Treatment overview

The treatment of breast cancer is individual for each woman. Your doctor will discuss all the options available to you, and you can ask any questions that will help you decide on the best treatment for you.

The treatment you have will depend on many factors, including:

• the stage and grade of the cancer
• your age
• whether or not you have had the menopause
• the size of the tumour
• whether the cancer cells have receptors for certain hormones (such as oestrogen) or particular proteins (such as HER2).

Most primary breast cancers will be treated with surgery| to remove the tumour. All or part of the breast tissue may be removed. If the whole breast is removed (mastectomy),  breast reconstruction| may be carried out, either at the same time as the initial surgery or later.

Sometimes chemotherapy| or hormonal therapy| may be given to shrink a cancer before surgery. This is known as neo-adjuvant therapy.

After surgery, radiotherapy| will be given to any remaining breast tissue, and may be given to the chest wall if the breast has been removed. This is to make sure that any cancer cells that may be left in the area are destroyed.

You may have further treatment with hormonal therapies, chemotherapy and/or a drug called Herceptin|®, depending on how likely your doctors think it is that the cancer could come back.

Further treatment

After surgery, the doctors can tell the stage and the grade| of the cancer, and they can look at several other factors to predict how likely the cancer is to come back or spread. Factors which affect the chance of the cancer coming back include:

• the size of the tumour
• whether the lymph nodes in the armpit were affected
• the grade of the tumour
• whether the cancer cells have spread into lymph or blood vessels close to the tumour (the pathologist checks for this)
• whether the cells have receptors for oestrogen or particular proteins (such as HER2) on their surface. Cancers with oestrogen receptors are less likely to recur in the short term, whereas those with HER2 receptors are more likely to come back unless Herceptin is given.

If the chance of the cancer spreading or coming back is very low, you won’t need to have any further treatment. However, if there is a risk of recurrence, many women who have oestrogen receptor negative (ER-) breast cancer will be advised to have treatment with chemotherapy, and those with oestrogen receptor positive (ER+) breast cancer are usually advised to have hormonal therapy. This treatment is known as adjuvant therapy. Many women who are ER+ will have both treatments, but not at the same time.

Some women have a large number of HER2 protein receptors on the surface of their cancer cells. This is known as being HER2-positive|. In this situation, treatment with trastuzumab (Herceptin®) may be helpful. Your cancer specialist can discuss this with you.