Treating early breast cancer

A number of treatments are available for early breast cancer. These include surgery, radiotherapy and a range of drug treatments. These are often used one after another rather than all at the same time.

You shouldn’t have to wait longer than one month for treatment after being diagnosed with breast cancer.

Surgery

For most people with breast cancer, surgery happens before any other treatment, although some women will have other treatments beforehand. During surgery, cancerous tissue in the breast is removed. Surgeons also look to see whether lymph nodes (glands) in the armpit have been affected. If they have, these are removed too.

Many women have a process called lumpectomy (also called wide local excision or breast conserving surgery). This is where just the breast cancer with a small margin of healthy tissue is removed, but surrounding healthy breast tissue is not removed. Other women, however, will need to have the whole breast removed in an operation known as a mastectomy. Women who are offered a mastectomy should also be offered breast construction. Women who do not have immediate reconstruction, or who choose not to have reconstruction at all, should be offered an appointment with a prosthesis fitting service (breast prosthesis are artificial breasts). Side effects of surgery may include:

• pain and discomfort
• infection
• the collection of fluid in the wound area, causing swelling (seroma)
• long-term swelling of your arm or nearby areas (lymphoedema)

Treatments are available to help relieve or reduce these side effects.

Your surgeon will explain to you the best approach to surgery in your case, and will help you to make any decisions you may have. More information about recovering from surgery can be found on the NHS Improvement website.

Radiotherapy

Radiotherapy is treatment with radiation (high energy X-rays). It is usually given after surgery and aims to destroy any cancer cells remaining after surgery. Radiotherapy is usually recommended for women who have undergone a lumpectomy or sometimes a mastectomy. It is usually given to the affected breast or the area from where the breast was removed. The lymph glands in the armpit and region above the collarbone are also sometimes treated.

Before you have radiotherapy, your radiologist will work out exactly where to point the X-ray’s beams and what dose to use so that cancer cells are destroyed with minimum damage to normal tissues. A typical course of radiotherapy for breast cancer is given five days a week for three to five weeks. Each session lasts a few minutes. Side effects of radiotherapy are generally short-lived. They may include:

• skin reactions
• tiredness and mood swings
• long-term swelling of your arm or nearby areas (lymphoedema)
• a slight hardening of the treated tissue (fibrosis)

Chemotherapy

Chemotherapy is treatment with one or more anti-cancer (cytotoxic) drugs. It aims to prevent the breast cancer spreading or coming back. Chemotherapy drugs are usually given directly into your bloodstream – either by injection directly into a vein or through a drip into a vein over a period of minutes or hours (an infusion). Chemotherapy is usually given after surgery, although some women have it before surgery.

Whether or not you are recommended to have chemotherapy will depend on a number of factors, including the grade of your breast cancer. There are several different chemotherapy drugs and a course of treatment generally combines two or three of these. A chemotherapy course is made up of repeated cycles of treatment, usually a few weeks apart, over a period of several weeks or months. Chemotherapy drugs circulate throughout the body. As well as cancer cells, they affect healthy body cells too – this causes side-effects.

Most women suffer some short-term side-effects with chemotherapy treatment, although these vary a great deal. Common side effects of chemotherapy include:

• tiredness
• nausea and/or vomiting
• a sore mouth and/or mouth ulcers
• muscle and joint aches
• diarrhoea
• hair loss (anything from slight to complete)
• weight gain
• menopausal symptoms

Remember though, that a lot can be done to help relieve side effects, so if you do experience any of these, tell your oncologist or breast care nurse. For details of different chemotherapy drugs, including side effects, visit Cancer Research UK.

Hormone therapy

Hormones are naturally occurring substances that control the growth and activity of cells in the body. However, the female hormones oestrogen and progesterone can also promote the growth of some breast cancers. Around three out of four breast cancers are sensitive to hormones in this way – these are known as hormone positive breast cancers. Hormone therapies are tablets that block the production of female hormones or reduce the ability of breast cancer cells to respond to the hormones.

They are only effective in treating breast cancers that are hormone positive (shown using receptor tests). All patients with hormone positive breast cancer should be offered hormone therapy.

Two types of hormone therapy that are commonly used are:

• Aromatase inhibitors, e.g. anastrazole (Arimidex), exemestane (Aromasin), and letrozole (Femara)
• Tamoxifen

The exact treatment will vary from person to person, and is typically five or more years in length.
Patients with hormone negative breast cancers will not be offered hormone therapy, as it will not be effective in treating their breast cancer.

Tamoxifen and aromatase inhibitors can cause menopausal symptoms. Aromatase inhibitors can also cause pain and stiffness and osteoporosis. If you are suffering from severe side effects, we recommend that you discuss this with your breast care team or GP.

Targeted (biological) treatments

A number of treatments have been developed to attack cancer cells directly (ie to target them). Although these treatments circulate through the body, they only attack the cancer cells, so do not cause side-effects such as sickness and hair loss. One example of a targeted therapy is Herceptin (also known as trastuzumab).

Herceptin targets breast cancers that express high levels of a protein called HER2. These breast cancers are known as HER2 positive breast cancers (shown using receptor tests) and account for around one in five breast cancers. Patients with HER2 negative cancers (those with low levels of HER2) do not benefit from Herceptin.

Women taking Herceptin may experience some side-effects including flu-like symptoms, and it can lead to heart problems. Due to this risk, Herceptin may not be a suitable treatment for everyone and all patients should have their heart function assessed before and during treatment.

Follow-up treatments

After you have been treated for breast cancer, you and your breast care team should agree on a care plan. The purpose of follow up is to detect and treat any local recurrence of breast cancer, deal with the side-effects of treatments and provide psychological support.

As part of your follow up, you should be offered regular mammography. You will also be seen regularly by a breast care nurse or doctor for a few years (often around three to five) for a physical examination and to discuss any problems or concerns you may have.

If you’d like emotional support or advice from a nurse or counsellor, you may wish to visit the Breast Cancer Care website or call them on 0808 800 6000. If you’d like emotional support or financial advice, you may wish to visit the Macmillan Cancer Support website or call them on 0808 808 0000.

Information last reviewed: 9 November 2012.