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Breast cancer treatment

The words used in breast cancer treatment are often unfamiliar at first and this page is intended to clarify what some of the terms we use mean to you.

Once you have been diagnosed with breast cancer, you will be offered treatment. There are a number of different ways of treating breast cancer and most people will be offered a combination of treatments. For example, you may be offered surgery, followed by chemotherapy. Your treatment plan will depend on the features of your cancer (such as size of the cancer, microscopic appearances on biopsy, lymph node involvement); whether you are fit to undergo a particular treatment and your preferences (such as whether you want to have a mastectomy with breast reconstruction).

In common with most breast cancer units in the UK, any significant treatment recommendations for you will have been discussed in a meeting of the multi-disciplinary team (MDT). As a minimum, this team consists of a specialist breast oncologist, surgeon, radiologist and pathologist, meeting twice weekly. In practice, the MDT meeting usually includes several representatives from each discipline, along with a co-ordinator, unit manager, breast care nurses and advanced nurse practitioners as well as doctors in training and medical students. In your next clinic appointment after the meeting, your treatment plan or options will be discussed with you. Many people find it helpful to bring a friend or family member to your clinic appointments. As sometimes there is a lot of information to take on board, one of the breast care nurses will usually be present in the consultation and afterards will make sure you have any written information you need to take away.

Breast cancer surgery

Most people who are diagnosed with breast cancer will  be offered surgery as part of their treatment. If you are offered surgery, there are two main considerations: what surgery you wish to undergo to remove the cancer from the breast and what surgery is needed to the lymph nodes in your armpit (the armpit is also called the "axilla", and hence surgeons talk about "axillary surgery").

Breast surgery

Breast surgery to remove the cancer falls into two main groups: mastectomy (removing the whole breast) and breast conserving surgery (BCS, wide local excision (WLE), therapeutic mammoplasty, "lumpectomy") in which the cancer is removed from the breast. If you have a mastectomy, breast reconstruction may be an option for you. Your surgeon and breast care nurse will be able to discuss your surgical options with you.

Axillary surgery

Axillary surgery has changed in recent years - but in general we need to remove some lymph nodes from your armpit at the same time as your breast surgery so that the pathologist can look at them under the microscope and find out whether any cells from your breast cancer have spread to the lymph nodes in your armpit. This is important to know as it can affect what treatments you need after your surgery (eg chemotherapy). The commonest axillary surgery is sentinel lymph node biopsy (SLNB) in which between one and four lymph nodes are removed from your armpit and sent to the pathologist to look at under the microscope. If you are found to have significant deposits of breast cancer cells in those nodes, you may be advised to come back for further surgery, which would be axillary node clearance (ANC). If you are already known to have cancer deposits in your armpit before your surgery (eg from a needle biopsy), you may be advised to have axillary node clearance (rather than sentinel lymph node biopsy) at the same time as your breast surgery.