Barts Cancer Centre

Barts Cancer Centre | Cancer types | Breast cancer

Breast cancer

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Treatments available
Research and clinical trials
For patients
For clinicians
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Our service

Advice for patients diagnosed with breast cancer

Consultant Medical Oncologist, Rebecca Roylance, talks about the different treatments for breast cancer, including the wide range of clinical care available at Barts Cancer Centre and explains how to be referred here.

As pioneers of the one-stop breast care clinic, Barts Cancer Centre has a state-of-the-art breast care centre situated in the Grade I listed West Wing at Barts Hospital. Alongside the very best technology and clinical care, the screening and diagnostic unit leads the way in combining first class clinical services, technology and genuine attention to the quality of the environment. The West Wing has undergone careful renovation to ensure that historical features were preserved while the space was adapted for clinical use, bringing the most up-to-date screening and diagnostic services under one roof, whilst creating a healing, reassuring, comfortable, private and dignified environment.

Our multi-disciplinary team provides the full spectrum of breast cancer care from screening and diagnostic services through to all treatment types including surgery, chemotherapy, radiotherapy, hormone and biological therapies. We also provide a full reconstructive breast surgical service. Individual care is co-ordinated by a team of specialists which include breast surgeons, pathologists, radiologists, medical and clinical oncologists, breast care and research nurses and physiotherapists. The medical and clinical oncologists also provide care for patients at the University Hospitals of Homerton, Newham and Whipps Cross.

At Barts Cancer Centre, we offer seamless care from diagnosis through to treatment on one site with the aid of experienced Clinical Nurse Specialists. We provide a one-stop service for patients with breast cancer and treat approximately 300 patients per year. To find out more about our treatment for patients with breast cancer please read on:

Diagnosis of breast cancer

Diagnosis is done in our one-stop-clinic and is likely to include:

A mammogram
An ultrasound
Aspiration cytology (FNA) and/or biopsy

A mammogram is a special low dose x-ray of the breast to identify any abnormal changes. We were the first unit in the country to provide full-field digital mammography for all our patients, meaning that a digital image is taken of the whole breast. By taking digital images, our specialists can view mammography images instantly, enabling us to quickly identify problem areas and plan treatment. Having a mammogram taken this way is also more comfortable and much quicker for patients.

An ultrasound scan can provide different information to the mammogram and in particular can tell the difference between a solid lump and a fluid filled cyst.

Aspiration cytology or fine needle aspiration cytology (FNA) involves taking a sample of cells from the breast using a small needle and syringe. It may be necessary to remove a larger piece of breast tissue using a needle biopsy.

MRI scanning – this procedure uses electromagnetic energy rather than x-rays to take images of the breast, and it enables us to detect breast cancer in situations where ordinary mammography is less effective. It is only used for breast screening in very specific circumstances, where the clinician feels it is appropriate.

Treatments available

A recommendation regarding each patient is always made within our multidisciplinary team and the type of treatment will depend on the patient’s age, grade and stage of tumour and other biological features of the cancer. So, it is possible for patients with the same cancer to have different treatment options and not all treatment options will be necessary for all women.

Surgery

This is usually but not always the first treatment option. Surgery is aimed at removing the cancer together with some surrounding normal breast tissue. Many women are able to have breast conserving surgery, but for some complete removal of the breast (mastectomy) is necessary. Reconstructive surgery for patients who have had a mastectomy is always discussed.

During surgery, our surgeons will remove one or more lymph nodes from the armpit – this is important as it will give the team more information about the cancer and additional treatments that are required. The surgeon will remove the nearest lymph node to the tumour – if it is cancer-free, this avoids removing more lymph nodes than absolutely necessary and is known as a sentinel lymph node biopsy. Sometimes removal of all the axillary lymph nodes or axillary node clearance is required.

Radiotherapy

Following surgery, radiotherapy is often recommended. This involves using x-ray treatment to the breast, chest wall or neck area to reduce the chance of cancer coming back. Radiotherapy treatment is started once you have fully healed from surgery and after your chemotherapy, if you needed it.

You will need to come to the hospital on a daily basis for between 3 and 5 weeks as an out-patient. Each radiotherapy session takes about 10 minutes each day. We have state-of-the-art radiotherapy machines in our brand new Cancer Centre.

We are also involved in radiotherapy clinical trials. You may offered information about these as part of your treatment.

Please click here for more details about our radiotherapy service at Barts Cancer Centre.

Hormone treatment

Approximately 70% of breast cancers are hormone sensitive. This means that hormones, like oestrogen may cause the cancer to grow. If a patient has this type of cancer, it is treated with medication to block the hormone action and reduce the chances of the cancer returning. Currently the recommended treatment is given in tablet form and needs to be taken daily for a period of 5 years. It will be given after chemotherapy but can start with radiotherapy.

Chemotherapy

Some women will require chemotherapy. This is typically a combination of drugs, injected into a vein and works by destroying the cancer cells. Chemotherapy may be given after surgery to reduce the chance of cancer returning and this will be given before radiotherapy and hormone therapy. In some cases chemotherapy is given before surgery to help shrink the cancer and to help make a breast-conserving operation possible. It is given on our chemotherapy day unit as an outpatient every 3-4 weeks for a total period of 4-6months.

Please click here for more details about our chemotherapy service at Barts Cancer Centre.

Biological or targeted therapy

This is the name given to newer drug treatments cleverly designed to interfere with the way cancer cells grow. An example is herceptin. This is usually given after breast surgery and sometimes together with chemotherapy. The current standard treatment is for it to be given every 3 weeks for a total of 1 year.

Breast reconstruction

This may be offered at the time of primary surgery or later by the breast surgeon or with the plastic surgeons. Wherever possible our surgeons will aim to conserve the breast.

For patients

At Barts Cancer Centre, all our patients are seen by doctors and specialists who are very experienced in all aspects of breast cancer care. When patients are given a diagnosis of breast cancer they may feel confused and frightened and may have lots of questions about their care.

Our patients are all introduced to one of our team of Clinical Nurse Specialists (CNS) who are registered nurses and have specialist knowledge and training in all aspects of breast care. Their role includes providing information about specific cancer treatment and its side effects, giving psychological and emotional support and promoting patient independence.

The CNS also takes on the role of the patient’s named key worker. The key worker takes a active role in coordinating the patients care and providing a point of contact for the patient from the point of diagnosis throughout the whole of the patients’ cancer pathway. This promotes continuity of care and ensures the patient, their carers and families know who to access for information.

We aim to ensure all our patients receive the best care that we are able to provide within a supportive environment.

Patients who stay with us for surgical treatment will be stay on the fourth floor in ward 4A.

Our chemotherapy unit is Ward 7A where patients will receive chemotherapy and supportive care like blood transfusions as a day case. This is a day care unit with 24 chairs and a 4-bedded bay.

For clinicians

For general enquiries and advice please call 020 346 55625 (direct line to the Breast Unit’s secretarial staff). This number can also connect to the appropriate consultant/member of staff.

Breast Unit Service Manager: either through 020 346 55625 above.

Medical oncology: 020 346 56049

Clinical oncology: 020 346 56392

Breast Care Nurses: 020 346 56386 (direct line)

Research Nurses: 020 346 55020

We consistently achieve national access targets for patients with suspected cancer and for treatment following diagnosis. Referral criteria and forms are all available on our website, please click here for referral forms.

Research and clinical trials

We actively participate in national and international oncology trials. The majority of these are co-ordinated by the National Cancer Research Network. All patients, providing they are suitable, will be offered access to one or more of these trials.

There is an active research programme in breast cancer, led by both clinicians and basic scientists, which is undertaken at the Institute of Cancer, Barts Cancer Centre, Queen Mary School of Medicine and Dentistry. The programmes of research include study of cell adhesion molecules and myoepithelial cells, regulation of genes involved in breast cancer, the development of endocrine resistance in breast cancer and the analysis of genetic changes associated with cancer growth.

Our team is also involved in the running of two national studies (GLACIER and ICICLE), which are aimed at identifying genetic variants which cause susceptibility to early preinvasive forms of breast cancer, lobular carcinoma in situ or LCIS and ductal carcinoma in situ or DCIS respectively.

Many members of the multi-disciplinary team are involved on the panels of national and international committees, national trial management groups and faculties of meetings.