Health related information and news from around the world.

Fortunately for many women, once an initial tumor has been detected and surgically removed, there is little chance of tumor recurrence. With the use of radiation, systemic chemotherapy, or tamoxifen the risk of recurrence may be further reduced. A number of women, however, will have tumors that recur either locally (in the treated breast or breast wall) or at a distance (in the form of metastatic disease).At one time the fear of tumor recurrence led many physicians to advocate radical mastectomies or modified radical mastectomies to patients initially diagnosed with breast cancer, in the hope of eliminating the tumor totally and preventing tumor recurrence. We now know that lumpectomies or partial mastectomies often are equally effective in completely removing the primary tumor.If another breast cancer develops after a lumpectomy or partial mastectomy, it may be a recurrence of the original tumor or it may be a new and unrelated cancer. If such a tumor develops on the chest wall outside the normal breast tissue or adjacent to the mastectomy site, it is likely that the original cancer has recurred.Unfortunately, there is then a high risk that the cancer will spread to other parts of the body.*36\320\2*

Cancer of the vagina is not common. Cancers of the vagina usually present similarly to cancers of the cervix, i.e. the woman will complain of abnormal bleeding or discharge, and the diagnosis is usually made by punch biopsy under local anesthetic.
Cancers of the upper vagina are usually treated as cancers of the cervix; (the patient is recommended to undergo a radical hysterectomy and removal of lymph glands from both sides of the pelvic wall.) For cancers of the middle vagina I and lower vagina, chemo-radiation tends to be the recommended treatment. This usually involves a combination of external treatments and the use of radiation needles inserted into the vagina, (‘brachytherapy).
When cancer of the vagina recurs in an area that has had radiation treatment, then treatment is enormously difficult as chemotherapy drugs have little benefit. Treatment is usually palliative and involves pain relief and local hygienic measures, such as vaginal douching with soda bicarbonate and/or antiseptic agents. Again, implantable spinal cord j pump devices for pain relief may be necessary, and occasionally blocking the blood vessel supply to the vagina is required to stop bleeding.
Survival rates for cancer of the vagina are very similar to those of cervix cancer, with very high levels of cure rates when the cancer is small and confined to the surface of the vagina itself.
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How long will I have to wait for an operation to remove a lump from my breast, and will a long wait make a difference to the outcome?

Although most breast cancers are relatively slow growing, and therefore a delay of up to a month or two between the discovery of a lump and its removal should make little, if any, difference to the outcome, efforts are made to avoid a long wait for surgery for the sake of the peace of mind of the woman concerned. The ideal strived for is usually to operate within a couple of weeks of diagnosis of a breast cancer. If you have to wait much longer than this because your consultant has a long waiting list, it may be worth asking your GP if it is possible for your operation to be done by another specialist who can treat you sooner.

I have had a mastectomy and there does not seem to be any sign of spread of my breast cancer to other parts of my body. However, I am constantly anxious about any small ache or pain I have in case it is a sign of cancer in the bones or brain. Can I ask for a total body scan to reassure myself that there is no further cancer in my body?

Unfortunately there is no test available which will confirm the presence or absence of cancer everywhere in the body. If you do develop any symptoms, tell you doctor, as scans can be done of individual parts of the body if necessary. Almost all doctors will be sympathetic and understand your anxiety, and will be quite prepared to put your mind at rest about any particular symptoms.

However, even if it were possible to scan the whole body, microscopic cancer cells would not be visible if they were present, and such a scan would therefore not tell you anything conclusive. The possibility that cancer could have spread to other parts of the body before an operation to remove the breast, or that it could recur in the future, is well understood as a cause of anxiety to women who have had breast cancer, and you should receive all the support you require when trying to come to terms with this.

You will have regular check-ups for many years so that any symptoms or signs can be picked up early, but do talk to your GP, consultant, or breast care nurse if you are worried, and do not be afraid that you are pestering them – they will understand your concerns and should take them seriously. You may want to discuss the possibility of having counseling if your fears continue to cause you distress.

What will the wound look like when I have had a mastectomy? I have a fear of seeing it after the operation, and of being horribly disfigured for the rest of my life.

After your mastectomy there may be a pressure dressing over your wound so that you will not be able to see it. When this is removed – usually about 24 hours after your operation – it will probably be replaced with a clear dressing which will remain until your stitches are removed or for up to 10 days if your wound has been stitched with an absorbable material. Through the clear dressing you will be able to see the cut edges of the wound and either a single ‘running’ stitch or separate stitches across the wound itself. The cut edges may be red and angry looking, and there is likely to be some bruising.

Once your stitches have been removed or the wound has started to heal, it will begin to look much better.

Although many women find the first sight of their wound shocking, most do gradually get used to seeing it as it heals. Within a few months, it will probably have faded to a white or pinkish line, which over the years will fade still further.

As your entire breast will have been removed, you will be left with a flat chest wall on that side, and the wound may be a horizontal or diagonal line. Your nipple will also have been removed during the operation. Sometimes, however, there may still be fat left on the chest which was overlying the breast. If so, you will have some breast contour rather than a dip where your breast used to be. There may be puckering around the wound which may settle after a while.

Following a wide lump excision or lumpectomy, when the nipple is retained, there is usually some nipple distortion, particularly if the operation was to remove a tumour just beneath the nipple. The length of the scar will depend on the size of the lump which was removed. Following a mastectomy, however, there should eventually be only a neat line where the skin was cut.

If I have to have chemotherapy or radiotherapy following my breast operation, what side-effects can I expect to experience?

The drugs used nowadays for chemotherapy are much improved in terms of their side-effects, and you may not experience any at all. It is unlikely that your hair will drop out, and although you may feel tired and nauseated for a while, many women do not even suffer these problems.

Radiotherapy for breast cancer is similarly unlikely to have any seriously debilitating side-effects, although – as with chemotherapy – different women react differently. The skin in the treated area may become sensitive, red and dry, and you will be advised about how to care for it during your treatment.

Do ask your consultant and/or breast care nurse to discuss any possible side-effects of the particular therapy you are to receive.

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