Being diagnosed with breast cancer is a frightening and confusing time. On this page is some initial information that may be helpful to read. It is important to remember that overall, breast cancer has a good prognosis and treatments are very effective.
DIAGNOSIS OF BREAST CANCER
Breast cancer is usually diagnosed through breast screening ( mammogram or ultrasound) or from symptoms such as a lump, dimpling, nipple inversion or discharge.
Once a suspicious area has been identified, a biopsy is necessary to make the diagnosis of cancer. This is usually performed by a radiologist who does a needle biopsy under guidance with either mammogram or ultrasound.
An ultrasound of the lymph nodes under the armpit is also performed and any suspicious lymph nodes are also biopsied with a needle.
MANAGEMENT OF BREAST CANCER
Usually the first step in the management of breast cancer is surgery. There are two surgical goals:
1. To remove the cancer
Removal of the breast cancer can involve either a wide local excision (lumpectomy) of the cancer followed by radiotherapy to the remaining breast (known as breast conservation) or a mastectomy.
The decision as to which is the best management is made on an individual basis and depends on the size and site of the cancer, the patient's breast size, age, and family history.
2. To assess the lymph nodes
If breast cancer spreads beyond the breast it usually involves the lymph nodes first. The lymph nodes that drain the breast are almost always under the armpit, in rare cases they can be under the ribs and sternum (breast bone).
The lymph nodes are removed to allow the pathologist to examine them for cancer cells. The number of lymph nodes removed depends on the type of surgery performed.
Sentinel lymph node biopsy is a technique for identifying and removing the first nodes the tumour drains to. Usually one to four lymph nodes are removed. These lymph nodes are identified by injecting a radio-labelled protein and a blue dye into the breast. The radio-labelled protein is injected in the radiology department and a scan is performed to identify the number of sentinel nodes and their location. This is called lymphoscintigraphy. In the operating theatre the blue dye is injected into the breast. A Geiger (radioactivity) counter is used to identify the sentinel nodes during the operation together with the blue dye. This technique is suitable for most patients with breast cancer; however, patients with known cancer in the lymph nodes, large cancers or multiple cancers may not be suitable.
Axillary dissection or clearance is an operation in which the lymph nodes under the armpit, which drain the breast, are removed. There are varying levels of axillary dissection based on anatomical landmarks, known as Level 1, 2 and 3. Axillary dissection is performed in patients who are known to have cancer in their lymph nodes, or in patients who are not suitable for sentinel lymph node biopsy.
Most patients will only require one operation for breast cancer, but some will require a second and rarely a third operation. The indications for further surgery are to obtain a clear margin of tissue around the breast cancer, or to perform an axillary clearance if the sentinel lymph node contains cancer.
Breast reconstruction can be performed either at the same time as mastectomy (immediate) or after the completion of treatment ( delayed). Breast reconstruction is performed by a plastic surgeon who works in conjunction with your breast surgeon.
Not all patients are able to have immediate reconstruction, especially those who will require radiotherapy. There are several different operations for breast reconstruction and these can be discussed with your surgeon.
More information on breast reconstruction can be found here.
The additional (adjuvant) treatments required after surgery will depend on the pathology report, specifically the size and grade of the cancer and number of lymph nodes the cancer has spread to. All patient’s results will be discussed in a multidisciplinary meeting with a group of medical oncologists, radiation oncologists, surgeons, pathologist, geneticist and radiologist. From this meeting an individualised plan regarding your adjuvant treatment is reached. International research has shown multidisciplinary approaches improve breast cancer outcomes. This ensures you get the highest standard of care.
Chemotherapy may be recommended following surgery. This decision is based on a patient’s age, tumour size and grade and lymph node status. Chemotherapy consists of medications, which are usually given intravenously. Modern chemotherapy is much improved, side effects are more effectively managed than in the past. The patient will be referred to a medical oncologist, if this treatment is recommended.
Sometimes chemotherapy is given prior to surgery ( neoadjuvant chemotherapy). This may be recommended if the cancer is large or if chemotherapy will allow the tumour to shrink to allow breast conservation (wide local excision) rather than mastectomy. Studies have shown that outcomes are equivalent between chemotherapy given prior to or after surgery.
All patients who have breast conservation (wide local excision) require breast radiotherapy.
Most patients who have a mastectomy do not require radiotherapy unless their cancer is greater than 4cm or lymph nodes are involved
Patients are referred to a radiation oncologist for radiotherapy.
Radiotherapy is given via a short treatment, 5 days a week for 6 weeks.
Hormonal (Endocrine) treatment is suitable for patients with oestrogen receptor positive cancers. These treatments are a tablet taken daily for 5 -10 years. There are two types of medication, tamoxifen and the Aromatase Inhibitors (anastrozole, letrozole, exemestane).
There are significant benefits to taking endocrine treatment. Side effects are common but are often very manageable.
More information is found in the Guide for women with Early Breast Cancer.
Please note that all care has been taken in providing the information on this site. It is intended for background information and should not be used to make any medical care decisions. You should always consult with your medical providers for all specific advice on your medical treatment.