Auckland Female Specialist Breast Surgeon, Thyroid Surgeon, General (Gallbladder surgery, hernia surgery, lipoma) surgeon

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Diagnosis

This is is the first step of assessing your problem.  A diagnosis often requires several steps, because we not only want to know what sort of disease is in your breast, but also how big it is and whether there are signs that it has spread anywhere outside of the breast.  Your pathway to diagnosis may involve any of the following:

• Mammogram

• Ultrasound

• Biopsy (this is a sample of the breast tissue which is collected by a "needle biopsy")

• MRI

• CT or PET scan

Not all patients will benefit from all of the above; Magdalena and the team will advise you, which of these are best for your situation

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Surgery

Surgery is generally (but not always) the first treatment step if a cancer is diagnosed.  Magdalena will advise you which surgical approach is best for your situation:

• Breast surgery

  • usually it is best to try to save your breast with "breast conserving surgery" techniques, but occasionally a full mastectomy may be required (in which case, reconstructive options will also be discussed)

• Lymph gland surgery

  • most breast cancer surgery involves removing at least some of the lymph glands to test whether any cancer spread has occurred

  • options are:

    • sentinel lymph node biopsy (this is a a very small sample)

    • Targeted Axillary Dissection (this is a lightly larger sample, suitable in some people who have had chemotherapy treatment first)

    • Axillary Dissection (this is removal of a larger number of lymph glads from the 'arm pit' area, often required if cancer is seen to be definitely spreading there at the time of initial diagnosis)
       

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Histology results

After surgery you will receive a "histology result".  This is information from the laboratory which reports on more detailed features about your cancer, including the margins of clearance around it which the surgery has achieved, and the status of the lymph glands.  This information helps to guide additional treatment.

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Adjuvant treatment

Cancer is like a weed in the garden: if you just pull it out, without treating the soil in which it grew, then it will often grow back.  Breast cancer is like this too, so when treating it, we almost always advise additional ("adjuvant") treatments, in addition to surgery.  There are various combinations of these therapies and you will receive guidance about what would work best for you.  The possibilities are:

• Radiotherapy

  • This is strong 'x-ray' (radiation) treatment which is required for most people treated with breast conserving surgery or those who have lymph nodes involved by cancer spread.  A radiation oncologist is a specialist who would deliver this care, and Magdalena works with a team of experienced radiation oncologists, who she will involve in your care if you need radiotherapy.

• Chemotherapy

  • This is a combination of strong intravenous (injected into veins) medicines which is very good at killing invisible cancer cells and so preventing a recurrence of disease.  The side effects can be significant, but fortunately few patients diagnosed with early breast cancer require this treatment. A medical oncologist is a specialist who would deliver this care, and Magdalena works with a team of experienced oncologists, who she will involve in your care if you need chemotherapy.

• Endocrine / Hormone therapy

  • These are tablets (or other medicines) which lower your body hormones.  In many types of breast cancer this decreases the chance that it will come back.   Magdalena works with a team of experienced medical oncologists, who she will involve in your care if you need this treatment.

• Herceptin / Herzuma / other therapy

  • For some types of cancer (such as Her2+ breast cancer), other targeted treatment is required in addition to some or all of the above.  Again, Magda would involve a medical oncologist in your care if this was appropriate for your situation

4

Follow up

Magdalena generally plans to see patients after surgery with the following approach

• One week after surgery:

  • The nurse will do a wound check in the week after surgery, to change dressings

• Two weeks after surgery:

  • Magdalena will see you with your histology result, to discuss and plan the next step in your care

• Six weeks after surgery:

  • Magda and the team will see you to check progress, ensure that you have been seen by the relevant oncologists and that you are recovering well. 

  • Physiotherapy (or lymphoedema therapy advice) referrals often occur at this time, to unsure that you make the best possible recovery

• Six months after surgery:

  • Magdalena and the team again check in to see how you are.  By this time you may have had other treatment such as radiotherapy and it is a good time to see if the appearance of your breast or scars have changed with these treatments.

• One year after surgery:

  • This is generally the time when your mammogram will be done; The team will arrange that and Magdalena will see you to discuss the result and future follow up

• Follow up generally continues annually.