types of treatment and treatment planning for breast cancer
The treatment of your breast cancer depends on a number of factors. You will nearly always receive more than one modality of treatment, which will be tailored to you and to your type of breast cancer. The timing and type of treatment chosen depends on:- the stage and grade of the cancer
- your age
- your general health
- whether or not you have had the menopause
- the size of the tumour
- the size of your breast
- whether the cancer cells have receptors for certain hormones (such as oestrogen) or particular proteins (such as HER2).
- Your views and opinions
For most women, the first traetment will be an operation to remove the cancer. Surgery will remove all (mastectomy) or part (partial mastectomy) of the breast. Surgery to remove some of the lymph nodes in the armpit will also be done if you have an invasive cancer.
After surgery the cancer and the rest of the tissue removed is looked at carefully by the pathologist. They will provide a full report on the cancer, which is used to help plan further treatments.
After surgery, radiotherapy may be given to the breast tissue, to make sure any cancer cells that may be left in the area are destroyed. This is almosts always recommended if you have had a partial mastectomy.
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.
Sometimes chemotherapy or hormonal therapy may be given to shrink a cancer before surgery. This is known as neoadjuvant therapy. This is discussed more in the section on locally advanced breast cancer.
treatment planning
Every woman is different, and every breast cancer is different. In order to plan the best possible individual treatment, a lot of factors need to be taken into account. In order to ensure that this is done effectively, we work as a team at St Mark's.
Once the diagnosis of cancer has been made, your case will be discussed at our weekly 'Biopsy Meeting'. At this meeting, we will review your mammograms, ultrasound and biopsy results. All the team members have to agree with the diagnosis, and be happy that no further investigations are required. Your surgeon will outline what surgery is planned and this will be discussed.
After you have had surgery, we will again review all of your initial investigations. We will also look at your pathology results (all the tests done on your tumour), and the pathologist will demonstrate what it looks like under the microscope. This is done at our 'Panel Meetings'. The panel consists of all of the team at St. Marks and is also attended by an oncologist (cancer specialist). Your GP is also invited to this meeting as they can add important insights into your individual circumstances.
At this meeting, we decide if any further surgical treatment is required, and plan this if necessary. If it is decided that you have had optimal surgical treatment, the benefits of other treatments are discussed and a plan for your future treatment is made.
This plan will be discussed with you when you see your surgeon to get your results. You will normally also be made an appointment to see an oncologist. The risks and benefits of the various treatment options, as they relate to you, will be discussed. It is up to you to decide what is right for you at this stage, and you are encouraged to bring a friend or relative to this meeting.
Once you decide which further treatments you want to have, further appointments will be made to plan and carry them out.