Breast cancer and other tumours

Where do we start?

This page has two parts: breast cancer and a general look at other tumours seen in medical oncology. Medical oncology means treating cancer with medicines, such as chemotherapy, hormone therapy and immunotherapy. Surgery and radiotherapy are done by other specialists, and usually several specialists write the treatment plan together.

Breast cancer

Signs

The most common sign is a new lump in the breast, but most breast lumps are not cancer. Do not put off having it checked. Other changes that should be looked at:

• Swelling of all or part of the breast, even without a lump
• Dimpling or change of the skin (like orange peel), redness, dryness or thickening of the skin of the breast or nipple
• A nipple turned inward, or a discharge that is not milk
• Pain in the breast or nipple
• Enlarged glands under the arm or near the collarbone

Many breast changes have a non-cancer cause, such as hormonal changes with periods, pregnancy and menopause. Any new lump or change should be seen by an experienced doctor. Regular screening matters too, because a mammogram may find cancer before there are symptoms.

How is it investigated?

• Examination and history
• Imaging such as mammography and ultrasound
• Biopsy. A piece of tissue is taken and examined under the microscope. The pathology report gives the type and features of the tumour.
• Receptor tests on the sample: ER, PR and HER2
• Staging. Stage means how big the tumour is and whether it has gone to the lymph nodes or elsewhere. The stage helps in choosing treatment.

What do ER, PR and HER2 mean?

• Cancers that are hormone receptor positive (ER or PR) grow with hormones and can be treated with hormone therapy. This treatment stops oestrogen and progesterone from reaching the receptor.
• Cancers that are HER2 positive have a lot of the HER2 protein. They are usually treated with HER2-targeted medicines.
• If all three are negative (triple negative), hormone therapy and HER2 medicines do not work, but chemotherapy can help.

The result of these tests has a direct effect on your treatment plan. Ask your doctor what it means for you.

Treatment in general

According to the sources, the options fall into six groups: surgery, radiotherapy, chemotherapy, hormone therapy, targeted therapy and immunotherapy. Most patients with early-stage breast cancer have surgery. The others are given before surgery, after it or both, depending on the type and stage. Several specialists have a role in treatment: a breast surgeon, a radiotherapy specialist, a medical oncologist (drug treatment) and sometimes a plastic surgeon.

Every patient’s treatment is different. Two people with seemingly the same disease may have different plans.

Other tumours

A tumour is an abnormal mass of tissue. A benign tumour does not invade the tissue around it and usually does not come back after removal. A malignant tumour (cancer) can invade its surroundings and go to distant places. A cancer going to another place is called metastasis. A cancer that has metastasised keeps the name of the first cancer; for example, a breast cancer that has gone to the lung is still called breast cancer.

Most cancers are of the carcinoma type, that is, from the cells lining the surface of the body and organs. Sarcoma comes from bone and soft tissue. Blood cancers are separate from these.

Diagnosis

The general path is similar: examination, imaging (CT, MRI, ultrasound, PET), blood tests and biopsy. An abnormal blood test result alone is not a definite sign of cancer; a biopsy and the pathology report, together with imaging, are the basis of diagnosis. The result of all of these must be explained to you by a doctor, because a worrying result on a portal or a sheet, without explanation, can be misleading.

Staging

The stage says how large the cancer has grown and whether it has spread. It is usually numbered from 0 to 4. Higher means larger or more widespread. The stage helps the doctor plan treatment and look for a suitable trial.

Treatment

According to the World Health Organization, treatment usually includes surgery, radiotherapy or drug treatment (chemotherapy, hormone therapy and biological targeted medicines). These are often used together or one after another. Drug treatment can have different aims: destroying the cancer, lowering the chance of it coming back, controlling or slowing its growth, or easing symptoms. Ask your doctor about the aim at the start of treatment.

What can you do yourself?

• Gather your mammography, ultrasound, pathology and test results and bring them
• Ask for the ER, PR and HER2 test result and write it down
• If drug treatment is going to start, read the page “Chemotherapy and drug therapies”
• Before treatment, ask about fertility and dental care (the page “Before treatment starts”)
• Ask family and friends for help and, if needed, get a second opinion

When should you get urgent help?

• A fever of 38 degrees or higher during chemotherapy: this is an emergency. Tell the treatment team at once.
• Sudden shortness of breath or new or severe chest pain, sharp or pressing: call 115 (the emergency number inside Iran).
• Swelling, pain and warmth in one arm or leg: it may be a clot. Tell the treatment team or the emergency department right now.
• Bleeding that does not stop with pressure: call 115.
• Sudden redness, warmth and pain around a catheter or port: call the treatment team right now.
• Back or spine pain with weakness, heaviness or numbness in the legs, being unable to pass urine, or losing control of your bladder or bowels: this may be pressure on the spinal cord. Call 115 or go to the emergency department, and do not wait to reach your treatment team.

What checks and treatment you need is decided by your treating doctor after seeing your records.