Breast cancer is common. Every cancer is different and each one needs to be treated individually.  In some cases the diagnosis is consistent with an entirely normal life expectancy and nowadays the majority of patients are successfully treated. Breast cancer usually presents as a lump in the breast or a change in or discharge from the nipple. It may be picked up on screening. It is commoner over 50 but can occur in young women especially with a family history. Diagnosis involves triple assessment (see 'Diagnosis procedure' ) although additional tests are sometimes necessary. The grade of the cancer is based on appearance of the cancer cells under a microscope; the stage of the cancer is determined by how far it has spread in the body. Breast cancers arise from the uncontrolled growth of breast cells. Sometimes these are capable of spreading outside the breast (invasive breast cancer) although this does not necessarily happen. In other cases the cancer is limited to the breast (in-situ cancer) and can be cured without chemotherapy. Breast cancer that has not spread beyond the glands in the armpit is called early breast cancer. Treatment may involve 5 different approaches in various combinations. Surgery The majority of patients simply have the cancer removed together with some glands in the armpit. Sentinel node biopsy or ultrasound biopsy is used to find if spread to the glands has occurred. A good cosmetic result can be achieved by a variety of surgical techniques developed in recent years (e.g. therapeutic mammaplasty). The surgery may only require a night in hospital. Removing the whole breast (mastectomy) is recommended in a minority of cases with large cancers. Reconstruction is usually possible if desired, using expandable implants and/or skin from the back (latissimus dorsi flap) or abdomen. (TRAM flap) In these cases surgery usually requires a week in hospital. In some cases reconstruction may be best deferred until later and surgery to the opposite breast. (augmentation/ reduction) may be necessary for symmetry. Radiotherapy This requires expensive specialized equipment and is given over 6 weeks on a daily basis at a radiotherapy centre by a consultant oncologist. It is not unpleasant. It is usually given after chemotherapy, when this is recommended. Chemotherapy This is determined by a consultant oncologist. It is not necessary in every case. Treatment continues over 4 months and is given every 3 weeks. Many people continue to work during treatment although most experience side-effects. Hair loss can occur though "cold-caps" may be helpful and the loss is temporary. In some instances chemotherapy is given before surgery to shrink the tumour down in which case the tumour may be marked with a tattoo so any residual disease can be removed later. Hormone therapy This (anti-oestrogens, aromatase inhibitors) is given as daily tablets for at least 5 years to patients whose tumours are hormone sensitive. The chief side effect is flushing; more serious side-effects are uncommon. The choice of agents is the subject of intense research at present. Herceptin Herceptin (trastuzumab) is appropriate for 20 per cent of women whose cancers have HER2-nue receptors and who do not suffer from serious heart problems. It is given over 12 months. The management of patients with breast cancer involves a multidisciplinary team including surgeons, oncologists, radiologists, pathologists and specialist nurses who dedicate most of their time to treating people with breast cancer.
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