Breast Cancer: What you need to know
This brochure was written to provide information to other women in similar circumstances. It is intended to help breast cancer patients with honesty and compassion.

Finding out you have Breast Cancer

Many of us are not prepared to face cancer. When told that we have cancer, we refuse to believe it. We think a mistake has been made. The reality however is that each year the number of Sri Lankan women who learn they have breast cancer is growing. Breast cancer strikes women of all ages, all communities, rich or poor - women who thought they were healthy, women like you and me.

This disease is frightening because it is potentially life threatening. It brings with it fear, confusion, pain, depression and even isolation. It forces us to make difficult choices at a time when we are confused and in shock. We fear for ourselves - whether the disease would be cured, whether it would spread to other parts of our body. We are also frightened for our families. Would the other female members of our family - mother, sisters, daughters get the disease? We fear the treatment and the aftereffects it may cause.

If you have learned that you have cancer, it is natural to fear, to feel anger and resentment, to cry and grieve. But it is also important that you learn that you are not alone, and you are not helpless. There are treatment methods that can help you survive. There are ways to live after a cancer diagnosis. Let us therefore look ahead. Let us replace fear with knowledge. Let us begin the process of healing.

This brochure tells you about some of these methods of healing, the treatment options you may have to face and their side effects.

What are the treatments available to me?

Treatment of breast cancer is highly advanced today and there are a number of options you can use, either alone or in combination. The option/s you choose will depend on your individual circumstances. Given below are the procedures usually employed.

SURGERY

This is the most commonly used treatment for localized breast cancer. There are different types of surgery.

Partial Mastectomy/Lumpectomy

In this surgical procedure, only the cancerous section of the breast and a margin of breast tissue that surround this section is removed. The surgeon may remove anywhere from 1-25% of the breast tissue. Fat and lymph nodes from the armpit area could also be removed to find out if any cancer cells had spread beyond the breast tissue. After a partial mastectomy, the patient may also need to follow a course of radiation treatment (See page 8).

Modified Radical Mastectomy

In this type of surgery, all the breast tissue including the nipple will be removed. Lymph tissue will also be removed from the armpit to see if the cancer has spread. You will be left with a scar across the flat chest wall.

What will surgery be like?

•Depending on the type of surgery and how soon you recover, your stay in hospital may last from one to seven days.

•You will be asked to check into the hospital a day or two before the surgery. You should tell your surgeon (or the anesthetist) if you have any allergies or have had any previous problems with an anaesthetic. You will not be allowed to eat or drink (no solids, no liquids, and no water) from the evening before the surgery until you have been brought back from the recovery room.

•Depending on the procedure, your surgery may take from two to four hours. Following surgery, your breast will be bandaged and a tube placed to drain fluid from the wound. You may feel nauseous, and tired. Your chest, shoulder, or arm may feel numb or you may be in pain. If you are in pain, you should ask for medication.

•After surgery it is important that you rest and regain your strength.

•If your lymph nodes were removed, your arm may be weak. You will be provided physiotherapy exercises to regain strength in your arm, and to maintain mobility. These exercises are an important part of your recovery. You should practise doing them as this will prevent your arm and shoulder from becoming stiff and frozen.

Coping after surgery

•Many women experience numbness or change of feeling in the area around this scar. This is caused by nerves which have been cut during surgery, and are healing. The numbness may take a year or even longer to diminish.

•You may find it helpful to use a soft pillow to support the arm when sitting or lying down.

•Avoid carrying a heavy handbag or heavy weights on the side on which you had surgery

•You will feel more comfortable if you wear soft, loose clothing as the scar heals.

•You should avoid creams or deodorants and avoid shaving in the area surrounding the scar.

•If you drive and are used to wearing a safety belt, you can prevent irritation and discomfort by putting a soft cloth between the belt and your shoulder

•Once the scar has healed, you can wear your bra as usual by inserting a prosthesis in your bra.

RADIATION THERAPY

Radiation therapy is a form of treatment which uses high energy x-rays to kill cancer cells or to shrink tumors. Radiotherapy (used with breast conserving surgery) reduces the chances of cancer returning in the breast.

•Radiation treatment is done by machines which direct the x-rays to the precise area of the breast.

•This treatment is given usually every day for four to six weeks. You are then given a break. This break allows normal cells to recover.

•Using small amounts of daily radiation, rather than a few large doses, helps to protect normal body tissues in the area being treated.

•Radiation treatment is painless although in some cases, the skin around the area receiving it may peel or become red as a result of the burn.

How is Radiation Treatment given?

•Radiation treatment itself takes only a few minutes. You will be asked to wear a hospital gown and lie on a treatment table.

•You will not see, hear or feel the radiation. A radiation therapist will be watching you during the treatment. During the treatment, family members or friends will not be permitted in the room with you.

What are the Side Effects of Radiation Treatment?

•Radiotherapy does not cause nausea, vomiting or hair loss. There are no dietary restrictions to follow while undergoing the treatment.

•You can lead a normal life during radiotherapy.

•If you get very tired, try to limit what you do. Get more rest by sleeping during the day and going to bed early. Ask family members or friends to help you with shopping, cooking and childcare.

Coping with Radiation treatment

•As you have to travel daily to the hospital, you can find this very tiring or stressful. You should try to rest as much as possible and eat well.

•You should not apply creams or powder to the area which is receiving radiation treatment. If your skin gets burnt, you should ask your doctor what you should do about it. There are special creams that can be used in such cases.

•Wear loose cotton clothing, as this would make you feel comfortable. Avoid irritating the skin by rubbing it. Use non-performed soap when bathing.

•Your skin may become sore so, treat it gently. Skin reactions generally heal within a few weeks.

CHEMOTHERAPY

Chemotherapy is the use of drugs to treat cancer by killing or preventing the growth of cancer cells. In the past, Chemotherapy was feared because the treatment was quite harsh. Today, however, the treatment has improved significantly and is much more bearable.

Chemotherapy works by destroying cells that grow rapidly, such as cancer cells.

Research studies have shown that chemotherapy improves survival, and reduces the chance of the cancer coming back.

How is Chemotherapy given?

Chemotherapy drugs used to treat breast cancer are usually given by injection into a vein (intravenously). Some drugs may also be taken as tablets. Sometimes both forms of chemotherapy are used.

What is the treatment procedure?

Generally chemotherapy drugs are given in 'cycles' - There is a break between one cycle and next. This rest time allows normal cells to recover before the next treatment.

Treatment programmes vary but generally involve four to six cycles. This can take about three to six months to be completed.

Coping with Chemotherapy side effects

Reactions to chemotherapy often vary, depending on the individual and the drugs used. You may have no side effects or only a few mild ones. Or you may have side effects that cause you concern. These effects can be prevented or managed. The most common side effects are discussed below:-

•Fatigue, or being tired, is the most common side effect. If you get very tired, try to limit what you usually do. If you are working, you may need to take leave from your work, or work part-time. Ask members of your family and/or friends to help with cooking, shopping or childcare. Try to get as much rest as you can. Gentle exercise such as walking also helps to reduce fatigue.

•Nausea and vomiting You may feel sick or nauseous. There are drugs that can prevent nausea. There are tablets that you have to swallow or dissolve in your mouth. Your doctor may prescribe such drugs.

If you do develop nausea and vomiting, you may not feel like eating food that is oily or greasy, and you may wish to avoid eating meat. Eating fruits and vegetables will help you. Remember it is important to keep up your fluid and food intake. Drink plenty of water.

•Hair loss Chemotherapy often causes loss of hair, especially hair on the head. However some drugs also cause loss of body hair. This can include eyebrows, eyelashes, and pubic hair. When hair loss happens, it usually begins two or three weeks after treatment starts. Some people may lose all their hair very quickly. Often the hair comes out in clumps during a bath or shower. Others may lose hair only after several treatments.

If you lose the hair on your head, you may find it comfortable to wear a scarf. In Sri Lanka, this is very acceptable. There are also a few places that sell wigs. If you are buying a wig, it is best to select one before all your hair falls out so that you can buy one that matches your natural hair and its colour. You may find that the loss of eyebrows and eyelashes make you look quite different. Using a pencil to draw eyebrows or as a liner usually helps to restore your normal appearance.

Remember that hair loss is not permanent. The hair will grow back either during the treatment period itself or after it is over. Sometimes it grows back differently. People who have had straight hair may find that they develop curly hair.

•Infection Sometimes chemotherapy may lower your white blood cell count making you more prone to infections. It is therefore safer to avoid crowded places (such as cinemas) or travelling in crowded buses as much as you can.

Blood tests are taken before each cycle of chemotherapy to make sure that the blood counts are normal before your next treatment starts.

•Mouth sores and problems Some people develop mouth sores during chemotherapy. Others may even develop teeth and gum problems. Drinking plenty of water and rinsing your mouth with a solution of baking soda and water often during the day will help to clean your mouth. Use a soft toothbrush to brush your teeth.

Many people find that food does not taste the same during treatment. Meat, especially may have a bitter taste. It also helps to reduce or stop your intake of coffee and tea.
•Forgetfulness and Mood Swings Chemotherapy seems to make some women forgetful and prone to mood swings. These changes are temporary but it can last for as long as two years after chemotherapy. It might help to talk to a friend or another woman with breast cancer.
•Menopausal symptoms If you are menstruating, your periods will become irregular or may stop altogether. For many women, their period returns when the treatment is over. However, for some women chemotherapy may also lead to an earlier menopause. If this happens, you may also get other menopausal symptoms such as body aches, hot flushes and loss of sexual desire.

•Lymphoedema Lyphoedema is a persistent swelling of the arm or breast. It can be quite mild or severe. Lymphoedema may occur any time after surgery (even after many years) and may be temporary or permanent. Lymphoedema may even occur after radiation treatment. Surgery and radiation can stop the flow of lymph from the arm back into the circulation. Because the fluid does not leave the arm, through the lymph vessels, the arm may swell.

Lymphoedema may be prevented by avoiding infection, limiting heavy lifting with the arm and avoiding cuts. For example do not permit blood tests on the affected arm.
