Consultant Oncoplastic Breast Surgeon at GenesisCare, Prof PG Roy, explains the differences in breast cancer treatment options.

Every patient receives all round personalised care. The care I received has been superb.

Ruth, patient at GenesisCare

Surgery is often the first step in treating breast cancer. In many cases, it’s not necessary to remove the entire breast (mastectomy). Your surgeon will look at the size and location of the tumour and try to keep as much healthy breast tissue as possible.

Types of breast cancer surgery include:

• Full mastectomy – where the whole breast is removed
• Breast-conserving surgery – also called partial mastectomy or lumpectomy, where only the tumour and surrounding areas are removed
• Breast reconstruction surgery – to rebuild the shape of the breast, which can be done at the same time or in the future

During the procedure, your surgeon may take out some or all of the lymph nodes in your armpit to check if the cancer has spread.

They’ll also talk to you about your cosmetic options after surgery. You may choose to have surgery to rebuild the shape of your breast (reconstruction), or you can leave the chest flat. Some choose to wear temporary prosthetics that fit inside a bra.

Our expert breast surgeons use the latest techniques to provide effective treatment while supporting your recovery after surgery. If your consultant recommends surgery, this can be arranged conveniently at one of our comfortable partner hospitals.

You can then continue any other treatments at GenesisCare.

It takes a few weeks for the wound to heal after breast cancer surgery, but it may be several months until you’ve fully recovered.

For most people, the side effects of breast cancer surgery are manageable and temporary. This can depend on how long and complex the surgery is.

After surgery, you might:

• Feel tired and nauseous
• Be bruised, sore or stiff
• Have a build-up of blood or fluid around the area

More serious complications include infections and blood clots (deep vein thrombosis). These are less common but need to be treated quickly.

Your care team will talk to you about what to expect after surgery and any important things to look out for. Speak to them if you have any worries during your recovery.

After surgery for breast cancer, some people may need further treatment with radiotherapy. The aim is to kill any left-over cancer cells and reduce the chances of cancer coming back.

Sometimes, radiotherapy is offered to people with secondary or advanced breast cancer to ease symptoms like pain. This is called palliative treatment.

GenesisCare is a leading private provider of radiotherapy in the UK. Not all radiotherapy treatments for breast cancer are alike, and our approach sets us apart. We use the latest technology and innovative techniques that can treat cancer effectively and minimise side effects.

Our radiotherapy treatment approaches for breast cancer include:

• Volume modulated arc therapy (VMAT) – where the machine moves around you to provide targeted radiotherapy in a precise continuous beam
• Intensity-modulated radiotherapy (IMRT) – where the beam is constantly adjusted to the size, shape and position of the tumour
• Deep inspiration breath hold – a simple but effective technique to minimise side effects, which involves holding your breath for short times during treatment

Recovery after breast radiotherapy is different for everyone. For most people, side effects are short-term and manageable. These include:

• Feeling tired and weak
• Sensitive, sore or damaged skin
• Swollen breasts or chest
• Hair loss in the treatment area
• A stiff arm or shoulder
• Feeling or being sick

Long-term risks of radiotherapy are less common, and the benefits usually outweigh the risks. These include changes to the skin or breasts, breathing problems and weakened bones.

Your care team will speak to you about what to expect after radiotherapy and how to manage any side effects or complications.

Our experienced consultants take every care to minimise the impact of side effects. This includes techniques like deep inspiration breath hold, a proven way to helps protect the heart, lungs, and liver during radiotherapy to the chest area.

Hormone therapy, also called endocrine therapy, may be part of your treatment plan if you have oestrogen receptor positive breast cancer (ER+). It works by reducing or blocking hormones that can help breast cancer to grow. It lowers the chances of your cancer coming back. 

The type of hormone therapy you have depends on:

• Whether you've had the menopause
• Whether your breast cancer is likely to return
• How its side effects might impact you

You'll usually start hormone therapy after surgery and chemotherapy, if these are part of your treatment plan. Most hormone therapies are given as a daily tablet, which you might take for at least five years. 

Hormone therapy side effects depend on the medicine you're taking. They usually get better with time, but you should talk to your care team about any concerns. There are ways to help manage them.

Common side effects include:

• Feeling hot and sweaty (hot flushes)
• Changes to your periods (if you're pre-menopausal)
• Tiredness
• A dry or sore vagina
• Joint pain
• Mood changes

Some hormone therapies can stop your ovaries working, causing early menopause. This is part of what makes the treatment effective, as your ovaries produce hormones that help oestrogen receptor positive breast cancer (ER+) grow. Your doctor will talk to you about what to expect and your options for fertility. 

Not everyone with breast cancer needs chemotherapy. If your doctor thinks you could benefit, your treatment plan may include chemotherapy:

• Before surgery – where chemotherapy helps shrink the tumour to make it easier to remove, which is called neoadjuvant chemotherapy
• After surgery – where chemotherapy helps kill any leftover cancer cells to reduce the chances of your cancer coming back, which is called adjuvant chemotherapy
• Palliative chemotherapy – given to help control advanced breast cancer and reduce symptoms, which can be effective for several months or years

You may have chemotherapy along with other treatments like radiotherapy, hormone therapy or targeted therapy.

At GenesisCare, we offer the latest chemotherapy and hormone treatments for breast cancer at our Macmillan-accredited treatment centres. You’ll be treated in a private chemotherapy suite, with a 24/7 on-call service with a dedicated cancer specialist nurse for anything you may need.

Before you have chemotherapy for breast cancer, you’ll have blood tests to check that you’re well enough to start each cycle of treatment.

Most side effects are temporary, and your care team will offer supportive care and advice to manage them.

The side effects of chemotherapy include:

• Feeling very tired
• Losing your appetite or losing weight
• Bleeding or bruising more easily
• Nausea or vomiting
• Changes to bowel movements
• Hair loss

Chemotherapy can increase your risk of getting a serious infection. Your care team will explain what to look out for and what to do if you become unwell.

Immunotherapy aims to help your immune system recognise and fight cancer cells. It might be given before or after surgery or as part of a palliative treatment plan to ease symptoms.

There are lots of different kinds of immunotherapy for breast cancer. The results of your biopsy can show which immunotherapies could be suitable for your type of breast cancer.

The options can include:

• Monoclonal antibodies – proteins that look and act like human antibodies, which bind to cancer cells to help your immune system find and destroy them
• Checkpoint inhibitors – stop cancer cells from turning off your immune system

The side effects of immunotherapy depend on the treatment you’re having, how long you have it for, and the other treatments you’re having. They include:

• Feeling tired
• Losing your appetite
• Low levels of blood cells
• Vomiting or nausea
• Sore or itchy skin, or a rash
• Chills, fever or dizziness
• Diarrhoea

Your care team will talk to you about what to expect during and after treatment and how to manage any side effects. 

Targeted therapy is the name for drugs that ‘target’ the special processes cancer cells use to grow and survive.

They work against certain types of breast cancer, such as HER2 positive breast cancer or BRCA mutations.

If you can benefit from targeted therapy, you might have it before or after surgery, and along with other treatments like chemotherapy or radiotherapy.

The side effects of targeted therapy depend on the treatment you’re having, how long you have it for, and the other treatments you’re having. They include:

• Headaches
• Fever
• Feeling or being sick
• Itchy skin or a rash
• Severe diarrhoea

Sometimes, targeted therapies can cause heart problems during treatment. Your care team will check your heart before or during treatment and talk to you about managing any side effects.