In this article

What is breast cancer? A genetic link Symptoms How's the diagnosis confirmed?

Treatment/Recovery Early breast Cancer Postoperative recovery Possible complications

Prostheses Reconstructive surgery Adjuvant treatment Treating secondary (metastatic) breast cancer

Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS) is quite commonly picked up on screening mammograms. Here, cancerous cells have formed a lump, but haven’t started to invade the surrounding normal tissue. Treatment is aimed at preventing the return of the DCIS within the breast as the risk of secondary disease is negligible.

Surgery is performed initially (normally a lumpectomy, where the tumour and surrounding tissue are removed). A mastectomy may be recommended if the area of DCIS within the breast is too extensive to allow breast conservation.

A lumpectomy performed for DCIS may be followed by radiotherapy depending on a number of factors such as the size of the lump removed and will be decided on an individual patient basis.

Your doctor may also discuss the role of hormone therapy in DCIS although the benefits are not as well defined as in invasive breast cancer. There is no evidence to suggest that aromatase inhibitors are better than tamoxifen in DCIS but trials are currently underway to test this.

Here abnormal (cancerous) cells begin to invade the surrounding breast tissues but it‘s confined to the area of the breast and possibly the nearby glands. There is no detectable secondary breast cancer.

Treatments for early breast cancer

Neoadjuvant therapy

While surgery is usually recommended as the first treatment, sometimes hormone treatment or even chemotherapy may be offered before surgery. This is called neoadjuvant treatment.

Surgery

Surgery may remove just the lump with a surrounding rim of normal tissue (lumpectomy) or the entire breast may be removed (mastectomy).

Normally, surgery also entails some form of assessment of the underarm glands (axillary lymph nodes), which helps to guide further treatment. The glands may be completely removed (axillary node clearance) or just a few sampled.

Sentinal lymph node biopsy is a very selective but accurate method of assessing just one or two axillary nodes.

There's been a move away from very aggressive surgery. Just 20 years ago, radical mastectomies were widely performed. This operation left a marked depression in the shape of the chest, and women had to cope with feelings of being mutilated and scarred.

Now it's widely appreciated that such destructive surgery is often not necessary. For example, a lumpectomy combined with radiotherapy has been shown to be just as effective as mastectomy for tumours up to 5cm in diameter.

How long you need to stay in hospital after breast surgery depends on your particular operation. Following mastectomy, it's often necessary to place a tube into the area of the wound to drain blood and fluid, improve healing, avoid bruising and reduce the risk of infection. This may need to stay in place for several days, but it may be possible for you to go home with the tube in place and have it removed by your district nurse.

After surgery, many women feel emotional and tired. Not only do they have to cope with the effects of a general anaesthetic and major surgery, but they also have to face many other issues, from living with a life-threatening condition to changes in their body image.

Plenty of rest and a healthy diet can help you get back on form, but it's also essential you address your psychological needs. Make the most of the support available. Most areas have trained breast care nurses, who'll be able to help with your worries and fears. Or you may prefer to find a local self-help group and talk to other women who've been through the same experiences.

Don't be afraid to ask any questions, no matter how trivial or silly they may seem to you. You may also like to give your partner and family a chance to find out more.

A number of women develop complications following breast surgery, including problems with wound healing and infection.

If you've had lymph nodes removed from your armpit, or if you've also had radiotherapy, you may experience:

• Damage to the nerves running through the area - this causes tingling, numbness or stiffness in your upper arm. It's usually temporary and may be improved with regular exercise. Ask to speak to a physiotherapist.
• Lymphoedema - this is swelling of the arm and hand due to interruption of the normal drainage of lymph fluid from the area. It may develop straight after surgery and resolve quickly, or appear slowly and be more long-lasting.

After a mastectomy, you may choose to wear a simple prosthesis to restore the shape of your breast. There are several different types available on the NHS. Your breast care nurse or doctor will be able to tell you more.

The charity Breast Cancer Care offers a free prosthesis fitting service, which is available throughout the UK. Trained staff offer information and advice on the range of prostheses and swimwear available.

Later, you may want to think about surgery to reconstruct the breast. Increasingly, women are being offered immediate reconstruction, with a new breast put in during the operation to remove the cancer. However, this can't be done in every case.