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Adjuvant Treatments Some women are advised by their doctor to have additional treatment after their surgery. The purpose of this treatment is to eradicate any remaining cancer cells which may have spread before surgery. This additional treatment is called adjuvant or systemic therapy. Occasionally this treatment is given prior to surgery to shrink the tumour so that surgery becomes possible (neo-adjuvant treatment).
Adjuvant (or additional) treatments may include:
A woman may be recommended to have none,
one or a combination of these therapies according to her test results.
What is radiotherapy? Radiotherapy (sometimes called radiation therapy) uses x-rays to kill cancer cells. The main type of radiotherapy used in Australia is called external beam radiotherapy and usually comes from a machine called a linear accelerator. If you have had breast conserving therapy your doctor will probably recommend that you have radiotherapy. Some women who have had a mastectomy may also have radiotherapy. The radiation can be targeted onto cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue. Your first radiotherapy appointment will be with your Radiation Oncologist who will examine you, explain your treatment and answer any questions you may have. At the second appointment they will make a number of marks on your skin (simulation planning). These marks consist of lines, crosses and dots applied with special inks. They are intended to ensure that exactly the same area is treated each time. Usually you will have radiotherapy to the whole breast for five days a week over several weeks. This treatment is administered by a Radiation Therapist. You have the treatment as an outpatient. It is painless and only takes a few minutes for each treatment.
What are the side-effects of radiotherapy? The side effects of radiotherapy may include general tiredness and some reddening or 'sunburning' of the skin which usually returns to normal in a few weeks. There may also be swelling of the breast which takes longer to settle. If your skin is damaged (blisters and breaks down) radiotherapy nurses can show you how to care for it. After radiotherapy, your breast may feel slightly firmer and may change a little in size or shape. There are other much less common side effects and your radiation oncologist will discuss these with you. For more information refer to The Cancer Council's "Coping With Radiotherapy".
What is chemotherapy? Chemotherapy is the use of drugs to kill cancer cells, or interfere with their growth. As well as treating the cancer, chemotherapy may be used to relieve symptoms. The treatment may be administered in different forms, such as tablets, injections into a vein or through a drip, or a combination of these. Chemotherapy is given in cycles, with each
period of treatment followed by a recovery period. If you have chemotherapy
after surgery, it will usually begin within a few weeks of your
surgery and prior to radiotherapy treatment.
What are the side-effects of chemotherapy? Most side-effects are temporary and can be controlled or even prevented. They vary with the particular drug used. Side-effects may include nausea, vomiting, feeling "off colour" and tired, and some thinning or loss of hair from your body and head. These side effects are temporary, and steps can be taken to prevent or reduce them. If you are still having periods, you may find that your period stops while you are having treatment. Depending on your age, it is possible that your periods may not return once the treatment has stopped. Before you undergo chemotherapy you may want to discuss issues regarding your fertility and early onset of menopause with your doctor. For more information refer to The Cancer Council's "Chemotherapy and Why It Is Used".
What is hormone treatment? The growth of some breast cancers may be influenced by hormones such as oestrogen and progesterone. These breast cancers can be treated by reducing the effect of the hormones. Currently the most common hormone treatment for breast cancer is tamoxifen. This blocks the effects of oestrogen in the cancer cells. In most people treated for early breast cancer, tamoxifen reduces the chance of the breast cancer coming back. It works in people whose cancers are oestrogen-receptor (ER) positive and/or progesterone-receptor (PR) positive. Tamoxifen is taken daily as a tablet, usually over five years. Other hormone treatments, such as Anastrozole, Letrozole and Exemestane are now also in use. Discuss your hormone treatment with your Medical Oncologist, Radiation Oncologist, Surgeon or GP.
What are the side-effects of hormone treatment? Side effects of tamoxifen include hot flushes, vaginal discharge or irritation and irregular periods (if you are still menstruating). A small percentage of women may develop blood clots or cataracts. Another risk of taking tamoxifen is that a small number of women (less than 1%) develop cancer of the uterus. Tell your doctor if you have any unusual vaginal bleeding or discharge. If you experience any of these side effects your doctor will be able to advise you about how to manage them. Your Breast Care Nurse may also be able to help. For more information refer to Better Health Channel's "Breast Cancer and Oestrogen".
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