• What is cancer?

The organs and tissues of the body are made up of tiny building blocks called cells.

Cancer is a disease of these cells. Cells in each part of the body are different but most mend and reproduce themselves in the same way. Normally, cells divide in an orderly way. But if the process gets out of control, the cells carry on dividing and develop into a lump called a tumour. Not all tumours are cancer. Doctors can tell if a tumour is cancer by removing a small sample of tissue or cells from it. This is called a biopsy. The doctors examine the sample under a microscope to look for cancer cells. In a benign (non-cancerous) tumour, the cells may grow but cannot spread anywhere else in the body. It usually only causes problems if it puts pressure on nearby organs. In a malignant (cancerous) tumour, the cells grow into nearby tissue. Sometimes, cancer cells spread from where the cancer first started (the primary site) to other parts of the body. They can travel through the blood or lymphatic system.

Breast cancer occurs when cells within the breast ducts and lobes become cancerous

• Causes and risk factors
  We don’t know what causes breast cancer. There are some risk factors that can increase your chances of getting it.
  • Age – The risk of developing breast cancer increases with age.
  • If you have had cancer or other breast conditions before
  • Hormonal factors – Exposure to the hormones oestrogen and progesterone for long periods can affect your breast cancer risk.
  • Lifestyle factors – These include drinking more than two units of alcohol a day over many years, being overweight and smoking heavily.
  • Family history – Only 5–10% of breast cancers are thought to be caused by an inherited breast cancer gene. Talk to your doctor if you are worried about your family history.
  • Breast cancer is not infectious and cannot be passed on to other people.
• SymptomsThese can include:
  • a lump in the breast
  • a change in size or shape of the breast
  • dimpling of the skin or thickening of breast tissue
  • a nipple that is turned in (inverted)
  • a rash on the nipple
  • discharge from the nipple
  • swelling or a lump in the armpit.

   

  If you have any of these symptoms, get them checked by your GP. All of them can be caused by illnesses other than cancer.

• TestsYou should see your GP if you are worried about breast cancer. 

  At the clinic:

  The doctor will ask if you have had any breast problems before and about your family history of cancer.

  The doctor will examine your breasts and under your arms. They will explain which tests you need.

   

  A mammogram is a low-dose x-ray of the breast.

  You’ll be asked to take off your top and bra and may have to wear a gown before the mammogram. The radiographer (who takes the x-ray) will position you so your breast is against the x-ray machine. Your breast is then flattened and pressed with a flat,

  plastic plate. This keeps the breast still to get a clear picture. It can be uncomfortable and a little painful, but does not last long. You have two mammograms of each breast.

  Mammograms are usually only done on women over 40.

   

  A breast ultrasound uses sound waves to build up a picture of the breast.

  You’ll be asked to take off your top and bra, and lie down on a couch with your arm above your head. The person doing the scan puts a gel onto your breast and moves a small hand-held device around it. A picture of the inside of the breast shows up on a screen. It only takes a few minutes and doesn’t hurt.

  An ultrasound is more useful than a mammogram in women under 40.

   

  Fine needle aspiration (FNA) is a simple test done in the x-ray department or the breast clinic. The doctor uses x-ray or ultrasound guidance to make sure the cells are taken from the right area. Using a fine needle, your doctor takes some cells from the

  lump into a syringe. The sample is sent to the laboratory to check for cancer cells. It can be uncomfortable when the needle goes in, but it’s usually over quickly. Yourresults may be ready on the same day. You may feel sore for a few days afterwards – taking some mild painkillers should help.

   

  Ultrasound and FNA of the lymph nodes You’ll also have an ultrasound of the lymph nodes in the armpit. If any of the nodes feel swollen or look abnormal on the ultrasound, the doctor will do an FNA on them.

   

  Biopsy This is when a small piece of tissue is removed from the lump or abnormal area and looked at under a microscope. There are different types of biopsy. Your surgeon or breast care nurse can explain which type you will have. After a biopsy your breast can be bruised and feel sore for a few days. You can take

  painkillers until it eases.

  If breast cancer is confirmed then you may have some other tests to prepare for an operation or to find out more about the cancer. These tests include:

  • Blood tests
  • Chest x-ray
  • MRI scan
  • CT scan

  Your doctor or nurse will explain which tests you are having and what they involve.

  • Treatment

  Deciding on the best treatment isn’t always easy. Your doctor will need to think about a lot of things. The most important of these are:

  • your general health
  • the stage and grade of the cancer
  • the likely benefits of treatment
  • the likely side effects of treatment
  • your views about the possible side effects.

  It’s important to talk about any treatment with your doctor, so that you understand what it means. It’s a good idea to take someone with you.

   

  The main treatment for breast cancer is surgery. Other treatments are also often given to reduce the risk of the cancer coming back. These can include radiotherapy, hormonal therapy, chemotherapy and biological therapy.

   

  You will be asked to sign a consent form to show that you understand and agree to the treatment. You will not have any treatment unless you have agreed to it.

• SurgerySurgery is often used to remove the cancer and an area of healthy cells all aroundthe cancer. Sometimes the whole breast may need to be removed (mastectomy) and

  sometimes just the cancer may be removed (lumpectomy or wide local excision).

   

  If you have a lumpectomy, you will usually be advised to have radiotherapy to the

  remaining breast tissue afterwards. You may also need to have radiotherapy after a

  mastectomy.

   

  Research has shown that in early breast cancer a lumpectomy followed by radiotherapy

  is as effective at curing cancer as a mastectomy. You may be asked to choose the

  treatment which suits you best. The different treatments have different benefits and side

  effects, so this can be a difficult decision to make. You can talk about both options with

  your doctor or nurse, or cancer support specialists.

   

  It’s often possible for women who have a mastectomy to have their breast reconstructed.

  It can be done at the same time as the mastectomy. It can also be done months or

  years after the operation. There are different methods of breast reconstruction and your

  surgeon can discuss the options that may be suitable for you.

   

  After a mastectomy, the doctor will give you an artificial breast, which you can put

  inside your bra. You can wear it straight away after the operation when the area

  feels tender. When your wound has healed, you will be fitted with a permanent

  prosthesis (false breast).

   

  Adopted from: Macmillan fact sheet 2014: Breast cancer