PATIENT INFORMATION about BREAST CANCER
What is Breast Cancer? The female breast is made up mainly of: Lobules (milk-producing glands) Ducts (tiny tubes that carry the milk from the lobules to the nipple) Stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels) When breast cells divide and grow without control, breast cancer occurs. Breast cancer that is confined to the ducts (Ductal Carcinoma In Situ) is non-invasive breast cancer. At this stage when detected early, breast cancer can be treated and has a very good chance for cure. Cancer that spreads beyond the ducts or lobules to the surrounding breast tissue enters the invasive stage. Over time, breast cancer in the invasive stage can spread to the lymph nodes and possibly to other areas of the body. Who is at risk? Women aged 40 years and above Family history (mother or sister) of breast cancer A personal history of breast cancer or benign (non-cancer) breast disease Early onset of menstruation and late menopause Having no children or having the first child at late stages (especially above 30 years) Those on hormone replacement therapy People who think they may be at risk should discuss this with their doctor. What are the signs and symptoms? In the early stages of breast cancer, there is usually no pain or symptoms at all. Breast cancer may cause any of the following signs and symptoms: A lump or thickening in or near the breast or in the underarm area Change in the size or shape of the breast Blood or unusual nipple discharge Dimpling or puckering of skin overlying the breast Itchy rash of the nipple Scaly, red or swollen skin on the breast, nipple or areola (the dark area of skin that is around the nipple) Recent history of nipple retraction (a nipple turned inward into the breast)
What can you do to prevent Breast Cancer? Practise a healthy lifestyle and maintain a healthy weight (Avoid alcohol intake) Avoid long-term hormone replacement therapy Most importantly, participate in screening mammograms regularly* *The chart below states the recommended guidelines for breast screening. How is Breast Cancer diagnosed? Breast cancer is sometimes found after symptoms appear, but many women with early breast cancer have no symptoms which is why getting the recommended screening test mentioned in the previous section is so important. Breast cancer is detected through: (1) Clinical Examination and (2) Mammography. Mammography is sometimes combined with an (3) Ultrasound scan of the breast to determine if the lump is mainly solid or cystic. If something suspicious is found during a screening exam such as the mammogram, you will be called in for further imaging. To confirm the diagnosis, your doctor will usually perform a breast biopsy where a sample tissue of the suspicious area in your breast is removed to be looked at under a microscope. A biopsy is the only way to tell if cancer is really present. Biopsy techniques include: Fine Needle Aspiration (FNA) Biopsy Core Needle Biopsy Excisional Biopsy Mammotome Biopsy The choice of which biopsy to use will depends on several factors which you can discuss with your doctor.
What are the treatment options? Stage 0 Treatments differ depending on what kind of stage 0 cancer the patient has 1 Early stage breast cancer: Cancer has not spread beyond the breast Treatment Surgery is the usual initial treatment for this stage. Smaller tumours: Lumpectomy (only the abnormal cells and some tissue is removed) Another option: Mastectomy (entire breast is removed) Radiation therapy is the standard treatment after a lumpectomy. It attacks any abnormal cells that might have been missed during surgery. Surgery is the standard treatment. Small tumour: Cancer is removed with the safest minimal amount of surrounding tissue (wide excision). In other cases, a mastectomy will be performed. Some of the lymph glands in the armpits are also removed at the same time. Radiation therapy is standard after a lumpectomy. Women with stage I cancer who get a mastectomy do not usually need radiation. Chemotherapy is treatment with drugs that attack cancer cells. It is often used after surgery to lower the risk of recurrence. Women who have larger tumours are more likely to need it. Hormone therapy is used after surgery in women who have hormone receptor-positive cancer (tumours whose growth seems dependant on estrogen). Drugs such as tamoxifen, an antiestrogen drug may be administered. 2 Cancer is still contained within the breast and (in some cases) in nearby lymph nodes 3 Cancer still has not spread far beyond the breast and nearby lymph nodes 4 Cancer has spread elsewhere in the body Affected areas may include the bones, brain, lungs, liver, or other sites The treatment options are similar to the ones for stage 1 cancer. Sometimes, chemotherapy in this stage is used as neoadjuvant therapy (treatment before surgery to shrink a tumour). If it works, the tumour might then be small enough to remove in a lumpectomy. Chemotherapy is a common treatment here. Surgery, chemotherapy and radiation therapy are usually used to treat Stage 3 breast cancer. As multiple areas may be involved, treatments like surgery or radiation alone are not sufficient. The objective is to shrink the cancer to slow down the disease and prolong life. Drug therapy like hormonal therapy, chemotherapy or targeted therapy is the main treatment here.
Support Group Established in 2001, the Breast Support Group is the first cancer support group that was established in National University Hospital (NUH). The support group was formed with the aim of providing an avenue for women diagnosed with breast cancer to share their experiences and offer mental and emotional support to each other. Membership is free. For more information, please call the CancerLine Nurse at: 9722 0569 (Mon Fri: 8.30am 5.30pm) or email CancerLineNurse@nuhs.edu.sg. About NCIS The National University Cancer Institute, Singapore (NCIS) is the only comprehensive public cancer centre in Singapore treating both paediatric and adult cancers in one facility. Located at the National University Hospital (NUH), NCIS offers a broad spectrum of cancer care with expertise in prevention, screening, diagnosis, treatment, rehabilitation and palliative care. Contact Information National University Cancer Institute, Singapore (NCIS) Cancer Centres Kent Ridge Wing, Level 3 and 4 Radiation Therapy Centre (RTC) Kent Ridge Wing, via Linkway on Level 4 Opening Hours: 8:30am 5:30pm (Mon Fri: except on Public Holidays) For appointments, please contact Tel: (65) 6773 7888 Email: CancerApptLine@nuhs.edu.sg For International Patients and Visitors The International Patient Liaison Centre (IPLC) is a one-stop centre to support all the medical needs of our foreign patients. Tel: (65) 6779 2777 (24-hour Helpline) Fax: (65) 6777 8065 Website: www.nuh.com.sg/iplc For all other general enquiries, please contact National University Cancer Institute, Singapore (NCIS) 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore 119228 Email: ncis@nuhs.edu.sg Website: www.ncis.com.sg
Nearest MRT Station: Kent Ridge Station (Circle Line) Commuters can alight at the Kent Ridge Station right at the doorstep of the NUH Main Building. Please exit the station via Exit A. For more information on directions to NUH, log on to www.nuh.com.sg. For more information on specific directions to NCIS Clinics, log on to www.ncis.com.sg. National University Hospital 5 Lower Kent Ridge Road, Singapore 119074 Tel: (65) 6779 5555 Fax: (65) 6779 5678 Website: www.nuh.com.sg Information in this brochure is given as a guide only and does not replace medical advice from your doctor. Please seek advice from your doctor if you have questions related to the surgery, your health or medical condition. Information is correct at time of printing (Mar 2012) and subject to revision without notice.