Breast cancer

Most women diagnosed with breast cancer are aged over 40 years, but younger women can also get it. In rare cases, men can also be diagnosed with breast cancer.

If primary breast cancer is detected early there is a good chance of recovery.

What to expect from your appointments with us

You may be sent and appointment for breast screening or directly by your GP If you have received an appointment for breast screening or have been referred by your GP on an urgent suspected cancer pathway this will take place at our dedicated unit at Thirlestaine Breast Centre. Some appointments may take place in mobile screening units this information will be provided in your appointment letter.

If you have been referred by your GP, it is usual at your first appointment to have a consultation with a doctor or specialist nurse. You will be asked questions about your concern, and your general health. You will have an examination of both breasts and both armpits.

You may have some further investigations. They can include:

• a mammogram
• an ultrasound scan
• a biopsy

If required, these tests will be performed on the same day, which helps us fully assess your symptoms and make a decision about your care. Occasionally you will need to come for a second appointment to have these tests.

What to expect from your diagnostic tests and investigations

• Mammogram – This is also known as an x-ray of the breast and takes around 30 minutes to complete.
• Ultrasound – This uses sound waves to build up a picture of the breast tissue. You may also have an ultrasound scan of the lymph nodes in the armpit. This will take around 30 minutes.
• Biopsy – A small piece of tissue from the abnormal area or lymph node will be removed. This is most commonly done at the same time as the ultrasound scan, using local anaesthetic to numb the area. Occasionally it is done at the same time as a second mammogram.

The sample is then checked for cancer cells under a microscope in our laboratory.

After these investigations, you will be seen by a consultant and offered an appointment around 2 weeks later for your results.

Treatment options and what to expect

Surgery

Wide Local Excision

Sometimes people call this a lumpectomy. This is where the cancerous lump from the breast is removed along with some of the surrounding tissue. Sometimes you need to have a metal marker coil placed into the affected area in the breast before the operation.

This operation is most commonly done under a general anaesthetic (so you are completely asleep,) and as a day case procedure, so you go home the same day. The tissue is then sent to our histopathology laboratory for examination. The results normally take 3 weeks, and you will see the consultant in the clinic with the results. If cancer cells are found in the surrounding tissue, close to the edge, you may need a further operation to remove more of your surrounding tissue. The likelihood is that 1 in 4 people will need a second operation.

Mastectomy

This is where the whole breast is removed (including the nipple). Most mastectomy operations are done under general anaesthetic (so you are completely asleep,) and as a day case, so you go home the same day as surgery. If you have the breast removed this can be followed by reconstructive surgery. The timing of this depends on your other cancer treatment, and you will able to discuss this with your surgeon before the operation.

Surgery to the lymph nodes: sentinel node biopsy, targeted axillary dissection, axillary clearance

Sentinel node biopsy: you had an ultrasound scan of your armpit, and this showed no large areas of cancer in the lymph glands there. We still remove a few glands at the time of the breast surgery to make sure that there aren’t microscopic cancer cells there. You will have an injection of some dyes prior to the operation to help find the correct ones. These injections are done in the Nuclear Medicine department the day before, or the morning of, your surgery. You may also have a blue coloured dye injected during the surgery.

Targeted axillary dissection: this operation is similar to the sentinel node biopsy, and is done for people who have chemotherapy as there first treatment, and had cancer in their lymph nodes on the first tests (armpit ultrasound scan and biopsy of lymph nodes). A small metal marker will be placed into the particular node prior to the surgery.

Axillary clearance: f investigations (armpit ultrasound scan and biopsy of your lymph nodes) show that your cancer has spread to your lymph nodes, you may need to have all or most of them removed. This is known as an axillary clearance and will be done at the same time as your breast surgery.

SACT treatments

You may hear the following treatment being described as SACT, which means systemic anti-cancer therapies. These include chemotherapy and immunotherapy and are treatments that work throughout the entire body.

Chemotherapy: this is a cancer treatment which uses medicine to destroy cancer cells. You may be given this as an oral tablet or intravenously (directly into your veins).[LR1] [EM2] This treatment can be given as your first treatment, or after your surgery.

CDK4/6 inhibitors: this is a cancer treatment given for certain types of breast cancer. It is prescribed by the Oncologist and given as a tablet. It is most commonly used after surgery.

Endocrine treatment: this is also called hormonal treatment and is given as a tablet. Some people take this tablet as their only treatment for breast cancer. Some people take it for a few weeks or months prior to their surgery. Most people take it after their surgery. You can take it for between 5 and 10 years. Only certain types of cancer need this treatment.

Bisphosphonates: this is a treatment that protects your bones in the long term. It is prescribed by the oncologists and can be given as an infusion (a drip into your vein) or as a tablet.

Radiotherapy

Radiotherapy involves using radiation to destroy cancerous cells. It is given after surgery, to the breast/or chest wall (after a mastectomy) and sometimes to the armpit and low neck. Our Radiotherapy pages have more detailed information.

Contacts

Gloucestershire Breast Screening Service, Thirlestaine Breast Centre, Thirlestaine Road, Cheltenham, Gloucestershire, GL53 7AS

Tel: 0300 422 3751