Your Care Instructions

Breast cancer means abnormal cells grow out of control in one or both breasts. These cancer cells can spread from the breast to nearby lymph nodes and other tissues. They can also spread to other parts of the body. The type and stage of cancer you have is based on:

• Where in the breast the cancer started.
• The genetics of those cancer cells.
• How far cancer has spread within the breast, to nearby tissues, or to other organs.
• What the cancer cells look like under a microscope.
• Whether there is cancer in the nearby lymph nodes.

Tests that help find the stage of your cancer can help choose the right treatment for you. These tests can include a breast biopsy, lymph node biopsy, blood tests, and X-rays. You may need other tests as well, such as a bone, CT, or MRI scan. Whether you have more tests depends on your symptoms and the stage of the cancer.

When you find out that you have cancer, you may feel many emotions and may need some help coping. Seek out family, friends, and counsellors for support. You also can do things at home to make yourself feel better while you go through treatment. Call the Canadian Cancer Society (1-888-939-3333) or visit its website at www.cancer.ca for more information.

How is breast cancer treated?

Your doctor may combine treatments. This is a common way to treat breast cancer. Treatment depends on what type and stage of cancer you have. You may have:

• Surgery to remove the cancer.
• Radiation. This uses high-dose X-rays to kill cancer cells and shrink tumours.
• Chemotherapy. This uses medicine to kill cancer cells.
• Hormone therapy. This uses medicines such as tamoxifen. It limits the effect of the hormone estrogen. This hormone can help some types of breast cancer cells to grow.
• Targeted therapy. This uses medicines such as trastuzumab (Herceptin) to help keep cancer from growing or spreading.
• Immunotherapy. This uses medicines like pembrolizumab to help your immune system fight cancer.

What surgeries are done for breast cancer?

Surgery is a key part of treatment for breast cancer. The main types of surgeries are:

• Breast-conserving surgery, such as lumpectomy. It removes the cancer in the breast and just enough tissue to make sure that all of the cancer was removed.
• Surgery to remove the breast. This includes:
  • Total mastectomy. This removes the whole breast.
  • Nipple-sparing mastectomy. This removes the whole breast but leaves the nipple.
  • Modified radical mastectomy. This removes the whole breast and some of the lymph nodes under the arm.
  • Radical mastectomy. This removes the whole breast and the lymph nodes under the arm (axillary lymph nodes).

If lymph nodes under the arm are removed, they are looked at under the microscope to check for cancer. There are two types of lymph node removal:

• Sentinel lymph node biopsy removes the lymph node that is the first to receive lymph fluid from the tumour. If cancer has spread from the breast to the lymph nodes, cancer cells most often show up in the sentinel node first.
• Axillary lymph node dissection removes most of the lymph nodes in the armpit.

The type of surgery you have depends on the size, location, and type of the cancer. It also depends on your overall health and personal preferences.

Even if your doctor removes all the cancer that can be seen at the time of your surgery, you may still need more treatment. You may get radiation, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left.

No matter what kind of surgery you have, you will get information about why you are having it, what its risks are, how to prepare, and what to do after surgery.