Which treatments may be needed after surgery?
When radiotherapy, hormone therapy and chemotherapy come into question, and how the pathology report shapes the plan.
The pathology report decides
Surgery is the first step of treatment, not all of it. Examining the removed tissue reveals the type, grade and size of the tumour, the state of the surgical margins, whether the lymph nodes are involved, and the hormone receptor and HER2 status. The treatment that follows is planned on that information.
Two patients at the same stage can therefore be offered different treatments. That is not an inconsistency; it follows from the biology of the tumour mattering as much as the stage.
The treatments that may come into question
Needed in almost every patient after breast-conserving surgery. After a mastectomy it is decided according to the size of the tumour and lymph node involvement. It usually takes three to five weeks and is given as an outpatient.
Used when the tumour carries oestrogen or progesterone receptors. Taken as a tablet, mostly for five years or longer. It clearly reduces the risk of the disease returning.
Not needed by every patient. It comes into question with lymph node involvement, high grade, young age or hormone receptor negativity. In some patients it is given before surgery, to shrink the tumour.
Smart drugs used in HER2-positive tumours. This is the development that has changed the course of that group most over the past twenty years; it is usually planned alongside chemotherapy.
Order and duration
If chemotherapy is needed it usually comes first, with radiotherapy left until afterwards. Hormone therapy is started once radiotherapy is finished and continues for years. This order can vary from patient to patient.
We run the treatment process together with medical and radiation oncology. So that you have a single point of contact, we take on the referrals and follow-up; you do not have to work out where to go at which stage.
Side effects and follow-up
Every treatment has its own side effects and most of them can be managed. Knowing about them in advance keeps you from panicking when they appear, which is why we go through all of them before treatment begins.
Once treatment is complete, follow-up begins: examinations every six months in the early years and annual imaging. Its purpose is not only to look for recurrence but also to watch the long-term effects of treatment.
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