Breast Cancer Information Portal

Transcription

1 Introduction Welcome to the Information portal. This portal has been designed as part of the Macmillan Beyond project which delivered as a collaboration between South Wales Cancer Network, Macmillan Cancer Support and Velindre Cancer Centre. These web pages are intended to give you an overview of wellbeing and pre treatment to follow up and beyond. How to navigate; Use the menu buttons on the left hand side The pink back arrow on the bottom right will take you to your previous page The home key is located at the top left and will bring you back to this page We have included a number of hyperlinks to websites* containing further information, you will notice their logo s on the page. The MBBCT project would like to thank all those who gave their time to input and assure these pages. Next

2 What is Cancer? Introduction Cancer starts in cells in our body. Cells are tiny building blocks that make up the organs and tissues in our bodies. They divide to make new cells in a controlled way. This is how our bodies grow, heal and repair. Cells receive signals from the body telling them when to divide and grow, and when to stop growing. When a cell is no longer needed or can t be repaired, it gets a signal to stop working and dies. Cancer develops when the normal workings of a cell go wrong and the cell becomes abnormal. The abnormal cell keeps dividing, making more and more abnormal cells. These eventually form a lump (tumour). Not all lumps are cancer. Doctors can tell if a lump is cancer by removing a small sample of tissue or cells from it. This is called a biopsy. The doctors examine the sample under a microscope to look for cancer cells. A lump that is not cancer (benign) may grow but cannot spread to anywhere else in the body. It usually only causes problems if it puts pressure on nearby organs. A lump that is cancer (malignant) can grow into nearby tissue. Sometimes, cancer cells spread from where the cancer first started (the primary site) to other parts of the body. They can travel through the blood or lymphatic system. When the cells reach another part of the body, they may begin to grow and form another tumour. This is called a secondary cancer or a metastasis. Next

3 The breasts Introduction Breasts are made up of fat, supportive (connective) tissue and glandular tissue containing lobes. The lobes (milk glands) are where breast milk is made. They connect to the nipple by a network of fine tubes called milk ducts. Usually breast cancer begins in the cells of the lobules and/or the ducts. Less commonly, breast cancer can begin in the fatty and fibrous connective tissues of the breast. Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes, small organs that filter out foreign substances in the body. If cancer cells get into the lymph nodes or the blood stream, they then have a pathway into other parts of the body. The breast cancer s stage refers to how far the cancer cells have spread beyond the original tumour. Breast cancer in men is rare. About 300 men in the UK are diagnosed with breast cancer each year. This accounts for fewer than 1 in every 100 cases of breast cancer. Many people don't know that men can get breast cancer but as men do have a small amount of breast tissue behind the nipples, this is where the breast cancer can develop. Further information can be found here. Next

4 Giving up smoking Cutting back on alcohol Am I at risk? Holistic Needs Assessment - HNA Your Feelings Saying safe in the sun Healthy eating Physical activity Being breast aware

5 Giving up smoking Giving up smoking may be stressful and difficult to do, but in the long term it will help you feel better and be healthier. TIPS Make a list of reasons to quit keep reminding yourself why you gave up and read it when you need support Think positive and make a plan make a promise, set a date and stick to it Keep your hands and mouth busy Nicotine replacement therapy (NRT) can make you twice as likely to succeed Identify when you want cigarettes a craving can last five minutes. Before giving up, make a list of five-minute strategies, for example go for a walk or make a phonecall Get some quitting support if family or friends want to give up too, suggest that you give up together. Ask your medical team or your GP for information and support when you are giving up smoking. For further information you can visit

6 Cutting down on alcohol There is no safe level of alcohol drinking. The more you cut down on alcohol, the more you reduce your risk. In the UK, the government guidelines are given in units of alcohol. People are advised not to regularly drink more than; 2-3 units a day for women : 1 drink a day for women 3-4 units a day for men : 2 drinks a day for men TIPS Make it a smaller one you can still enjoy a drink but go for smaller sizes. Try bottled beer instead of pints, or a smaller glass of wine instead of a large one. Have a lower strength drink cut down the alcohol by swapping stronger beers or wines for ones with a lower strength (ABV in %) Make a plan and set a budget - Before you start drinking, set a limit on how much you are going to drink. Only take a fixed amount of money to spend on alcohol if you are going out. Stay hydrated - Drink a pint of water before you start drinking. Do not use alcohol to quench your thirst; have a soft drink instead. Take it a day at a time - Cut back a little each day. That way, every day you do cut back is a success. Take a break - Try to have 2 days each week when you don t have an alcoholic drink. For further information you can visit here

7 Staying safe in the sun Sun damage does not just happen when you are on holiday in the sun. It can happen when you are not expecting it - For example when you go for a walk or sit in your garden. TIPS Spend time in the shade between 11am and 3pm Aim to cover up with a t-shirt, hat and sunglasses Use a factor 25+ sunscreen Make sure you never burn Some cancer treatments can make your skin more sensitive to damage from the sun so its important to protect your skin during and after treatment. This can be temporary or permanent. Ask your medical team for more information and support on staying safe in the sun.

8 Being breast aware Get to know how your breasts normally look and feel. If you notice any changes it is important that you visit your GP or Breast Care Nurse. These are the breast changes to look out for;

9 Holistic Needs Assessment - HNA A HNA is an assessment which will help to identify any concerns you may have physical, emotional, practical, financial and spiritual. It will give you the chance to think about your concerns and discuss possible solutions. It usually has 3 parts; a simple set of questions or checklist to identify any concerns you may have a discussion with your health or social care professional the development of a written care plan The questions can be answered on paper or electronically (ipad, smart phone, laptop, tablet). You may be offered an assessment at time of diagnosis, during treatment or after treatment has ended. Because your needs may change as you progress through your treatment pathway you can ask for a HNA at any time you feel it would help. These are your concerns, so it s up to you what is discussed. This may include concerns such as; Physical symptoms weight loss, lack of appetite, tiredness issues side effects, fertility, risks and benefits of treatment Emotional concerns worries about the future and relationships Sexual concerns loss of sex drive, body image Family matters worries about genetic risks, talking to your children Job, money or housing worries balancing work and treatment, benefits & financial advice Practical issues sorting out housework Spirituality your faith, beliefs and any impact this may have on your treatment You can download a copy by clicking here

10 Hand Held summaries Keeping my own record Pathways Breast Services in South Wales Cancer Network I have been diagnosed with breast cancer. What next? How is treatment planned? Referral to a breast clinic Types of breast cancer It s your appointment Choosing Together Fertility

11 Hand held summaries - Keeping my own record Macmillan s Mobile app To help you record everything from appointment times and contact details, to when to take your medication, Macmillan has a free app that s like a personal organiser. So whether you re at home or on the go, you can stay on top of things. It's easy to navigate and simple to use, so give it a try today by downloading for free from the Apple App Store or Google Play using your mobile phone. Hand help summaries my own treatment logs Your Breast Care Team may issue you with a booklet that you can use as your own log and personal record. There are 3 types; Oncology treatment & follow up Surgical (only) & follow up only You can also download them here LINK!

12 Pathways In most instances, your treatment would flow as shown in the diagram below For more details or clarification of your treatment pathway, please speak to your Breast Care Nurse

13 Breast Services in South Wales Cancer Network The South Wales Cancer Network (SWCN) breast service teams are long-established specialists for the diagnosis and treatment of benign breast disorders and of breast cancer. SWCN Breast services include; Routine screening Surgical care Oncology care Cancer follow up The breast service teams service pathways may vary by geographical areas across South Wales but all services are carried out within Best Practice Guidelines and in consideration of the Welsh Government Principles of Prudent healthcare.

14 I have been diagnosed with breast cancer. What next? Following your diagnosis your Surgeon and Breast Care Nurse will explain your individual plan for treatment. It can be very difficult to take everything in when you first hear that you have cancer. Your breast team understand the shock a diagnosis of breast cancer can bring. Depending on your breast cancer type, and your individual circumstances you may require; Surgery and medication (anti-hormone therapy) from the surgical team Surgery followed by treatments from the oncology team (there are a range of treatments including radiotherapy, chemotherapy, anti-hormone therapy or targeted therapy such as Herceptin) Chemotherapy or anti-hormone therapy before surgery Anti-hormone therapy only Your oncologist and Breast Care Nurse can explain which treatments you are advised to have and why. When your treatment is complete, you will be discharged to Follow Up. You may find it useful to contact a Breast Support Charity, they can provide group support or information support. Click for more for information about diagnosis

15 How is planned? MDT A team of specialists will meet to discuss and decide on the best treatment for you. The multidisciplinary team (MDT) will include; a surgeon, who specialises in breast surgery and may also specialise in breast reconstruction an oncologist (cancer specialist), who specialises in chemotherapy, radiotherapy, hormonal therapy and targeted therapy a specialist breast care nurse, who gives information and support a radiologist, who analyses x-rays and scans a pathologist, who examines the tissue and tells us the type of the cancer It may also include other healthcare professionals, such as a research nurse, physiotherapist, plastic surgeon - who specialises in breast reconstruction, psychologist, social worker or counsellor. Your cancer team looks at different factors to help decide which treatments are likely to work best for you. These include; the size, position and grade of the cancer if the cancer cells have specific characteristics eg hormone (oestrogen) receptors or HER2 (human epidermal growth factor) receptors your individual circumstances and wishes They will also assess the chance of your cancer coming back when planning how much treatment to offer you. After the MDT meeting (also known as an MDM multi disciplinary meeting), your cancer specialist or nurse will talk to you about the best treatment for your situation.

16 Fertility Some treatments such as chemotherapy, can affect your ability to become pregnant. The likelihood of becoming infertile depends on the type of treatment used, the dose given and your age. If you want to have children in the future it s important to talk to your team about fertility before you begin treatment. Your team can refer you to see a fertility specialist to discuss your options, this should be done as soon as possible after your diagnosis to minimise any possible delays to your treatment. Women are born with a set number of eggs in their ovaries (you don t produce new ones). By the time a woman reaches puberty, the number of eggs she has will have already decreased, and the number continues to decrease as she gets older. The ovaries stop releasing eggs, and monthly periods stop, when a woman reaches the menopause. Women are usually advised not to get pregnant during treatment and to use a suitable method of contraception. This is because treatment for breast cancer can damage an unborn baby at the early stages of development. Women having treatment are recommended to use non-hormonal methods of contraception, such as condoms or a diaphragm, these may also be referred to as barrier-method. You should use reliable contraception before and throughout treatment. After treatment your decisions about contraception will depend on how you feel about getting pregnant. Generally, you should assume you could still get pregnant unless you haven t had a period for at least a year after completing your treatment if you re 40 or over, or two years if you re under 40. However, this is a general guide and varies for each person. For further information visit

17 Menopause The ovaries produce the hormones oestrogen and progesterone which control a woman s monthly periods. The menopause happens when the ovaries stop producing these hormones. Permanent menopause signals the end of fertility, meaning you won t be able to have children. Some breast cancer treatments can affect the way the ovaries work, result in women starting their menopause earlier than expected. Other treatments may cause a temporary menopause or side effects similar to menopausal symptoms. Around 70% of women will have menopausal symptoms during and after treatment for breast cancer. Symptoms may include; Hot flushes and night sweats A lower sex drive Vaginal dryness and pain Palpitations (heartbeats that suddenly become more noticeable) Aches and pains Mood changes depression, anxiety, tiredness Sleeplessness Poor concentration There are ways to manage symptoms and live more comfortably with menopause, lifestyle changes such as diet, exercise and stopping smoking, may be just as important and effective in helping you feel better and live well, and your local cancer centre may have classes to help with the effects. for breast cancer causes changes in you and how you feel. If you find you are unable to cope or you keep feeling down, try talking with your GP or breast care team. They may be able to refer you to a qualified counsellor or therapist who can help.

18 Types of breast cancer There are different types of breast cancer. Knowing the type you have allows your doctor to plan your individual treatment see How is treatment planned (MDT) Ductal carcinoma in situ (DCIS) Lobular carcinoma in situ (LCIS) Invasive ductal breast cancer Invasive lobular breast cancer Inflammatory breast cancer Paget s disease of the breast

19 Ductal carcinoma in situ (DCIS) This is the earliest form of breast cancer. It s when there are cancer cells in the ducts of the breasts but they re contained (in situ) and haven t spread into normal breast tissue. DCIS shows on a mammogram and is usually diagnosed when women have breast screening.

20 Lobular carcinoma in situ (LCIS) Lobular carcinoma in situ is a term that can be misleading, it is not cancer. It is when there are changes in the cells lining the lobes, which increases a woman s risk of breast cancer later in life. Most woman with LCIS don t get breast cancer.

21 Invasive ductal breast cancer Most invasive breast cancers (80%) are this type. It is sometimes referred to as no special type (NST) or not otherwise specified (NOS) because when the cells are looked at under the microscope they have no particular features that class them as specific of breast cancer. Breast cancer starts when cells in the breast begin to divide and grow in an abnormal way. Invasive ductal breast cancer means the cancer cells are no longer only in the breast ducts. They have spread outside the ducts to the surrounding breast tissue and have the potential to spread to other parts of the body.

22 Invasive lobular breast cancer Breast tissue is made up of ducts and lobules where milk is made, stored and carried through to the nipple during breastfeeding. Invasive lobular breast cancer occurs when cancer cells have started to grow within the breast lobules and then spread outside into the surrounding breast tissue.

23 Inflammatory breast cancer This is when cancer cells grow along and block the tiny channels (lymph vessels) in the skin of the breast. The breast then becomes inflamed and swollen. Inflammatory breast cancer is a rare, fast-growing type of breast cancer. It accounts for one to four per cent of all breast cancers. Men can also get inflammatory breast cancer, but this is extremely rare.

24 Paget s disease of the breast Paget s disease of the breast is when the cancer usually affects the ducts of the nipple first, then spreads to the nipple surface and the areola (the dark circle of skin surrounding the nipple). The nipple and areola often become scaly, red, itchy and irritated. Malignant cells known as Paget cells are a telltale sign of Paget disease of the breast. These cells are found in the surface layer (epidermis) of the skin of the nipple. Paget cells often have a large, round appearance under a microscope; they may be found as single cells or as small groups of cells within the epidermis. Most people with Paget disease of the breast also have one or more tumours inside the same breast. The breast tumours are either ductal carcinoma in situ or invasive breast cancer.

25 It s your appointment Choosing Together How to get the most from your time with your clinician Before your appointment Write down your two or three most important questions, for example, What are my options? List or bring all your medicine and pills - including vitamins and supplements Write down details of your symptoms, including when they started and what makes them better or worse Ask for an interpreter or communication support if needed Why not ask a friend or family member to come with you Use this list to help you decide what you might want to discuss with your clinician. Your medicines and dealing with side effects Managing symptoms Keeping well, for example, smoking, healthy eating, physical activity, and alcohol Managing your emotions e.g. stress, anxiety, low mood to Benji re Ba comments During your appointment Don t be afraid to ask if you don t understand. For example, Can you say that again? I still don t understand If you don t understand any words, ask for them to be written down and explained Write things down or ask a family member or friend to take notes If you would like a copy of the full leaflet, which includes further information, please CLICK (LINK)

26 After a cancer diagnosis your care is delivered by a multidisciplinary team (MDT) The main treatments for breast cancer are Chemotherapy Radiotherapy Surgery Hormone (endocrine) therapy Biological therapy Clinical Trials Choosing the right treatment for you; When deciding what treatment is best for you, your doctors will consider: the stage and grade of your cancer (how big it is and how far it's spread) your general health whether you've experienced the menopause You can discuss your treatment with your care team at any time and ask questions.

27 How is planned? MDT A team of specialists will meet to discuss and decide on the best treatment for you. The multidisciplinary team (MDT) will include; a surgeon, who specialises in breast surgery and may also specialise in breast reconstruction an oncologist (cancer specialist), who specialises in chemotherapy, radiotherapy, hormonal therapy and targeted therapy a specialist breast care nurse, who gives information and support a radiologist, who analyses x-rays and scans a pathologist, who examines the tissue and tells us the type of the cancer It may also include other healthcare professionals, such as a research nurse, physiotherapist, plastic surgeon - who specialises in breast reconstruction, psychologist, social worker or counsellor. Your cancer team looks at different factors to help decide which treatments are likely to work best for you. These include; the size, position and grade of the cancer if the cancer cells have specific characteristics eg hormone (oestrogen) receptors or HER2 (human epidermal growth factor) receptors your individual circumstances and wishes They will also assess the chance of your cancer coming back when planning how much treatment to offer you. After the MDT meeting (also known as an MDM multi disciplinary meeting), your cancer specialist or nurse will talk to you about the best treatment for your situation.

28 Chemotherapy Chemotherapy involves using anti-cancer (cytotoxic) medication to kill the cancer cells. It's usually used after surgery to destroy any cancer cells that haven't been removed. This is called adjuvant chemotherapy. In some cases, you may have chemotherapy before surgery, which is often used to shrink a large tumour. This is called neo-adjuvant chemotherapy. Chemotherapy is usually given as an outpatient treatment, which means you won't have to stay in hospital overnight. The chemotherapy drugs are usually given through a drip straight into the blood through a vein. In some cases, you may be given tablets that you can take at home. It is usual to have chemotherapy over a period of four to eight months. is given once every two to three weeks, to give your body a rest in between treatments. The most common side effects of chemotherapy include: Increased risk of infections Loss of appetite Nausea and vomiting Tiredness Hair loss Sore mouth Most side effects can be prevented or controlled with medicines that your doctor can prescribe. Chemotherapy medication may also affect your periods and you may display signs of early menopause. You can talk to your treatment team for advice on managing side effects and you will be given a 24 hour contact number to call for advice if you are unwell at home following chemotherapy. Chemotherapy for secondary breast cancer If your breast cancer has spread beyond the breast and lymph nodes to other parts of your body, chemotherapy won't cure the cancer, but it may shrink the tumour, relieve your symptoms and help lengthen your life. This is called palliative chemotherapy.

29 Secondary Secondary breast cancer is often called metastatic breast cancer, advanced breast cancer, or stage 4 breast cancer. Being diagnosed with secondary breast cancer means that the cancer cannot be cured, although it can be treated and controlled, sometimes for years. Secondary breast cancer happens when cancer cells in the breast spread through the blood or lymph system to other parts of the body. When these breast cancer cells are seen in other parts of the body they are often called metastases, secondaries or secondary tumours. When you hear that your breast cancer has spread you may experience a mix of emotions, feelings can range from disbelief, denial and shock, to anger, numbness and helplessness. You may feel in turmoil, with your emotions close to the surface, however difficult this may seem, you can still have some control over how you manage the disease and deal with the emotions and practical issues it brings. You may find that you develop your own ways of coping or you may want to talk to a trained professional who can offer support and advice. The following healthcare professionals may be able to help you live with secondary breast cancer and will know what support is available in your area; Breast care nurse Macmillan or palliative care nurse Social worker Hospice / home care teams GP Psychology services Health visitor / school nurse For further information visit

30 Radiotherapy Radiotherapy is a treatment for cancer using high energy x-rays. The type and amount that you receive is carefully calculated to damage the cancer cells. This stops them from dividing properly so they are destroyed. Your treatment is planned to avoid as much healthy tissue as possible. Your treatment will usually begin about a month after your surgery or chemotherapy, to give your body a chance to recover. You'll have radiotherapy sessions up to five days a week, for three to six weeks. Each session will only last a few minutes. The type of radiotherapy you have will depend on your cancer and surgery type. Some women may not need to have radiotherapy at all. The types available are: breast radiotherapy radiation is applied to the whole of the remaining breast tissue chest wall radiotherapy radiotherapy is applied to the chest wall and may include the SCF (SupraClavicular Fossa - the triangular shaped indent above your clavicle) breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit (axilla) and the surrounding area to kill any cancer that may be present in the lymph nodes The side effects of radiotherapy include: Skin reactions Sore and tender breast Fatigue (extreme tiredness) Lymphoedema (excess fluid build-up in your arm caused by blockage of the lymph nodes under your arm) Sore throat and nausea (in some cases) Your radiographer will explain how to manage any reactions during your treatment.

31 Surgery There are two main types of breast cancer surgery: surgery to remove the cancerous lump (tumour), known as breast-conserving surgery surgery to remove the whole breast, which is called a mastectomy In the majority of cases Lymph node surgery will also be required Breastconserving surgery Mastectomy Lymph-node surgery In some cases women are given the choice of mastectomy or breast conserving surgery and the risks and benefits of each option can be fully discussed with your breast care nurse. It is essential that you consider all the pros and cons in order to make the right decision for you. There is a website specifically to help women make this decision; click for further information

32 Breast-conserving surgery Breast-conserving surgery ranges from a lumpectomy or wide local excision, where the tumour and some surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, where up to a quarter of the breast is removed. If you have breast-conserving surgery, the amount of breast tissue you have removed will depend on: the type of cancer you have the size of the tumour and where it is in your breast the amount of surrounding tissue that needs to be removed the size of your breasts Your surgeon will always remove an area of healthy breast tissue around the cancer, which will be tested for traces of cancer. If there's no cancer present in the healthy tissue, there's less chance that the cancer will reoccur. If cancer cells are found in the surrounding tissue, more tissue may need to be removed from your breast. After having breast-conserving surgery, you will usually be offered radiotherapy to destroy any remaining cancer cells.

33 Mastectomy A mastectomy is the removal of all the breast tissue, including the nipple. If you are going to have a mastectomy, your breast surgeon may discuss the option of having breast reconstruction with you. If you re having this at the same time as the mastectomy (immediate breast reconstruction), your breast surgeon may discuss other types of mastectomy but they will not be suitable for everyone. A skin sparing mastectomy This is removal of the breast tissue and nipple area without removing much of the overlying skin of the breast. A nipple-sparing mastectomy This is removal of all the breast tissue, without removing much of the overlying skin and the nipple area of the breast. You may be offered a delayed reconstruction (reconstruction months or years after your mastectomy) if there are medical reasons why an immediate one isn t advised. Or you may decide to have a mastectomy and consider a reconstruction at some point in the future. Many women chose not to have further breast surgery at all and your breast care nurse can fit you with a silicone prosthesis (falsie) which sits in the cup of your bra with or without a special pocket. The prosthesis is moulded to resemble the natural shape of a woman s breast, or part of a breast. The outer surface feels soft and smooth, and may include a nipple outline.

34 Lymph node surgery In most cases your surgery will involve your lymph nodes in the armpit nearest the affected breast, as this is usually the first place that breast cancer cells move to and this can help your team advise you on further treatments. If there are no obvious signs that the cancer has spread to your lymph nodes you will be offered a sentinel lymph node biopsy. This is a way of checking that, and involves finding and removing a small number of nodes when you have your breast surgery If the cancer has spread to your lymph nodes, you may need more extensive removal (clearance) of lymph nodes from the axilla (under your arm).

35 Hormone (endocrine) therapy Most breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body. These types of cancer are known as hormone-receptor-positive cancers. Hormone therapy works by significantly lowering the levels of hormones in your body or by stopping their effects. If your breast cancer isn't sensitive to hormones, hormone therapy will have no effect. If it is an appropriate therapy for you, you may be prescribed it after surgery, chemotherapy and radiotherapy. It is sometimes given before surgery to shrink a tumour, making it easier to remove. Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you from having surgery, chemotherapy or radiotherapy. The most commonly used hormone therapies are: Tamoxifen Letrozole Exemestane Anastrozole These 3 are aromatase inhibitors and work in a different way to Tamoxifen they can only be taken after you have gone through the menopause Tamoxifen can sometimes bring on early menopause, if that happens or if you are prescribed one of the aromatase inhibitors, you will have a DEXA (dual-energy x-ray absorptiometry) scan to check your bone density. Women at risk of bone thinning (osteoporosis) are advised to take vitamin D supplements to help with calcium absorption and may be prescribed drugs called bisphosphonates to protect their bones. Hormone therapy is an active treatment and if it is prescribed you should expect to take it for 5 to 10 years. It is very important that you do not stop taking it without discussing with your breast cancer team. You are likely to be reviewed at 5 years to decide whether to stop or continue for another 5 years. The type of hormone therapy may change during that time, dependent on your menopausal status.

36 Menopause The ovaries produce the hormones oestrogen and progesterone which control a woman s monthly periods. The menopause happens when the ovaries stop producing these hormones. Permanent menopause signals the end of fertility, meaning you won t be able to have children. Some breast cancer treatments can affect the way the ovaries work, result in women starting their menopause earlier than expected. Other treatments may cause a temporary menopause or side effects similar to menopausal symptoms. Around 70% of women will have menopausal symptoms during and after treatment for breast cancer. Symptoms may include; Hot flushes and night sweats A lower sex drive Vaginal dryness and pain Palpitations (heartbeats that suddenly become more noticeable) Aches and pains Mood changes depression, anxiety, tiredness Sleeplessness Poor concentration There are ways to manage symptoms and live more comfortably with menopause, lifestyle changes such as diet, exercise and stopping smoking, may be just as important and effective in helping you feel better and live well, and your local cancer centre may have classes to help with the effects. for breast cancer causes changes in you and how you feel. If you find you are unable to cope or you keep feeling down, try talking with your GP or breast care team. They may be able to refer you to a qualified counsellor or therapist who can help.

37 Bone Health Some treatments for breast cancer can increase your risk of getting osteoporosis, a condition that affects the bones so that they thin and become more brittle. Any cancer treatment in women that lowers oestrogen levels can increase the risk of osteoporosis. The National Institute for Health and Care Excellence (NICE) recommends that people with early invasive breast cancer should have a DEXA scan to assess bone mineral density if they; are starting aromatase inhibitor treatment have treatment-induced menopause are starting ovarian ablation or suppression therapy DEXA or DXA scan stands for dual energy X-ray absorptiometry. It is a scan that shows the density of your bones. You have X-rays (usually of your hip and your lower spine) and a machine detects how much of the X-ray is absorbed and how much passes through. The scan will take between ten and twenty minutes and is not in any way unpleasant or painful. Osteoporosis in people who have breast cancer is most commonly treated with a group of drugs called bisphoshonates. These drugs may also be prescribed alongside an aromatase inhibitor (exemestane, letrozole or anastrozole) to help protect against its effects on the bones. If you have osteoporosis, you will be advised about the appropriate treatment and given guidance on any changes to your diet or lifestyle that may be helpful. For further information click here

38 Biological therapy Some breast cancers are stimulated to grow by a protein called human epidermal growth factor receptor 2 (HER2). These cancers are called HER2-positive. Biological therapy works by stopping the effects of HER2 and by helping your immune system to fight off cancer cells. If your cancer has high levels of the HER2 protein and are able to have biological therapy, you'll probably be prescribed a medicine called Trastuzumab. Trastuzumab, also known by the brand name Herceptin, can be given after or at the same time as chemotherapy. Trastuzumab (Herceptin ) Trastuzumab is a type of biological therapy known as a monoclonal antibody. Antibodies occur naturally in your body and are made by your immune system to destroy harmful cells, such as viruses and bacteria. The Trastuzumab antibody targets and blocks the HER-2 receptors on and stops the cancer from growing Trastuzumab can be given in 2 different ways; Through a drip as an infusion into a vein in the back of the hand or arm As an injection under the skin into the thigh Trastuzumab may cause some heart problems. This is rare and the risk of developing serious heart problems is less than 1%. Your heart function will be monitored usually every 4 months for the first year of treatment. Other side effects of Trastuzumab may include : an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever diarrhoea tiredness aches and pains

39 Clinical Trials Cancer research trials are carried out to try to find new and better treatments for cancer. Trials that are carried out on patients are known as clinical trials. These are carried out to: Test new treatments, such as new chemotherapy drugs, hormonal therapies Compare the effectiveness of drugs used to control symptoms Look at new combinations of existing treatments, or change the way they are given to make them more effective or reduce side effects Find out how cancer treatments work Trials are the only reliable way to find out if a different type of surgery, chemotherapy, hormone therapy, radiotherapy or other treatment is better than what is already available. Clinical trials are key to developing new methods to prevent, detect, and treat cancer. It is through clinical trials that researchers can determine whether new treatments are safe and effective and work better than current treatments. When you take part in a clinical trial, you add to the knowledge about cancer and help improve cancer care. To find out more information click here

40 Follow Up After treatment for early stage breast cancer Breast prosthesis & reconstruction Routine breast screening Lymphoedema after breast cancer Medical Tattoos Fatigue FAQ after treatment

41 After treatment The end of treatment is a big event for most people. You may start to feel better and get back to doing things you like to do. The weeks and months of going to hospital frequently are over. Many feel like celebrating, but many do not, after treatment you may still be weak and have side effects that are impacting on you. You may feel you are not returning to normal, rather you are finding a new normal. This can be challenging and it is not unusual to feel scared. Be kind to yourself give yourself time to recover, this could take up to 12 months. What is Normal? It is normal to expect a wide range of emotions after cancer diagnosis and treatment. Many feel relieved and happy, but also can feel lonely, angry, worried and sad. It is very common to feel lonely or have a sense of being on your own after treatment ends. It is important to be aware of and manage expectations: Give yourself and those close to you time to get used to things,to sort through feeling and expectations Be honest about how you feel and what you need. Let others know what you are able to do Consider face to face support groups or online communities for yourself and also for family members. Enrol on Self management courses such as; Care Moving Forward or Macmillan Cancer Support HOPE

42 Macmillan Self Management Programme - Hope If you have or have had a cancer diagnosis Macmillan s free self management programme, HOPE, can help you set positive goals for your future. How do I sign up? To find out more please contact: Genette Webster, Learning and Development Manager for Wales waleslearning@macmillan.org.uk

43 for early stage breast cancer After you have completed all the parts of your breast cancer treatment, such as surgery, radiotherapy or chemotherapy, you will be monitored in follow up. If you have been prescribed hormone (endocrine) therapy you should not stop taking it unless your consultant advises you to. Across the South Wales Cancer Network area this is carried out by the surgical teams at the Breast Centres. During your follow up you will be invited to attend for regular mammograms over a specified number of years. Your follow up may also include appointments with the surgeon and/or oncologist or BCN. After you are discharged to follow up you may also receive and invitation from your breast care nurse to attend a Beyond Consultation, this is an additional opportunity for you to talk through what has happened and what will happen, and how you feel in general. You can contact the surgical breast care team during your follow up if you have any concerns; Ongoing hormone (endocrine) therapy Possible side effects from your chemotherapy or radiotherapy treatment Problems related to your original breast surgery Questions about breast reconstruction New changes in your breasts or chest wall region New medical symptoms that you are worried could represent a spread of your breast cancer

44 Breast prosthesis & reconstruction Breast prosthesis A breast prosthesis is an artificial breast form used to restore shape. Many women wonder how they will cope emotionally and practically after breast surgery if they have lost all or part of a breast. Reactions like this are very natural and it may take time for you to feel comfortable with the changes to your body. Most breast prosthesis are made from soft silicone gel in a plastic skin. They are moulded to resemble the natural shape of a woman s breast. NHS patients do not have to pay for their prosthesis and your surgical breast care nurse will arrange a fitting appointment for you. Reconstruction Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast. Reconstruction can sometimes be carried out at the same time as a mastectomy (immediate reconstruction), or it can be carried out later (delayed reconstruction). It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast. Further information can be found here If you have any questions or concerns, please contact your surgical breast care nurse

45 Routine breast screening BREAST TEST WALES provides breast screening for ladies in Wales, it is a free NHS test that is carried out at screening centres and accessible mobile units across Wales. Ladies aged 50 to 70 years are invited for a breast X-ray (mammogram) every three years Ladies over the age of 70 can ask for a screening appointment When Breast Test Wales are screening ladies from your GP practice, they will send you an appointment letter and information leaflet. You will receive your first invitation before your 53rd birthday. Don t ignore your breast screening, it could save your life. Breast screening reduces your risk of dying from breast cancer. Screening can find cancers when they are too small to see or feel. Finding and treating cancer early gives you the best chance of survival. You should: Be aware how your breasts normally look and feel. If you notice any changes it is important that you visit your GP. Breast cancer can run in families. If you are worried about your risk speak to your GP.

46 Lymphoedema after breast cancer Lymphoedema means long term (chronic) swelling. It can happen because cancer, or the effects of treatment, block the normal fluid drainage channels of the lymphatic system. Lymphoedema develops when lymph nodes or vessels are damaged or blocked, this means that lymph fluid is unable to pass through and drain away in a normal way. The lymphatic system becomes overloaded and fluid builds up between the tissues which then cause swelling. There are things you can do to help reduce your chances of developing lymphoedema. It s important to protect your arm and hand, and to look after the skin in that area. Here are some tips: Keep active and maintain a healthy lifestyle and weight Keep your skin clean and moisturise it every day with unperfumed cream or oil to keep it in good condition Wash small grazes and cuts straight away, put on antiseptic cream and cover if necessary See your GP straight away if you get signs of infection around a cut, for example, if it becomes hot, red or swollen Wear gloves and long sleeves when doing household tasks, DIY, gardening or when handling animals/pets Use nail clippers to cut your toe nails and don t push back or cut the cuticles Use an electric razor if you shave under your arms Here are some simple shoulder and arm exercises you could try and do everyday; Clench your hand to make a fist and then open and spread your fingers out wide repeat 10 times With your arm straight and your palm facing upwards lift your arm up so that your hand touches your shoulder repeat 10 times Sit upright and lift your arm up so that your hand is behind your head repeat 10 times Lymphoedema cannot be cured. However, with proper care and treatment, the affected limb can be restored to a normal size and shape. In addition, lymphoedema can be treated and controlled so that it does not progress further. If you notice any swelling or feeling of tightness in a limb, tell your doctor or specialist nurse. They ll be able to examine the area and do tests to check for lymphoedema. For further lymphoedema information click

47 Medical Tattoos If you have had a breast reconstruction, you may have been left without areolae (the small circular area around the nipple) or sometimes nipples. Medical tattooing can be used to create realistic looking reconstructions for you, this is also called micropigmentation. Medical tattooing can; Replicate the appearance of realistic looking areolae Reposition, recolour or reshape the overall appearance of nipples and areolae Reduce the appearance of radiotherapy marks Diffuse scarring from mastectomies s in medical tattooing are simple, safe, effective and minimally invasive. If you have had a breast reconstruction you must wait at least 3 months from surgery before having this procedure and we would not recommend you to have a tattoo whilst undergoing chemotherapy. This tends not to be a permanent procedure and often you will need to return for top up micropigmentation. Further information can be found by clicking here

48 FAQ after treatment My treatment has finished... now what?! You may wish to consider attending a supporting course, such as; Care Moving Forward or Macmillan HOPE When will I be notified of my mammogram appointment? You will normally have a mammogram either annually or 18 monthly for 5-10 years once your treatment is completed. You should receive your appointment to attend 4 weeks before it is due. If you have not received an invite, please contact your surgical breast care centre. What happens about my mammograms after my follow up from treatment is complete If you are UNDER 50 yrs- your Breast Centre will continue to carry out your mammograms until you reach 50 years of age If you are OVER 50 yrs your mammograms will be carried out by Breast Test Wales Screening Service every 3 years. If you are OVER 70 yrs you may contact Breast Test Wales Screening Service to request mammograms every 3 years Why do I need a bone health (DEXA) scan? A DEXA scan measures the density of bones and the risk of early stage osteoporosis if the patient is post menopausal and starting aromatase inhibitor (AI) therapy. What happens when my hormone (endocrine) treatment is due to end? Your breast care team will arrange an appointment, in person or by phone to discuss any requirements for medication in year 4 to 5 of your follow up Who can I discuss my hormone (endocrine) therapy medication with? Any symptoms / side effects, concerns or general queries you have with your hormone (endocrine) medication can be discussed with your treatment team, GP or community pharmacist. I take other medication regularly who can I discuss this with? You can request a general Medication Use Review (MUR) with your community pharmacist or GP, up to twice a year. An MUR can provide compliance/side effects information for any regular prescribed medication you may be taking.

49 Macmillan Self Management Programme - Hope If you have or have had a cancer diagnosis Macmillan s free self management programme, HOPE, can help you set positive goals for your future. How do I sign up? To find out more please contact: Genette Webster, Learning and Development Manager for Wales waleslearning@macmillan.org.uk

50 Hormone (endocrine) therapy Most breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body. These types of cancer are known as hormone-receptor-positive cancers. Hormone therapy works by significantly lowering the levels of hormones in your body or by stopping their effects. If your breast cancer isn't sensitive to hormones, hormone therapy will have no effect. If it is an appropriate therapy for you, you may be prescribed it after surgery, chemotherapy and radiotherapy. It is sometimes given before surgery to shrink a tumour, making it easier to remove. Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you from having surgery, chemotherapy or radiotherapy. The most commonly used hormone therapies are: Tamoxifen Letrozole Exemestane Anastrozole These 3 are aromatase inhibitors and work in a different way to Tamoxifen they can only be taken after you have gone through the menopause Tamoxifen can sometimes bring on early menopause, if that happens or if you are prescribed one of the aromatase inhibitors, you will have a DEXA (dual-energy x-ray absorptiometry) scan to check your bone density. Women at risk of bone thinning (osteoporosis) are advised to take vitamin D supplements to help with calcium absorption and may be prescribed drugs called bisphosphonates to protect their bones. Hormone therapy is an active treatment and if it is prescribed you should expect to take it for 5 to 10 years. It is very important that you do not stop taking it without discussing with your breast cancer team. You are likely to be reviewed at 5 years to decide whether to stop or continue for another 5 years. The type of hormone therapy may change during that time, dependent on your menopausal status.

51 Bone Health Some treatments for breast cancer can increase your risk of getting osteoporosis, a condition that affects the bones so that they thin and become more brittle. Any cancer treatment in women that lowers oestrogen levels can increase the risk of osteoporosis. The National Institute for Health and Care Excellence (NICE) recommends that people with early invasive breast cancer should have a DEXA scan to assess bone mineral density if they; are starting aromatase inhibitor treatment have treatment-induced menopause are starting ovarian ablation or suppression therapy DEXA or DXA scan stands for dual energy X-ray absorptiometry. It is a scan that shows the density of your bones. You have X-rays (usually of your hip and your lower spine) and a machine detects how much of the X-ray is absorbed and how much passes through. The scan will take between ten and twenty minutes and is not in any way unpleasant or painful. Osteoporosis in people who have breast cancer is most commonly treated with a group of drugs called bisphoshonates. These drugs may also be prescribed alongside an aromatase inhibitor (exemestane, letrozole or anastrozole) to help protect against its effects on the bones. If you have osteoporosis, you will be advised about the appropriate treatment and given guidance on any changes to your diet or lifestyle that may be helpful. For further information click here

52 Fatigue Fatigue is being tired physically, mentally, and emotionally. It's the most common side effect of cancer treatment, and it often hits without warning. Everyday activities talking on the phone, shopping for groceries, even lifting a fork to eat can be overwhelming tasks. 75% of people with cancer have to cope with low energy levels. Low energy levels can stop you from doing things that are important to you. Things that used to take not much energy now take lots of energy. It can be helpful to think about energy levels as a rechargeable battery. Before your diagnosis, you would use the energy in your battery and then recharge it with food, rest and sleep. Now you have a smaller battery, that uses energy faster. Food, rest and sleep do not always recharge your battery. Prioritise. Does it all need to be done? Does it need to be done by you? Give yourself permission to say no and to tell others how you are feeling. Plan. Use an energy diary to help you know when your energy levels are highest. This information can help you to plan your day. You can break things down into smaller tasks and do them over the whole day. Pace. Allow extra time to get things done. Always stop before you get tired. Can you make the task easier? For example, sit instead of standing when ironing or gardening.

53 Secondary Menopause Bone health Talking to your children Intimacy Looking in the mirror

54 Secondary Secondary breast cancer is often called metastatic breast cancer, advanced breast cancer, or stage 4 breast cancer. Being diagnosed with secondary breast cancer means that the cancer cannot be cured, although it can be treated and controlled, sometimes for years. Secondary breast cancer happens when cancer cells in the breast spread through the blood or lymph system to other parts of the body. When these breast cancer cells are seen in other parts of the body they are often called metastases, secondaries or secondary tumours. When you hear that your breast cancer has spread you may experience a mix of emotions, feelings can range from disbelief, denial and shock, to anger, numbness and helplessness. You may feel in turmoil, with your emotions close to the surface, however difficult this may seem, you can still have some control over how you manage the disease and deal with the emotions and practical issues it brings. You may find that you develop your own ways of coping or you may want to talk to a trained professional who can offer support and advice. The following healthcare professionals may be able to help you live with secondary breast cancer and will know what support is available in your area; Breast care nurse Macmillan or palliative care nurse Social worker Hospice / home care teams GP Psychology services Health visitor / school nurse For further information visit

55 Menopause The ovaries produce the hormones oestrogen and progesterone which control a woman s monthly periods. The menopause happens when the ovaries stop producing these hormones. Permanent menopause signals the end of fertility, meaning you won t be able to have children. Some breast cancer treatments can affect the way the ovaries work, result in women starting their menopause earlier than expected. Other treatments may cause a temporary menopause or side effects similar to menopausal symptoms. Around 70% of women will have menopausal symptoms during and after treatment for breast cancer. Symptoms may include; Hot flushes and night sweats A lower sex drive Vaginal dryness and pain Palpitations (heartbeats that suddenly become more noticeable) Aches and pains Mood changes depression, anxiety, tiredness Sleeplessness Poor concentration There are ways to manage symptoms and live more comfortably with menopause, lifestyle changes such as diet, exercise and stopping smoking, may be just as important and effective in helping you feel better and live well, and your local cancer centre may have classes to help with the effects. for breast cancer causes changes in you and how you feel. If you find you are unable to cope or you keep feeling down, try talking with your GP or breast care team. They may be able to refer you to a qualified counsellor or therapist who can help.

56 Bone Health Some treatments for breast cancer can increase your risk of getting osteoporosis, a condition that affects the bones so that they thin and become more brittle. Any cancer treatment in women that lowers oestrogen levels can increase the risk of osteoporosis. The National Institute for Health and Care Excellence (NICE) recommends that people with early invasive breast cancer should have a DEXA scan to assess bone mineral density if they; are starting aromatase inhibitor treatment have treatment-induced menopause are starting ovarian ablation or suppression therapy DEXA or DXA scan stands for dual energy X-ray absorptiometry. It is a scan that shows the density of your bones. You have X-rays (usually of your hip and your lower spine) and a machine detects how much of the X-ray is absorbed and how much passes through. The scan will take between ten and twenty minutes and is not in any way unpleasant or painful. Osteoporosis in people who have breast cancer is most commonly treated with a group of drugs called bisphoshonates. These drugs may also be prescribed alongside an aromatase inhibitor (exemestane, letrozole or anastrozole) to help protect against its effects on the bones. If you have osteoporosis, you will be advised about the appropriate treatment and given guidance on any changes to your diet or lifestyle that may be helpful. For further information click here

57 Talking to your children A diagnosis of and a treatment for cancer can affect lots of different relationships in your life. Including; o Your partner o Adult family members o Children o And friends and colleagues Relationships can be an important source of support during and after treatment. But sometimes it can be hard to talk to each other about how you are feeling or what is happening. Many parents and carers worry about how to talk to their children about cancer. You cannot protect them from feeling sad, but you can help them to understand what s going on. Children who know what is happening can feel safer, supported and less worried. Try to keep your family routine as normal as possible. This helps children feel safe and secure. Let them know it s ok to ask questions and to talk to other people they trust too. Let people who care for them know what is happening, for example school. Let them know that someone will always look after them, even when you are not able to, for example, when you are in hospital. Tell them how they can talk to or be with you if you need to go into hospital. Remember to keep having fun together.

58 Intimacy Breast cancer changes may affect the way you see your body. It will almost certainly affect how you feel about sex and intimacy. People with breast cancer may lose interest in sex and intimacy for many reasons, it may be as a result of diagnosis itself, treatment or side effects or concerns about body image. Body image and self esteem play an important part in how we feel about our sexuality and appearance. Open communication between you and your partner is an important step towards reclaiming your sexuality. Partners may be confused or unsure of the best way to show support and affection. They may retreat or wait for cues from you about when to resume an intimate or sexual relationship. Discussing each person's fears, hopes and comforting each other can help you and your partner have a satisfying sexual relationship. If you re not comfortable with your body, you could wear lingerie. There s nothing wrong with getting a little help. A soft, satin nightie can be sexy and arousing. At the same time, it can help to conceal areas you re still shy about. Your sexual health and wellbeing are linked to your overall health. Eating well, controlling weight, reducing stress, getting enough sleep and doing regular exercise are all important to maintain a positive body image and increase energy levels during treatment and recovery. As you become more comfortable and gain confidence with the new you, other parts of your body may be causing you problems in your intimate and sexual relationship. You may go through temporary or early menopause because of chemotherapy or anti hormone medication - Tamoxifen. Common side effects occur particularly menopausal flushes, joint aches and pains, vaginal dryness, vaginitis and other symptoms that may contribute painful intercourse and an unfulfilled sex. There is support and help available, you don t have to suffer in silence speak to your Specialist nurse

59 Looking in the mirror Cancer treatment can change your appearance and many people feel very angry when they first look at themselves in the mirror after their treatment. The effect of surgery, loss of eyebrows, eyelashes and hair from your head, your skin may be drier or greasier than usual. Just give yourself a bit of time to let it all sink in. It might be hard to imagine but slowly you will start to feel a bit better about things. Our appearance is closely linked to our feelings of self esteem and trying to accept sudden changes in your looks can be hard. You may feel worried about how your friends and family see you. You may think that you are no longer physically attractive to your partner. It s natural to worry about these things. The important thing to remember is that the people closest to you will not see you any differently as a person. They will want to support you as much as they can, so it is important to tell them how you re feeling. Talking things through can help you to feel less isolated and more able to cope. Make up Hair Skin changes Weight changes

60 Make up Using make up can help you to look brighter and this in turn can help you to feel better about yourself. There are lots of websites that have information and online tutorials for women having chemotherapy. Look Good Feel Better Look Good Feel Better doesn't make any bold claims: what it does is help with the visible sideeffects of cancer, showing patients how to care for dry skin or pencil in eyebrows that have thinned after treatment. But that's the whole point. Because when you look at yourself in the mirror and see someone who doesn't look like a cancer patient, you don't feel like one either. Hannah Partos Baldly Beautiful When Andrea Pelligrini was diagnosed with breast cancer she decided to use her skills as a make up artist to advise others dealing with cancer. She set up the YouTube channel, Baldly Beautiful, an on-going series of make-up tutorials for women having chemotherapy. Semi permanent makeup and medical tattooing You may wish to consider semi permanent make up prior to starting your chemotherapy treatment. The treatment lasts around 3 5 years and are carried out in accordance to strict health and safety protocols using single use sterile needle cartridges. Boots Macmillan Beauty Advisors The beauty advisors can give you tips for your skin, hair and nails to help you look and feel good.

61 Hair Hair loss is one of the most well known side effects of cancer treatment. It is a common side effect of chemotherapy. Hair loss and hair thinning can be very stressful. Some people find it the hardest part of having cancer and its treatment. Hair loss is almost always temporary and hair usually starts to grow back once chemotherapy has finished, sometimes sooner. Cold caps are tightly fitting, strap-on hats filled with gel that s chilled, that may help some women keep some or quite a bit of their hair during chemotherapy. Because the caps are so cold, they narrow the blood vessels beneath the skin of the scalp, reducing the amount of chemotherapy medicine that reaches the hair follicles. With less chemotherapy medicine in the follicles, the hair may be less likely to fall out. You wear the caps before, during, and after each chemotherapy session. Wigs and hairpieces are practical solutions to hair loss. There are different styles available so you can find one that suits you. Toni&Guy Strength in Style Offering people affected by cancer specialist support and advice on hair care. The service includes styling pre, during and post treatment hair, and wig personalisation with the option to purchase synthetic and human hair wigs. Click here to book an appointment For further information, help and advice

62 Skin changes Cancer treatment may affect the appearance of your skin and nails. Your skin may become dry or oily, sore or red and more sensitive. Your nails may become brittle, flaky, ridged or lined. Sometimes they may become painful or swollen. For some people, skin changes are difficult to cope with because they cause visible changes to the body. General tips; Clean your body with lukewarm water and non-perfumed bath and shower oils Pat your skin dry with a clean, soft towel A good cleanser and a light, oil-free moisturiser should help keep your skin in good condition. Protect yourself in the sun with minimum factor SPF30 sun cream Wear a hat or scarf on your head when it s sunny Wear loose clothes made of cotton or natural fibres Use petroleum jelly or lip balm on dry or sore lips Use an electric razor instead of wet-shaving to minimise the risk of cuts Use a hand, foot and nail cream regularly Massaging a good cuticle cream into your cuticles will help prevent dryness, splitting or hangnails Use an emery board rather than cutting or clipping your nails Wear gloves while doing household chores, especially the washing-up Don t use false nails during treatment or when nails are sore or damaged During treatment, if you develop any pain or a rash, always get it checked by your oncology team straightaway. They will know the cause and be able to give you some advice.

63 Weight changes After your treatment for breast cancer you may find you ve gained or lost weight. Weight gain, especially around the waist can be a distressing as well as unexpected effect of treatment. It can affect how you feel about your body and leave you with low self-esteem. Weight gain may be due to; the side effects of some drugs the body retaining fluid being less active that usual overeating when you re anxious the menopause Remember; eat plenty of fruits and vegetables eat wholegrain varieties of bread, pasta and cereals limit fat, sugar, and refined flour. drink plenty of water. use healthier cooking methods whenever possible, such as steaming instead of frying If you ve lost weight during treatment, some simple changes to your diet can help; add extra oil, butter, margarine or cheese to savory dishes make hot drinks with milk rather than water Avoid low-fat or healthy option foods There is evidence to show that being active and maintaining a healthy weight after treatment can reduce the risk of breast cancer coming back. Care has produced a DVD, Eat well, keep active after breast cancer to help people get back into activity and eat healthily after breast cancer treatment. Your GP or practice nurse will be able to give you more information on achieving a healthy weight if needed or they can refer you to a dietician for further advice if necessary.

64 Family history of breast cancer Benefits & other financial support Who is who? Meet the team

65 Who is who Advanced Nurse Practitioner ANP Diagnostic Radiographer Oncologist Specialist Nurse CNS or BCN Specialist Registrar - SpR Therapeutic Radiographers (radiotherapy) Advanced nurse practitioners are highly experienced nurses with additional responsibilities in the clinical environment. Their extra training and high level of knowledge means they can diagnose, treat and prescribe medications as appropriate to their specialty. Your diagnostic radiographer will take x-rays, CT scans, ultrasounds and MRI s as requested by the clinician An Oncologist is a doctor that specialises in the treatment of cancer. There are two types; a medical oncologist, who specialises in the administration of chemotherapy and a clinical oncologist, who also has training in the administration of radiotherapy. A Specialist Nurse will be an expert in nursing practice, with a certain speciality ie breast care. They will provide information, practical and emotional support and act as your key worker (a point of contact for you and your carers) throughout your treatment. Your nurse may be a CNS Clinical Nurse Specialist, a BCN Breast Care Nurse, or an ANP Advanced Nurse Practitioner An SpR (or StR) is a doctor who is receiving advanced training in a specialist field of medicine in order to become a consultant. A team of radiographers who will plan and administer your radiotherapy treatment. The radiographers will look after any side effects caused by radiotherapy treatment.

66 Macmillan Care Tenovus Look Good Feel Better CoppaFeel! Cancer Research Patient Liaison Group Velindre Cancer Centre Velindre Information Portal NHS Choices

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