Breast oncology at Parkside Hospital

What is breast oncology?

Breast oncology is the area of medicine that diagnoses and treats breast cancer, along with related conditions of the breast. It brings together surgery, imaging, drug treatments and radiotherapy, tailored to the type and stage of cancer found.

What conditions does it treat?

Breast cancer is the most commonly diagnosed cancer in women, though it's rare in men too. It falls into 2 broad categories: pre-invasive conditions, where abnormal cells are confined to the milk ducts or lobules, and invasive cancers, which grow within normal breast tissue and may spread elsewhere in the body.

• ductal carcinoma and lobular carcinoma are the most common types
• Paget's disease of the breast
• inflammatory breast cancer, a rare, fast-growing type that causes skin changes, such as swelling, discolouration or an orange-peel texture, rather than a typical lump
• cancers classified by hormone receptor status, including hormone-receptor-positive, HER2-positive and triple-negative breast cancer
• benign (non-cancerous) breast problems such as fibroadenomas or cysts, which are ruled out or confirmed as part of assessment.

What are the benefits of breast oncology treatment?

Finding and treating breast cancer early gives the best chance of a full recovery and can help prevent it spreading to other parts of the body. A multi-disciplinary, personalised approach means treatment can be tailored closely to your specific cancer type, and oncoplastic techniques aim to preserve or reconstruct the breast's appearance alongside removing the cancer.

Genetic testing can also identify people who may benefit from options to lower their future cancer risk, and one specialist source reports that over 90% of patients treated go on to return to normal life with little impact on their lifespan.

Are there different types of surgical approaches?

Surgical options include breast-conserving surgery (a lumpectomy), which removes the cancer with a margin of healthy tissue while keeping most of the breast, and mastectomy, which removes the whole affected breast. A sentinel lymph node biopsy checks whether cancer has reached the nearest lymph nodes, and further nodes may need removing (axillary clearance) if it has.

Reconstruction options include an implant (placed under or over the chest muscle, sometimes with a supporting mesh called an ADM), a back flap combined with an implant, or using your own tissue, such as a DIEP or TUG flap. Where the breast is conserved, radiotherapy usually follows, either as a single targeted dose given during the operation itself (a technique called TARGIT-IORT, used as standard care in 35 countries) or as a 3 to 6 week course of daily treatments afterwards.

Drug treatments are chosen according to the cancer's characteristics: chemotherapy can be given before surgery to shrink a tumour or afterwards to reduce the risk of it returning, hormone (endocrine) therapy is used for hormone-receptor-positive cancers, and targeted therapy or immunotherapy is mainly used for HER2-positive cancers. For inflammatory breast cancer specifically, treatment usually follows a step-by-step approach of chemotherapy first, then mastectomy with lymph node removal, then further drug treatment afterwards.

What happens before treatment?

Diagnosis typically follows a 'triple test': a detailed history and clinical breast examination, imaging such as a mammogram or ultrasound, and a biopsy to check tissue for cancer cells. A needle biopsy can often be done at the same appointment, with results usually ready within a few days.

If cancer is confirmed, further tests such as a CT scan, blood tests, a bone scan or a PET scan help determine the stage, looking at the size of the tumour, whether lymph nodes are involved, and whether it has spread elsewhere. Your biopsy sample may also be tested for hormone receptors, HER2 status and other genetic markers to help guide your treatment.

Your care team will also consider your individual risk factors, such as family history, previous breast biopsies and body mass index, and may offer genetic counselling or testing for inherited gene changes such as BRCA1, BRCA2 or PALB2.

What happens during treatment?

For surgical treatment, the general pattern is:

1. You're given a general anaesthetic so you're asleep throughout.
2. The surgeon removes the cancer with a margin of healthy tissue (a lumpectomy), or the whole affected breast if the cancer is too large or widespread for breast conservation (a mastectomy).
3. A sentinel lymph node biopsy is usually carried out at the same time, removing the first lymph node or nodes the cancer would spread to, so they can be checked for cancer cells.
4. If cancer is found in these nodes, further lymph nodes in the armpit may need to be removed.
5. If the breast is conserved, a single targeted dose of radiotherapy may be given during the same operation (TARGIT-IORT), or radiotherapy may be planned as a course of treatment afterwards instead.
6. If reconstruction is planned, this can be carried out at the same time as the cancer surgery or at a later date, using an implant, your own tissue, or a combination of both.

What does recovery look like?

After surgery, you'll be seen again to discuss your results and agree the next steps, which may include radiotherapy, chemotherapy, hormone therapy or targeted therapy depending on your specific cancer. You'll then have regular follow-up appointments and scans to monitor your recovery and check for any signs of the cancer returning.

Recovery involves both physical and emotional adjustment. Physical effects can include early menopause, side effects from hormone therapy, tiredness, difficulty concentrating, weight changes and reduced bone strength, while removal of lymph nodes can sometimes lead to swelling in the arm (lymphoedema). Feelings such as fear of recurrence, uncertainty about the future and changes in self-image are common and understandable.

Support is available throughout treatment and beyond, including breast care nurses, counsellors, support groups and a cancer care coordinator who helps you communicate with the different specialists involved in your care. Staying physically active, maintaining a healthy weight, and attending regular GP reviews can all help support your wellbeing during and after treatment.

What are the risks and complications?

• lymphoedema, a build-up of fluid in the arm or breast after lymph node removal, causing swelling, discomfort or pain
• early menopause or menopausal symptoms, such as hot flushes, muscle aches or mood changes, particularly after chemotherapy or if the ovaries are affected
• anxiety and depression, which are common and understandable, and which your medical team can help you manage
• recurrence, where the cancer returns in the same area, nearby, or in another part of the body such as the bones, lungs, brain or liver
• for inflammatory breast cancer specifically, a higher tendency for rapid spread to other organs, meaning prompt treatment is especially important.