Breast cancer is the most common form of cancer after prostate cancer. There are different types of breast cancer. Most people get rid of the disease after treatment if the breast cancer is detected early. There are also treatments that can make you live a good life for a long time if the breast cancer is discovered later and has been able to spread.
In the beginning, breast cancer usually gives no symptoms. After a while you may have one or more symptoms.
Lump in the chest or armpit
A lump in the chest or armpit can be breast cancer. This is especially true if you are older and if the tuber is new and it has been a few weeks without it appearing to be about to disappear.
Lumps that disappear after a menstrual period are usually harmless. It is not possible to determine with your fingers whether a lump is a cancerous tumor.
The breast may look different than it usually does. The skin or nipple may be retracted.
Having pain is an unusual symptom of breast cancer. It is much more common that it depends on the menstrual cycle. The week before menstruation , the breasts may feel swollen, tense and sore. Such regular changes are harmless and usually present in both breasts.
Other unusual symptoms are having a wound that does not heal, or a redness of the skin without injuring yourself. The breast can flush, become swollen and sore if, for example, you breastfeed and get milk compression .
It is also an unusual symptom that the skin on any part of the breast becomes thicker with small pits.
Fluid from the nipple is an unusual symptom of breast cancer. The liquid may be bloody, brownish or translucent watery.
When and where should I seek care?
If you think you have breast cancer, contact a health care provider. In some places you can seek specialized outpatient care without the need for referral. It may be, for example, at a breast clinic or the surgeon’s reception at a hospital.
You can contact many receptions by logging in .
Investigations and investigations
You are offered an examination according to a standardized course of care if the doctor suspects that you have breast cancer. Standardized care is a way of organizing the investigation so that it goes as quickly as possible. Among other things, there are times set for the examinations you may need. The doctor writes a referral and tells you why you should be investigated, what it means and when you can be told if you have cancer or not.
It is often quick to get calls for examinations in a standardized course of care. It is good if you are clear about how the staff most safely reach you, so that you do not miss any time.
The doctor feels on the breasts and lymph nodes
A doctor knows the breasts and lymph nodes in the armpit, at the clavicles and on the neck. The doctor may ask you to answer various questions, for example:
- How is your mens bike?
- Do you have a close relative who has had breast or ovarian cancer ?
- Do you use birth control pills , or do you get any other hormone therapy, for example due to menopause?
It is also important to tell about previous hormone treatments that have ended.
A full mammogram can be done from both breasts. This means that more x-rays are taken than in the mammography health check called screening. Women between the ages of 40 and 74 are regularly called for such health checks.
You are examined with ultrasound if there is a lump or if the mammography images show any deviation. You may also be examined with ultrasound if mammography images are difficult to assess because you have dense glandular tissue.
Cell samples and tissue samples
A sample from the tuber can be examined under a microscope to see if there is cancer. Sometimes cells from the tubercle are sufficient, sometimes a slightly larger tissue sample is needed.
Surveys to see if the cancer has spread
You may need to investigate more if you have cancer and the cancerous tumor is large or if there is evidence that the cancer has spread to the lymph nodes in the armpit. The studies can show if the cancer has spread to other parts of the body as well.
It is common to need to be examined with computed tomography . You may also need to have your liver examined with ultrasound . The skeleton may also need to be examined. It is done with a magnetic camera or with skeleton scintigraphy.
In skeletal scintigraphy, a small dose of a radioactive tracer is injected into the blood. The tracer searches for areas in the skeleton where some type of injury may exist, for example due to cancer. It is visible when you are examined with a special camera called gamma camera. The radioactive tracer disappears quickly from the body.
A group of different specialists advise each other on which treatment will be best for you based on your research results. Your doctor will tell you what treatment the specialists recommend.
What treatment you can receive depends, among other things, on what kind of breast cancer you have, what stage it is in and how you feel otherwise. In this chapter you can read more about the different treatments.
The breast is operated on
Most people who get breast cancer are operated on. Sometimes a part of the breast is operated on, other times the entire breast needs to be removed.
The armpit is also operated
Most breast cancer surgery is performed simultaneously in the armpit. There are lymph nodes that need to be examined. The lymph nodes are removed if the cancer has spread there. It is called axillary evacuation.
Drugs for breast cancer
You will be treated with medication before surgery if the cancer tumor needs to shrink. It can be done with cytostatic drugs that are sometimes combined with targeted drugs. Sometimes the cancer tumor can shrink with drugs that affect your hormones.
It is more common to receive treatment with drugs after surgery. The purpose is to remove cancer cells that may be left in the body. Treatment can reduce the risk of relapse and increase the chance of you getting rid of the disease.
Drugs with cytostatic drugs
Cytostatic drugs are a group of drugs that can inhibit cancer cells in different ways. You get cytostatic drugs in cures. The most common is to get six courses of cytostatics with a three-week break between the courses.
Cytostatic drugs are usually given as a drop directly into the blood. It is common to get a combination of different cytostatic drugs as it usually gives better effect. Some common drugs are those containing epirubicin, doxorubicin, cyclophosphamide, 5-FU, docetaxel or paclitaxel.
The treatment with cytostatic drugs can make you sensitive to infections, feel sick or get dry mucous membranes. Some suffer from pain in the body or numbness in the fingers and toes. There are good drugs to both prevent and mitigate most of the side effects.
It is common for the hair to fall off but it almost always comes back after the treatment. You can get a wig that you try out before treatment begins.
The treatment can also make you feel tired.
Drugs for breast cancer affected by hormones
It is common for the hormone estrogen to cause the breast cancer to grow. There are drugs that target the hormone estrogen in various ways, so-called anti-hormonal drugs:
- Medicines containing the active substance tamoxifen block the effects of the estrogen you have in your body. Then the cancer cells are prevented from growing and proliferating.
- Medicines belonging to the aromatase inhibitor group prevent the production of estrogen that you have in your body fat even after menopause. Aroma inhibitors have no effect if you still have menstruation because the ovaries produce estrogen then. Sometimes you can get medicines with goserelin if you still have menstruation but need aromatase inhibitors.
- Medicines containing goserelin shut off estrogen production in the ovaries. It can be used with tamoxifen, or sometimes with aromatase inhibitors, if you are under 40 years of age.
It is common to need treatment with anti-hormonal drugs for five years, sometimes ten years. It is important to follow the treatment without interruption.
The drugs can cause you to get menopause-like problems even if you have already been in menopause. Common symptoms are sweating, hot flashes and dry mucous membranes of the genital area. You may get joint pain if you are treated with aromatase inhibitors.
Talk to your doctor about the side effects. You may be able to change your medication or receive treatment that mitigates the side effects if you have any problems.
Targeted drugs for breast cancer that are HER2 positive
Targeted drugs are drugs that affect any particular property of the cancer cells. HER2-positive breast cancer contains a protein called HER2. The protein allows the cancer cells to grow faster. Growth can be stopped with the help of targeted drugs. They contain antibodies that block the protein.
Some need treatment both before and after surgery, some first and then receive treatment.
You will receive the trastuzumab and pertuzumab antibodies along with cytostatic drugs if treatment begins before surgery. After surgery, trastuzumab usually continues for one year.
You will receive trastuzumab if you need treatment only after surgery. The first treatments are usually combined with cytostatic drugs.
Trastuzumab can be given as a drop or injection into the subcutaneous tissue. Pertuzumab is given as a drop directly into the blood. The most common thing is to get treatment every three weeks.
Treatment can affect the heart of some people. It is treatable and usually disappears after treatment. Your heart is examined several times during the course of treatment.
Drugs that strengthen the skeleton
Treatment with drugs belonging to the bisphosphonate group can strengthen the skeleton and reduce the risk of the disease coming back and affecting the skeleton.
You may need treatment if you have passed menopause and the risk is greater that the cancer will return. The risk is greater, for example if the cancer had spread to the lymph nodes in the armpit. You receive the treatment as a drop in the blood once a month.
You need to be examined by a dentist before treatment begins. This is because bisphosphonates can cause jaw damage if you have had problems with, for example, tooth loss.
It is common to receive radiotherapy after an operation, especially if only part of the breast has been removed. Radiation treatment after surgery reduces the risk of the cancerous tumor coming back into the breast.
You can also receive radiotherapy if the lymph nodes contained cancer cells. You will then receive radiation treatment to both the chest and the areas of the lymph nodes that are close to the chest.
Radiation treatment you usually get every weekday for three to six weeks. Sometimes the treatment is longer, for example if it is difficult to determine if all the cancer was removed at the time of surgery or if you are younger than 50 years. The risk of relapse is higher if you are younger than 50 years.
Radiation treatment can, among other things, make the skin irritated and sore while the treatment is in progress. It is good to lubricate the skin every day with unscented skin cream. The radiated area may also become slightly swollen.
Follow-up after treatment
You may make an initial return visit two to three weeks after the operation to check the wound. The follow-up you need next depends on the type of cancer tumor you had and what other type of treatment you receive.
Follow-ups are organized in different ways in different parts of the country. Sometimes a doctor at the surgeon or cancer clinic is responsible for the visits, sometimes a contact nurse . Cancer clinics are the same as oncology clinics.
Most people are usually called for a return visit one year after treatment is completed. The breasts are examined with mammography. A doctor, contact nurse or other specially trained nurse knows both breasts and examines if there are swollen lymph nodes in the armpits or neck.
At the follow-up, you can also get help with any side effects of the treatment, such as lymphedema or skin disorders after radiation.
Sometimes follow-ups continue for a few years. Most need only be examined with mammography every year or every two years. It may be enough to participate in screening with mammography that you are called to regularly if you are a woman and 40-74 years.
You get a special notice if you are, for example, younger than 40 years or older than 74 years or if you are a man.
Contact your healthcare provider if you have new symptoms
It is more common for you to find out if you have new symptoms than to discover them at a follow-up. Immediately contact the healthcare provider if one or more of the following is true:
- You have some symptoms from the chest, such as a lump in the chest or around the chest.
- You have been suffering from, for example, the skeleton for more than two weeks.
- You have a cough that doesn’t go over.
- You feel unusually tired.
The contact nurse can answer questions even between the follow-ups and can quickly arrange a visit so you can be examined. Contact a health care center instead if the contact with the contact nurse has ceased because it has been a long time since the surgery.
The breast cancer may come back
It is called relapse if the breast cancer comes back after treatment. Relapse can mean different things. The cancer may come back in the chest that you have left or in the lymph nodes in the armpit.
The cancer can also come back as metastases. It is the same as daughter tumors and means that the cancer has spread to other parts of the body, such as the skeleton, liver or lungs.
Metastases in other parts of the body than the breasts reduce the chances of getting rid of the cancer, but there are good opportunities to curb the disease.
Many can live a good life for several years even if the disease cannot be removed. Distributed breast cancer is also called chronic breast cancer.
The risk of relapse decreases over time
The risk of relapse depends on several different characteristics of the breast cancer. Here are some examples:
The risk of recurrence is less the smaller the cancer tumor.
The risk of relapse is less if the lymph nodes are free of cancer.
Breast cancer that is independent of hormones: Relapse after five years is very rare.
Breast cancer dependent on hormones: The risk of relapse may persist even after more than ten years. The risk is small if the cancer was only present in the breast without spreading to the lymph nodes. The risk of relapse is reduced if you take drugs that affect the hormones.
Breast cancer if you are pregnant
The doctor will decide in consultation with you which treatment will be best if you are pregnant and have breast cancer. The treatment depends on several things:
- How serious is the cancer tumor?
- What are the risks to the child?
- What do you want?
If you have a partner or other close relatives, it is good if they can also be part of the decision.
Surveys if you are pregnant
You can be examined with mammography and ultrasound even if you are pregnant or breastfeeding.
You can submit cell samples or tissue samples . There may be a risk that it will leak milk from the place where the sting is made if you breastfeed.
The lungs can be x-rayed and the liver can be examined with ultrasound to see if the cancer has spread. You can also be examined with a magnetic camera even though you are pregnant.
Treatments if you are pregnant
Treatment depends on when in pregnancy the breast cancer is detected. It can be operated during all parts of pregnancy. After the 16th week of pregnancy, chemotherapy can be given . Then the risk is very small for the fetus to be affected by the treatment.
Treatments that need to wait after delivery are radiotherapy , anti-hormonal therapy and targeted therapy.
Treatments that need to wait after delivery are radiotherapy , anti-hormonal therapy and targeted therapy.
What is Breast Cancer?
Breast cancer is the second most common cancer disease, after prostate cancer . More than 8,000 people get breast cancer every year. It is unusual, but sometimes you can get cancer in both breasts and therefore the number of diagnoses is slightly more than the number of people who get breast cancer.
Cancer of the milk aisles is most common
Breast cancer can occur in different parts of the breast:
- Ductal cancer is a breast cancer in the milk ducts that leads the breast milk through the nipple. It is the most common form of breast cancer.
- Lobular cancer is the cancer of the milk glands that forms breast milk.
Cancer can also occur in the connective tissue and the fatty tissue between the mammary glands. It’s called sarcoma . Lymph node cancer can also occur in the breast. Both diseases are very rare in the breast. They are not treated as breast cancer.
Different types of breast cancer
There are different types of breast cancer. They are treated differently. It is almost always possible to be completely free of all types of breast cancer if the cancer is detected at an early stage. Otherwise it is usually possible to slow down the disease for a long time.
Luminal cancer is affected by hormones
Luminal cancer is the most common form of breast cancer. Eight out of ten breast cancer tumors are luminal. The cancer is dependent on sex hormones to grow, such as estrogen and progesterone. Luminal cancer is divided into luminal A and luminal B.
Luminal A develops a little slower. It is common to need surgery and to receive radiotherapy and hormone therapy.
Luminal B develops faster. It is common to need to be operated on and receive radiation therapy, cytostatic therapy and anti-hormonal therapy.
HER2-positive breast cancer
About every eighth breast cancer is HER2 positive. The cancer cells have an extra amount of a protein called HER2 that allows the cancer tumor to grow faster. It is common to have to be operated on and receive radiotherapy. You also need treatment with cytostatics and targeted treatment with antibodies.
Triple negative breast cancer
Approximately every tenth breast cancer tumor is triple negative. This means that it grows independently of estrogen, progesterone or HER2. The treatment consists of cytostatics, radiotherapy and surgery. It may be good to do an investigation to find out if the breast cancer is hereditary. The risk of it is greater if you have triple negative cancer.
Different stages of breast cancer
Breast cancer is usually divided into different stages. How far a stage is can vary greatly even between different people who have the same type of breast cancer.
Precursor – cancer in situ
The earliest form of breast cancer is called cancer in situ. Then the cancer still only grows in the place where it originated. It is a precursor to breast cancer. Most have no symptoms, but mammography can detect cancer in situ.
The first stage – the cancer grows in the breast
The cancerous tumor can grow through the wall of the milk duct or the mammary gland into the fat or connective tissue in the breast. This means that the cancer is invasive. Sometimes it is possible to feel a lump, but many breast cancer tumors are only a few centimeters even when invasive. Then they are usually unable to feel. However, they can be detected by mammography.
Second stage – the cancer may have spread to lymph nodes
The cancer tumor can be up to five centimeters. It may have spread along the lymph vessels to the lymph nodes. The lymph nodes are found in the armpit.
The cancerous tumor is larger than five centimeters or it has grown into the skin or chest. It may also have spread to several lymph nodes in the armpit.
Fourth stage – the cancer forms metastases in other parts of the body
The cancer cells grow into blood vessels so that the disease spreads to other parts of the body and forms new cancer tumors. It’s called daughter tumors or metastases. Metastases may be present in, for example, the skeleton, lungs or liver.
Metastases are most often formed when the cancerous tumor has been in the breast for several years and when it has grown and become several centimeters large. But it can also take both shorter and longer time for breast cancer to spread.
Breast cancer can be detected early
It is important that you go when you are called for screening with mammography. Mammography can detect the earliest forms of breast cancer that give no symptoms. You get regular calls for screening if you are a woman and between 40 and 74 years.
Feel the breasts regularly. It may not replace screening with mammography, but you can more easily notice changes if you learn how your breasts usually feel.
Contact your health care provider if you have any symptoms, even if you have recently been on a mammogram screening.
What is the cause of breast cancer?
It is never possible to say exactly why a person has had cancer. However, there are things that can increase the risk of getting breast cancer. Many risk factors can not be done, others can be affected.
Before the age of 40, breast cancer is uncommon. Then the risk increases.
The hormone estrogen affects
Much estrogen in the body over long periods increases the risk of breast cancer. Getting men early and getting into menopause late means that estrogen affects the body extra long.
Hormone therapy for a long time against menopausal disorders increases the risk of breast cancer. The risk of cancer is probably very small if you receive hormone therapy for less than five years. The risk of breast cancer increases slightly if you use birth control pills for a long time, for example longer than five years. The risk is reduced if you stop taking the pill.
Dense breasts – a lot of breast tissue
Dense breasts increase the risk of breast cancer. It is not clear why this is so. Dense breasts mean you have a lot of breast tissue. You cannot decide for yourself if you have tight breasts, but it is visible on mammography images.
Overweight, alcohol and not moving
Being overweight after menopause increases the risk of breast cancer.
Breast cancer is one of the cancers most affected by alcohol . The risk increases the more you drink.
Being still a lot probably increases the risk, no matter what you weigh.
Breast cancer can be hereditary
Between five and ten percent of all breast cancers are hereditary. Heredity is found in the succession. You may not get breast cancer even if you have inherited the tendency. It is common for people with hereditary breast or ovarian cancer to become sick when they are 40 years or younger.
There are some known breast cancer genes. There are genes with a defect that can cause breast cancer. But the known breast cancer genes do not explain all hereditary breast cancer.
The risk can be investigated
You can get a referral to a special reception that investigates hereditary cancer if you have one or more close genetic relatives who have had breast or ovarian cancer. Such receptions are found in several places in the country. By close relatives is meant children, parents, siblings, grandparents, grandparents or siblings of the parents.
It can be especially important to get an investigation if you or your relative have had the disease at age 40 or earlier.
Special checks if you have a hereditary predisposition
You may be given special checks if you have a hereditary predisposition to breast cancer or close genetic relatives who have breast or ovarian cancer. Then the breasts are examined with mammography and ultrasound , among other things .
Surgery can prevent you from getting hereditary cancer
You can have your breasts removed for safety if you have an inherited risk of breast cancer. You can also remove the ovaries. You can still get breast or ovarian cancer despite an operation but the risk is very small.
A thorough investigation is done before deciding on an operation that can prevent you from getting breast or ovarian cancer. You can meet different specialist doctors and also a curator or a psychologist if you need to.
Pregnancy and breastfeeding can protect against breast cancer
Being pregnant reduces the risk of breast cancer. The risk is reduced for each pregnancy. Most seem to reduce the risk of an early first pregnancy, before the age of 25.
Breastfeeding also reduces the risk of breast cancer, but not as much as being pregnant.
You have lower levels of estrogen in your body if you are pregnant or breastfeeding. Pregnancy and breastfeeding also appear to make the mammary glands mature in a way that makes them more resistant to being transformed into cancer cells.
How is life affected by breast cancer?
For most people who have had breast cancer, there are no physical or practical obstacles to continuing life as it was before the illness message.
It varies from person to person how much sick leave is needed, if you are entitled to it. Most people who receive cytostatic treatment need to be fully registered while the treatment is in progress. Some who receive radiotherapy may work part time while the treatment is in progress.
It is common to be able to return to everyday life when treatment with cytostatic or radiotherapy is completed. This also applies if you need to continue with anti-hormonal or antibody therapy. You may need to increase working hours a little at a time if you have been on sick leave. Here you can read more about sick leave .
Sometimes the treatment needs to take a long time
Some treatments need to go on for a long time, for example, treatment with antihormonal drugs. Treatment can cause troublesome side effects.
You may feel more motivated to follow the treatment if you know more about how it works. One way is to get help from a patient association. There you can talk to someone who has received the same treatment and who can tell you what it means.
Talk to your doctor or contact nurse if the side effects bother you, there are often good ways to relieve them.
Help if you are in pain
Sometimes you may be in pain, even for a while after the treatments. There are various help and treatments available, depending on why it hurts. Learning more about why it hurts can also relieve the pain.
It is important to measure the pain and effect of the pain relief you receive, so that you can receive as much help as possible. There are various tools to measure pain .
Feelings and self-image can be affected
You may get a prosthesis, partial denture or breast reconstruction to replace all or part of the breast that has been removed.
The loss of a body part can still create feelings of sadness. You may feel different to your body. It can affect self-esteem and sexuality. There is help to get.
So you can keep the energy
You feel better, you get less pain and you can do more if you take care of yourself. Touch yourself as much as you can. Choose a physical activity that you enjoy and feel you can handle.
Ask your doctor for a referral to a physiotherapist if you need help. Physiotherapists are sometimes called physiotherapists. Also try to eat well and to rest well. Avoid resting for a long time. Rather rest several short moments.
It is important that you recover
Life can feel different even if everything has gone well and you can live as you did before the illness and treatment. You always have the experience of what you have been with. It is common for these to feel painful periods. It usually gets better, although it can take time. Some feel vulnerable and worried long after treatment is over.
It is important that you recover in the way that suits you. Do things you like. Spend time with people who feel good to you.
Fertility and pregnancy after breast cancer
Some treatments can impair fertility, regardless of your gender. It can still be possible to get a pregnancy.
Important with birth control if you do not want to get pregnant
Use birth control if you have had breast cancer and want to avoid a pregnancy. Talk to your doctor if you need hormonal contraceptives.
You can be fertile even if one or more of the following is true:
- You have been treated with cytostatic drugs.
- You will be treated with tamoxifen.
- You have irregular while or no while.
Keep the possibility of getting pregnant
You can save eggs or embryos before the cancer treatment so you can get pregnant afterwards. The preparations needed may mean that the cancer treatment is delayed a little.
Your cancer doctor and a gynecologist will meet with you and your potential partner so that you can talk about the opportunities and risks of fertility treatment that apply to you.
You are offered to freeze semen if you are male .
Pregnancy after breast cancer
The hormones needed to conceive are at the same time a risk of breast cancer. But the risk of relapse seems low if you become pregnant after being treated for breast cancer. It shows the research results that exist.
You may be able to go to specialist maternity care if you become pregnant after having breast cancer.
Talk to your doctor if you want to get pregnant and have had breast cancer.
Cancer treatment can affect both fertility and the fetus
Cytostatics impair fertility. But often it is only temporary. The first three to twelve months after treatment can be difficult to get pregnant. Some who receive cytostatic treatment arrive in the menopause prematurely.
Tamoxifen can harm the fetus. Therefore, you need to pause treatment for two to three months before trying to get pregnant. You can start with tamoxifen again when the baby is born and when you are not breast-feeding.
Radiation therapy does not affect fertility.
Breastfeeding after breast cancer
It is possible to breastfeed even if some of the breast has been removed. Radiation treatment can make it less come with milk, but only in the treated breast.
Getting a sick message
There are many ways to respond to a cancer message. It is common to need a lot of time to talk to your doctor and other healthcare professionals about what the message means.
If possible, please let a relative accompany you. The related person can act as a support and help to remember what has been said.
You can also ask to receive the information in writing so that you can read it peacefully. Ask questions if you don’t understand. You have the right to receive information in your own language. You also have the right to receive interpreting assistance if you have a hearing impairment .
In many hospitals there are special nurses called contact nurses who can provide support and also help with various practical things.
You can get help in several places
Talk to the contact nurse or the hospital’s curator if you feel anxious or have questions. You can also contact for example Cancer Counseling, Cancer Foundation or any of the patient associations that exist for people with breast cancer.
It is common to feel easier once treatment has begun and you know what is going to happen.
Children need to know
A minor child has the right to receive information and support based on his or her own needs if a relative is ill. You can get help with what you can say if you want to tell the child yourself. Often it is good to make children as involved as possible, no matter how old they are. That doesn’t mean you have to tell everything.
Be involved and influence your care
You have the right to be involved in your care as far as possible. The healthcare staff should tell you what treatment options are available. They should make sure you understand what the different options mean, what side effects are available and where you can get treatment. This way you can help decide on your treatment.
You can get a new medical assessment
You may get a new medical assessment from another doctor if you have a life-threatening or particularly serious illness. Obtaining another doctor’s assessment can help you, for example, if you are unsure of which treatment or treatment is best for you.
Make a care plan
You can make a care plan together with the contact nurse, the doctor and other staff. The care plan should contain information that is important to you, such as contact information and how to get the rehabilitation you need. Here you can read more about the contact nurse and the care plan .
It can feel difficult to be close to someone who is sick. It is common to want to support while you yourself have a strong concern and feel bad.
People in your vicinity can be a support. It often becomes easier for others to help you by telling them how it feels. You can also talk to the contact nurse if you are close and need supportive calls.
You can get relief if you help take care of or support the sick person. You can also get support, for example in the form of calls or help with practical things.