Breast Cancer Information

Breast cancer is common affecting 1 in 9 women in their lifetime.

Breast cancers detected by breast screening with mammogram or ultrasound generally have a good prognosis with good long-term survival in most women.

There are several different types of breast cancer; the most common is invasive ductal carcinoma.

Types of Breast Cancer

Invasive ductal carcinoma
These cancers arise from the ductal cells of the breast. They are the most common cancers detected on screening mammogram.

Invasive lobular carcinoma
These cancers arise from the lobular cells of the breast. These cancers are often difficult to diagnose, as they result in subtle changes on mammogram and ultrasound.

DCIS (ductal carcinoma in-situ)
In this condition cancer cells are contained within the duct of the breast and do not yet have the ability to invade into the surrounding tissue.

DCIS is the earliest stage of breast cancer and over time the cancer cells will develop the ability to invade and will become invasive ductal carcinoma.

DCIS is detected as microcalcifications (tiny spots of calcification) on screening mammography. Most women with DCIS do not have any breast symptoms.

Malignant Phyllodes tumour
Rare cancer of the stromal (supporting cells) of the breast. Presents as a rapidly growing mass in the breast.

Breast Cancer Treatments

Diagnosis of Breast Cancer

Patients may detect a lump in the breast, or a suspicious area may be detected on breast screening with mammography.

Once a suspicious area has been identified a biopsy is necessary to make the diagnosis of cancer. This is usually performed by a radiologist who does a needle biopsy under guidance with either mammogram or ultrasound.

An ultrasound of the lymph nodes under the armpit is also performed and any suspicious lymph nodes are also biopsied with a needle.

Management of Breast Cancer

Usually the first step in the management of breast cancer is surgery. There are two surgical goals:

To remove the cancer
Removal of the breast cancer can involve either a wide local excision of the cancer followed by radiotherapy to the remaining breast (known as breast conservation) or mastectomy.
The decision as to which is the best management is made on an individual basis and depends on the size and site of the cancer, the patient's breast size, age, and family history.
To stage the lymph nodes
If breast cancer spreads beyond the breast it will involve the lymph nodes first. The lymph nodes that drain the breast are almost always under the armpit, in rare cases they can be under the ribs and sternum (breast bone).

The lymph nodes are removed to allow the pathologist to examine them for cancer cells. The number of lymph nodes removed depends on the type of surgery performed.

Sentinel lymph node biopsy is a technique for identifying and removing the first nodes the tumour drains to. Usually one to four lymph nodes are removed. These lymph nodes are identified by injecting a radio-labelled protein and a blue dye into the breast. The radio-labelled protein is injected in the radiology department and a scan is performed to identify the number of sentinel nodes and their location. In the operating theatre the blue dye is injected into the breast. A Geiger (radioactivity) counter is used to identify the sentinel nodes during the operation together with the blue dye. This technique is suitable for most patients with breast cancer; however, patients with known cancer in the lymph nodes, large cancers or multiple cancers may not be suitable.

Axillary dissection or clearance is an operation in which the lymph nodes under the armpit, which drain the breast, are removed. There are varying levels of axillary dissection based on anatomical landmarks, known as Level 1, 2 and 3. Axillary dissection is performed in patients who are known to have cancer in their lymph nodes, or in patients who are not suitable for sentinel lymph node biopsy.

Most patients will only require one operation for breast cancer, but some will require a second and rarely a third operation. The indications for further surgery are to obtain a clear margin of tissue around the breast cancer, or to perform an axillary clearance if the sentinel lymph node contains cancer.

Breast Reconstruction

Breast reconstruction can be performed either at the same time as mastectomy (immediate) or (delayed) after the completion of the adjuvant treatments (chemotherapy & radiotherapy).

Not all patients are able to have immediate reconstruction, especially those who will require radiotherapy. There are several different operations for breast reconstruction and these can be discussed with your surgeon.

Management after Surgery (Adjuvant Treatments)

The additional (adjuvant) treatments required after surgery will depend on the pathology report, specifically the size and grade of the cancer and number of lymph nodes the cancer has spread to.

Radiotherapy

All patients who have breast conservation (wide local excision) require breast radiotherapy.

Most patients who have a mastectomy do not require radiotherapy unless their cancer is greater than 5cm or there are more than 4 lymph nodes which the cancer has spread to. Patients are referred to a radiation oncologist for radiotherapy.

Endocrine Therapy

Hormonal (Endocrine) treatment is suitable for patients with oestrogen receptor positive cancers. These treatments are a tablet taken daily for 5 years.

There are two types of medication, Tamoxifen and the Aromatase Inhibitors (Arimidex, Femara and others).

Chemotherapy

Chemotherapy is recommended for patients based on their age, tumour size and grade and lymph node status.

Chemotherapy consists of medications, which are usually given intravenously. The patient will be referred to a medical oncologist, if this treatment is recommended.

Please note that all care has been taken in providing the information on this site. It is intended for background information and should not be used to make any medical care decisions. You should always consult with your medical providers for all specific advice on your medical treatment.