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e.nelson@medmin.co.uk

Patient Information

Breast Cancer

Breast cancer is the most common cancer diagnosed in women and the incidence is increasing in the UK.

Approximately 1 in 7 women will be diagnosed with breast cancer in their lifetime. Fortunately, the majority of breast cancer is treatable and with modern therapies, many of our patients are going on with their lives unaffected by cancer.

Being diagnosed early, provides the greatest chance of a good outcome with the 5 year survival for stage 1 breast cancer being approximately 99%.

Want to find out more?

To find out more information or to make an appointment please get in touch with Mr Jamie Vatish.

 

 

Breast cancer treatments

Surgery to the Breast:

Surgery is often the first line of treatment for breast cancer. It involves the removal of the tumour and surrounding tissues and can be categorized into:

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Lumpectomy: Removal of the tumour and a small margin of surrounding tissue.

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Mastectomy: Removal of the entire breast. Variants include total mastectomy, radical mastectomy, and skin-sparing mastectomy.

Surgery to the Axilla/ Lymph Nodes:

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Sentinel Lymph Node Biopsy: Removal of one or a few lymph nodes to check for cancer spread.

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Axillary Lymph Node Dissection: Removal of multiple/the majority of lymph nodes in the underarm area.

Further Treatments

In the majority of cases, further treatments will also be required to reduce the chance of any cancer recurring. This is called adjuvant therapy and includes:

Radiotherapy uses high-energy x-rays to target and destroy cancer cells. It is usually given after surgery to remove any remaining cancer cells and lower the risk of recurrence.

Types of radiotherapy include:

External Beam Radiation: The most common form, where radiation is delivered to the breast from a machine outside the body.

Intraoperative Radiation Therapy (IORT) is a form of radiation treatment administered during surgery. It delivers targeted radiation directly to the tumor site while minimizing exposure to surrounding healthy tissue.

Hormone Therapy

Hormone Therapy, also known as endocrine therapy, is used to treat hormone receptor-positive breast cancers.

It works by blocking the body’s ability to produce hormones or by interfering with how hormones affect breast cancer cells. Common hormone therapy treatments include:

Tamoxifen: Blocks oestrogen receptors on breast cancer cells, preventing oestrogen from fuelling tumour growth.

Aromatase Inhibitors: Lowers oestrogen levels in postmenopausal women by inhibiting the enzyme aromatase. Examples include Anastrozole, Letrozole, and Exemestane.

Ovarian Suppression: In premenopausal women, ovarian suppression can be achieved through surgery, radiation, or medication to stop the ovaries from producing oestrogen.

Chemotherapy

Chemotherapy often involves a combination of drugs given in cycles to target and destroy any remaining cancer cells. These cycles allow the body time to recover between treatments. Chemotherapy is sometimes used before surgery to help reduce the size of a tumour and to assess the response to treatment.

Targeted Treatments and Immunotherapies

Targeted Treatments and Immunotherapies are newer types of treatment often given alongside chemotherapy to improve overall outcomes. They work on specific features of breast cancers with typically less side effects than conventional chemotherapy.

Lifestyle Modification

Lifestyle Modification is a vitally important and often overlooked aspect of breast cancer treatment. Regular exercise, a healthy diet, stopping smoking, reducing alcohol consumption and maintaining a healthy weight are all known to reduce your risk of breast cancer as well reducing the chance of recurrence.

Oncoplastic and Reconstructive Surgery

Oncoplastic Breast Surgical Techniques help preserve the overall aesthetic appearance of the breast when breast cancer surgery is performed alongside keeping scaring to a minimum.

Common reasons to utilise oncoplastic breast surgery are:

A small volume breast, where removing a cancer would leave a significant and unsightly defect in breast volume

A large cancer which when removed would overly distort the breast or lead to asymmetry between breasts

A breast cancer in a challenging position such as in the cleavage area

When a patient has a desire to improve the overall appearance or volume of their breasts

Common oncoplastic techniques include mammoplasty, mastopexy, chest wall perforator flaps and lipomodeling. Mr Vatish has extensive experience in utilising these procedures to provide the best aesthetic outcomes for his patients.

Occasionally when a cancer is very extensive, in multiple parts of the breast or a patient has a high risk genetic variant, then a mastectomy will be recommended. In suitable women, reconstruction is an option. Mr Vatish will go through the various options with you including an implant based reconstruction or using your own tissue (autologous).

Benign Breast Conditions

The Common Benign Breast Issues that we see in the One Stop Clinic are:

Breast Pain

Fibroadenoma

Breast Cysts

Infection

Duct Ectasia

Intraductal Papilloma

Fat Necrosis

Fibrocystic Change

Breast Cancer Genetics

Some individuals are at a higher risk of developing breast cancer compared to the general population due to their family history.

If a first-degree relative such as a mother, sister, or daughter has been diagnosed with breast cancer, a person’s risk of developing the disease is roughly doubled. The risk is even greater if multiple close relatives have had breast cancer or if a relative was diagnosed before the age of 50. However, most women with a family history of breast cancer will never develop the condition.

If you have a strong family history of certain cancers, there may be a faulty gene in your family that increases your risk of developing breast cancer. Scientists have identified several gene mutations that can raise the risk, and tests are available for some of them.

The most well-known genes associated with breast cancer risk are BRCA1 and BRCA2. BRCA stands for BReast CAncer gene. Everyone has BRCA1 and BRCA2 genes, which normally help prevent cells from growing and dividing uncontrollably. If either of these genes has a mutation (fault), it can lead to uncontrolled cell growth, increasing the risk of several cancers, including breast cancer.

Other genes that may raise the risk of breast cancer if they are faulty include:
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TP53

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PALB2
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ATM
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CHEK2
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STK11
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PTEN

Testing for these gene mutations can help identify individuals at higher risk of breast cancer. If you are identified as carrying a faulty gene, then there are options to reduce your risk of developing cancer including surgery.

Rare Breast Conditions

Breast Angiosarcoma is a rare cancer that accounts for less than 1% of all breast cancers. Secondary Breast Angiosarcomas develop after previous breast cancer treatment with radiotherapy and are more common than Primary Angiosarcomas.

Mr Vatish forms part of the Regional Multidisciplinary Team that treats patients from the West Midlands who develop a Breast Angiosarcoma.

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare type of immune cancer associated with breast implants.

Fortunately, the condition is rare (1 in 24000 risk) and more prevalent in implants with a rougher surface. The classic presentation is the sudden onset of a large swelling (seroma) around a previously normal implant and this is typically many years after the implant was inserted.

Mr Vatish has a specialist interest in this condition, having treated many patients with BIA-ALCL during his fellowship in the Leeds Breast Unit.