FOLLOW UP TREATMENT AFTER BREAST CANCER SURGERY

Most women will be recommended to have some further treatment after surgery to minimise the risk of the cancer recurring. We work closely with the cancer centre at Charing Cross Hospital, and following your surgery, you will usually be given an appointment to see the specialist team. The type of treatment will vary according to individual circumstances. If there is any thing you do not understand or are unsure about, please do ask.

The main factors influencing the selection of treatments are:
· the type and size of cancer,
· the extent of surgery performed,
· the presence/absence of cancer cells in the lymph nodes under the arm,
· whether or not the patient has been through the menopause.
· whether or not the cancer has hormone receptors
· signs of spread to other parts of the body

The following treatments are the ones most commonly recommended:

Radiotherapy
Radiotherapy will usually be recommended to treat the remaining breast tissue when patients have had an operation which removes only part of the breast.

Radiotherapy is treatment with high energy rays accurately directed to the breast tissue with the intention of eradicating any abnormal cells. The treatment is carried out at Charing Cross Hospital. This involves an initial appointment for the planning and simulation of treatment when X rays and measurements will be taken as the treatment is 'set up'. It is important to have regained reasonable arm movement to enable you to be comfortable in the treatment position. The course of treatment usually starts a couple of weeks later and then you will need to attend daily, Monday to Friday each week for a period of about 6 weeks. The treatment can cause some tiredness, but otherwise the side effects are local to the area being treated. The skin may become red during treatment and very occasionally 'weepy'. This will improve once treatment is completed.

Tamoxifen
Tamoxifen is frequently used in post menopausal women, but may also be of benefit to some pre menopausal women.
Tamoxifen is one of the most commonly used hormone therapies. It works by blocking the stimulating effects that oestogen has on tumour cells. It is taken as a tablet, once a day and maybe continued for up to five years. There may possibly be some side effects which can include hot flushes, weight gain, vaginal discharge or bleeding. Occasionally nausea or skin rash may occur. Many of these effects settle after a time and generally the drug is well tolerated. Pre menopausal patients may experience changes in the menstrual cycle. Care should be taken to avoid the risk of pregnancy by using barrier methods of birth control.
Repeat prescriptions are available from your own G.P.

Chemotherapy
Chemotherapy is most commonly used for pre menopausal women who have cancer cells identified in the lymph glands. It may also be recommended in other instances; in either pre or post menopausal women if there are indications to suggest that chemotherapy would be of benefit or where Tamoxifen is not suitable.

Chemotherapy is treatment with a special group of drugs (cytotoxics) which have a destructive effect on dividing cells in the body. There are several different combinations of drugs which have been shown to be effective against breast cancer.
Treatment is usually given either as a course of injections into a vein or as a combination of injections and tablets. Each course will be repeated every 3-4 weeks for up to six months. This is usually done on an outpatient basis at Charing Cross Hospital.
Chemotherapy will have an effect on some of the normal cells of the body and this may cause side effects during treatment which will pass as the cells recover.
The blood cells are affected and regular blood tests will be carried out to monitor this. You will be given specific advice about this and also about symptoms which need attention.
The cells of the ovaries may be affected and menstrual periods can become irregular or stop during treatment. They may then return but this is very individual. Future fertility may be affected and this should be discussed fully prior to commencing treatment.
Generally for a few days after the treatment you may feel 'under the weather'. Other side effects may include nausea, sore mouth, diarrhorea, thinning or loss of hair; but will vary depending on the different drugs used. The potential side effects will be explained to you in relation to your plan of treatment and where possible you will be given advice and medication to help minimise these effects.

The above treatments are the ones which are recommended in the majority of cases, but in some instances other alternatives may be offered.

Charing Cross Cancer Centre is actively involved in research for breast cancer. By studying groups of women undergoing specific treatments, important information can be gained to help the future treatment of breast cancer. For this reason you may be asked to enter into a clinical trial. This will be fully discussed with you and you will be allowed time to make a decision. You are under no obligation to participate.

We aim to provide information appropriate to each patient by individual discussion in addition to this general information. Please do let us know if you have any uncertainties or queries and we will try our best to help. You may find it helpful to write down any particular points that you would like to discuss.

If you require further advice or information please contact the
Macmillan Breast Care Nurses, Hazel Ricard and Hilary Rickwood on 020 8565 5885