What is breast cancer?

An abnormal growth of normal cells in any lump is known as a benign (non-cancerous) tumour. If a lump turns out to be an abnormal growth of abnormal cells it is usually called a cancer. Cancer is different in that it can spread into and invade other breast tissue or other parts of the body.

What can I do now?

The surgery and other treatments you have had for breast cancer will have been tailored specifically to you and your type of cancer. At this point, it is natural that you will have many questions and concerns that reach beyond simply whether the initial cancer has been cured.

Your recent experiences mean you may need access to good advice on what you, those closest to you and your medical team can do to help you best cope with the physical, emotional and psychological upheaval this has had on your life. Your doctor and practice nurse are important members of that team who can provide ongoing care. They can also offer, or direct you to, sound advice. Regular follow-up health checks for women who have had breast cancer are, in general, recommended for 10 years, starting on a three-monthly basis.

This topic highlights some of the common concerns women treated for breast cancer will have - your doctor, breast care nurse and cancer specialist team can help you find ways to minimise ongoing problems. Fortunately, after breast cancer treatment, most women will be able to resume most activities within a few weeks.

Common problems in which help/advice can be offered:

Pain and numbness

Surgery for breast cancer is usually less extensive today than it once was, but pain after surgery, radiation treatment or chemotherapy is still a reality for some women. Pain is not something you should ignore (even if that is possible). Pain does not help your recovery, and it can mean the things that do help (eg, sleep and ability to exercise) are hindered.

There are ways to minimise pain, not all of which involve medications. Your doctor, nurse or pain clinic can suggest suitable options (eg, a programme of exercise, yoga, meditation or acupuncture). Low doses of certain antidepressant medications can ease some sorts of pain.

Numbness or tingling in your arm is more common if lymph nodes have been removed from the armpit (axilla). This is normal as some nerves, which needed to be cut during surgery, are slowly regrowing. If it does not clear up in a few weeks or months you should tell your doctor or nurse.

Fluid build-up

If the cancer, surgery or radiation treatment involved the lymph nodes in the armpit, the normal drainage of fluid (lymph) from the hand and arm back to the trunk may be affected. In some women, this can cause arm swelling (lymphoedema), but it is less common with today's treatments.

Where this is a risk, it can often be prevented by regaining shoulder mobility and by carrying out regular arm exercises recommended by your breast care nurse. It is important  that you continue to protect this arm from injury, infection and sunburn and do not use it for heavy lifting. The problem can develop months or years after treatment.

Weight loss and fatigue

Weight loss and fatigue are known problems when recovering from breast cancer. In the past, women were advised to rest, but now research shows women may feel better if they keep up a certain level of regular physical activity. Exercise can boost the immune system, help relieve pain, stress and depression, stimulate the appetite and help you sleep better. You should ask your doctor about suitable forms of exercise, and find one you can enjoy.

Menopause

The growth of some types of breast cancer is stimulated by the female hormone oestrogen and sometimes progesterone. For hormone-sensitive cancers, ongoing antihormonal drug treatment may be recommended. If you have not already been through menopause, the removal of the ovaries (surgically or medically) may be necessary with some treatments.

Stopping the body's oestrogen production or blocking its action on the cancer reduces the chances of a recurrence. However, the sudden onset of menopause with some treatments creates unwanted symptoms. While women who have had breast cancer are advised against oestrogen replacement therapy for menopausal symptoms, your doctor, nurse and wider team may still be able to help alleviate some of these.

Fertility

Some types of treatment (eg, chemotherapy) often cause infertility. Being unable to have children is a difficult adjustment for many women, and having to deal with this as well as breast cancer means you should take time to adjust to this loss and seek support from your partner, family, a friend and through your doctor and breast cancer team.

If your treatment does not cause infertility, it is important after some treatments not to become pregnant because of the potential harm to a baby. And, even if a treatment is likely to make you infertile, it may not do so immediately. Such women are usually advised to use a reliable method of contraception for a couple of years after the end of treatment because this is the time cancer recurrences are more likely.

For women who become pregnant after finishing successful treatment, there is no evidence pregnancy increases the risk of breast cancer recurring.

Self-image and self-confidence

The degree to which your breast and body has been altered will vary from one woman to the next, as will the reaction by each woman. Immediate shock and sadness are natural, but any loss of confidence or self-esteem can be overcome. Your breast nurse is trained to help with any problems you may have, including scarring, skin rash and finding a suitable prosthetic breast to wear inside your bra. And your surgeon should always be willing to discuss with you what options are available for breast reconstruction or implants if you have had a mastectomy.

Intimacy and sexuality

Breast cancer treatment can cause tiredness and stress that may affect your sex drive (libido). The possible onset of menopause caused by treatment can also create symptoms (eg, hot flushes, dry skin, vaginal dryness, loss of libido), but some of these can be helped if you mention them to your doctor. It may take a little time before you feel able to undress in front of your partner, who may also be going through a difficult time.

The best approach is to try to communicate how you are feeling. Counselling to help with confidence or intimacy may be available. If pain or skin tightness is a problem, it is may be helpful to explain this.

Depression and sleep problems

One in four women have some depression after breast cancer treatment. It is a normal response, but your doctor can discuss and provide treatment options for depression and assist you to find the support you need. Exercise is also beneficial for alleviating depression and for aiding sleep. Good sleep is important as it can improve your mood and energy level, so if sleep is a problem, talk to your doctor.

Heredity and your family

About one in 20 breast cancers is caused by a faulty breast cancer (BRAC) gene. If yours was caused by such a gene, your doctor can help you decide whether genetic testing would be helpful for your wider family.

Original material provided by UBM Medica (NZ) Ltd, updated November 2007.