Breast Cancer & your treatment options
As a specialist Breast Surgeon, Dr Graham knows that surgery is not the only tool at her disposal. Dr Graham works with her team to decide which tool, and when to use it, based on each patient’s individual needs and the specifics of the cancer.
When considering treatment of breast cancer, many different things are taken into consideration. There are several different types of breast cancer. The type of cancer you have is very important when making decisions about timing of treatments. Dr Graham will talk to you about what options are best suited to your individual needs and circumstance, your treatment may be different to that of other people. Treatment options depend on what type of breast cancer you have, the grade of the tumour, the stage of the tumour and whether there is cancer in the lymph nodes under your arm.
Treatment options for breast cancer include:
Breast Cancer Surgery +
Breast cancer surgery aims to remove the cancer cells from the breast. It includes removing the cancer in the breast, as well as surgery on some or all of the lymph nodes located in the axilla (armpit). Other treatments, such as chemotherapy, radiotherapy, hormonal therapy, and targeted therapy are sometimes recommended following (or adjuvant) to surgery. Sometimes, they are recommended before (neoadjuvant) to surgery. Most women with breast cancer can be treated with either:
- Breast Conservation Surgery (BCS)- Removal of the cancer with a margin of normal tissue around it (Wide Local Excision). BCS is almost always combined with radiation treatment to the breast.
- Mastectomy (with or without reconstruction) - Surgery to remove the whole of the breast. In appropriate circumstances, it is possible to preserve your own skin and nipple to facilitate reconstruction. Radiotherapy is sometimes required after a mastectomy. Sometimes, unfortunately, the nature of a cancer dictates what kind of breast surgery is possible for a patient. Dr Graham always aims to offer her patients techniques that are extremely safe in terms of cancer removal, whilst maximizing the cosmetic outcome as well through the use of oncoplastic techniques.
FIND OUT MORE ABOUT BREAST CANCER SURGERY HERE
Chemotherapy +
These are the group of medicines used to destroy cancer cells that may be present in the bloodstream or elsewhere in the body. Traditionally, chemotherapy was given after surgery (adjuvant), but now, it is often used before surgery. The aim of treatment is to reduce the size of the tumour in the breast as well as any cells that may be present elsewhere in the body. There are some benefits in having neoadjuvant chemotherapy, but it is not for everyone. You will be referred to a medical oncologist to discuss chemotherapy in more detail.
Chemotherapy is usually given through a drip (or injection into the vein) every 1-3 weeks for a total of 12-24 weeks. There are many different types of chemotherapy. The risks and benefits of the treatments most suitable for you will be discussed.
Neoadjuvant Chemotherapy +
Chemotherapy may be recommended before surgery in some cases. It is important to know that studies have shown no difference in cancer prognosis when cancer is given before rather than after surgery. Some of the reasons Dr Graham may recommend neoadjuvant chemotherapy include:
- To reduce the size of the tumour if it is too advanced or too big to be removed
- If you have inflammatory breast cancer
- To reduce the size of the tumour with the hope that a breast conserving surgery is possible instead of a mastectomy
- To reduce the size of the tumour so that amount of breast tissue that needs to removed is less to allow a better cosmetic outcome
- To give time for genetic testing if this is recommended
- To give you time to consider surgical options including reconstruction Some of the benefits of give chemotherapy in the neoadjuvant setting include:
- Allowing breast conserving surgery instead of a mastectomy
- Converting an inoperable tumour into an operable tumour
- Monitoring response of chemotherapy. By giving the chemotherapy first, we are able to monitor the response of the tumour to the chemotherapy drugs. The response of the tumour helps us to more accurately determine your prognosis and see if you require any additional treatments after surgery.
- Avoid delays in chemotherapy treatment due to surgical complications. This is particularly important if you are considering major surgery like reconstruction.
There are some benefits in having neoadjuvant chemotherapy, but it is not for everyone. Dr Graham will discuss your treatment plan with you in detail to ensure the options are best suited to your individual needs and circumstance. You will also be referred to a medical oncologist to discuss chemotherapy in more detail. Please remember that your treatment may be different to that of other people.
Radiotherapy +
Radiotherapy is a treatment that uses X-rays to destroy cancer cells. It helps reduce the chance of cancer returning to the area after surgery. For breast cancer treatment, radiotherapy can be given to the breast, chest wall, or lymph nodes. Radiotherapy is typically given every weekday, Monday to Friday, for three to six weeks. You will be referred to a radiation oncologist to discuss this in more detail.
Hormonal Therapy +
This is a group of medicines used to hormone receptor positive breast cancers. These cancers have receptors for the hormones oestrogen and/or progesterone (ER and/or PR positive cancer). Most breast cancers are ER positive. Hormone therapies essentially ‘starves' breast cancer cells of the oestrogen that makes them grow. This is very effective in lowering the risk of breast cancer coming back, or a new breast cancer developing.
Targeted Therapy +
These drugs "target" specific parts (receptors, proteins or enzymes) of cancer cells that play a role in cancer growth. They are only used when cancer cells display these specific target sites, so are not suitable for everyone. Herceptin (trastuzumab) is the best known drug in this treatment category. It is used to treat HER2-positive breast cancer. It is used in conjuction with chemotherapy. Other targeted therapies that may be recommended depending on the type and stage of your cancer include Perjeta (pertuzumab), Kadcyla (T-DM1) and Tykerp (lapatinib).