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Breast cancer treatment, possible side effects

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Q/ 1. Is surgery the only treatment option for breast cancer, and what is its potential side effects on a patient? Janet.

A/ Hello Janet,
Breast cancer is cancer that forms in the cells of the breasts. In Uganda, it is the third commonest cancer in our population and second commonest among women.

Signs and symptoms
1. A breast lump or thickening that feels different from the surrounding tissue. l Change in the size, shape or appearance of the breast.

2. Changes to the skin over the breast, such as dimpling.

3. A newly inverted nipple.

4. Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin.

5. Redness or pitting of the skin over your breast, like the skin of an orange.

A cancerous breast. (Photo/courtesy)

About treatment and to answer the question asked above, no, surgery is not the only treatment option for treating breast cancer.

Other treatment options include: Pharmacological management (chemotherapy and hormone therapy), radiation therapy, supportive management including palliative care for patients with advanced cancer.

Radiation therapy
Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells.

Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation).

Breast cancer radiation can last from three days to six weeks, depending on the treatment.

Chemotherapy
Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. This can be done in isolation or given in preparation for surgery to shrink the tumor or after surgery to kill the remaining cancer cells.

Chemotherapy side effects depend on the drugs used. Common side effects include hair loss, nausea, vomiting, fatigue and an increased risk of developing an infection.

Rare side effects can include premature menopause, infertility (if premenopausal), damage to the heart and kidneys, nerve damage and very rarely, blood cell cancer.

Hormone therapy
Hormone therapy, perhaps more properly termed as hormone-blocking therapy, is used to treat breast cancers that are sensitive to hormones.

This can be used before or after surgery or other treatments to decrease the chance of your cancer returning.
If the cancer has already spread, hormone therapy may shrink and control it.

Hormone therapy side effects depend on your specific treatment, but may include hot flashes, night sweats and vaginal dryness. More serious side effects include a risk of bone thinning and blood clots.

Supportive care
Palliative care is specialised medical care that focuses on providing relief from pain and other symptoms of a serious illness.

This form of care is mostly given when the cancer is in its advanced stage. The choice of treatment option is based on the type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones.

Most women undergo surgery for breast cancer and many also receive additional treatment after surgery, such as chemotherapy, hormone therapy or radiation.

Chemotherapy might also be used before or after surgery in certain situations.

Surgical options
l Removing the breast cancer lump (lumpectomy). This is considered where tumors are small in early stages of cancer. It aims to conserve the breast.

l Removing the entire breast (mastectomy). A mastectomy is an operation to remove all the breast tissue.

l Removing both breasts. Some women with cancer in one breast may choose to have their other (healthy) breast removed (contralateral prophylactic mastectomy) if they have a very increased risk of cancer spreading to the other breast because of a genetic predisposition or strong family history.

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