Your breast care team will consider many factors, including:

• the type of breast cancer you have
  
   
• how big the cancer is, and how fast-growing (aggressive) it seems to be
  
   
• how likely it is to have spread elsewhere
  
   
• your general state of health
  
   
• your wishes.

The team will tell you about the benefits, risks and side-effects of the treatment options. They will advise you to have the treatment that best suits you, to give you the best chance of cure.

You will then need to agree to the treatment before it can start. This is called giving your consent. Don't be afraid to ask questions if there is anything you don't understand

Surgery

The aim of surgery is to remove the cancer with the least possible chance of it coming back. Surgery may be:

Wide local excision

This means removing the part of the breast where the cancer is.

Mastectomy

The whole of the breast is removed.

It may be possible to reconstruct your breast (build it up again). This may be done at the same time as the operation to remove the cancer. If so, it is called primary breast reconstruction. Alternatively, it may be done later on. The results can be very good, but the breast can never look and feel exactly as it did before.

If you decide not to have breast reconstruction you may want to wear a false breast (a prosthesis) inside your bra. There are different types of prosthesis available. If you would like to wear one, your breast care nurse will help you to choose one that feels comfortable and looks natural under your clothes.

Removal of lymph nodes

During the operation to remove the cancer, the surgeon may also take out lymph nodes from your armpit. Normally at least four nodes are removed in women who have invasive cancer. This is to find out whether the cancer has spread, and also to reduce the risk of the cancer coming back in the armpit.

Sometimes a small amount of radioactive liquid and/or blue dye is injected to identify the lymph nodes to be removed. This is called a sentinel procedure.

Removing lymph nodes may cause a problem called lymphoedema later on. This is when lymph fluid can't drain away properly and it builds up and causes swelling. Your hospital doctor or breast care nurse can tell you more about this.

Your doctor will talk with you about the type of surgery you need, how your breast is likely to look after surgery and how it might be reconstructed, if that is possible and it is what you would like. The type of surgery you have will depend on the size of the cancer, where it is in the breast and whether lymph nodes need to be taken out.

After surgery you are likely to have other treatments to reduce the chance of the cancer appearing elsewhere in the body. Treatment may be radiotherapy, chemotherapy or hormone therapy, or often a combination of these.

Some patients have radiotherapy after mastectomy. Whether you need it will depend on a number of factors, including the size of your cancer.

If you have a wide local excision to remove your cancer, you are likely to have radiotherapy afterwards.

Radiotherapy uses radiation to kill cancer cells. It may be given from inside or outside the body. When given from outside the body it is called external beam radiotherapy, and a machine directs high energy X-rays at the cancer.

You will have a number of treatment sessions each week, for several weeks. Afterwards some patients need a short course of extra treatment called a boost.

The boost is usually a short course of a different type of X-ray called electrons. These are given in the same way as the first treatment, over three to 10 days.

Your overall chance of survival is the same whether you have a mastectomy or wide local excision plus radiotherapy.

You may be offered chemotherapy after surgery, for example if you have an aggressive (fast-growing) cancer, or if your lymph nodes have cancer in them.

Chemotherapy uses special drugs to kill cancer cells. There are several different drugs available, and your team will choose the one that's right for you. The drugs are usually given by injection. You will need to have several cycles of chemotherapy treatment, normally over a period of up to six months. Each patient is individually assessed.

Some people with large cancers have chemotherapy before surgery, to shrink the cancer before the operation.

Chemotherapy may also be used to relieve symptoms and help people whose cancer can't be cured.

Hormones are substances that occur naturally in the body. A few cancers, including some breast cancers, need hormones to grow.

One form of hormone therapy is Tamoxifen. It works by blocking the effect of the hormone oestrogen on breast cancer cells. Without oestrogen, the cancer cells are less well able to grow and multiply.

Most breast cancer patients take Tamoxifen for five years after their surgery. The aim is to help stop the cancer from coming back. Tamoxifen is almost always given as a tablet to take each day.

Hormone therapy can also be used to help those whose breast cancer can't be cured. It is often able to keep the disease under control for long periods, allowing patients to enjoy good quality of life.