cure rate. Treatments for breast cancer are improving and so is survival. Despite the fact that more women are diagnosed with breast cancer every year, the number of women who actually die from breast cancer is falling, which demonstrates how effective current treatments are.

Asking questions and understanding the answers

The shock and stress after a diagnosis of breast cancer can make it hard to think of questions to ask your doctor. It often helps to make a list of questions when you are going to discuss treatment.

To help you remember what the doctor says, there are a number of different options. You may wish to make notes, take a member of your family or a friend with you, or use a tape recorder to record the conversation.

Most breast cancer treatment takes place in specialist breast units, and treatment decisions are usually taken by a team of specialists. You are likely to have different doctors for each type of treatment.

Who looks after me?

The team of doctors involved in your care is likely to include a specialist breast surgeon, and one or more oncologists. Some oncologists specialise in radiotherapy and others in drug treatments such as chemotherapy, hormone therapy or trastuzumab. Yet other oncologists give radiotherapy and drug treatment. When considering treatment other doctors involved include radiologists, who specialise in interpretation of X-rays and scans, and pathologists, who report on the needle biopsies performed when you are first seen at the clinic and the specimens that the surgeons remove. Some breast units have their own plastic surgeons who specialise in managing breast problems, including breast reconstruction. Also involved are breast care nurses who see patients in the clinic to discuss how they are coping with the diagnosis of breast cancer, provide information and act as a link between the patient and the doctors.

Other nurses see patients in clinics (nurse practitioner) and nurses play an enormously important role in research (research nurses) and looking after you while you are in hospital. Diagnostic radiographers take the X-rays, and some also do ultrasound scans; other therapeutic radiographers are involved in giving you radiotherapy. Physiotherapists will give you advice on exercises to stop shoulder stiffness and get you back to normal as soon as possible after any operation.

Any team also needs good administrative and secretarial support. There are a huge number of people involved and you may meet some or all of the people listed above during your patient journey.

If you are concerned about whether you are being treated in a specialist unit, ask. If you are unhappy at any stage with your treatment discuss this with your doctors and nurses.

Although very few patients switch to another hospital or request a second opinion, these options are available and you need to be certain that you have confidence in the team of doctors and nurses looking after you.

Treatment generally begins within a few weeks of diagnosis. There is no need to rush to start treatment so there is time for you to talk to your doctors and nurses about it.

All specialist units now have breast care nurses. They will see you after discussion of treatment with your doctor. Patients often find it easier to speak to breast care nurses than they do to doctors. If the treatment plan that you receive is not clear, ask the breast care nurse.

Many units give patients a treatment diary, which is helpful because it allows you to write down which treatments you are likely to get and the exact dates of any appointments or operations.

What types of treatment are there?

Treatment of cancer consists of:

• local therapies (which treat the breast and armpit)

• systemic therapies (which treat any cells that could have escaped anywhere else in the body).

Local therapies

Surgery and radiotherapy are local treatments. They remove or destroy cancer cells in the breast and the lymph glands.

Systemic therapies

Hormone therapy, chemotherapy and biologic therapy are systemic therapies. They enter the bloodstream and destroy or control cancer throughout the body.

Some women with breast cancer will have systemic therapy as their initial treatment. This may be given to shrink the tumour before surgery or radiotherapy either to make surgery possible if it is not an option or to allow less extensive surgery.

Most women who have surgery and radiotherapy will have systemic treatment after their local treatment.

Other women whose cancer has spread may only have systemic treatments so cancer cells at these sites are destroyed or controlled.

How do I find out more about treatment?

Most women want to know how treatment will change their lives and how they will look during and after treatment. Doctors and nurses are the best people to describe each treatment, the side effects and the expected results of treatment.

Breast care nurses usually have pictures of patients who have had different surgical treatments. They can also arrange for you to meet women who have had each type of treatment.

As well as getting information from your doctors and nurses, you can get information from a number of self-help groups. They have telephone lines that you can call. This allows you either to speak to someone or to get information sent to you through the post. You can also get lots of information from their websites.

The most commonly used organisations are Breast Cancer Care, Breakthrough Breast Cancer and Macmillan Cancer Relief. Their contact details are included in ‘Further information’.

Your role in treatment

Where there are choices or options for treatment these will be explained to you. If you have concerns or preferences make sure that your breast care nurse and your doctors are aware of these. Treatment involves a partnership of you, your doctors, nurses and other members of the breast cancer team.

Complementary medicine

Most doctors are concerned at any stage of disease if women with breast cancer opt solely for alternative or complementary medicine when their disease can be effectively treated by conventional medical treatments. Nevertheless, many people find great comfort in having some input into the control of their condition by visiting herbalists or other practitioners of so-called natural medicines.

The commonsense approach is to discuss this openly and honestly with your doctor. He or she is unlikely to raise any objections, provided that you do not opt for complementary medicine instead of conventional treatment.

KEY POINTS

• Following a thorough assessment an appropriate treatment can be worked out

• The most important factor determining treatment is the stage of the disease

• Treatment is decided only after taking account of each individual woman’s wishes

• Breast cancer is a very treatable cancer and associated with a high cure rate

• Make a list of questions when going to discuss treatment

• Consider taking a friend or relative with you when going to discuss treatment