Treatment

The aim of treatment is to stop any spread of cancer and, if possible, to remove all the cancer from your body. In deciding the most suitable treatment, your doctor will consider:

  • The size of the breast cancer.
  • The type of breast cancer.
  • Whether the breast cancer has spread to the lymph nodes under your arm or any other part of your body.

In St. James’s Hospital, treatment plans are discussed by the consultant breast surgeons, consultant breast radiologists, consultant pathologists, consultant medical oncologist, consultant radiation oncologist and breast care nurse specialists at the multidisciplinary team meeting. The main treatments for breast cancer are:

  • Surgery.
  • Chemotherapy.
  • Radiotherapy.
  • Hormone Therapy.
  • Biological Therapies.

These therapies may be used individually or in combination to treat breast cancer. Surgery is referred to as local treatment, radiation as loco-regional treatment and chemotherapy and hormone therapy as systemic treatment. You will be given the treatment that is right for you.

Surgery

There are two types of breast surgery:

  • Breast-Conserving Surgery: Involves the removal of part of the breast. Radiotherapy will be required afterwards.
  • Mastectomy: Refers to the removal of the breast.

There are two types of axillary surgery, referring to surgery of the armpit carried out to determine the course of treatment based on whether the cancer has spread.

  • Sentinel Lymph Node Biopsy. If the ultrasound of your armpit shows no enlarged lymph nodes, this test is performed to definitely check whether cancer cells have reached the lymph nodes. The sentinel lymph node/s (1-3) are surgically removed and examined instead of removing all of the nodes. The benefits of this test are that you spend less time in hospital, experience less discomfort and are at a reduced risk of lymphoedema (swelling of the arm).
  • Axillary Clearance. If the lymph nodes from your armpit are tested and show cancer cells, some or all of them will be removed. Afterwards, you will need to do special exercises, as shown by the specialist breast physiotherapist.

Chemotherapy

Chemotherapy is the use of drugs to treat cancer. Chemotherapy may be given before or after surgery. It can help to make the cancer smaller before surgery (neoadjuvant) or can help reduce the risk of recurrence when given after surgery (adjuvant). It can also be used to treat breast cancer that has spread or come back. The drugs can be used as a single agent or in combination with each other. The drugs used in chemotherapy travel through the bloodstream to almost every part of the body, and they are often given in cycles of two to three weeks with a rest period in between. They may be given as an injection, an intravenous drip or in tablet form. The side-effects may include:

  • Nausea and vomiting.
  • Infection.
  • Anaemia.
  • Sore mouth.
  • Hair loss.
  • Constipation and diarrhoea.
  • Fatigue.
  • Skin and nail changes.

Hormone Therapy

Hormone therapy uses hormones that can kill cancer cells, make them grow more slowly or stop them from growing. It might be given before or after surgery. It can help to make the cancer smaller before surgery (neoadjuvant) or can help reduce the risk of recurrence when given after surgery (adjuvant). It can also be given to treat breast cancer that has spread or come back. You might receive hormone therapy if your breast cancer is hormone-receptor positive.

Radiotherapy

Radiotherapy uses high-energy X-rays to kill cancer cells. The aim is to kill the cancer cells while causing as little damage as possible to normal cells.  Radiotherapy is given after breast surgery, especially breast-conserving surgery, or after chemotherapy as adjuvant treatment. This is done to reduce the risk of the cancer coming back. It can also be given to help shrink a large tumour. If the cancer has spread and is causing pain or pressure, a small dose of radiotherapy can relieve pressure by reducing the cancer size. The side-effects may include:

  • Skin changes.
  • Tiredness (fatigue).

Biological Therapies

Biological therapies are also known as targeted therapies. Most targeted therapies work like the antibodies made by your immune system, using the body’s immune system to fight cancer and other diseases. These drugs target specific features of cancer cells. Unlike chemotherapy, targeted therapies do not harm healthy cells. Targeted therapies used in the treatment of breast cancer include:

  • Trastuzumab (Herceptin).
  • Lapatinib (Tykerb).
  • Bevacizumab (Avastin).