Post Surgery Care
“Do I need more treatment?”
“How do I Follow-up after treatment?”
“How will Support Group help me?”
After the Surgery
After surgery, we go through the pathology report with you and your family. Every post-operative case is discussed at our weekly multidisciplinary meeting, where the team agrees the plan for further treatment.
Our multidisciplinary team includes the surgical oncologist, radiologists, pathologists, medical and radiation oncologists, a physiotherapist and supporting staff.
What treatment might follow surgery
Which of these you need depends on the biology of your cancer and on what the surgery found. Very few patients need all of them.
- Chemotherapy, usually over four to six months
- Radiation, most often over about three weeks
- Endocrine therapy, for hormone-receptor-positive cancers, taken as a daily tablet for five years or longer. This is the single most important treatment for most women with this type of breast cancer.
- Targeted therapy, for HER2 positive cancers, given over about a year
- Immunotherapy, for some triple negative cancers
Treatment after surgery usually begins four to eight weeks later, once you have healed. Endocrine therapy generally starts after chemotherapy and radiation are finished.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells or stop them growing. It can be given by injection, by a drip or as tablets, on its own or alongside other treatments.
You might have chemotherapy:
- Before surgery, to shrink the cancer and to show us how it responds
- After surgery, to reduce the chance of the cancer coming back
- As a treatment in its own right, where the cancer type responds well to it
- To treat cancer that has spread beyond the breast
Will I need chemotherapy?
This is the question that haunts almost every patient, so let me answer it properly.
Not everyone with breast cancer needs chemotherapy. For many women with hormone-receptor-positive cancer that has not spread to the lymph nodes, a genomic test on the tumour tissue can tell us how likely chemotherapy is to help. Where the test shows little or no benefit, we can safely leave chemotherapy out and treat with endocrine therapy alone. This is now standard practice and it spares a great many women a treatment they do not need.
Where chemotherapy is indicated, its role is crucial. It works on cancer cells circulating in the body and it substantially reduces the chance of the disease returning.
Most of what patients have heard about the side effects is worse than the reality. When I talk to my own patients after they have finished, most of them tell me it was not as bad as they had feared. Please come to this decision with correct information from your medical oncologist rather than with the fear you arrived with.
Will I lose my hair permanently?
For almost everyone, hair loss is temporary. Your hair will grow back once the cycles are over, though the texture can be different for a while.
Nothing affects a woman’s sense of herself more than losing her hair, and I take that seriously rather than dismissing it. Scalp cooling during treatment reduces hair loss for many patients, and it is worth asking your oncologist whether it is available and suitable for you.
Radiation Therapy
Radiation therapy is a local treatment. It is targeted at the breast or chest wall, and sometimes at the nodes above the collarbone, to destroy any cancer cells that may remain in those areas after surgery.
It is delivered by a machine that looks much like a scanner, and it is planned and supervised by a radiation oncologist.
How long does it take?
Shorter than it used to. Most patients now complete radiation in about three weeks rather than five, and in selected cases an even shorter course of about a week is appropriate. Treating only part of the breast rather than the whole breast is another option for some patients. Each session itself takes only a few minutes.
Is it painful?
The treatment itself is painless. You feel nothing while the machine is running.
The effects build up gradually over the course. The skin in the treated area usually darkens and may become dry, itchy or tender, rather like sunburn, and this settles over the weeks after treatment finishes. Tiredness is common and often the symptom patients find hardest, particularly if radiation follows chemotherapy.
Tell your radiation oncologist about skin soreness early rather than waiting. It is much easier to manage before it becomes severe.
Follow up care after treatment
It is normal to worry about the cancer coming back once treatment is over. We will talk this through with you and agree a follow-up plan.
How often will I be seen?
Counting from the end of your treatment:
- First three years: every three to six months
- Years four and five: every six to twelve months
- After five years: once a year
Each visit involves talking through any new symptoms and a physical examination, with a mammogram once a year. Staying with your family doctor for general health checks matters too.
Why you will not be sent for routine scans
CT, PET-CT, MRI and blood tumour markers are not recommended as routine follow-up tests for someone with no symptoms. They do not improve outcomes, and they generate findings that lead to further tests and considerable anxiety without changing anything. This is a deliberate decision based on good evidence, and it is what international guidelines advise.
If you develop a symptom that needs investigating, we will investigate it properly and promptly. That is a different situation.
If you are on endocrine therapy
Follow-up also covers how you are managing with the tablets. Side effects are common and often treatable, and stopping early reduces how well the treatment works, so please tell us rather than stopping on your own. If you are taking an aromatase inhibitor, your bone density will be monitored as well.
Support Group
“We are with you.”
Cancer affects your body, but it also affects your mind. From the moment of diagnosis and through the long months of treatment, almost every patient has periods of anxiety and low mood. There is a fear of the unknown, and a sense of emptiness that is hard to describe to people who have not been through it.
Our support group offers:
- A place to meet, in person or online
- Hope and practical guidance for newly diagnosed patients
- Support for the families and friends who are carrying this too
- Advice on diet, fitness and yoga for breast cancer survivors
- Information for anyone who wants to understand breast cancer and its treatment better
- Survivors sharing their own stories of how they came through it
Meeting women who have finished treatment and are living well again does something that no amount of medical reassurance can. It is often the moment a patient starts to believe she will get through this.
Ask us at your next appointment and we will tell you when the group next meets.
Online Counselling
Cancer brings up things that are difficult to say out loud to the people closest to you, often because you are trying to protect them. Sometimes it is easier to talk to someone outside the family who understands what this illness does to a person.
An experienced counsellor or psychologist can help you find ways to face what is ahead, whether that is fear about the treatment, changes to how you feel about your body, strain at home, or the flatness that can settle in once treatment ends and everyone assumes you are fine.
Write to us with what is troubling you and one of our counsellors will get in touch. Everything you share is kept strictly confidential.
