What to expect after a breast cancer diagnosis, including breast cancer stages and treatments

If you, or someone you know, has received a breast cancer diagnosis, it's likely you feel incredibly overwhelmed and have lots of questions about what happens next.

It’s important to remember the resources which are available to support you through your breast cancer diagnosis and cancer treatment, including your doctors, cancer support groups and charities.

We've worked with Breast Cancer Now to put together a guide explaining what to expect after your breast cancer diagnosis and what breast cancer treatment options you have.

Breast cancer diagnosis: what to expect

Initial consultation with your GP

No one knows your body better than you, so it’s important to regularly look and feel for any unusual breast changes and report anything different or new, such as a lump or a change to the skin, like puckering or dimpling, to your doctor as soon as possible.

If you suspect your have breast cancer symptoms arrange an appointment with your GP. At your appointment, your GP will examine your breast and may refer you to a specialist breast clinic for tests.

The Breast Cancer Now website says, "Being referred to a breast clinic doesn’t necessarily mean that you have breast cancer. It just means that more tests are needed to find out what’s going on."

What to expect at a breast clinic

Once referred to a breast clinic you will have an examination and various tests of your breasts that may take several hours to complete. You can take a family member or friend to your appointment for support if you are worried. Though, some people prefer to attend their appointment on their own.

At the appointment the doctor or nurse may ask you questions about your family history to find if anyone in your family has had breast health problems previously. They will also ask questions about any other health problems you may have, and whether you are currently taking any medications.

According to Breast Cancer Now, you will usually have a breast examination, followed by one or more of the following further tests and procedures.

Breast examination

During the initial examination the doctor will feel your breast when you are sitting down and lying down. They will also check the armpit area, as breast cancer can sometimes spread to your lymph nodes.

Mammogram

A mammogram is a breast x ray. During your appointment, a mammographer (an expert in taking breast x-rays) will ask you to undress to the waist and stand in front of the mammogram machine. Your breasts will be placed one at a time on the x-ray machine. The breast will be pressed down firmly on the surface by a clear plate.

Ultrasound scan

An ultrasound scan uses sound waves to produce an image of the breast tissue. The scan is painless and generally done in a few minutes, but can take longer.

You’ll be asked to undress to the waist and lie on a couch with your arm above your head. To help gain a clear image, some gel will be spread over the area of the breast first. The person doing the scan will move a handheld scanning probe over the breast to look at the underlying breast tissue. The area under your arm may also be scanned.

Core biopsy

A core biopsy will be carried out when your mammogram or ultrasound picks up something in your breast that needs analysing more closely. A core biopsy involves taking a small part of your breast tissue through a small cut in your skin. You will have an injection to numb the area beforehand. The doctor will send the sample tissue to the laboratory for testing.

Fine needle aspiration (FNA)

Fine needle aspiration will be carried out if your mammogram or ultrasound picks up something in your breast that needs analysing more closely. Fine needle aspiration is a process of taking a sample of cells from your breast using a syringe with a fine needle. This might feel a little uncomfortable, but the procedure doesn't last very long. The doctor will send the sample tissue to the laboratory for testing.

Breast cancer stages

Once your doctor diagnoses your breast cancer, they will work out the extent of your cancer and determine what cancer stage you are in.

Carolyn Rogers, clinical nurse specialist at Breast Cancer Now said, "Your cancer stage will be determined by the size of the cancer and how far it has spread. The grade is how different the cancer cells are to normal breast cells and how quickly they are growing."

Your cancer's stage and grade helps determine your prognosis and the best treatment options. There are different ways to stage breast cancer. Most hospitals use two main types of cancer staging systems including the TNM Staging System. and the number system.

You can read more about these on Breast Cancer Now’s website.

The TNM Staging System

TNM stands for Tumour, Node, Metastasis. This system describes the size of the initial cancer whether the cancer has spread to the lymph nodes, and a different part of the body.

• T refers to the size of the cancer – it can be 1, 2, 3 or 4, with 1 being the smallest

• N refers to whether the cancer has spread to the lymph nodes – it can be between 0 and 3 – with 0 meaning no lymph nodes

• M refers to whether the cancer has spread to another part of the body – it can either be 0 meaning the cancer hasn't spread or 1 it has a spread

The cancer number system

According to Cancer UK, here is a summary of the difference cancer stages graded by the number system.

Stage 1  means that a cancer is relatively small and contained within the organ it started in.

Stage 2 means that the tumour is larger than in stage 1, but the cancer has not started to spread into the surrounding tissues.

Stage 3  means the cancer is larger. It may have started to spread into surrounding tissues and there are cancer cells in the lymph nodes in the area.

Stage 4 means the cancer has spread from where it started to another area in the body or organ.

Determining your course of breast cancer treatment

Carolyn Rogers explains, "After all the necessary tests if you are diagnosed with breast cancer, the next step will be for a Multidisciplinary team (MDT), including surgeons, oncologists, breast care nurses and radiologists, to have a meeting to discuss and agree on a treatment plan for you.

"This treatment plan - and possible side effects of treatment - will then be discussed with you. Treatment plans will vary depending on the features of your breast cancer."

When deciding on your cancer treatment your doctor will take into account the following:

• The type of cancer you have and the features of the cancer • Position of the cancer in the breast • Other treatment you've had in the past • Your general health and fitness

Breast cancer surgery

Surgery is often the first treatment for women with breast cancer.

Carolyn Rogers further explains, "Treatment will depend on the features of the breast cancer and may include surgery, chemotherapy, radiotherapy, hormone therapy and targeted therapy. You may be offered the option to take part in a clinical trial and your treatment team will explain this to you."

There are two types of breast cancer surgery:

Breast-conserving surgery: The cancer is removed along with a border of healthy breast tissue.

Mastectomy: All breast tissue is removed including the skin and nipple area.

Chemotherapy

Chemotherapy can be given before and after breast cancer surgery. Chemotherapy may be given before surgery to slow the growth of rapidly growing breast cancer or to shrink a larger breast cancer (this may mean breast-conserving surgery is an option, rather than a mastectomy).

Chemotherapy can also be given after surgery for primary breast cancer to reduce the risk of cancer coming back in the future.

Chemotherapy is a treatment that uses anti-cancer drugs to destroy cancer cells. It works by interfering with the cancer cells’ ability to divide and grow. Different chemotherapy drugs work in different ways and a combination of drugs is often used. Chemotherapy affects cells throughout the body and can cause side effects such as hair loss, nausea and fatigue.

Radiotherapy for breast cancer

Radiotherapy uses high-energy x-rays to destroy cancer cells. Radiotherapy uses ionising radiation (high energy) to destroy any cancer cells that may have been left in the breast and surrounding area after surgery.

Radiotherapy is given after your breast cancer surgery to reduce the risk of breast cancer coming back in the future. If you’re breast cancer treatment also involves chemotherapy, radiotherapy is usually given after the chemotherapy treatment.

Hormone therapy

Some breast cancers are stimulated by the hormone oestrogen. This means that oestrogen in the body ‘helps’ the cancer to grow. This type of breast cancer is called oestrogen receptor positive (ER+).

If your breast cancer is oestrogen receptor positive, hormone therapy drugs such as tamoxifen, anastrozole and letrozole may be used to block the effect of oestrogen on the cancer cells.

All breast cancers are tested for oestrogen receptors using tissue from a biopsy or after surgery. If hormone receptors are not found, then hormone therapy will not be of any benefit.

Targeted cancer drugs

This is a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer to grow. Targeted therapies can cause side effects such as flu like symptoms. The most common targeted therapies used for primary breast cancer are trastuzumab and pertuzumab. Whether you are offered this type of treatment will depend on the features of your breast cancer.

Support for women after a breast cancer diagnosis

Talk to your family and friends

Carolyn Rogers said, "Hearing the news you have breast cancer can be life-changing and telling your loved ones can be incredibly difficult. Who you tell and how you tell them is up to you. While you may find it difficult to talk openly about your cancer, especially at first, the support of those around you can be really helpful when you are going through breast cancer treatment.

"If you have children, deciding what and how to tell them can be challenging. It’s usually best to be honest. Breast Cancer Now offers some information about how to talk to children."

Talk to breast care nurses

If you have questions about your breast cancer diagnosis, or you are worried about your breast health, you can call the Breast Cancer Now helpline for free on 0808 800 6000.

Macmillan Cancer Support also have advisers who you can contact online or on the phone if you have any questions about your breast cancer diagnosis, financial issues, or just want someone to talk to.

Support in your local area

If you're worried about your breast cancer diagnosis, Breast Cancer Now offers a variety of free face-to-face support that provides the opportunity to meet others diagnosed, share experiences or concerns and hear from expert speakers providing a wealth of information, including Younger Women Together events for women diagnosed with breast cancer under 45 years old and Moving Forward courses, run in partnership with NHS hospitals, at the end of hospital treatment.