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Breast CancerDr Kingsley’s comments Clinical Features of Breast Cancer. According to the histories I have taken from many patients who have been diagnosed with breast cancer, there is a number of ways in which it can present. The first, and probably the most common, is that the patient herself is having a shower and feels a lump somewhere in one of her breasts. Very occasionally she first finds a lump in an armpit, then examines her breast. Conventional Treatment for Breast Cancer. Depending upon the nature, site and certain characteristics of the cancer, the team of surgeons and oncologists will decide what they think is the best way of treating it. To be fair, the first specialist to be seen in a special breast clinic is nearly always a surgeon, as a biopsy is likely to be done to confirm the diagnosis. So some form of operative procedure is inevitable. The surgeon is the person who will decide whether an oncologist needs to be consulted. The range of treatments involves a lumpectomy, when an area of the breast is removed, or a mastectomy, when the whole of the breast is removed. Some or many of the lymph glands in the axilla (armpit) may be removed, but, as this can sometimes lead to swelling of the arm (known as lymphoedema), attempts are being made to limit how many glands are removed. Sometimes ‘sentinel’ nodes only are removed, which leads to less arm swelling. Radiotherapy should be avoided after removing most or all of the axillary lymph glands because of the high risk of lymphoedema. Chemotherapy may well be recommended, but the choice of what is used will vary according to the nature and status of your cancer. There is limited value in naming them all, as that is a specialist subject. Your oncologist will decide on what he or she considers is most appropriate for you. However, please read carefully all the information in the <Questions Room> to find out all you want to know about what is being proposed for you. It is most likely that a course of radiotherapy will be offered to you. This is mainly to ‘mop up’ any cancer cells that have not been removed by the surgeon. You may even be advised to have a course of both chemotherapy and radiotherapy. Whatever is recommended, remember to ask those questions. Metastatic Breast CancerIf you have ‘metastases’, it means that your cancer has spread beyond its original site in the breast. Although the majority of women present with localised disease, in 80% of them cancer spreads to other parts of the body. When this happens, it is accepted that the patient cannot be cured, but useful remissions can be achieved. Spread to bones is common with breast cancer, and it can also spread to the lungs, liver and brain, as well as locally. Sometimes when a woman has had a mastectomy, secondary spread occurs in the scar. I have seen a number of very smelly, putrefying, fungating breast cancers in women who have refused to undergo a mastectomy. While I have described them as very brave to follow their own way, they say they are cowards because they are afraid of having a mastectomy. An Explanation by Dr Kingsley Before Your Consultation about your Breast Cancer “Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having breast cancer. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of your breast cancer, but, by then, you were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat breast cancer in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. We would like you to take advantage of all the benefits of becoming a member of our Cancer Help Centre, which is free to join, so please look at the Members’ Area Overview, where you will find a summary of all that is on offer. |
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(c) 2006 |
