Breast cancer

 

Breast cancer is the most common type of cancer in the UK, but with the treatments available there is a very good chance of recovery, particularly if it is detected at an early stage.

Women are advised to check their breasts regularly for any changes and to see their GP promptly if they are concerned. Men can also be diagnosed with breast cancer but this is much less common.

We also encourage you to attend your local screening appointments between the ages of 50 – 70 years.

A cancer diagnosis has a significant impact on people’s lives and we aim to provide the best possible care for all patients who are diagnosed with breast cancer. This includes emotional support and information for patients, their families and carers throughout the time you are under our care.

A breast cancer diagnosis covers a wide spectrum, ranging from non-invasive conditions such as DCIS (Ductal Carcinoma in situ) to invasive breast cancer. See below for more detail on the treatments offered.

More on what we do

When you are referred to us by your GP, you will meet one of our breast doctors for a breast examination. This takes place in the presence of a chaperone (someone who helps to support patients during intimate investigations). The examination might include a mammogram and ultrasound scan.  Sometimes we take a core biopsy – where a small amount of breast tissue is removed. We will contact you once we have the results of these assessments and discuss treatment options with you.

The most common treatments for breast cancer are surgery, radiotherapy and hormone treatments. Chemotherapy and targeted treatments such as Herceptin and bone strengthening drugs are also advised on an individual basis. We aim to start treatment within one month of your diagnosis.

The purpose of treatment is to remove the cancer (local treatment) and treat the rest of your body (systemic treatment) with the aim of reducing the risk of recurrence in the long term.

Surgery is usually the first treatment for breast cancer, although sometimes chemotherapy or hormone treatments can be given first. If patients have other health conditions which limit their surgical options they may be advised hormone therapy to treat their cancer as first line treatment.

There are a number of surgical options available, depending on your cancer and your wishes.

Your surgical options are either:

  • breast conserving surgery
  • mastectomy - removal of all the breast tissue and nipple (depending on your cancer diagnosis and the size of the cancer in relation to the size of your breast)

Breast conserving surgery is performed with the aim of maintaining the optimum breast volume and shape following removal of the cancer. The types of surgery this includes are:

  • Wide Local Excision
  • Therapeutic Mammoplasty
  • Chest Wall Perforator Flap

All patients who are advised a mastectomy will have an opportunity to discuss breast reconstruction. If this is not appropriate for you, the Breast Care Nursing Service will provide you with an external breast prosthesis.

Lymph node testing is routinely advised for all women who have an invasive cancer. It may also be discussed if you have a diagnosis of ductal carcinoma in situ (DCIS); the presence of abnormal cells within a milk duct in the breast.

Sentinel Node Biopsy is performed at the same time as breast surgery and involves removing some of the nodes in your axilla (armpit) to test if they are affected. If we know that the nodes are involved when you are diagnosed, an axillary clearance will be advised. This means that the majority of the nodes in your axilla will be removed as treatment.

Surgery is usually followed by medical (Adjuvant) treatments to help reduce the risk of the cancer coming back. The treatments you will be offered depend on the results of your surgery which gives us information about your individual cancer. You may only require surgery or a combination of one or all treatments including radiotherapy, hormone treatment, chemotherapy, targeted treatments and bone strengthening therapy.

We also provide a reconstruction service for women who are considering a mastectomy because of a high risk of breast cancer in the family especially those who carry the BrCa1 and 2 genes.

Clinical trials

The RD&E is actively involved in clinical trials and we are keen to involve patients wherever we can. Clinical research enables new treatments to be developed and can improve healthcare for all patients (we offer a range of different types of research that provide evidence for new approaches that are safe and effective).

We work closely with your medical team and if appropriate you will be approached and offered participation in any clinical trials that are currently open, these can be local, national or international trials.

You will be given written information and the opportunity to discuss further with a research nurse. For further information please refer to the Research and Development page and always ask your medical team what opportunities for research are available if it is important to you.

If you choose not to be involved in any clinical trials discussed this does not affect your care or the treatment you are offered.

Treatments

DCIS (Ductal Carcinoma In Situ)

When cancer cells have developed within the ducts of the breast but remain within the ducts (‘in situ’), it is called DCIS. The cancer cells have not yet developed the ability to spread outside these ducts into the surrounding breast tissue or to other parts of the body.  It is often picked up through the screening process.

It is usually treated with surgery and in some cases radiotherapy.  The types of breast surgery you may be offered are similar to those with an invasive breast cancer and are discussed below. Lymph node testing may be discussed with a diagnosis of DCIS and a sentinel lymph node biopsy may be recommended. You can find out more on the Breast Cancer Now website.

Invasive breast cancer

The most common treatments for invasive breast cancer are surgery, radiotherapy and hormone treatments. Chemotherapy and targeted treatments such as Herceptin and bone strengthening drugs are also advised on an individual basis. We aim to start treatment within one month of your diagnosis.

The purpose of treatment is to remove the cancer (local treatment) and treat the rest of your body (systemic treatment) with the aim of reducing the risk of recurrence in the long term.

Breast Surgery

Surgery is usually the first treatment for invasive breast cancer, although sometimes chemotherapy or hormone treatments can be given first. If patients have other health conditions which limit their surgical options they may be advised hormone therapy to treat their cancer as first line treatment.

There are a number of surgical options available, depending on your cancer and your wishes.

Your surgical options are either:

  • breast conserving surgery
  • mastectomy - removal of all the breast tissue and nipple (depending on your cancer diagnosis and the size of the cancer in relation to the size of your breast)

Breast conserving surgery is performed with the aim of maintaining the optimum breast volume and shape following removal of the cancer. The types of surgery this includes are:

  • Wide Local Excision
  • Therapeutic Mammoplasty
  • Chest Wall Perforator Flap

All patients who are advised a mastectomy will have an opportunity to discuss breast reconstruction. (Add Hyperlink to breast reconstruction section). If this is not appropriate for you, the Breast Care Nursing Service will provide you with external breast prosthesis.

Lymph node surgery

Lymph node testing is routinely advised for all women who have an invasive cancer and may be discussed if you have DCIS.

Sentinel Lymph Node Biopsy is performed at the same time as breast surgery and involves removing some of the nodes in your axilla (armpit) to test if they are affected.

If we know that the nodes are involved when you are diagnosed, an axillary clearance will be advised. Here, the majority of the nodes in your axilla will be removed as treatment.

Adjuvant treatments

Surgery is usually followed by medical (Adjuvant) treatments to help reduce the risk of the cancer coming back. The treatments you will be offered depend on the results of your surgery which gives us information about your individual cancer. You may only require surgery or a combination of one or all treatments including radiotherapy, hormone treatment, chemotherapy, targeted treatments and bone strengthening therapy.

We also provide a reconstruction service for women who are considering a mastectomy because of a high risk of breast cancer in the family especially those who carry the BrCa1 and 2 genes.

Our team

Our dedicated team is made up of surgeons, oncologists, radiologists, breast clinical nurse specialists, breast reconstruction clinical nurse specialist and radiographers.

This includes:

Douglas Ferguson, Consultant Oncoplastic Breast Surgeon

Julie Dunn, Consultant Breast Surgeon

Sisse Olsen, Consultant Oncoplastic Breast Surgeon

Rachel Tillett, Consultant Plastic and Breast Surgeon

Charlotte Ives, Consultant Oncoplastic Breast Surgeon

Di Cameron, Trust Breast Physician

Tanvir Ahmad, Trust Breast Specialist Registrar

Russell Davies, Consultant Breast Radiologist

Rachael Currie, Consultant Breast and General Radiologist

Simon Ewart, Consultant Breast Radiologist

Sarah Knightley, Consultant Breast Radiographer

Amanda Carter, Clinical Psychologist

Gill Gray, Lead Breast Care Nurse Specialist

Sue Avery, Breast Reconstruction Nurse Specialist

Katherine Bonnin, Secondary Breast Clinical Nurse Specialist

Dawn Peters, Breast Care Nurse Specialist

Mary Allen, Breast Care Nurse Specialist

Sara Green, Breast Care Nurse Specialist

Amanda Green, Breast Care Nurse Specialist

Liz Powe, Breast Care Nurse Specialist

Alice Osigli, Breast Care Nurse Specialist

Sam Headon, Breast Care Nurse Specialist

Di O’Reilly ,Assistant Breast practitioner

Gareth Ballyn, Breast Cancer Support Worker

Dr Andy Goodman, Consultant Oncologist

Dr David Hwang, Consultant Oncologist

Dr Anne McCormack, Consultant Oncologist

Dr Chris Hamilton, Consultant Oncologist

Dr Peter Stephens, Consultant Oncologist

Dr Kate Scatchard, Consultant Oncologist

Dr Jenny Forrest, Consultant Oncologist

Where to find us

RD&E Wonford, Barrack Rd, Exeter EX2 5DW

Consultations with Breast Surgeons and the surgical team: Surgical Outpatients Department Level 1, Area K

Consultations with Breast Oncologists and the oncology team: The Exeter Oncology Centre, Level 1, Area A

Breast imaging is carried out in the Breast Care Unit: Level 2, Area N

Breast Care Nursing Team: Breast Care Unit Level 2, Area N

The journey between these departments involves use of stairs or lift and the distances can be considerable. We recommend that patients who find walking difficult bring a wheelchair or ask at the main hospital entrance for the use of a wheelchair.

Contact us

If you have a surgical outpatient appointment and need to change it please contact our booking office on 01392 406992 stating your NHS number.

For other surgical related queries please contact your consultant surgeon’s secretary via the hospital switchboard on: 01392 411611

Breast Care Unit queries regarding booked mammograms, ultrasound scans and biopsies please call: 01392 402478 8.30am – 5pm

Breast Care Nursing Service: messages taken Monday – Friday, 8.30 - 4pm, call 01392 402707

Oncology appointment queries - 01392 406181

Radiotherapy appointment queries - 01392 402115

Clinics

• New Patient/ Fast Track Clinics daily Monday – Friday
• Surgical Results Clinics Daily Monday – Friday
• Family History Clinics weekly (Heavitree Hospital)
• Oncology Clinics Daily Monday – Friday
• Nurse Led Pre and Post Mastectomy Clinics organised on an individual patient basis
• Nurse Led Breast Reconstruction Clinics

Supporting you

Breast Cancer Clinical Nurse Specialists

Our team of Breast Cancer Clinical Nurse Specialists (BCNs) are available to support you and your family through your diagnosis and treatment. They provide clinical support and guidance with decision making related to treatments. They are able to offer emotional support and provide signposting to additional services offered locally and nationally. Find out more here.

FORCE Cancer Charity

FORCE works locally to support anyone affected by cancer and will work closely with the people involved in your treatment. Find out more about the support FORCE can offer at forcecancercharity.co.uk / Telephone: 01392 406151. 

Breast Cancer Care

Mummy's lump (a story for children)

Fruit Fly Collective

Website for children with a parent who has a diagnosis of cancer. 

www.fruitflycollective.com

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