Treatment for breast cancer

The treatment of breast cancer depends on many factors, including:

• the stage and grade of the cancer
• your age
• whether or not you have had the menopause
• the size of the tumour
• whether the cancer cells have receptors for certain hormones (such as oestrogen) or particular proteins (such as HER2) on their surface.

Most breast cancers will be treated with surgery to remove the tumour. All, or part, of the breast tissue may be removed. If the whole breast is removed, breast reconstruction may be carried out at the same time as the initial surgery or at a later stage. Sometimes chemotherapy or hormonal therapy may be given to shrink a cancer before surgery. This is known as neoadjuvant therapy.

After surgery, radiotherapy may be given to the breast tissue, to make sure any cancer cells that may be left are destroyed. After surgery the doctors can tell the stage and the grade of the cancer, and they can look at several other factors to predict how likely the cancer is to come back or spread.

Factors which affect the chance of the cancer coming back include:

• the size of the tumour
• whether the lymph nodes in the armpit were affected
• the grade of the tumour
• whether the cancer cells have spread into lymph or blood vessels close to the tumour (the pathologist checks for this)
• whether the cells have receptors for oestrogen or particular proteins (such as HER2) on their surface.

If the chance of the cancer spreading or coming back is very low, further treatment is not necessary. However, most women will be advised to have treatment with chemotherapy or hormonal therapy to reduce the chance of the cancer coming back. This is known as adjuvant therapy. Some women may have both treatments, but not at the same time.

This booklet discusses the treatments for stage 1 – 3 breast cancer.   CancerBACUP has separate information on secondary breast cancer, which  disucsses the treatments for secondary breast cancer.

If you have any questions about your own treatment don’t be afraid to ask your doctor or hospital nurse. You may like to take a close relative or friend with you to remind you of questions at the time or the answers afterwards. It often helps to make a list of the questions you want to ask and the answers that you are given.

Giving consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision about what to do when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, immediately so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.