Most women diagnosed with breast cancer survive it thanks to the major advances in medical intervention that have happened over the last 20 years.
Treatments like chemotherapy and hormonal therapy actually stop cancer cells from spreading throughout the body, but effectively treating breast cancer isn’t limited to systemic therapies.
Breast cancer surgery has also made massive strides over the past 20 years and is a vital part of a successful recovery.
How do I check if I have breast cancer?
Breast cancer is picked up when a you feel a lump in your breast or during a routine mammogram. The minute you feel something that doesn’t feel normal, get in touch with your doctor who’ll remove a sample of the suspect breast tissue, under local anaesthetic, and send it off to a pathologist to find out whether it’s cancerous or noncancerous.
I’ve been diagnosed with breast cancer. Now what?
There’ll be two specialists primarily involved in your care. First, your breast surgeon will discuss management options and together you’ll decide on a tailor-made approach. Second, your oncologist will do a full systemic work-up and oversee chemo, radio and hormonal therapy, as well as your long-term follow ups.
When it comes to breast cancer surgery, there are three different operations can be done to remove the tumours (cancerous tissue):
- Mastectomy: This the removal of the majority of breast tissue.
- Breast conservation therapy: After the tumour is removed, the remainder of the breast tissue receives radiotherapy for six weeks once the wounds have healed.
- Skin-sparing mastectomy with immediate reconstruction: Again the majority of the breast tissue is removed, but the breast ‘envelope’ – the skin surrounding the breast tissue – is preserved. This allows for immediate plastic surgery reconstruction with silicone or saline implants, or with more complicated soft tissue flaps.
Deciding on which is the best option for you comes down to what you want, your health, breast size, and nature and position of the tumour (cancerous breast tissue).
What about my lymph nodes? Is it still common practice to remove all of them to avoid the cancer spreading?
The way surgeons deal with the lymph nodes in the axilla has also changed a lot over the last two decades. Before, they were just removed as a standard precaution, but this often led to swollen arms (lymphoedema), causing lifelong difficulty. Now, surgeons try preserve the lymph nodes whenever possible. If the lymph nodes show no obvious signs of enlargement at the time of the initial diagnosis, a ‘sentinel lymph node biopsy’ will be done. This treatment involves the injection of a radioactive tracer into the breast at the site of the cancer. It’s transported via the lymph drainage network to the first lymph node in the draining basin. This specific lymph node is identified using a gamma-probe, which picks up radioactivity, and only this lymph node is removed. This is often sufficient treatment of the lymph system. Further prognosis and therapeutic treatments can be made later on based on the histological assessment of the removed node.
How long will I be hospitalised for?
You can typically expect to be hospitalised for two to three days after breast surgery. This is to make sure there are no wound complications like bleeding and for pain control. I usually discharge my patients with their breast drains still in place after careful instruction on how to safely care for them at home. Once they drain less than 30ml/day, you’ll come back to me and I’ll remove the drains in the rooms.
When does chemotherapy start, and for how long will it last?
Chemotherapy starts 6 to 8 weeks after surgery once all operative wounds have completely healed. Usually 6 months of chemotherapy is needed with the first 3 months being the most intensive,and hardest, phase. This is when you’ll experience hair loss. The second 3 months are less intense and your hair will start to grow back.
How is the chemotherapy administered?
Once a week, or every 2 weeks, you’ll go to the Hopelands Oncology Centre, situated next to Life Hilton Hospital, where you’ll be put on a drip and the chemotherapy will be administered over a 3 to 5 hour period. Afterwards, it’s straight off home for you!
What about radiotherapy treatment?
Depending on the size, position and your lymph node involvement of your cancer, you might need 3 to 6 weeks of radiotherapy after you’ve completed chemotherapy. If you’ve chosen to undergo breast conservation surgery, the remaining breast tissue will need to be treated with radiotherapy.
Will I need any other therapy?
Yes, usually hormone-blocking therapy is given for 5 years after chemotherapy, provided your particular cancer is sensitive to this type of treatment.