| Breast cancer | Diagnosing breast cancer | Treatment for breast cancer |
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See also our genetics and breast cancer, breast cancer trials and breast health pages.
On this page: Treatment | Surgery | Breast conserving surgery | Mastectomy | Breast reconstruction | Which surgery is best? | Removing lymph nodes | Side effects of surgery | Recovery after surgery | Further treatment | Radiotherapy | Chemotherapy | Hormone therapy | Complimentary and alternative treatments | When cancer can't be cured
Treatment for early breast cancer aims to remove the cancer and to reduce the risk of the cancer spreading or coming back.
Treatment may include surgery, radiotherapy, chemotherapy and hormone therapy. Usually more than one treatment is used. Women and men with early breast cancer have similar treatment.
Your doctor will advise you on the best treatment for your breast cancer. The choice of treatment will depend on your test results; where the cancer is and if it's spread; whether your cancer is oestrogen, progesterone or HER2 receptor positive; your age and general health; and what you choose. If you talk to other people with breast cancer, remember there are different types of breast cancer and the best treatment for one person may not be best for another.
You may want to read the National Breast and Ovarian Cancer Centre's book Guide for women with early breast cancer. For a copy visit www.nbocc.org.au or call 1800 624 973.
Surgery for breast cancer will involve one of the following:
In most cases, breast surgery also involves removal of one or more lymph nodes from the armpit.
Surgery to remove the breast cancer and some surrounding healthy tissue is called breast conserving surgery. It's also called lumpectomy , complete local excision, partial mastectomy or wide local excision. Breast conserving surgery is offered if the cancer is small compared to the size of your breast.
The surgeon removes the smallest amount of breast tissue possible, but this will leave a scar and the breast may change slightly in shape and size.
Radiotherapy is usually given to the breast after surgery to destroy any cancer cells that may be left in the breast or armpit. Some lymph nodes from the armpit may be removed at the time of surgery.
A pathologist examines the removed breast tissue to see if there's an area of healthy cells all around the cancer - this is known as a clear margin . If cancer cells are found at the edge of the removed tissue, this increases the chance of cancer returning. You may need more tissue removed (re-excision) or your doctor may recommend a mastectomy.
‘Every time I saw a new doctor they would mention that I was very young to get breast cancer, that it's more common in older women. It made me feel special in a way that I never wanted to feel special!'
Surgery to remove the whole breast is called mastectomy. Usually the nipple is also removed. The chest muscles are not removed. Some or all of the lymph nodes in the armpit closest to your affected breast may also be removed (see Removing lymph nodes, below).
You may be offered a mastectomy if the cancer is large compared to the size of the breast or the cancer is in more than one area of the breast.
While your wound heals, you can wear a soft temporary breast form (prosthesis) inside your bra. You may choose to be fitted for a breast form or have surgical breast reconstruction.
‘Choosing to have a second mastectomy was a difficult decision. I thought about the long term and the fear that I could have of further breast cancer. I decided that at my age, I really didn't need breasts, so that was it.'
During a breast reconstruction, the breast shape is recreated using either an implant or tissue from another part of your body.
Some surgeons do the reconstruction at the same time as the mastectomy (immediate reconstruction). Others prefer to wait for several months or longer (deferred reconstruction). Talk to your surgeon about what's best for you.
See our Breast reconstruction page to learn more.
Research has shown that breast conserving surgery, with sentinel node biopsy (see Sentinel node biopsy, below) followed by radiotherapy is as effective as mastectomy for most women with early breast cancer. These treatments have different benefits, side effects and risks. Talk to your doctor or breast care nurse about the best option for you.
Lymph nodes are found throughout the body, including in the armpit. They're small, bean-shaped collections of lymph cells that protect the body against disease and infection. The lymph nodes are part of the lymphatic system.
The lymph nodes in the armpit (axilla ) are often the first place breast cancer cells spread to outside the breast. To check if breast cancer has spread to the lymph nodes, they're removed. There are 2 ways of removing the lymph nodes.
This may be done at the same time as your breast surgery or as a separate operation and removes some or all of the axillary lymph nodes. After the lymph nodes are removed they're examined and the results help your doctor recommend further treatment.
The sentinel node is the first lymph node that breast cancer cells may spread to outside the breast. There can be more than one sentinel node. Usually it's in the armpit but it may be found near the breast bone (sternum). Removing only the sentinel node/s will mean fewer side effects than axillary surgery.
To find the sentinel node, a small amount of radioactive substance is injected around the cancer before surgery. A scan is taken to show which sentinel node the substance travels to. During surgery, a blue dye is injected around the cancer in your breast. The dye moves into the lymphatic vessels and turns the lymph node blue. The nodes that become blue or radioactive first are known as the sentinel nodes. The surgeon removes only the sentinel nodes so they can be tested to see if they contain cancer cells. If the sentinel nodes are clear, no further surgery is needed. If the nodes do contain cancer cells, axillary surgery will be needed.
The following are some side effects of surgery. Not every woman has these side effects.
Fluid may collect in or around the scar in your breast or lymph nodes. This may last up to 6 weeks following surgery. The fluid will need to be drained using a fine needle and syringe. This can be done by your breast care nurse, specialist or GP.
Exercises can help prevent or manage shoulder stiffness. A physiotherapist or occupational therapist can help.
Surgery may damage nerves, causing your arm, and perhaps shoulder, to feel numb. The numbness will improve but may not go away completely. Shoulder exercises will help improve movement.
The arm may swell following lymph node surgery or some time later. Read more about ways to manage lymphoedema.
Many people find that feeling tired and having no energy is a major problem. Fatigue is not just a side effect of treatment; the emotional impact of the diagnosis can also be tiring. Your tiredness may continue for quite a while even after treatment has finished. You may need to plan your activities during the day so that you get regular rest periods.
Talk to your doctor about any side effects you're concerned about as most can be managed.
‘I felt guilty since I couldn't do much - it helped when I realised that this tiredness was normal.'
Depending on the type of surgery a have, your recovery rate and whether you have help at home, you may be in hospital for 1 to 7 days.
You will have several tubes in place after the surgery. A drip will give you fluid as well as medication. There may also be a tube in your breast to drain fluid from the surgical site. These tubes are usually removed within 3 to 5 days. If you've had axillary surgery you'll have a drain from this site, which is usually removed in 3 to 7 days. Some people are discharged with drains still in place, but this will depend on what support they have at home.
You may have a dressing covering the wound to keep it clean. It will usually be removed after a week.
You'll be given pain relief by injection or tablets while in hospital. Pain medication will be provided for when you go home.
This will clear up after 2 to 3 weeks.
To help prevent blood clots, move your legs while you're still in bed. As soon as you're able, get out of bed and walk around. Medication may be prescribed to lower the risk of blood clots.
Recovery time varies. Most people start to feel better after 2 weeks. Take it easy and only do what's comfortable.
Exercising your arm as soon as possible after surgery will help it get back to normal faster. See Looking after yourself for more information.
Avoid driving for a couple of weeks after surgery until your arm feels agile.
Many people feel grief at the loss of their breast and find talking to someone in a similar position helpful. To find out more, call 13 11 20 to be linked to Cancer Connect.
A week after your operation, your doctor will have all the test results and will discuss the need for any further treatment such as radiotherapy, chemotherapy or hormone therapy with you. Further treatment will depend on the stage of the cancer and whether there's a clear margin around the cancer. You should be given a treatment plan and copies of your pathology reports for your patient-held record.
Radiotherapy uses x-rays to kill cancer cells or stop them growing. This treatment is recommended after breast conserving surgery to help destroy any cancer cells left in the breast and reduce the risk of the cancer coming back. It's also sometimes given after a mastectomy.
Radiotherapy to the lymph nodes in the armpit is not often recommended as it may increase the chance of developing lymphoedema .
Treatment is carefully planned to do as little harm as possible to your normal body tissues. Before you start treatment, you'll have a planning session at the radiotherapy centre. During this visit, x-rays are taken to pinpoint the area to be treated and marks will be put on your skin so that the radiation oncologist treats the same area each time. These marks are small and may be temporary or permanent.
Once treatment starts, you'll probably have radiotherapy once a day from Monday to Friday for 5 to 6 weeks.
Usually you can just go to the radiotherapy centre each day.
Each radiotherapy session will be in a treatment room. Although you'll only get radiation for 1 to 5 minutes, you might be in there for 10-30 minutes. Most of the time is spent positioning you and the treatment machine. You'll lie on a table under the radiotherapy machine. Once the machine is turned on, the radiation therapist will leave the room, but you can talk to staff through an intercom. Radiotherapy is not painful but you need to lie still while the treatment is given.
‘I had 6 weeks of radiotherapy. It caused skin irritation towards the end. I'm not sure if I felt more tired from the radiotherapy or not: I was feeling a bit over the whole thing by then! I found the daily radiotherapy especially hard emotionally because it meant I was reminded every day of the cancer.'
Radiotherapy can cause side effects.
Tiredness usually begins the week after radiotherapy starts and eases a few weeks after treatment finishes.
The skin near the x-ray site may become red and dry after the 3rd week of treatment. The skin usually returns to normal 4 to 6 weeks after your treatment ends.
Inflammation and blistering are less common.
Radiotherapy nurses can show you how to care for your skin. Radiotherapy does not cause hair loss.
See our Coping with radiotherapy section for ways to manage side effects.
‘I was lucky not to have any side effects from radiotherapy and went on with my daily workload. My employer was very supportive of my regular visits to the surgeon and radiotherapy treatment.'
Chemotherapy uses drugs to kill or slow the growth of cancer cells. Chemotherapy may be used:
Chemotherapy is usually given into a vein. Most people are treated as day patients but sometimes an overnight stay is needed.
You may have a number of chemotherapy sessions, maybe up to 8, every 2 to 3 weeks over several months. This gives your body time to recover before the next session. How long you have chemotherapy will depend on the type of breast cancer you have and what other treatments you're having.
‘Even though I'd been told about losing my hair, I found it quite distressing. Then my hair was in funny little bits, so I had my head shaved. Once I coped with the fact that I didn't have hair for the minute, I quite enjoyed looking for hats and a wig and all of that sort of stuff.'
The side effects caused by chemotherapy depend on the drugs used. Most side effects are temporary and steps can often be taken to prevent or reduce them.
Side effects may include feeling sick (nauseous), vomiting, tiredness, mouth ulcers, weight changes, and some thinning or loss of body and head hair. Some women's periods become irregular during chemotherapy but return to normal after treatment. For other women, chemotherapy may cause periods to stop permanently (menopause). After menopause, women can't have children.
Ask your doctor before treatment starts about your fertility options.
See our Coping with chemotherapy page for ways to manage side effects.
Hormone therapy, also called endocrine therapy, is for people who have hormone receptors on their breast cancer cells. The aim of hormone therapy is to slow or stop the growth of hormone receptor positive cancer cells.
Talk to your doctor about which type of hormone therapy is suitable for you - this will depend on your age, the type of breast cancer you have and whether you've reached menopause.
Learn more about hormone receptor cancer cells.
Tamoxifen is known as an anti-oestrogen drug. It works by stopping cancer cells responding to oestrogen. Tamoxifen is suitable for women of any age, regardless of whether they've reached menopause. It's taken as a daily tablet over 5 years. Tamoxifen is usually started after surgery or following radiotherapy or chemotherapy treatment.
Tamoxifen does not cause menopause, but the side effects may be similar. The most common side effects include hot flushes, trouble sleeping, vaginal dryness or discharge, weight gain and irregular periods. You may have some or none of the side effects.
The side effects usually get better as treatment continues and tend to improve when treatment ends. Talk to your doctor about ways to manage them.
A rare side effect of tamoxifen is cancer of the uterus. See your doctor as soon as possible if you have any unusual bleeding. If you're having tamoxifen for more than 5 years, you should have yearly checks of your uterus.
There are other anti-oestrogen drugs. If you have severe side effects from tamoxifen, discuss these options with your doctor.
For women who've not reached menopause, treatments that stop the ovaries from producing oestrogen may be recommended.
Temporary ovarian treatments include the drug goserelin (Zoladex), which only works while it's being taken. As this drug brings on a temporary menopause you may have side effects such as low sex drive, hot flushes, mood swings, trouble sleeping, vaginal dryness and headaches. Ask your doctor for ways to best manage these side effects.
Ovarian ablation stops the ovaries from producing oestrogen permanently. This is done by removing the ovaries or giving radiotherapy to the ovaries. Ovarian ablation will bring on menopause. This means you'll no longer be able to have children. You may have some symptoms, including hot flushes and a dry vagina. Your doctor or breast care nurse will be able to advise you on treatments for these symptoms. Your risk of osteoporosis may increase.
Aromatase inhibitors help prevent the growth of oestrogen-dependent cancer cells by reducing the amount of oestrogen in the body.
Aromatase inhibitors are used in women who've reached menopause .
Examples of aromatase inhibitors include anastrozole (Arimidex), exemestane (Aromasin) and ietrozole (Femara).
Side effects may include osteoporosis, vaginal dryness, hot flushes and weight gain.
Targeted therapies are drugs used to treat certain types of cancer cells. The most common targeted therapy for early breast cancer is trastuzumab, also know as Herceptin.
Trastuzumab is a drug used to treat HER2-positive breast cancer. This drug works by attaching itself to HER2 receptors on the breast cancer cells. This reduces the stimulation for cancer cells to divide and grow. The drug also encourages the body's own immune cells to help destroy the cancer cells. Trastuzumab is given by injection into a vein.
It's common for people with cancer to seek out complementary and alternative treatments. Many people feel that it gives them a greater sense of control over their illness, that it's ‘natural' and low-risk, or that they just want to try everything that seems promising.
Complementary therapies include massage, meditation and other relaxation methods that are used along with medical treatments.
Alternative therapies are unproven and include some herbal and dietary remedies that are used instead of medical treatment. Some of these have been tested scientifically and found to be not effective or even harmful.
Some complementary therapies are useful in helping people to cope with the challenges of having cancer and cancer treatment. However, some alternative therapies are harmful, especially if:
Be aware that a lot of unproven remedies are advertised on the Internet and elsewhere without any control or regulation. Before choosing an alternative remedy, discuss it with your doctor or a cancer nurse at the Cancer Council Helpline.
Learn more about complementary and alternative therapies or phone 13 11 20.
See also the US National Center for Complementary and Alternative Medicines website.
If your cancer has spread and can't be cured by surgery, your doctor may still recommend treatment. In this case, treatment may help relieve any symptoms, can make you feel better and may help you to live longer.
Whether or not you choose to have anti-cancer treatment, symptoms can still be controlled. For example, if you have pain, there are effective treatments for this.
General practitioners, specialists and palliative care teams in hospitals all play important roles in helping people with cancer.
For further information,
Learn more about advanced cancer, contact our Cancer Council Helpline on 13 11 20 or Palliative Care Victoria on 9662 9644.
Reviewed by:
Assoc. Prof. John Boyages, Exec. Director NSW Breast Cancer Institute, Westmead Hospital
Lynn Buglar, Breast Physician, BreastScreen NSW
Sally Crossing AM, Breast Cancer Action Group NSW
Cynthia Murphy, Breast Cancer Action Group NSW
Esperance Coelho, Cancer Council NSWDr Amanda Hordern, Cancer Council Victoria
