Breast Cancer

Aim of Breast Surgery

• remove the breast cancer from the breast
• test whether breast cancer cells have spread to the lymph nodes in the armpit.

Breast surgery for breast cancer involves one of the following:

• surgery to remove the breast cancer and a small margin of healthy tissue around it.
• breast conserving surgery is sometimes called a lumpectomy,complete local excision, partial mastectomy or wide local excision.

Surgery is not commonly used in the treatment of women with metastatic breast cancer.
However, surgery can sometimes be used to treat cancer in the bones, lungs or brain, or more rarely in the liver.  Surgery may also be recommended if this is your first diagnosis of breast cancer.

The aim of breast surgery is to:

• remove the breast cancer from the breast
• test whether breast cancer cells have spread to the lymph nodes in the armpit.

Breast surgery for breast cancer involves one of the following:

• surgery to remove the breast cancer and a small margin of healthy tissue around it.
• breast conserving surgery is sometimes called a lumpectomy,complete local excision, partial mastectomy or wide local excision.

Surgery is not commonly used in the treatment of women with metastatic breast cancer.
However, surgery can sometimes be used to treat cancer in the bones, lungs or brain, or more rarely in the liver.  Surgery may also be recommended if this is your first diagnosis of breast cancer.

Breast conserving treatment

Breast conserving surgery plus radiotherapy is as effective as mastectomy for most women with early breast cancer. This means that, for most women, the chance of the breast cancer spreading to other parts of the body or the chance of dying from breast cancer is the same after either treatment. Ask your doctor about the benefits and risks of these treatments for you.
Breast conserving surgery
Breast conserving surgery is considered an option if: the cancer is small enough compared to the size of your breast so as to: safely remove all the

cancer and a surgical margin of healthy tissue, and give an acceptable appearance it is your preference.

What does breast conserving surgery usually involve?

Breast conserving surgery usually involves:

• removal of the cancer and a small area of healthy tissue around it, called the surgical margin
• removal of lymph nodes from the armpit after surgery, radiotherapy to the conserved breast

Both types of breast surgery usually also involve axillary dissection, which is surgery to remove some lymph nodes from the armpit. A new surgical procedure called sentinel node biopsy is currently being researched. This involves removing a smaller number of lymph nodes.

What are the advantages of breast conserving surgery?

If you have breast conserving surgery, you:

• will be able to keep your breast, although it will not look the same as it did before surgery
• will usually not need to wear a breast prosthesis or consider breast reconstruction
• are likely to feel better about the way your body looks, compared with how you might feel if you had a mastectomy.

What does breast conserving surgery look like?

Note that the position of the scar on your breast will depend on the location of your cancer. Your breast will also change in shape and size, depending on how much breast tissue is removed.

Mastectomy

When is mastectomy considered an option?

For some women, breast conserving surgery plus radiotherapy is not considered the best treatment option. Mastectomy is considered an option if:

• the area of cancer involved is large compared to the size of your breast
• the cancer is in more than one area of your breast
• you’ve had breast conserving surgery and the area of healthy-looking tissue (surgical margin) around the breast cancer is not considered ‘clear’
• the cancer has come back again in your breast and you had radiotherapy for your initial treatment – if radiotherapy has already been used to treat your breast, it can’t be used again to treat that same breast it is your preference

What does mastectomy involve?

Mastectomy usually involves:

• removal of the entire breast (usually including the nipple)
• removal of lymph nodes from the armpit – this is usually done through one mastectomy cut, so there are no separate scars under the arm
• some breast tissue is left on the chest after mastectomy. Radiotherapy to the chest is sometimes considered for women at high risk of the cancer coming back on the chest wall.

Side Effects

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Cells grow by dividing. Chemotherapy works by damaging cancer cells that are dividing. It travels around the body in the blood stream, attacking cells. The cells most affected by chemotherapy are those which divide rapidly. This means that both cancer cells and normal cells are affected. However, normal cells are able to renew themselves quickly. Cancer cells recover more slowly and with more difficulty. The rest periods between chemotherapy treatments allow your normal cells to recover. However, as the cancer cells do not recover, more are killed with each treatment.
Key Points

• chemotherapy can be used on its own or in combination with surgery or radiotherapy depending on what type of cancer it is.
• chemotherapy is given by mouth using tablets or by injection- most commonly into a vein through the use of an intravenous drip treatment is in cycles usually lasting for several weeks or months. You have a treatment then a period of rest before the next treatment
• usually before each treatment you have blood tests done to measure the levels of different types of cells in the blood. Blood is made up of white cells (which fight infection), red cells (these carry oxygen from the lungs around the body) and platelets (these help your blood clot)
• if your blood cell levels are too low, the time between treatments may be lengthened to allow your body to get stronger or your drugs may be changed.

Hormone Therapy

Hormonal therapies include:

• anti-estrogens (for example, tamoxifen)
• ovarian treatments (called ovarian ablation)
• aromatase inhibitors (newer drugs that are being researched).

Hormonal therapies may be used in addition to surgery and radiotherapy for treating your breast cancer. Hormonal therapies can also be used in addition to chemotherapy.

The aim of hormonal therapies is to:

• destroy any cancer cells that could be left in the breast after surgery and/or radiotherapy
• destroy any cancer cells that might have spread outside the breast and armpit, but cannot be detected
• reduce the risk of a new breast cancer developing in either breast.

Hormonal therapies are called systemic treatments because they work on the whole body to control cancer. Systemic treatments aim to destroy any cancer cells that could have spread outside the breast or armpit area but cannot be detected.

Side effects

Different types of hormonal therapies have different side effects. Also, each woman is different in how she responds to a particular hormonal therapy.
The main side effects of the different types of hormonal therapies are discussed below. If you notice any of these side effects, or any other symptoms you think may be due to your hormonal therapy, talk to your doctor as soon as possible.

Side effects of anti-estrogens

Some women will have few or no side effects from taking anti-estrogens.

Menopausal symptoms – menopausal symptoms, such as hot flushes and vaginal dryness, can be experienced while taking anti-estrogens. The symptoms usually stop when your treatment stops.

However, sometimes the menopause is permanent. If you are sexually active and have not yet reached menopause, it is possible you could become pregnant, even if your period stops, while you take anti-estrogens. It is recommended that you use contraceptives that do not affect your hormones, such as condoms or diaphragms.

Blood clots – this is a rare side effect of anti-estrogens. Talk to your doctors if you have had blood clots before, and ask how to help prevent blood clots. Contact your doctor immediately (or hospital emergency department if your doctor isn’t available) if you have chest pain, or if you notice any pain, warmth, swelling or tenderness in an arm or leg.

If you develop a blood clot, make sure that the doctor managing your hormonal therapy knows about it, as changes may need to be made to your treatment. If you are having surgery or if you fracture a bone (for example, if you break your leg) while taking anti-estrogens, tell your doctor. In some cases you might need to stop taking the anti-estrogens for a short while.

Stroke – this is a rare side effect of anti-estrogens. Talk to your doctors about how to help prevent stroke.

Cancer of the uterus - this is a rare side effect of anti-estrogens, affecting women who have already reached menopause. The risk is very small. See your doctor as soon as possible if you have any irregular vaginal bleeding. Note that irregular vaginal bleeding doesn’t necessarily mean that you have cancer of the uterus, but it is important to find out the cause of the bleeding as soon as possible.

Changes in vision – this is a very rare side effect of anti-estrogens. See your doctor as soon as possible if you notice any changes to your vision.

Anti-estrogens can also have benefits in addition to treating cancer, such as:

• Lessening your chance of getting osteoporosis (a disease causing frail bones, which often develops in older women)
• Lowering your cholesterol level and lessening your chance of getting heart disease.
• Note that there is no evidence that taking anti-estrogens leads to putting on a lot of weight.

Pain management

Choosing a drug or a combination of drugs for pain depends on the type and severity of pain. Every individual is different and therefore it may take time to establish the treatment that is right for you.

While most pain relief drugs have some side effects, they are generally not serious. Not everyone experiences side effects. They can be reduced by treatment or by changing to a different medication. Your doctor should advise you about any side effects that you should look for, and what to do if you experience them. You can also ask your pharmacist for a drug information printout.

There is evidence to show that drugs for chronic pain should be taken regularly, such as every 4 hours, rather than waiting until pain is experienced.

Alternative Healing Treatment

Relaxation
There is evidence to show that relaxation therapy can ease cancer pain. Relaxation techniques can be helpful for people coping with pain. Simple techniques include abdominal breathing, jaw relaxation, methods of self hypnosis and yoga.
Education programs about how to take pain medication
There is evidence to show that education programs can ease cancer pain.
Acupuncture
There is evidence to show that acupuncture can ease pain. Acupuncture involves placing small needles in key areas of the body. Consult your doctor about the location of qualified practitioners.
Massage
Some health professionals and other women diagnosed with cancer suggest that massage and aromatherapy (gentle massage using essential oils) may help with relaxation and coping with pain.
Healthy living
including a good diet, exercise within limits, enough sleep and relaxation, and effective management of stress – is important for everybody.

What are complementary and alternative treatments or therapies?

Complementary and alternative therapies are any treatments or therapies that are not part of the conventional treatment (such as surgery and radiotherapy) of a disease.

Complementary and alternative therapies include:
acupuncture, relaxation therapy/meditation, gentle exercise, yoga, tai chi, positive imagery, faith/spiritual healing, laughter, music, art, massage, aromatherapy, dietary therapies, some support group programs, naturopathy, immune therapy, homeopathy, Chinese herbs, megavitamins.

Most women who use complementary and alternative therapies also use conventional treatments. You may find that complementary and alternative therapies are helpful for you. However, it’s important to remember that many of these therapies have not been tested for side effects, or for their interactions with conventional treatments. Talk with your doctor about any complementary or alternative treatments you’re taking. Many complementary and alternative therapies have not been tested in clinical trials, so there is little evidence about how effective they are. There is no evidence that alternative and complementary therapies can remove breast cancer, prevent it from coming back, or prevent it from spreading to other parts of the body. Some alternative therapies and complementary therapies may increase your wellbeing, although this is yet to be fully researched.

Awareness

How common is breast cancer?

Breast cancer is fairly common. If all Australian women lived to the age of 75 years, then one in 11 women would develop breast cancer before this age. Over 10 000 women are diagnosed with breast cancer each year in Australia.

Breast cancer can occur at any age. The average age of women when they are diagnosed with breast cancer is 64 years. However, one-third of women diagnosed with breast cancer are younger than 50 years.

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