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4. Treatment and care

When your specialist team has all the results of your tests and investigations, they will be able to advise you about what sort of treatment you should have. There are five main types of treatment for breast cancer:

• Surgery;

• Chemotherapy;

• Radiotherapy;

• Hormone therapy;

• Targeted therapy.

Occasionally only one of these is recommended but usually someone will be advised to have a combination of at least two, and often more, types of treatment.

Take every opportunity to discuss your planned treatment and ask questions about it before you make any decisions. Be sure that you understand what the treatment involves before you agree to it. You will need to consent (agree) to any treatment before it starts, and of course you can also refuse treatment if you wish. Your doctors and your breast care nurse will explain what the different treatments involve. They are also there to listen to you and to answer your questions.

Question: Why me? What caused my breast cancer?

 Answer: Probably everyone who develops cancer asks these questions. Many people ask them when they first hear that they have breast cancer (or suspect they have it), and may ask them repeatedly during any treatment and beyond. One of the hardest things for anyone else to do is to provide an answer, because there isn’t one, single explanation.

Why you have breast cancer or why it has happened at this point in your life is unlikely to be known. This is little comfort at a time when you are likely to be feeling many mixed emotions. And the last thing you are likely to find helpful is to be told ‘not to worry’ or to ‘put on a brave face’ or to feel you have to keep your own feelings inside you to ‘protect’ others.

Question: Can breast cancer be cured?

Answer: Yes, most people treated for breast cancer don’t develop recurrent or secondary breast cancer and will live the rest of their lives with no further breast cancer. Unfortunately, not everyone is cured and some people will develop secondary breast cancer which can still be controlled with treatments (sometimes for years) but which cannot be cured.

No doctor or nurse can guarantee anyone a cure but the type of cancer and its characteristics will help them make broad estimates.

Question: How will my specialist team know what treatments might work for me?

Answer: They will use the accumulation of many years’ experience, and the results of thousands of documented research cases. They will decide which treatments will suit you by taking several factors about your particular type of breast cancer into account. These are some of the factors.

• The size of the tumor. A large tumor relative to the size of the breast is more likely to require removal of the whole breast (mastectomy).

• The pattern of the cancer within the breast. If it is in several areas you are more likely to be advised to have the whole breast removed (mastectomy) than if it is confined to one area.

• How much the cancer cells resemble normal breast tissue. This is called the grade.

• Whether any cancer cells have spread to the lymph glands in the axilla (armpit). Fluid from the breast drains into the lymph glands in the axilla and cancer cells can travel in this fluid.

• Whether the breast cancer has been stimulated to grow by hormones. This is called oestrogen and/or progesterone positive breast cancer.

• Whether the breast cancer has been stimulated to grow by having too much of the protein HER-2. This is called HER-2 positive breast cancer, and only occurs in 20% of all invasive breast cancers.

Question: I have been told I have grade 3 breast cancer. What does this mean?

Answer: Breast cancers are graded according to how they look under a microscope and how closely they resemble normal breast cells. The amount of resemblance is called differentiation. The less ‘differentiated’ the cells are, which means they look least like normal breast cells, the faster the cancer cells are growing. There are three grades. Grade 1 is known as low grade; the cancer cells look most like normal breast tissue cells and are said to be ‘well differentiated’ and grow slower. Grade 3 is known as high grade; the cancer cells have undergone more change and look very different to normal breast cells;

they are said to be ‘less differentiated’ and grow faster.

Question: I have stage II breast cancer. What does that mean?

Answer: When people talk about the stage of breast cancer, they mean the size of the cancer and its extent – whether it has reached the lymph nodes and whether it has spread elsewhere in the body. In breast cancer there are four main stages.

• Stage I breast cancer is less than 2 cm across and has not spread either to the lymph nodes or elsewhere.

• Stage II breast cancer is between 2 and 5cm and may have involved the lymph nodes but has not spread to any other parts of the body.

• Stage III breast cancer is larger than 5cm, may have involved the lymph nodes, the chest muscles or the skin over the breast.

• Stage IV refers to a cancer of any size that has spread to other parts of the body.

Question: I have grade 2, stage I breast cancer. What does that really mean?

Answer: A grade 2 cancer means that the cells are ‘moderately differentiated’, look less like normal breast cells and grow slightly faster than normal cells. Stage I means that the

cancer is less than 2 cm across and no cancer cells were found in any lymph nodes or anywhere else in your body. Your doctor will use this information to decide on the best treatment to offer you.

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