Understanding Cancer - A guide for women with breast cancer
Cancer Society – Te Kāhui Matepukupuku ō Aotearoa
Adapted in accordance with Section 69 of the Copyright Act 1994 by the Royal New Zealand Foundation of the Blind, for the sole use of persons who have a print disability.
Produced 2012 by Accessible Format Production, RNZFB, Auckland
This edition is a transcription of the following print edition:
Published by the Cancer Society
PO Box 12700, Wellington 6011
Copyright 2011 Cancer Society of New Zealand Inc.
ISBN: 0-908933-91-6
Publications Statement
The Cancer Society's aim is to provide easy-to-understand and accurate information on cancer and its treatments.
Our Understanding Cancer information booklets are reviewed every four years by cancer doctors, specialist nurses, and other relevant health professionals to ensure the information is reliable, evidence-based, and up-to-date. The booklets are also reviewed by consumers to ensure they meet the needs of people affected by cancer.
This edition of Breast Cancer/Te Matepukupuku ō ngā Ū includes new features in response to suggestions from those who review our booklets, and to meet the needs of our readers. Our key messages and important sections have been translated into te Reo Māori. Our translations have been provided by Hohepa MacDougall of Wharetuna Māori Consultancy Services.
Other titles from the Cancer Society of New Zealand/Te Kāhui Matepukupuku ō Aotearoa
Advanced Cancer/Matepukupuku Maukaha
Bowel Cancer/Matepukupuku Puku Hamuti
Bowel cancer and bowel function: Practical advice
Breast Cancer in Men: From one man to another
Cancer Clinical Trials
Cancer in the Family: Talking to your children
Chemotherapy/Hahau
Complementary and Alternative Medicine
Eating Well during Cancer Treatment/Kia Pai te Kai i te wā Maimoatanga Matepukupuku
Emotions and Cancer
Got Water?/He Wai?
Kanesa ō le susu/Breast Cancer (Samoan)
Lung Cancer/Matepukupuku Pūkahukahu
Melanoma/Tonapuku
Prostate Cancer/Matepukupuku Repeure
Radiation Treatment/Haumanu Iraruke
Secondary Breast Cancer/Matepukupuku Tuarua ā-Ū
Sexuality and Cancer/Hōkakatanga me te Matepukupuku
Understanding Grief/Te Mate Pamamae
Being Active When You Have Cancer
Being Breast Aware
Bowel Cancer Awareness
Gynaecological Cancers
Questions You May Wish To Ask
Talking to a Friend with Cancer
Thermography
Page 1
This booklet has been prepared to provide you with information about cancer of the breast. It gives information about diagnosis, treatment, practical support, and the emotional impact of cancer.
A specific booklet covering secondary breast cancer is available from your local Cancer Society, or by phoning the Cancer Information Helpline 0800 CANCER (226 237).
In the past, breast cancer surgery was quite extensive and women feared not only the disease but also the treatment. Today, with early detection methods and the trend towards smaller operations, breast cancer can be treated successfully with better cosmetic results.
We can't advise about the best treatment for you personally. You need to discuss this with your own doctors who are familiar with your full medical history. However, we hope this information will answer some or your questions and help you think about the questions you may want to ask your doctors.
If you find this booklet helpful, you may like to pass it on to your family and friends who might also find it useful. The words in bold are explained in the glossary at the end of this booklet.
Page 2
Box:
Ko te kaupapa o tēnei puka, he āwhiNa i te iwi kia puta whānui ngā māramatanga mō tēnei mate te matepukupuku o ngā ū. He pārongo kei roto mō te whakatau mate, te maimoatanga, ngā āwhiNa i ngā pānga o te mate nei ki te taha kikokiko, ki te taha wairua.
I tua atu, ka taea te tono i tētahi puka anō mō te matepukupuku tuarua o ngā ū mai i te tari o te Kāhui Matepukupuku tata ki a koe, waea rānei ki Waeaāwhina Pārongo Matepukupuku 0800 CANCER (236 237).
Hei ngā rā ki mua, he āhua whārahi tonu ngā pokanga matepukupuku ū, me te kaha mataku o ngā wāhine ki te mate nei, tae noa ki ngā maimoatanga. I ēnei rā, nā runga i ngā huarahi kite moata me te ia kia iti ake ngā pokanga, ka angitu ake te maimoatanga me te pai ake o ngā huanga whakanako.
Kāore e taea e mātou te tohutohu i a koe e pā ana ki ngā maimoatanga pai mōu. Me kōrero kē koe ki ō rata, ina rā kei a rātou ngā kōrero e pā ana ki tō mate. Hāunga tērā, ko te tūmanako, mā tēnei puka ka taea ētahi o ō pātai te whakautu, me te āwhiNa i a koe ki te whakaaro ake ki ētahi pātai hei pātai mau ki tō rata.
Mehemea i whai āwhina koe i te puka nei, me tuku ki tō whānau me ō hoa, tērā pea he āwhina kei roto mā rātou. Ka taea ngā whakamārama mō ngā kupu miramira i te rārangi kupu kei te pito ō te puka.
End of Box
What is cancer? – Page 4
Your breasts – Page 7
What is breast cancer? – Page 9
Diagnosis – Page 14
Planning treatment – Page 20
Treatment – Page 23
Making decisions about treatment – Page 55
After treatment – Page 62
Support – Page 68
What can I do to help myself? – Page 80
Relationships and sexuality – Page 88
Questions you may wish to ask – Page 91
Glossary – Page 95
Suggested reading and websites – Page 99
Feedback – Page 105
Page 4
Cancer is a disease of the body's cells. Our bodies are always making new cells to replace worn-out cells, or to heal damaged cells after an injury. This process is controlled by certain genes: the codes that tell our cells how to grow and behave. Cancers are caused by damage to these genes. This damage usually happens during our lifetime, particularly as we get older. A small number of people inherit a damaged gene from a parent.
Normally, cells grow and multiply in an orderly way. However, damaged genes can cause them to behave abnormally. They may grow into a lump, which is called a tumour. Tumours can be benign (not cancerous) or malignant (cancerous). Benign tumours do not spread to other parts of the body.
Diagram:
Title: The beginnings of cancer
Transcriber's Note: The diagram shows 4 stages to cancer.
The first stage shows a row of light coloured "Normal Cells".
Beneath these cells is a black line called "Basement Membrane".
Beneath the Basement Membrane is a "Lymph Vessel"
Beneath the Lymph Vessel is shown a "Blood Vessel"
The second diagram is the same except for a few of the normal cells at the top have changed to a dark colour and are labelled "Abnormal Cells".
The third stage shows these abnormal cells multiplying upwards and outwards. These dark cells are labelled "Abnormal cells multiply (Cancer in situ)"
The fourth and final stage shows a large cluster of these dark cells, which now have a direct line into the blood vessel. This large group of cells is labelled "Malignant or invasive cancer".
End of Note.
End of Diagram.
Malignant tumours invade into the surrounding tissues, and may form a secondary cancer or metastasis in another part of the body.
For a cancer to grow bigger than the head of a pin, it must grow its own blood vessels. This is called angiogenesis.
Sometimes, cells break away from the original (primary) cancer and spread to other organs. When these cells reach a new site they may form a new tumour. This is called secondary cancer or metastasis. So, for example, if breast cancer spreads to the bones, it is called a breast cancer secondary in the bone. It is not considered to be bone cancer, which is a separate disease.
Box:
He mate te matepukupuku ka pa ki ngā pūtau o te tinana. E kore e mutu te mahi a te tinana ki te hanga pūtau hou hei whakahou i ngā putau kua ruha, ki te whakaora hoki i ngā pūtau kua hē i ngā wharahanga noa. Whakahaerehia ai tēnei mahi e ētahi ira: ara ko ngā tohu ka whakarite i te ahua tipu a ngā putau, tae noa ki tōna whanonga. Ka puta te matepukupuku nā runga i ngā wharanga ki ēnei momo ira. Ka pā ēnei wharahanga puta noa i te koiora o te tangata, ina koa, ka kaha ake te pā ka pakeketia ana. Tērā ētahi tāngata torutoru nei, ka whānau mai ki te ao me tētahi ira hē i heke mai i tētahi o ō rātou mātua.
Page 6
Ko te tikanga, ka tipu pai, ka rahi haere ngā pūtau. Heoi, ka tareka e te ira hē te whakararu i te mahi a ngā pūtau. Tērā pea ka tipu hei puku, ā, kīia hoki tēnei, he puku. Ko ētahi puku he mārire (kore matepukupuku), ko ētahi he marere (kawe matepukupuku). Kaore ngā puku mārire e hōrapa ki ētahi atu wāhi o te tinana.
Ka whakaeke ngā puku marere ki roto i te kikokiko e karapoti ana, ā, tērā pea ka tipu mai he matepukupuku tuarua, ka kīia he metastasis ki wāhi kē o te tinana.
Kia tipu ai te matepukupuku kia nui ake i te kōhao o te ngira, me whakatipu ano ia i ētahi ia toto. kīia ai tēnei ko te angiogenesis.
Hei ētahi wā ka maunu mai ētahi pūtau i te wāhi tipu taketake (matua) o te matepukupuku ka hōrapa ki ētahi atu whēkau. Ka tau aNa ēnei pūtau ki tētahi wāhi hou, tērā pea ka tipu mai he puku hou. Kīia ai tēnei ko te matepukupuku tuarua, ko te metastasis rānei. Hei tauira, ki te hōrapa atu te matepukupuku i te ū ki ngā kōiwi, kīia ai ko te matepukupuku tuarua i te kōiwi. Ehara tēnei i te matepukupuku ki ngā kōiwi, he mate atu anō tera.
End of Box
Diagram:
Title: How Cancer Spreads
Transcriber's Note: The diagram shows a cross section of skin and how cancer grows.
There are 7 labels on the cross section. The first, starting from the top and working down is:
"Primary Cancer" – This shows a raised dark area on top of the skin cells.
The second is "Local Invasion" – This shows very dark cells beneath the primary cancer. It is spreading through the lymph and blood vessels.
The third is "Basement membrane" – This shows a thin dark area beneath the normal cells.
The fourth is "Lymph Vessel" – This shows a lymph vessel within the skin which has been enveloped partially by the local invasion. There are dark black cell spots within this lymph vessel.
The fifth is "Metastasis" – This shows dark cells in the skin and blood and lymph vessels.
The sixth is "Cells move away from primary tumour and invade other parts of the body via bloody vessels and lymph vessels".
The seventh is "Bloody vessels" – This shows the blood vessel leading up to the tumour. There are dark cancer cells within the bloody vessel.
End of Note
End of Diagram.
Your breasts are designed to make milk after pregnancy. The breast tissue extends almost to the collar bone at the top and to the armpit at the side. Lying beneath the breasts are the chest muscles and ribs.
Breast tissue is made up of milk glands, connective tissue, and fat. The milk glands consist of milk sacs (lobules) where milk is made, and ducts which take the milk to the nipple.
Page 8In your breast area and armpit there are lymph glands or nodes which are connected by a system of lymph ducts. These glands and ducts are part of the lymphatic system, which helps your body to fight infection.
Your breasts do not stay the same throughout your adult life. Your monthly period, pregnancy, age, and weight changes can all alter their shape. Some women find their breasts feel more tender and lumpy before their period. This tenderness and lumpiness disappears after the period ends. This is quite normal.
Box:
Ko te mahi a ngā ū, he waihanga waiū whai muri i te hapūtanga o te wahine. Ka toro te kikokiko o ngā ū ki te tāhei ki runga, ki ngā kēkē i ngā taha. Kei raro iho i ngā ū ko ngā uaua o te uma, ko ngā rara.
Hangaia ai ngā kikokiko ū mai i ngā repe waiū, ngā pānga kikokiko me te mōmona. He kahu waiū (lobules) ngā repe waiū, he wāhi mahitia ai te waiū, ko te wāhi hoki noho ai ngā ngongo kawe i te waiū ki ngā kōmata o ngā ū.
Ehara i te mea ka rite te āhua o ngā ū puta noa i te wā o tō pakeketanga. Ka panoni ngā ū o te wahine nā te rere o te toto ia marama, nā te hapūtanga, nā te hipanga o ngā tau, nā te piki me te heke hoki o te taumahatangā. Hei mua i te rerenga ō te toto ia marama, ka ngohengohe ka pupuke ngā ū o ētahi wāhine. Mutu ana te rere o te toto, kua kore haere te ngohengohe me te pupuketanga. He mea puta i ngā wa katoa.
End of Box
Breast cancer is a malignant tumour that starts in the breast tissue. The majority of breast cancers begin in the milk ducts (ductal cancers). A small number start in the milk sacs or lobules (lobular cancers). Within these two groups there are different subtypes of breast cancer. Some grow very slowly. Others develop more rapidly.
Breast cancer can spread to the lymph glands and to other parts of the body, most commonly the lung, bones, and liver.
Box:
He puku marere te matepukupuku o ngā ū ka tīmata ki roto i te kikokiko ū. Ka tipu te nuinga o ngā matepukupuku o te ū ki ngā ngongo waiū (kīia ai he matepukupuku ki te ngongo waiū). Ruarua noa ngā matepukupuku o te ū ka tipu i ngā ngongo waiū, ki ngā lobules (matepukupuku lobular). Kei roto i ēnei mate e rua nei, ētahi atu momo matepukupuku o ngā ū. He pōturi te tipu ō ētahi o ngā momo matepukupuku ū, he kakama te tipu o ētahi atu.
Tērā pea ka hōrapa te matepukupuku o ngā ū ki ngā repe waitinana me ētahi atu wāhi o te tinana, tae noa ki ngā pukahukahu, ki ngā kōiwi me te ate.
End of Box
Diagram:
Caption: Illustration of a woman's breast showing ductal carcinoma in situ and invasive breast cancer
This diagram is reproduced with permission from the National Breast and Ovarian Cancer Centre.
Transcriber's Note:
The diagram shows a side view cross section of a woman's breast.
There are 8 labelled areas on this cross section. Starting from the top and working in a clockwise direction, these labels are:
"Fatty Tissue". This label has an arrow which points to a light coloured tissue area all within the breast.
"Muscle: (your breast sits on top of a layer of muscle". An arrow points to a wall of muscle at the back of the breast.
"Ribs: (the muscle sits on top of your ribs)". Two arrows point to two ribs, one above the other, which are shown behind the wall of muscle.
"Ductal carcinoma in situ: (cancer cells are contained within milk ducts)". A dark spot is shown inside a milk duct close to where the lobules are.
"Nipple". The nipple is shown at the tip of the breast. From the nipple are milk ducts which lead back towards the lobules.
"Milk Ducts". An arrow points to one of many milk ducts which carry milk from the lobules to the nipple.
"Lobules: (Milk sacks)". These are clusters of tiny sacks at the ends of each milk duct. Each cluster is separate from the next.
"Invasive breast cancer: (Cancer cells have spread from milk ducts into the surrounding breast tissue)". An arrow points to a dark patch on where one of the milk ducts meets a lobule.
End of Note
End of Diagram
Breast cancer is the most common cancer in New Zealand women. Approximately 2,500 women are diagnosed each year. Breast cancer can occur at any age but is most common in women between the ages of 50 to 70 years. Although it is very unusual, men can develop breast cancer (approximately 1 percent of all breast cancer). For information on male breast cancer contact your local Cancer Society, phone the Cancer Information Helpline 0800 CANCER (226 237) for a copy of our booklet Breast Cancer in Men: From one man to another. This booklet can also be viewed on the Cancer Society's website (www.cancernz.org.nz) under "Cancer Information".
Box:
Ko te matepukupuku o ngā ū te matepukupuku nui rawa ka pā ki ngā wāhine o Aotearoa. Āwhiwhiwhi ki te 2500 ngā wahine ka whakataungia ia tau. Ka pā te mate nei ki te wāhine ahakoa he aha te pakeke; heoi, ka kaha rawa te tipu i ngā wāhine e 50–70 tau te pakeke. Ahakoa te rerekē, ka pā anō te matepukupuku ū e ki te tāne (tata ki te 1 ōrau o ngā matepukupuku katoa). Mō te roanga ake o ngā kōrero mo te matepukupuku ū o ngā tāne, whakapā atu ki te Kāhui Matepukupuku kei tō rohe, me waea atu rānei ki te Waeaāwhina Pārongo Matepukupuku 0800 CANCER (226 237) mō tētahi kape o tā mātou puka Breast Cancer in Men: From one man to another. Ka taea hoki te pānui i tēnei puka i runga i te paetukutuku a te Kāhui Matepukupuku (www.cancernz.org.nz) i raro i "Cancer Information".
End of Box
The causes of breast cancer are not clear, so there is no certain way to prevent it. There are some clues, or risk factors, about who is more likely to develop the disease. The risk factors include:
age – a woman's chances of developing breast cancer increase as she gets older
previous breast cancer
atypical hyperplasia (increased number of abnormal cells) can be seen in breast biopsy
a family history of breast cancer
having a faulty BRCA gene. The BRCA1 gene when working normally helps to repair DNA
having an altered gene that is associated with the risk of breast cancer
hormone replacement therapy
alcohol consumption
obesity.
The risk from family history depends on:
the number of relatives affected
whether they are close relatives
the age of the relative(s) when their breast cancer was found.
However, a family history of breast cancer does not necessarily mean a woman will develop breast cancer.
Women who are shown to have inherited one of the faulty genes (for example BRCA) associated with breast cancer do have an increased risk. If it seems possible that you may be a member of a family at increased risk, you will be referred to a family cancer genetic clinic.
Most women who develop breast cancer have no family history of the disease.
Box
Kāore i te mārama ngā takenga o te matepukupuku o ngā ū, nā reira, kāore he tikanga kaupare hāngai rawa atu. Ka puta he tīwhiri, he ahuataga mōrearea rānei mō ngā tāngata tērā pea ka whakahiato i te mate nei. Ko ngā ahuatanga mōrea ko ēnei:
te pakeke – ka pakeke haere te wahine, ka nui atu te tūponotanga ka tipu te matepukupuku o ngā ū
te pānga o te matepukupuku o ngā ū i mua
atypical hyperplasia (kua piki te tipu o ngā pūtau tino rerekē) kitea ai i roto i ngā biopsy ū
kua pā kē te matepukupuku o ngā ū ki te whānau
te whai ira BRCA muhu (mena kai te mahi tika te ira BRCA1, ka āwhina ia i ngā mahi whakatikatika i te pitau ira (DNA)
te whai ira rerekē kua whakahāngaitia ki te mōrea o te puta o te matepukupuku ū
haumanu taiaki whakahoki
te kai waipiro
te tino mōmona.
Ka hāngai te mōrea ka ahu mai i te whakapapa ki ēnei āhuatanga:
te nui o ngā whanaunga i pāngia ki tēnei mate
mehemea he whanaunga pātata
te pakeke o ngā whanaunga i te wā i kitea te matepukupuku.
Oti rā, ehara i te mea ka puta te matepukupuku ki te wahine mēnā kei roto i tōna whakapapa. Heoi anō rā, mēnā kua heke iho te ira hē e hāngai ki te matepukupuku ū, pērā ki te BRCA, ka piki te mōrea. Mehemea nō tētahi whānau koe e kawe aaa i taua mōrea, ka tohua koe ki te haere ki tētahi whare haumanu ira matepukupuku ā-whānau.
Ko te maha o ngā wāhine ka puta te matepukupuku ū, kāore he whakapapa o te mate ki roto i te whanau.
End of Box
Breasts undergo changes throughout a woman's life, particularly the normal changes experienced during the menstrual cycle.
Page 15Some breast changes may be early signs of breast cancer, including:
a lump or lumpiness
thickening of the tissue
nipple changes; for example a blood-stained discharge from one nipple, an inverted nipple (unless the nipple has always been turned in), and a rash on a nipple
skin dimpling
a change in shape
a painful area
a rash or red marks which appear only on the breast.
Although these changes do not necessarily mean you have breast cancer, any breast change should be checked by a doctor.
Box:
"When I was diagnosed I felt totally shocked. I couldn't remember much after I heard the word 'cancer'. I was so pleased I had my partner there to write down what was said."
End of Box
Box:
Ka panoni ngā ū puta noa i te koiora o te wahine, tae atu ki ngā panonitanga i te wā ka heke ōna toto.
Tērā pea ko he tohu ētahi o ngā panonitanga ki ngā ū, i tētahi tohu ipu haere o te matepukupuku o ngā ū pērā i:
tētahi puku, pupuketanga ranei
te mātotoru haere o ngā kikokiko ū
te panoni o ngā kōmata, hei tauira, te rere o te toto i tētahi o ngā ū, he kōmata kua huri kōaro rānei (i puta kē rānei tēnei āhua i te whānautanga mai) he kōpukupuku i runga i tētahi o ngā kōmata
te komekome o te kiri
te rerekē o te āhua hanga
te mamae ki tētahi wāhi
he kōpukupuku, he waitohu whero rānei ka puta ki ngā ū.
Ehara i te mea he tohu ēnei kua pāngia koe i te matepukupuku o ngā ū; engari me tirohia ngā rerekētanga kua puta ki ngā ū e te Rata.
Mehemea kua rerekē te āhua o ō ū, tērā pea ka whakahaerehia ētahi whakamātautau. Mā tō rata ake ēnei whakamātautau hei whakarite, mā te mātanga ū rānei.
End of Box
If you have a change in your breast, you may have several tests. Your general practitioner may arrange these tests or you may be referred directly to a breast specialist.
The doctor will take your medical history and examine your breasts.
A mammogram is a breast X-ray. It will give your doctor more information about any lump or other change noticed.
Occasionally, a lump that can be felt is not seen on a mammogram. Such a lump should not be ignored. Other tests will need to be done.
An ultrasound is a test using high frequency sound waves to help detect lumps or other changes.
An MRI scan is a scan that uses magnetic resonance to detect abnormalities in the breast. Occasionally, an MRI is recommended in young women when their breast tissue is very dense. This type of scan is sometimes used in lobular carcinomas to make sure there is not more than one cancer present, and it can check the other breast. It can also be used to check the breast if a mammogram is negative but the specialist is still concerned about the lump or changes in the breast.
Page 18
A fine needle aspiration can be done in your specialist's rooms, in a hospital outpatient department, or at a laboratory by a pathologist. A very narrow needle is used to take some cells from the lump. These cells are then sent to a laboratory for examination. A fine needle aspiration may cause a little discomfort but is not usually any more painful than a blood test. Results from this test may be available immediately or take some time, depending upon where it is done.
Often, a biopsy will be necessary. A biopsy is the removal of a sample of a lump or the entire lump for examination under a microscope.
Box:
I te nuinga o te wa, me whakahaerehia he unuhanga.
Ko te tikanga o te unuhanga, ka tangohia he wāhanga, te katoa rānei o te pupuketanga kia āta mātaitia raro i te karuwhakarahi.
End of Box
A larger needle than that used for fine needle aspiration is used to obtain a sliver of tissue from the lump. This is done with a local anaesthetic. It can be done by a radiologist under ultrasound guidance or in a mammogram machine (stereotactic core biopsy). Sometimes, it is done by palpation (feeling) of the lump by the specialist.
Page 19
Sometimes, a surgical or open biopsy is necessary to remove the whole lump. This small operation is usually done under general anaesthetic, although occasionally a local anaesthetic is all that is needed. To have an open biopsy, you may need to stay in hospital overnight.
If the abnormality in the breast can only be detected by the mammogram (your doctor cannot feel your lump), a fine guide wire may be inserted in the breast to mark the area of the breast to be removed. This takes place in the radiology department under local anaesthetic. The abnormality is then removed, as in an open biopsy, under general anaesthetic and sent to the laboratory for testing.
If the lump is a cancer, hormone receptor tests will be done using immuno-histochemistry (IHC) on the sample that was removed. These tests show whether the cancer cells have special 'markers' on them called hormone receptors (oestrogen/progesterone). If these markers are present, the cancer is described as 'hormone receptor positive', and the cancer is more likely to respond to hormone treatment if this is needed later.
Page 20HER2 is a growth factor protein which tells breast cancer cells to grow. Approximately one in five breast cancers makes too much of this protein, which means that the cancer is more aggressive. This is often called HER2 positive breast cancer.
Two tests are available to check HER2–IHC and FISH. IHC is used first and if it is not a clear result then the FISH test is used.
If tests show that you have HER2 positive cancer, this will influence future choices of chemotherapy, hormones, or monoclonal antibodies. The most commonly used monoclonal antibody drug is called trastuzumab (Herceptin) which targets the growth factor protein. A diagnosis of breast cancer (see page 14) can be very stressful (see page 74) for information on the support available).
Before any treatment begins, make sure that you have discussed the choices with your doctor. Your doctor may advise that one method of treatment is better than another. The treatment choices you are offered will be based on all the information the doctor has about your cancer and what is right for you. These include:
the size of the cancer
the grade of the tumour (how the cancer looks under the microscope. Aggressive cancers have a special appearance that tells doctors they are more likely to spread)
the number of lymph nodes under your arm that contain cancer cells
whether the cancer was growing into the blood or lymphatic vessels. (This is described as lymphatic vascular invasion (LVI).)
whether the cancer cells have hormone receptors (oestrogen/progesterone) on them
whether there were cancer cells present at the edges of the tissue removed (also called positive margins)
HER2 receptor test results (see page 20).
your general health.
Breast cancer is treated by several different methods: surgery, radiation treatment, chemotherapy, hormone treatment, and monoclonal antibody therapy.
You may find it useful to have your husband, partner, or a friend with you when you talk to the doctor. You may also find it helpful to make a list of questions before your visit (refer to the list of questions at the end of this booklet and take notes during your discussion). The Cancer Society also has a booklet titled Questions You May Wish To Ask that you can receive from your local Cancer Society, by viewing it on our website, or by phoning the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).
Make sure you understand the reasons for your doctor's advice. Ask for a second opinion if you want one.
Page 22Box:
I mua i te tīmatatanga o ētahi maimoatanga, me matua kōrero ki tō rata e pā ana ki ngā kōwhiringa. Tērā pea ka kī tō rata he pai ake tētahi huarahi maimoatanga ki tētahi atu. Ko ngā kōwhiringa maimoatanga katoa ka whakaatunga ki a koe, ka hāngai ki ngā pārongo e pupuri ana tō rata e pā ana ki tō matepukupuku, me ngā ahutanga e tika ana mōu.
He maha ngā huarahi maimoatanga mō te matepukupuku o ngā ū: ko te hāparapara, ko te haumanu iraruke, ko te hahau, ko te taiaki, ko te haumanu paturopi monoclonal.
He pai anō pea kia whai tō tāne, tō hoa rangatira rānei, tētahi o ō hoa rānei i a koe ki te kōrero ki te rata. Tērā pea ka whakaaro koe mō ētahi pātai i mua i tō haerenga (titiro ki ngā pātai kei te pito mutunga ō te puka nei; tango tuhituhinga i te wā ō te hui me te rata). He puka tā te Kāhui Matepukupuku e kīia ana, ko 'Ngā pātai e hiahia ana koe ki te tuku', ka taea te tono kia tukuna atu ki a koe, ka taea rānei te mātakitaki i runga i tō mātou paetukutuku, mā te waea atu rānei ki te Waeaāwhina Pārongo Matepukupuku.
Kia mārama koe ki te take o ngā tohutohu a tō rata. Ki te hiahia koe, me tono i ngā whakaaro tuarua a tētahi atu rata.
End of Box
From the time that you are first diagnosed with breast cancer you will be cared for by one or more of a team of health professionals including:
your family doctor
breast care nurses, who specialise in the care of women with breast cancer
a breast surgeon, who specialises in breast diseases, and, sometimes, a (plastic) reconstructive surgeon
a pathologist, a doctor who diagnoses disease by studying cells and tissues under a microscope
a radiation oncologist, a doctor who specialises in the use of radiation in the treatment of cancer
a medical oncologist, a doctor who specialises in the use of drug treatments for cancer
radiation therapists, who prepare you and give you your radiation treatment
oncology nurses who give chemotherapy and monoclonal antibody treatments, and support you through your treatment
dieticians, who will recommend the most suitable foods to eat
social workers, counsellors, physiotherapists, and occupational therapists, who will advise you on the support services available, and help you get back to normal activities.
Ideally, your hospital should have all available means of diagnosis and treatment, although this will not be the case in some areas.
The first treatment for breast cancer is usually surgery. This includes surgery on the breast and, for most women, some of the glands in the armpit (the axillary lymph nodes) are removed. Examination of the cancer and the lymph glands by the pathologist will indicate whether further treatment should be considered after the surgery.
The aim of surgery is to remove all of the cancer. The type of surgery depends on a number of factors including the size of the cancer, the size of the breast, the position of the cancer in the breast, and the patient's choice. Surgery will remove the cancer and a margin of healthy breast tissue around it (wide local excision) or the whole breast (mastectomy). At the same time, some of the lymph glands in the armpit are also removed.
Studies have shown that women who have a wide local excision followed by radiation treatment (breast-conserving surgery) have the same survival rates as women who have a mastectomy. For more information see the section titled "Breast-conserving treatment (wide local excision)".
Page 25Box:
Hei te nuinga o te wā, ko te hāparapara te huarahi maimoatanga tuatahi mō te matepukupuku ū. Ka mahia te hāparapara ki te ū, ka mutu, mō te nuinga o ngā wāhine, ka tangohia ētahi o ngā repe i te kēkē (nga tipona waitinana kēkē). Waihoki, whai muri i te tātari a te pathologist i te matepukupuku me ngā repe waitinana, e tohu mēnā ka haere tonu ētahi maimoatanga whai muri i te hāparapara.
E ai ki ngā akoranga tiro whānui, he ōrite te oranga o ngā wāhine ka whai tapahitanga whānui me te whai o te maimoatanga iraruke (hāparapara pena-ū) ki era ka whai mastectomy. Mō te roanga o ngā kōrero, titiro ki te wāhanga e kīia ko te "Hāparapara pena-ū (tapahitanga ā-rohe whānui)".
End of Box
Staging is a process of assessing the extent of a tumour. Other tests may also be necessary if cancer is diagnosed. These include blood tests and a chest X-ray.
In some situations a bone scan and a CT scan of the chest, abdomen and pelvis may be done.
The complete results from the biopsy and any further tests will help to determine the best treatment for you.
With this information your doctors will know if you have an early breast cancer, locally advanced breast cancer, or metastatic (secondary) breast cancer.
Box:
He hātepe te mahi tātari hei aromatawai i te whārahi o te puku. Tērā pea ka whai atu ētahi atu whakamātautau mēnā kua whakataungia he matepukupuku, pērā ki ngā whakamatautau toto me ngā whakaata roto o te uma.
Mā ngā putanga o te unuhanga me ētahi atu whakamātautau e tohu ko tēhea te huarahi maimoatanga ka tika mōu.
Mā ēnei pārongo ka mārama ō rata mehemea kua pāngia koe ki tētahi matepukupuku tōmua o ngā ū rānei, te matepukupuku maukaha o ngā ū rānei, te matepukupuku tuarua o ngā ū (metastatic) rānei.
End of Box
The following table sets out the breast cancer stages.
Table:
|
T |
N |
M |
|
|---|---|---|---|
|
Early Breast Cancer Stage 1 or 2 |
T1-2 Tumour up to 5cm |
No – None N1 – Up to 3 involved nodes |
No metastases |
|
Locally Advanced Stage 3 |
(Any size) |
N2 – 4 or more nodes, or fixed nodes N3 – Nodes other than in axilla |
No metastases |
|
Blank |
T3 – More than 5cm T4 – Fixed to skin or chest wall |
(Any nodes) |
No metastases |
|
Metastatic Stage 4 |
(Any Size) |
(Any nodes) |
Metastases |
End of Table
Specialists treat Stages 1 and 2 and early Stage 3 in the same way: an operation, or operation as well as radiation, then possibly other treatments, such as chemotherapy, hormone therapy, or monoclonal antibody therapy, according to the woman's cancer. When the tumour is too large to remove by surgery, chemotherapy may be used. This is to shrink the cancer so it can be more easily removed by surgery.
Page 28TNM is an international staging system
T = tumour (numbered 1 to 4 to indicate the size and extent of the tumour).
N = node (whether or not lymph nodes are affected by cancer).
M =metastases (the spread of cancer from the breast to other parts of the body).
The pathologist (the doctor who looks at cancers in the laboratory) 'grades' the cancer according to the way the cancer cells look. The grades are numbered from 1 to 3.
The cells of a Grade 1 breast cancer look more like normal breast cells whereas the cells of a Grade 3 breast cancer look very abnormal, indicating a faster growing cancer.
Mastectomy is the removal of the whole breast including some of the skin and the nipple. The chest muscles are not removed. Some lymph glands in the armpit are also removed during the operation.
Usually, the lymph nodes are removed through the same incision during this operation. This is called axillary node clearance (or dissection).
Page 29Mastectomy is less disfiguring than the radical mastectomy of the past. The new type of mastectomy performed today allows for easier breast reconstruction. After mastectomy, most women will have a horizontal scar across their chest. Breast reconstruction can be performed for women having mastectomy. This can be done at the same time as mastectomy (immediate reconstruction) or after all the treatments for the cancer are completed as a separate operation (delayed reconstruction).
Diagram:
Title: Mastectomy
Transcriber's Note: The diagram shows two cartoon outlines of the upper half of a woman. Both show the woman's breast and under her right arm.
The first has two labels. One points to the armpit and is labelled "Removal of lymph nodes". Two points to a circular dashed line around the right breast. This is labelled "Removal of breast".
The second image has one label. It points to where the right breast was before removal. This is labelled "Scar after mastectomy". Only the left hand breast is left. And there is only one scar.
End of Note
End of Diagram
For many women it is now possible to have smaller operations, such as partial mastectomy (wide local excision).
A breast-conserving operation involves removing the breast lump with some surrounding normal breast tissue to ensure a good clearance. Surgery is then followed by radiation treatment to the remaining part of the breast. This is usually six to eight weeks after surgery. Often, if chemotherapy is also needed, radiation treatment will be delayed until after chemotherapy treatment is finished. This significantly reduces the risk of cancer recurring in the remaining breast tissue.
Diagram:
Title: Breast-conserving treatment
Transcriber's Note: This diagram is like the one above: two cartoon images of a woman's right side, showing us her right breast and under her right arm.
The first of the two images has two labels. One points to her armpit and is labelled "Removal of lymph nodes". Two points to a small dashed circle at the top of the breast close to the chest. This is labelled "Removal of breast tissue".
The second image has one label. It points to a scar under the woman's armpit and one above her breast. This is labelled "Scars after conserving surgery".
End of Note
End of Diagram
Lymph glands are also removed for examination in these smaller operations and this is often through a separate incision (cut) in the armpit.
Breast-conserving operations have been routinely performed now for many years. Breast-conserving surgery followed by radiation treatment is as effective as mastectomy for most women with early breast cancer. However, with breast-conserving surgery followed by radiation treatment there is a higher chance that the cancer could come back in the breast area. This is called local recurrence and does not increase the chance of cancer spreading to other parts of the body. Checking for local recurrence is one of the reasons why follow-up tests are important after treatment for breast cancer.
Women with early breast cancer will have their lymph nodes in their armpit checked for spread of breast cancer cells. This is usually done by sentinel node biopsy or lymph node dissection.
Page 32
A sentinel node biopsy locates the first lymph node(s) that drains from the area where the breast cancer developed. This node(s) is detected after injecting a blue dye and a radioactive tracer into the breast tissue where the cancer was found. The node(s) is then removed surgically so that the tissue can be examined. It is thought that removing this node(s) alone may avoid larger operations in the armpit (called axillary clearance). This will reduce the likelihood of surgical side effects (for example lymphoedema). It is also an accurate way of checking if cancer has spread to the lymph nodes.
If the sentinel node shows cancer cells, the surgeon will need to remove further lymph nodes from the armpit, usually 10 to 20 nodes (axillary clearance). This may be done at the same time or in a separate operation.
Sentinel node biopsy is not always possible if there is a larger cancer (greater than 3cm) or more than one cancer (known as multifocal) in the breast.
Lymph node dissection (axillary clearance) is the removal of lymph nodes in the armpit that could drain breast tissue. There are usually more than 10 glands removed and care is taken to avoid damage to nerves and blood vessels. There is usually a plastic tube, called a drain, left in the armpit after axillary clearance. The drain is removed when fluid reduces to a very small amount after surgery. Side effects of axillary clearance include shoulder stiffness, nerve pain or numbness in the upper arm, and lymphoedema.
Page 33Diagram:
Title: Lymph node areas adjacent to breast area
Transcriber's Note: The diagram shows a front on view of a cartoon woman.
There are 6 letter references on the diagram from A to F which have explanations below. Starting at A these are as follows:
A. Points to a muscle behind the breast. This is labelled "Pectoralis major muscle".
B. Points to a lymph node down the far right side of the right breast. This is labelled "Axillary lymph nodes: level i".
C. Points to a lymph node in the right armpit. This is labelled "Axillary lymph nodes: level ii".
D. Points to a lymph node about where the collar bone is on the right hand side. This is labelled "Axillary lymph nodes: level iii".
E. Points to a lymph node in the centre of the neck above the collar bone. This is labelled "Supraclavicular lymph nodes".
F. Points to a lymph node on the left side of the right breast, about midway up the chest. This is labelled "Internal mammary lymph nodes".
End of Note
End of Diagram
Box:
Ko te mahi a te unuhanga tīpona sentinel, he rapu i te tīpona waitinana tuatahi e rere ana i te wāhi tīmata ai te matepukupuku o ngā ū. Ka kitea tēnei tīpona mā te wero i te tae kikorangi me tētahi mātai iraruke ki te wāhi o te ū i kitea ai te matepukupuku. Ka tapahia te tīpona kia taea taua wāhi o te ū te tātari. Ko te whakapae, ka tangohia te tīpona kia kore ai e pokaina te kēkē. Mā tēnei, ka iti ake ngā pānga o te pokanga ka puta ki te taha, pērā ki te pupuhitanga (lymphoedema). He huarahi tika hei tirotiro mehemea kua hōrapa te matepukupuku ki ngā tīpona waitinana.
End of Box
After your operation you may have one or two tubes (drains) coming from the area of your operation into small bags. These drain fluid, which if not removed can cause discomfort, delay wound healing, and may cause an infection. They are usually left in place for a few days. Many women are discharged with their drains in place. If this happens, your nurse will show you how to care for them at home. Your doctor will arrange for them to be removed at a later date or this may be managed by a district nurse. Removing the drains is quick and causes only mild discomfort. It can be done at the doctor's rooms or at the outpatients clinic.
Page 35
While many women may want a breast-conserving operation, the choice between a mastectomy and a breast-conserving operation depends upon the size of the breast cancer and the size of the breast.
It is helpful to weigh up the advantages and disadvantages of each method for yourself.
The main advantage of the smaller operation is that the breast is saved. However, a disadvantage is that further treatment with radiation treatment is almost always needed. This can take up to six weeks. In the future, a small number of patients with small tumours may be candidates for partial breast irradiation.
Small-breasted women may also find that the smaller operation still leaves them with a big change in their breast shape.
An advantage of mastectomy is that radiation treatment may not be needed. However, in some cases if the tumour is large, close to the underlying muscle, or if there are many lymph nodes involved, radiation treatment is still recommended to reduce the risk of cancer recurring.
Page 36The main disadvantage of mastectomy is the loss of the breast.
Reconstruction is possible and can be carried out at the time of the mastectomy or in the future. In some small-breasted women, mastectomy and reconstruction will give a better cosmetic result than breast-conserving surgery.
Side effects of surgery may include:
wound infection – the wound may feel tender, swollen, and warm to touch. There may be redness in the area and/or discharge from the wound. You may feel unwell with a fever and need antibiotics.
bruising and haematoma (a collection of blood within the tissues surrounding the wound causing swelling, discomfort, and hardness). The body will reabsorb the blood within a few weeks.
pain – if you have lymph glands removed you are more likely to have pain in the armpit or down the arm. You will be advised about exercises to reduce pain and improve arm movement after surgery (see the arm care section later in this booklet on page 63).
cording – a pain like a tight cord running from your armpit, down your upper arm and through to the back of your hand. Cording is thought to be due to hardening of the lymph vessels. Cording may restrict movement and may continue for many months (physiotherapy and exercise may help).
Photograph:
Caption: Image above: Information from the planning CT scan and/or simulator is used to create an individual map of where the radiation will be delivered.
Photographer: Louise Goossens
Transcriber's Note: The photograph shows a young woman viewing a CT scan on a computer screen. End of Note.
End of Photograph
reduced sensitivity of the inner side or down the back of your upper arm, due to nerve damage, may sometimes occur. This is usually temporary and improves or disappears about three months after surgery.
some women have a swelling caused by fluid build-up (seroma) that may need to be drained several times over a period of days or weeks.
swelling of the arm (lymphoedema) may occur in some women after lymph glands have been removed from the armpit. Occasionally, this swelling can extend into the chest wall or abdomen (see the arm care section on page 63).
Photograph:
Caption: Image above: The radiation therapist will explain your treatment to you.
Photographer: Louise Goossens
Transcriber's Note: The photograph shows a therapist with a patient in a hospital room. End of Note.
End of Photograph
reduced range of movement in the shoulder. You will be given an exercise programme to improve this after surgery. Sometimes a physiotherapist will help you with this.
Discuss possible side effects with your doctor before your operation. Report any problems that occur after surgery to your breast care nurse or doctor.
After your cancer has been removed, your surgeon will discuss your tumour with other specialists to determine what further treatment, if any, will be recommended.
For additional practical tips regarding breast surgery, phone the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).
Page 39Box:
"My whole breast was sore, it was so uncomfortable but the nurses put on me this beautiful dressing. And I loved that dressing."
End of Box
This is the use of radiation (rays of energy called photons or little particles called electrons) to destroy cancer cells, usually using a machine called a Linear Accelerator. You will see a radiation oncologist who will discuss this treatment with you.
Treatment is carefully planned to reduce any effect on normal cells. Before you start a course of radiation you will need at least one visit to the cancer centre to work out the exact position you will lie in during treatment (this is called simulation). Simulation involves a CT scan and a computerised treatment plan.
Treatment is given four to five days a week over about four to five weeks. It is painless and only takes a few minutes for each treatment.
Page 40An extra radiation 'boost dose' may be given to the area where the breast cancer was located, taking the overall treatment time up to five to six weeks.
Giving radiation to part of the breast (partial breast irradiation) is currently being investigated as an alternative to giving radiation to the whole breast in certain patients. Radiation is routine if a wide local excision is carried out.
Photograph:
Caption: Image above: The Linear Accelerator is positioned to deliver treatment to where it is needed. (c): There is a handle to hold as well as supports under the arms so you can just lie back and relax.
Photograph: Louise Goosens
Transcriber's Note: The photograph shows a woman lying under a Linear Accelerator. End of Note.
End of Photograph
Sometimes, radiation is given after mastectomy and axillary surgery to reduce the likelihood of developing recurrence in/ over the chest wall or in the axillary or supraclavicular (above the collar bone) lymph nodes. This decision is usually made once the results of the surgery are available and the risks for recurrence in these sites have been assessed.
Radiation may also be used for the treatment of recurrence or cancers that cannot be removed, either in the area of the breast or in other parts of the breast. The aim is to try to control the disease or reduce symptoms. This usually requires fewer visits.
Box:
"It's like an X-ray machine. No worries. You've got a comfortable room, music going, then it's over."
End of Box
Box:
Ko tā tēnei, he whakamahi i te iraruke (he hihi pūngao kīia ai he photon, he tōpata iti e ki ana he irahiko) hei patu i ngā pūtau matepukupuku, mā te whakamahi i tētahi mīhini kīia ai he Linear Accelerator. Ka kōrero tētahi kaimātai matepukupuku iraruke ki a koe mō tēnei huarahi maimoatanga.
Ka ata maheretia te maimoatanga hei whakaiti i te pānga ki nga pūtau pai. I mua i te tīmatatanga o tētahi whakahaere iraruke, me haere koe ki te pokapū matepukupuku ki te whakarite i te takotoranga ka whai koe i te wa o tō maimoatanga (kīia ai tēnei ko te whaihanga) kei roto i te mahi whaihanga, ko matawai roro me tētahi mahere maimoatanga kua rorohikotia.
Ka whakamahia anōtia te iraruke mō ngā matepukupuku ka hoki mai ki te rohe o te uma, ki wāhi kē rānei o te uma, a, kāore e tareka te tango. Ko te whāinga, kia tāmia te mate, kia whakaitia rānei ngā tohumate. Ko te tikanga ka iti ake ngā wa whakamahia ai.
End of Box
Early side effects of radiation treatment, most of which short term may include:
General tiredness
Some reddening or 'sunburning' of the skin
Follow the advice of your radiation therapist on skin care and underarm hygiene.
your breast may feel firmer
If you are having radiation treatment you should get extra rest and regular exercise to help cope with the tiredness.
Try to wear loose cotton clothing whenever possible to reduce any irritation to the area having the radiation. Talk with your doctor or the radiation treatment staff about any possible side effects and how to manage them. Phone your local Cancer Society for a copy of the booklet Radiation Treatment/ Haumanu Iraruke, download the booklet from our website www.cancernz.org.nz, or call the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237) for a copy.
Late side effects, which develop many months or years later, may include skin changes, changes in size, shape, colour, or feel of the breast. Radiation to the lymph nodes can increase the risk of developing lymphoedema.
Box:
"I'd always been proud of having really long hair and I think I coped well. I got it cut shorter and shorter as I came up to treatment."
End of Box
Photograph:
Photographer: Louise Goossens
Transcriber's Note: The photograph shows a woman sitting in an arm chair receiving chemotherapy treatment. End of Note.
End of Photograph
If you live a long way from the nearest cancer centre, you will need to stay nearby during your radiation treatment. Oncology centres have special accommodation close by.
This is the treatment of cancer with drugs. The aim is to destroy cancer cells while having the least possible effect on normal cells. The drugs are usually given intravenously via a drip and circulate around the body. Chemotherapy is a systemic treatment (treating the whole body) compared with surgery and radiation treatment, which are local treatments to a specific area in the body (for example, breast, chest wall, and axilla).
There are different regimens or combinations of drugs used in breast cancer. Most will contain an anthracycline drug, for example, doxorubicin (Adriamycin). If there is a greater risk of spread and, therefore, greater benefit from chemotherapy, taxanes, for example paclitaxel (Taxol) or docetaxel (Taxotere), may be used.
Treatment is often in cycles at three-weekly intervals, and may last for several months. A medical oncologist will discuss all aspects of the treatment with you.
Chemotherapy is offered to some women with early breast cancer as an additional treatment to surgery, radiation treatment, or both. This is called adjuvant chemotherapy. Adjuvant chemotherapy aims to destroy cancer cells that remain in the body which cannot be detected. In time, these cells will grow to form a recurrence of the breast cancer.
Page 46The purpose of adjuvant treatment is to reduce the chance of that happening.
Radiation treatment, if it is necessary, comes after chemotherapy, starting about four weeks after the last cycle of chemotherapy. Hormone therapy, if recommended, may begin either before or after the radiation treatment.
Women who will most likely benefit from chemotherapy are:
women with cancer cells in the lymph glands in their armpit
some women with more aggressive cancers (Grade 3) with no spread of cancer to the lymph nodes
women who are HER2 positive (chemotherapy given with trastuzumab (Herceptin)).
In some cases of larger tumours where women wish to try to avoid mastectomy neo-adjuvant chemotherapy may be used.
Women with a cancer called inflammatory breast cancer are normally offered chemotherapy before surgery. This is called neo-adjuvant chemotherapy. Neo-adjuvant chemotherapy is also used when women have tumours that are large and have to be reduced in size before successful surgery is possible.
Page 47Box:
"I was determined I wasn't going to look sick. I did my hair and wore makeup during treatment. These little things helped me feel better about myself."
End of Box
Box:
He patu i te matepukupuku mā te rongoā te tikanga o tēnei huarahi maimoatanga. Ko te whāinga ko te patu i ngā pūtau matepukupuku, me te aro ki te tiaki i ngā pūtau pai. Ka whakaurua te rongoā mā te whāngai-ā-iaia mā tētahi turu, mā reira ka hurihuri haere i te tinana. He maimoatanga ā-pūnaha te hahau (ko te maimoa i te tinana katoa) mēnā ki te whakarite ki te pokanga me te maimoatanga iraruke, he maimoatanga ki tētahi wāhi hāngai o te tinana, pērā ki te ngā ū, te pātū uma me te axilla.
End of Box
Chemotherapy side effects vary depending on the particular drugs used. When adjuvant chemotherapy is given to women with breast cancer, side effects may include:
infections–the drugs can lower your ability to fight infections. If you are feverish (your temperature is 38 degrees C or more), or if you feel unwell in any way–don't wait to see what happens–take action immediately. Contact your cancer doctor or nurse, and follow the advice given.
sore mouth
nausea and vomiting
loss of appetite or taste changes
feeling off-colour and tired
temporary thinning or loss of hair. If you have temporary hair loss you are entitled to a benefit to buy a wig.
weight gain. This is quite common after chemotherapy so trying to keep up regular exercise is important.
difficulty concentrating for some. This is temporary but can take some months after chemotherapy to go away.
loss of libido (interest in sex)
hot flushes, vaginal dryness, mood swings, or other symptoms of menopause.
If you are still having periods, you may find that your periods become irregular or stop while you are having treatment. If you are approaching menopause, your periods may not return once the treatment has stopped.
If you are sexually active, with a male partner, you and your partner should use a reliable contraceptive, such as a diaphragm or condom, during treatment because the drugs can cause birth defects or miscarriage.
Your ability to become pregnant may be affected. Some women may be permanently infertile (unable to become pregnant). This can be very hard to cope with and it may be helpful to talk with others who have been through this; your doctor or to a counsellor or fertility expert.
Chemotherapy drugs may have particular side effects, and these will be discussed with you. Discuss any side effects with your doctor. Side effects are usually temporary and there are ways of reducing the impact of any unpleasant symptoms.
Phone your local Cancer Society for a copy of the booklet Chemotherapy/Hahau, download the booklet from our website www.cancernz.org.nz, or phone the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).
Page 50
Women with HER2 positive breast cancer are treated with a monoclonal antibody called trastuzumab (Herceptin). Trastuzumab (Herceptin) is given intravenously once every week or three weeks, and is usually well-tolerated. Monoclonal antibodies are drugs that recognise and bind to specific proteins (receptors) that are found in particular cancer cells or in the blood stream.
In New Zealand, trastuzumab may be used for up to one year in early breast cancer.
In secondary breast cancer it can be continued until the cancer is no longer responding to it. When this occurs, lapatinib (a pill taken by mouth) can be used instead to shrink the cancer, usually in combination with further chemotherapy. As of 2011, this medicine is not funded in New Zealand.
Trastuzumab may cause some problems with heart pumping function. Before starting trastuzumab treatment your doctor will check your heart using an echocardiogram or a multi-gated acquisition (MUGA) scan. Your doctor will check your heart at intervals while you are receiving treatment.
Page 51An echocardiogram will be done every 12 to 18 weeks.
Box:
Echocardiogram: A type of ultrasound test that looks at the size, shape, and function of the heart.
Multi-gated acquisition (MUGA) scan: a test that measures how well the heart pumps blood.
End of Box
Monoclonal antibodies may cause other side effects. Talk to your doctor about these.
Box:
Ko ēnei rongoā ko ngā monoclonal antibodies, ka mōhio kia piri ki ngā pūmua ka kitea i ētahi pūtau matepukupuku, i te ia toto rānei.
End of Box
Many breast cancers appear to be influenced by the female hormones, oestrogen and progesterone.
Pre-menopausal women may be offered tamoxifen, a hormone treatment taken as a tablet. They may also have menopause induced to stop their own production of hormones. This can be done by four-weekly injections with goserelin (Zoladex) or by surgical removal (laparoscopic oophorectomy) of the ovaries. Once you stop taking goserelin your periods will usually return.
Post-menopausal women may be offered oral hormone treatments - either tamoxifen or aromatase inhibitors, for example, anastrozole (Arimidex), letrazole (Letara), or exemestane (Aromasin) which reduce the production of hormones in the body (other than from the ovaries).
Generally, women with breast cancer should not take any hormone replacement therapy or have an interauterine device (IUD) that secretes hormones.
Page 53Box:
Te āhua nei, ka awenga te maha o ngā matepukupuku ū e ngā taiaki wāhine, arā, ko te oestrogen me te progesterone.
Tērā pea ka tāpaea te tamoxifen ki ngā wahine kāre anō i timata te koero. He momo maimoatanga taiaki ka kāinga ai pēnei i te pire. Tērā pea ka poapoatia te koero kia kore ai te tinana e hanga taiaki. Ka tareka tēnei mā ngā werohanga o te (goserelin) Zoladex ia whā wiki, mā te pokanga (laparoscopic oophorectomy) o ngā kiato kākano rānei. Hei te nuinga o te wā, mutu ana tō kai i te goserelin ka rere anō ō toto ia marama.
Ka tāpaea ngā rongoā taiaki ā-waha ki ngā wahine kāore anō i pā te koero – he tautawhi tamoxifen, he tautawhi aromatase rānei pērā ki te anastrozole (Arimidex), te letrozole (Letara), te exemestane (Aromasin) rānei – ka tāmi i te hanga a te tinana i te taiaki ki roto i te tinana (i tua atu i ngā kiato kākano).
End of Box
Side effects of hormone treatments may include:
menopausal symptoms such as hot flushes, vaginal dryness, and mood swings. For suggestions on coping with these it may be helpful to talk to another woman who has been through this or to call your local Cancer Society or phone the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237) for more information. The Cancer Society has an Information Sheet titled Cancer and Early Menopause which is available from our website (www.cancernz.org.nz).
effects on fertility–if you have not reached menopause it may still be possible to become pregnant while you are taking hormone therapies. If you are sexually active, with a male partner, it is recommended that you use reliable contraception, such as a diaphragm or condom. Sometimes you may have permanent menopause as a result of your hormone therapy. (See .infertility' in the section on 'Chemotherapy' on page 49.)
aromatase inhibitors can cause more rapid loss of minerals from bones (osteoporosis) and fractures are slightly more common while on these medicines. It may be recommended that you have a bone density study before starting and at some time during treatment. Treatment may be given for several years. Osteoporosis can be treated with oral bisphosphonates (bone hardening drugs).
muscular and joint aches are common side effects of aromatase inhibitors.
Hormone drugs may cause additional side effects. Discuss these with your doctor.
Sometimes it is difficult to make decisions about what is the right treatment for you. You may feel that everything is happening so fast that you do not have time to think things through. It is important not to be rushed into a decision; it must be the right one for you.
While some people feel they are overwhelmed with information, others may feel that they do not have enough. Understanding your illness, the possible treatment, and side effects will help you to make your own decisions.
If you are offered a choice of treatments you will need to weigh their advantages and disadvantages. You may want to ask your doctor whether the benefits of treatment outweigh the side effects.
If only one type of treatment is recommended, ask your doctor to explain why other treatment choices have not been advised.
Page 56
Box:
Hei ētahi wā he uaua te whiriwhiri ko hea te huarahi maimoatanga pai mōu. Nā te tere rawa, ka ānini te māhunga, kua kore e aro me aha. Ko te mea nui kia kaua e pōnānā i to whakataunga, āta whiri i te huarahi tika mōu.
End of Box
You may want to see your doctor a few times before making a final decision on treatment. It is often difficult to take everything in, and you may need to ask the same questions more than once. You always have the right to find out what a suggested treatment means for you, and the right to accept or refuse it.
Before you see the doctor, it may help to write down your questions. There is a list of questions at the end of this booklet, which may help you. Taking notes during the session can also help. You may find it helpful to take a family member or friend with you, to take part in the discussion, take notes, or simply listen. Some people find it is helpful to record the discussion.
Page 57Box:
"My only advice is to talk about it. Be very careful because some people are very forceful. If you listen to everyone the right advice may become apparent whilst the unusual advice will be the stuff you ignore."
End of Box
Box:
Tērā ka hiahia kōrero koe ki tō rata i mua i te whakatau ko hea te huarahi maimoatanga pai mōu. Me uaua ka tarea e koe ngā kōrero katoa, hei ētahi wā me hoki atu tuarua, tuatoru ō pātai. Kei a koe te tika ki te rapu he aha ngā putanga o tētahi maimoatanga mōu ake, ā, kei a koe te tika ki te kaupare i te maimoatanga ahakoa he aha taua momo maimoatanga.
End of Box
Once you have discussed treatment options with your doctor, you may want to talk them over with someone else, such as family or friends; specialist nurses; your family doctor; the Cancer Society; the hospital social worker or chaplain; your own religious or spiritual adviser; or another person who has had an experience of breast cancer.
Page 58Photograph:
Photographer: Louise Goossens
Transcriber's Note: The photograph shows two women in a small office. One is offering the other booklets and information. End of Note.
End of Photograph
Talking it over can help you to sort out what course of action is right for you. Family and friends will often give you advice about breast cancer treatment. This can be helpful, but remember "your cancer is your own". They may be giving you advice about a situation that is different from yours.
Box:
Ina oti ō whitiwhitinga kōrero me tō rata, tērā pea ka pīrangi kōrero koe ki ētahi atu pērā i tō whānau, ō hoa, ngā tapuhi, te rata o tō whānau, te Kāhui Matepukupuku, te minita te kaimahi hapori rānei i te hōhipera, tōu ake minita, pirihi, pīhopa, aha atu, tētahi atu tangata rānei kua pāngia i te matepukupuku o ngā ū.
End of Box
You may want to ask for a second opinion from another specialist. Your specialist or general practitioner can refer you to another specialist and you can ask for your records to be sent to the second doctor.
You may be interested in looking for information about breast cancer on the internet. While there are very good websites, you need to be aware that some websites provide wrong or biased information.
We recommend that you begin with the recommended websites at the end of this booklet (see page 99).
Page 60
Research into the causes of breast cancer and into ways to prevent, detect, and treat it is ongoing. Your doctor may suggest that you consider taking part in a clinical trial.
Clinical trials are a vital part of the search to find better treatments for cancer, and are conducted to test new or modified treatments and see if they are better than existing treatments. Many people all over the world have taken part in clinical trials that have resulted in improvements to cancer treatment. The decision to take part in a clinical trial is always yours.
If you are asked to take part in a clinical trial, make sure that you fully understand the reasons for the trial and what it means for your treatment. Before deciding whether or not to join the trial, you may wish to ask your doctor:
Which treatments are being tested and why?
What tests are involved?
What are the possible risks or side effects?
How long will the trial last?
Will I need to go into hospital for treatment?
What will I do if any problems occur?
If the treatment I receive on the trial is successful for my cancer, is there a possibility of carrying on with the treatment after the trial?
If it is a randomised trial, you will be chosen at random to receive one treatment or the trial treatment, but either treatment should be appropriate for your condition. You won't be able to choose from the treatments offered. In clinical trials, people's health and progress are carefully monitored.
If you join a clinical trial, you have the right to withdraw at any time. Doing so will not jeopardise your treatment.
Box:
Kei te haere tonu ngā rangahau mō te pūtake o te matepukupuku o ngā ū, tae atu ki ngā kauparetanga, ngā tūhuratanga, ngā maimoatanga hoki. Tērā pea ka whakataunaki tō rata kia kuhu koe ki tētahi whakamātautau haumanu.
He wāhi nui tā ngā whakamātautau haumanu i te rapunga oranga i te matepukupuku, ā whakahaeretia ai ki te whakamātautau haumanu hou, ki te whakamātautau i ngā maimoatanga kua whakapanoni ki te kimi mēnā he pai atu ēnei momo maimoatanga i ngā maimoatanga kei te mahia i ēnei ra. Ka hia tāngata puta noa i te ao kua whai wāhi ki ngā whakamātautau haumanu, me te aha, kua pai atu ngā maimoatanga i te matepukupuku. Oti rā, kei a koe te tikanga i ngā wā katoa ki te kuhu ki tētahi whakamātautau haumanu, ki te kore rānei.
End of Box
Following treatment, you will find your energy will gradually come back. You may need to have extra rest for a while. Increase your exercise and general activities as you feel able. Research has shown that regular exercise during and after treatment is beneficial. The majority of women find they can do most things within a few weeks of surgery.
After the completion of your treatment, you may need to have regular check-ups. Your doctor will decide how often you will need these check-ups as everyone is different. Check-ups will gradually become less frequent if you have no further problems. Generally, women have a yearly mammogram after breast cancer treatment.
Many people worry that any pain or illness is a sign that the cancer is coming back. This is usually not the case but if you are worried about whether the cancer is going to come back ask your doctor what to expect. You may feel less worried if you know exactly what to look for and what you do not have to worry about.
If the cancer returns, you will most likely be offered further treatment. It is important to report any new symptoms to your doctor without delay.
You might feel worried or depressed when your treatment is over and have time to realise what has happened to you. You may find it helpful to continue in or join a cancer support group to help your through the months ahead.
Page 63Box:
Whai muri i ngā maimoatanga, me hokihoki koe kia tirohia koe. Mā tō rata e tohutohu kia hia ngā wā hokihoki ai koe ki ngā rata, i te mea he rerekē tēnā tangata, i tēnā tangata. Mehemea kei te pai te hauora, ka iti haere ngā hokinga ki ngā rata. Ko tōna tikanga, ka whai whakaata ū ā-tau nga wāhine whai muri i ngā maimoatanga matepukupuku ū.
End of Box
Following your surgery, it may take some time to regain the full use of your arm. Your physiotherapist or breast care nurse will give you instructions for exercises.
You may be concerned that your arm will swell after your lymph glands have been removed. This is much less common today because of the better methods of surgery and radiation treatment. However, a few women will still develop problems with arm swelling (called lymphoedema). To reduce the risk of this happening, you should try to avoid injury or infection to your arm or hand.
Some simple measure may help:
Regular exercise is helpful
Wear gardening gloves when gardening, an oven glove when handling hot dishes, and use a thimble for sewing.
If you're out in the sun, protect your arm from sunburn by wearing a long-sleeved shirt. Use a good sunscreen (SPF30+) on uncovered areas.
If you have a cut, clean it well and use an antiseptic dressing. See your doctor quickly if you think it is infected.
Get help with heavy jobs like moving furniture or carrying heavy luggage, and avoid using heavy backpacks for any length of time.
It is suggested that it may be beneficial to wear a support sleeve when flying.
If possible, use the unaffected arm to have your blood pressure, injections, or blood taken from that arm.
Be aware of swelling in the arms at any point in the future. Contact your doctor if this occurs.
Lymphoedema therapists and physiotherapists can also advise about massage techniques and the need to wear a support sleeve if swelling occurs.
Box:
Whai muri i te hāparapara, ka roa te wā kātahi anō ka hoki mai te kaha ki tō ringa. Mā tō kairomiromi, tō tapuhi tiaki ū ranei, e hoatu tohutohu mō ngā mahi korikori tinana.
Tērā pea ka āwangawanga koe mō te pupuhi ō tō ringa i te tangohanga o ngā repe waitinana. Kua kore e tino pēnā i ēnei rangi nā runga i te pai ake o ngā mahi pokanga, me ngā maimoatanga iraruke. Heoi anō rā, ka pā tonu tēnei mate pupuhi ki ngā ringa o ētahi wāhine tokoiti nei (kīia ai he lymphoedema). Kia iti ake ai te tuponotanga ka puta tēnei, me kaha te karo i ngā wharanga me ngā whakapokenga ki tō ringa.
End of Box
If you have had a mastectomy it's important to know about a breast form (prosthesis). A breast form can give a good cosmetic appearance as well as helping your balance and posture.
Many women choose to use a breast form although some women prefer not to. Breast forms are also available for women who have had lesser surgery (partial mastectomy). Immediately after surgery, temporary prostheses may be available from your local Cancer Society or breast care nurse.
Page 66About six weeks after the operation, you may choose to wear a permanent prosthesis. You are entitled to a benefit for a permanent breast form. Ask your surgeon or breast care nurse for a medical certificate of entitlement.
Box:
Mehemea i whai mastectomy koe, he mea nui kia mōhio koe mō te hanga ū (kīia ai he prosthesis). He pai tonu te āhua whakanako o te hanga, tae noa ki tōna āwhina i a koe kia mau tō ū āwhina i te hanga ū kia pai ai tō āhua, kia pai ai hoki tō tauriterite me tō tū.
Ka whai wāhi koe ki tētahi penihana mō tētahi hanga ū pūmau. Me uiui i tō rata, ki tō tapuhi tiaki ū rānei mō tētahi tiwhikete e āhei ana koe te tono.
End of Box
After a mastectomy your breast can be reconstructed either immediately or at a later date. A surgeon's decision about which method of reconstruction to recommend is based on many different factors. Reconstruction should be discussed fully with your specialist and you may be referred to a plastic (or reconstructive) surgeon. Many women do not wish to have a reconstruction. Speaking with a breast care nurse or with a woman who has had a reconstruction may be helpful. Information is available from your local Cancer Society or phone the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).
Page 67
Sometimes, breast cancer can come back (known as a recurrence). This can be in the breast or in more distant parts of the body.
Most recurrences appear within five years after the initial treatment. Regular check-ups are necessary during this period. You should also regularly examine your remaining breast and mastectomy area and report any unusual breast symptoms or general symptoms to your doctor. You will need a yearly mammogram. The risk of a new breast cancer is increased once you've had breast cancer.
Treatment of recurrent breast cancer may be by surgery, radiation treatment, chemotherapy, hormone treatment (refer to pages 23 to 55), or trastuzumab (refer to page 50), or combinations of these. It aims to control the disease.
Successful treatment of recurrent breast cancer will allow many women to continue leading normal lives.
A specific book Secondary Breast Cancer/Matepukupuku Tuarua ā-Ū is available from your local Cancer Society, or by phoning the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).
Page 68Box:
"I said to them, 'Look, you just have to support me now. It's my time.' It was role reversal."
End of Box
Women react in different ways when they learn they have breast cancer. Feelings can be muddled and change quickly. This is quite normal and there is no right or wrong way to feel.
Some women may have particular concerns–they may be worried about the change in their appearance after surgery and how it will affect their lives and relationships. Younger women may be worried about fertility, pregnancy, and breast feeding following treatment (this should be discussed with your specialist). Other women may feel that they are not getting enough personal support to help them deal with their illness.
Page 69 - 70It may be helpful to talk about your feelings with your partner, family members; friends; or with a breast care nurse; your local Cancer Society; counsellor; social worker; psychologist; or your religious/spiritual adviser. Talking to other women with breast cancer may also help.
Sometimes, you may find your friends and family do not know what to say to you: they may have difficulty with their feelings as well. Some people may feel so uncomfortable they avoid you. They may expect you to lead the way and tell them what you need. You may prefer to ask a close family member or friend to talk to other people for you.
Anyone you tell needs time to take it in and to come back with his or her questions and fears–just like you. You can help them to adjust, just as they can help you. But remember that while you are having treatment your needs should come first. If you do not feel like talking, or you cannot cope with any more visitors, say so. If there are practical things they can do to help–let them know. Some friends are better at doing something practical to help than they are at sitting and talking. Everyone is different, and some may find it so difficult that they stop visiting for a while.
Breast cancer and its modern treatment is a huge life journey.
You may be shocked about your cancer diagnosis and you may worry about the time it is taking to decide on treatment. This is because your oncologist cannot give you detailed advice about your best choices until the pathologist has reported on your lump or breast tissue, the lymph glands, and hormone receptors.
Page 71Your oncologist's advice about which treatment is best for you is based on the size of the cancer; how abnormal it is (its grade); whether it has been completely removed; whether the lymph nodes have cancer in them or not (and if so, how many lymph nodes were involved); whether the cancer had oestrogen (ER) and progesterone (PR) receptors; and whether the HER2 receptor is positive.
That visit to discuss the pathology report is a huge step, and we suggest you take along a person to support you. Many women cope well with the first part of chemotherapy, but the length of the programme means that by the end of chemotherapy, many women are tired.
It is often when the treatment is finished that the full impact of the breast cancer diagnosis, and its treatment, 'hits home'. Many women feel vulnerable at this time. The family and friends may have 'moved on', but you may feel differently.
There may be an impact on relationships, sexuality, and the ability to work. This 'vulnerable phase' may last 6 to 12 months. The first mammogram is often 'a hurdle' as is the anniversary date of the diagnosis.
Your oncology team understands the impact of this journey and can help more if you are open and tell them of your emotional and coping concerns. For details of additional support services available, phone the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).
Page 72
Box:
He rerekē te urupare a tēnā wahine a tēnā wahine ki te pānga o te matepukupuku o ngā ū. Ka hurihuri ngā whakaaro, ka piki, ka heke. Ehara i te mea kei te hē ēnei hurihuringa, kāore e tareka te kī kei te tika tēnei, kei te hē tēnā.
Kāore e kore he āwangawanga ake ā ētahi wāhine kei te māharahara mō te rerekē o tā rātou āhua whai muri i te hāparapara, tae atu ki te pānga ki ō rātou koiora me ō rātou hononga. Tērā pea ka āwangawanga ngā wāhine rangatahi ake whai muri i te hāparapara mō ō rātou whare tangata, te hapūtanga, me te whāngai tamariki ki te waiū (me kōrero koe ki tō mātanga). Tērā pea kei te whakapae ētahi atu wāhine kāore rātou i te whiwhi āwhina e tika ana e puta ai rātou i ō rātou mate.
He mea pai pea te kōrero mō ōu kare ā-roto ki tō hoa tata, tō whānau, ō hoa, te tapuhi tiaki ū, he kaitakawaenga, he tauwhiro, te kaimātai hinengaro, tae atu ki tō kaiāwhina i te taha wairua. Tērā pea, he mea āwhina i a koe te kōrero ki ētahi atu wahine mate i te matepukupuku ū.
Tērā pea kāore ō hoa, tō whānau rānei i te mārama me pēhea te kōrero ki a koe. Nā te kaha mataku o ētahi, tērā pea ka karo haere i a koe. Kei te tatari pea rātou mōu ki te ārahi i a rātou, ki te whāki atu he aha ō hiahia.
Page 73
Tērā pea ka hiahia koe ko tētahi o tō whanau, ko tētahi hoa rānei e tū hei kaikōrero mōu.
Ahakoa ko wai te tangata ka kōrero koe, me tuku he wā mōna ki te whakaaro mō tēnei take; tērā pea ka hoki mai a ia me āna pātai, āna māharahara, pērā i a koe nā. Kia maumahara i te wā o tō maimoatanga me aro koe ki a koe anō i te tuatahi. Ki te kore koe pīrangi kōrero ki ētahi tāngata, kāore rānei koe e pīrangi ki ētahi manuhiri, kōrerotia. Mēnā ka taea he āwhina i ētahi atu tāngata – kōrerotia. He pai atu ētahi hoa ki ngā mahi, tērā ki te noho ki te kōrero me koe. He rerekē tēnā tangata, tēnā tangata; nā te kaha wehi, kāore ētahi tāngata e puta ake kia kite i a koe mō tētahi wā.
End of Box
How much you tell children will depend on how old they are. Young children need to know that your illness is not their fault. They also need to know that you may have to go into hospital. Slightly older children can probably understand a simple explanation of what is wrong. Adolescent children can understand much more. All children need to know what will happen to them while you are in hospital, who will look after them, and how their daily life will be affected.
Sometimes, children rebel or become quiet. Keep an eye on them or get someone else to, and get help if you need it; for example, from the school, a counsellor or a hospital social worker.
Pages 74 - 75The Cancer Society has a booklet, Cancer in the Family, written to support parents and carers in the difficult task of talking with your child or children about cancer. To get a copy of this booklet, contact your local Cancer Society, phone the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237) or download it from our website at www.cancernz.org.nz.
Your local Cancer Society provides confidential information and support.
The Cancer Information Helpline is a Cancer Society service where you can talk about your concerns and needs with trained nurses. Call your local Cancer Society and speak to supportive care services staff or phone the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).
Local Cancer Society centres offer a range of support services for people with breast cancer and their families. These may include:
volunteer drivers providing transport to treatment
accommodation
support and education groups
contact with other women who have had breast cancer
the Look Good...Feel Better workshop. Contact your local Cancer Society about attending this workshop.
You may be interested in Cancer Connect NZ, which arranges telephone peer support calls for people living with cancer and their caregivers. For more information call the Cancer Information Helpline (0800 CANCER (226 237). Cancer Chat is an online/support and information forum (www.cancerchatnz.org.nz).
The range of services offered differs in each region so contact your local centre to find out what is available in your area. If you are having treatment at a private hospital ask your treatment team what services you may be eligible for.
Box:
Whakarato ai tō Kāhui Matepukupuku ā-rohe i ngā purongo matatapu me te tautoko.
He ratonga te Ratonga Parongo Matepukupuku nā te Kāhui Matepukupuku; ka taea te noho me te kōrero i ō āwangawanga ki ētahi tapuhi matatau ki tō mate. Waea atu ki te Kāhui Matepukupuku i tō rohe ka kōrero ki ngā kaimahi, waea rānei ki Waeaāwhina Pārongo Matepukupuku 0800 CANCER (226 237).
Kei ngā pokapū Kāhui Matepukupuku ā-rohe ngā ratonga āwhina mō te hunga kua pāngia i te matepukupuku o ngā ū me ō rātou whānau. Ko ētahi o ēnei āwhina ko:
ngā kaitaraiwa hei hari i a koe ki ngā mahi maimoatanga
ngā kāinga noho
ngā rōpū tautoko me ngā rōpū ako
he whakapānga ki ētahi atu wāhine kua pāngia i te matepukupuku o ngā ū
te awheawhe Look Good...Feel Better. Whakapā ki te Kāhui Matepukupuku tata ki a koe mō tēnei kaupapa.
Tērā pea ka whakaaro koe mō Cancer Connect NZ, he rōpū whakarite kōrero tautoko ā-hoa mā te whakamahi i te waea mā te hunga noho matepukupuku me ā rātou kaitiaki. He wānanga pārongo me te tautoko ā-ipurangi a cancerchatnz. org.nz.
He rerekē ngā ratonga i tēnā rohe, i tēnā rohe, nā reira pātai ki te pokapū i tō rohe he aha ā rātou ratonga.
Mehemea kei te whai maimoatanga koe ki tētahi hōhipera tūmataiti, pātaitai tō rōpū maimoatanga, he aha ngā ratonga e māraurau ana koe ki te tono.
End of Box
Box:
"The Helpline nurse was great. I rang and said 'Help! I can't do this on my own.'"
End of Box
Cancer support groups offer support and information to people with cancer and their families. It can help to talk to others who have gone through the same experience. Support groups can also offer many practical suggestions and ways of coping. Ask your hospital or local Cancer Society for information on cancer support groups in your area.
A breast care nurse may be available in your hospital to provide specialist support and guidance.
Help may be available for transport and accommodation costs if you need to travel some distance to your medical and treatment appointments. Your treatment centre or local Cancer Society can advise you about what sort of help is available.
Financial help may be available through your local Work and Income office. Work and Income has pamphlets and information about financial assistance for people who are unable to work. Short-term financial help is available through the Sickness Benefit and longer-term help is provided through the Invalids Benefit. Extra help may be available; for example, accommodation supplements and assistance with medical bills.
Page 79More information is available on the Ministry of Social Development's website, www.msd.govt.nz or by phoning 0800 559 009.
Nursing care is available at home through district nursing or your local hospital. Your doctor or hospital can arrange this.
You may be entitled to assistance with household tasks during your treatment. For information on what help is available, contact your hospital social worker or the District Nursing Service at your local hospital.
New Zealand's Health and Disability Code states that everyone has the right to have an interpreter present during a medical consultation. Family or friends may assist if you and your doctor do not speak the same language, but you can also ask your doctor to provide an interpreter if using family members is inappropriate or not possible.
Pages 80 - 81Box:
"Nutrition wise, I changed from week to week. I got to the stage where I didn't like beef anymore. I got into vegetables. I was into wholesome food. Now my cupboards don't have any processed food."
End of Box
Many people feel that there is nothing they can do when they are told they have cancer. They feel out of control and helpless for a while. However, there are practical ways you can help yourself.
Box:
He nui ngā tāngata ka pōuri rawa atu i te rangona kua pāngia rātou i te matepukupuku. Kāore rātou e aro ko hea te huringa mō rātou. Hāunga tērā, ka taea tonu e koe ngā mahi te awhi i a koe anō.
End of Box
A balanced, nutritious diet will help to keep you as well as possible and cope with any side effects of treatment. The Cancer Society's booklet called Eating Well during Cancer Treatment/Kia Pai te Kai i te wā Maimoatanga Matepukupuku has useful advice and recipes. Phone your local Cancer Society office for a copy of this booklet, phone the cancer information nurses at the Cancer Information Helpline 0800 CANCER (226 237), or view the booklet on our website at www.cancernz.org.nz. The hospital will also have a dietitian who can help.
Food safety is of special concern to cancer patients, especially during treatment, which may suppress immune function.
To make food as safe as possible, we suggest you follow these guidelines:
Wash your hands thoroughly before eating.
Keep all areas and utensils you use for food preparation clean, including washing hands before preparing food and washing fruit and vegetables.
Handle raw meat, fish, poultry, and eggs with care, and clean carefully any surfaces that have been in contact with these foods.
Keep raw meats separate from cooked food.
Cook meat, poultry, and fish well, and use pasteurised milk and juices.
Refrigerate food quickly to reduce bacterial growth.
When eating in restaurants, avoid foods that may be contaminated with bacteria, such as salad bars, sushi and raw or undercooked meats, fish, poultry, and eggs.
If there is any concern about the purity of your water (for example, if you have well or tank water) have it checked for bacterial content.
Box:
Mā te kai tika me te kai pai hei āwhina i a koe ki te noho ora me te ārai i ngā pānga kino ka whai i ngā maimoatanga. Kei roto i te pukapuka Eating Well during Cancer Treatment / Kia Pai te Kai i te wā Maimoatanga Matepukupuku a Te Kāhui Matepukupuku o Aotearoa, ētahi tohutohu whai kiko mō te kai, me ētahi tohutaka. Waea atu ki tō Kāhui Matepukupuku ā-Rohe mō tētahi kape o te pukapuka nei, me waea atu rānei ki a Waeaāwhina pārongo Matepukupuku 0800 CANCER (226 237) mō tētahi kape, me tikiake i tō mātou paetukutuku www.cancernz.org.nz. Kei te hōhipera tētahi tohunga mō te kai pai, hei āwhina anō.
He mea nui te haumaru ō ngā kai mō ngā tūroro kei te pāngia i te matepukupuku, tae atu ki te wā o tō rātou maimoatanga. Ki te hē ngā kai, tērā pea ka tāmia ngā taunga kauparetanga o te tinana.
End of Box
Many people find regular exercise helps recovery. Research has shown that people who remain active cope better with their treatment. The problem is that while too much exercise is tiring, too little exercise can also make you tired. Therefore, it is important to find your own level. Discuss with your doctor or nurse what is best for you.
New research shows exercise may be better for your immune system than any other therapy. Recent publications show that maintaining a normal weight and exercising may reduce the risk of breast cancer recurrence.
For more information on the benefits of regular physical activity for people with cancer, phone the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237) or contact your local Cancer Society to receive a copy of our pamphlet Being Active When You Have Cancer.
Box:
He tokomaha ngā tāngata e kite ana ka āwhina te korikori i te hoki anō ki te ora. E ai ki ngā rangahau, ki te rite tō korikori tinana ka pai atu koe i te wā o te maimoatanga. Ko te raruraru kē, ahakoa ka pau tō hau ki te kaha rawa tō kori tinana, ka pau rā to hau ki te iti rawa ō korikoringa. Nā reira, he mea nui kia mōhio koe he aha te korahi o te kori tinana e pai ana mōu. Kōrero ki tō rata, ki tō nēhi rānei mō te huarahi pai rawa mōu ake.
End of Box
Box:
"When it was painful I transported myself to the market with fresh fruit at home. I went to songs that have no words that reminded me of home, like streams and natural sounds. I imagined myself at moments throughout my lifetime - special places on the beach, certain things we did as children. I took myself there."
End of Box
Some people find relaxation or meditation helps them to feel better. The hospital social worker, nurse, or Cancer Society will know whether the hospital runs any relaxation programmes, or may be able to advise you on local community programmes.
Complementary therapy is a term used to describe any treatment or therapy that is not part of the conventional treatment of a disease. It includes things like:
acupuncture
relaxation therapy/meditation
yoga
positive imagery
spiritual healing/cultural healing
art
aromatherapy/massage.
Complementary methods are not given to cure disease, but they may help control symptoms and improve wellbeing.
Alternative therapy is a term used to describe any treatment or therapy that may be offered as an alternative to mainstream treatments. It includes things like:
homeopathy
naturopathy
Chinese herbs.
Alternative treatments are sometimes promoted as cancer cures. However, they are unproven treatments, as they may not have been scientifically tested, or, if tested, they were found to be of little use. They can also be expensive.
It is important to let your doctor know if you are taking any complementary or alternative therapies because some treatments may be harmful if they are taken at the same time as conventional treatments.
Page 88
Box:
He mea nui te kōrero ki tō rata mēnā kei te nanao koe i ētahi atu haumanu tautoko, haumanu whiringa hoki, i te mea, tērā pea ka puta he takakino i ētahi maimoatanga ka kawea ngātahitia i te wa o ngā maimoatanga. Me whāki ki tō rata mēnā kei te nanao koe ki ētahi atu maimoatanga aronga whānui.
End of Box
If you feel uncomfortable or unsure about your treatment, it is important that you discuss any concerns with those involved in your care, including your general practitioner (GP).
The anxiety and/or depression felt by some women after diagnosis or treatment can affect their sexual desire. Sometimes, women feel that they are less sexually attractive. Tiredness following an anaesthetic, major surgery, radiation treatment, or chemotherapy will also reduce sexual desire.
If you have had a mastectomy, looking at yourself in the mirror can be difficult. Sometimes women feel nervous about showing their mastectomy scar to their partners.
Page 89It helps if you are able to talk openly about your feelings so that your partner understands your fears and concerns. However, sometimes partners may be unsure of their own reactions to the breast surgery. While many partners are a great support and may adjust more quickly to the changes than you do, others have greater difficulty. They may also feel nervous about their sexual relationship with you.
If you are without a partner you may fear you may not be able to have an intimate relationship in the future. You may question how and when you will tell a new partner about your treatment.
While some women may quickly begin their usual pattern of love making, for others it may take longer. If you and your partner need to make changes, it's important to remember that sexual intercourse is only one of the ways that you can express affection for each other. Communicating and sharing your feelings can result in greater openness, sensitivity, and physical closeness between you both. A gesture of affection, gentle touches, cuddling, and fondling also set your mind at rest about your need for each other.
When you feel ready for intercourse, you may find some positions more comfortable. If you are on top or on your side, there may be less pressure on the affected side. If sexual intercourse is painful because of vaginal dryness, special creams, such as Sylk, or Replens may be useful.
Page 90Talk to someone you trust if you are experiencing ongoing problems with sexual relationships. Friends, family members, nurses, or your doctor may be able to help. The Cancer Society can also provide information about counsellors who specialise in this area. You may find the Cancer Society's booklet Sexuality and Cancer/Hōkakatanga me te Matepukupuku helpful. You can get a copy from your local Cancer Society, by phoning the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237), or by downloading it from our website at www.cancernz.org.nz.
Box:
Nā te māharahara me te pōuri ka rongo ētahi wāhine whai muri i te whakataunga mate, te maimoatanga rānei, ka puta he pānga ki to rātou hiahia onioni. I ētahi wa, ka whakaaro ētahi wāhine kua kore rātou e hiahiatia. Nā te ngenge ka puta i te rehu tokitoki, i te hāparapara nui, i te haumanu iraruke, i te hahau, ka heke te kaha hiahia onioni.
Kāore noa iho e roa ka hoki ētahi wāhine ki ngā aitanga o mua. Mō ētahi atu wāhine, he roa atu te wā katahi anō rātou ka tau.
Mehemea me huri kōrua ko tō hoa ki te kimi panoni, he mea nui ki te mahara ake, ehara ko te onioni anake te whakaputanga o te aroha ki waenganui i a kōrua. Mā te tuwhera o ngā kōrero me te ngākau, ka nui atu tā kōrua aroha, tā kōrua piringa. Ko te awhiawhi, te mirimiri, te pā o te ringa ngā tohu ki te hōhonutanga o ngā whakaaro a tētahi ki tētahi.
End of Box
1. What type of cancer do I have?
2. How extensive is my cancer? What stage is it?
3. What treatment do you advise for my cancer and why?
4. Are there other treatment choices for me?
5. What are the risks and possible side effects of each treatment?
6. How long will the treatment take?
7. I would like to have a second opinion. Can you refer me to someone else? It is your right to do so.
8. Is there any cost for treatment?
9. If I choose not to have treatment either now or in the future, what services are available to help me?
10. Is my cancer hereditary?
11. Can you suggest any books I can read on breast cancer?
12. What will the scar look like?
13. Can I have breast reconstruction?
14. When can I drive again?
15. How much does a prosthesis cost and will I be eligible for a free prosthesis?
16. Is there a risk of lymphoedema?
Page 92
17. If I need further treatment, what will it be like and when will it begin?
18. Will I still be able to have children?
19. Will I go through menopause? What are the effects of menopause?
20. Will the treatment affect my sexual relationships?
21. When can I return to work?
22. How frequent will my check-ups be and what will they involve?
"Can you explain that again?"
"I am not sure what you mean." or
"Would you draw a diagram, or write it down?"
1. He aha taku momo matepukupuku?
2. Pēhea te kaha whārahi o taku matepukupuku? Kei tēhea wāhanga?
3. He aha tō whakaaro mō te maimoatanga me whai au? He aha ai i tohungia e koe tēnei maimoatanga?
4. He maimoatanga atu anō hei whiringa maku?
5. He aha ngā tūponotanga mōrea me ngā putanga kētanga i te taha o tēnā me tēnā maimoatanga?
6. Ka hia te roa o ngā mahi maimoatanga?
7. E hiahia ana au ki te whai whakaaro tuarua mai i tētahi atu. Ka taea e koe te tuku i a au ki tētahi atu? Kei i a koe te tikanga ki te whai i tēnei.
8. He utu anō mō ngā maimoatanga?
9. Ki te whakatau au me whai maimoatanga au i nāianei, a ko ake rānei, he aha ngā ratonga e wātea ki te āwhina i a au?
10. He mea tuku iho ki a au taku matepukupuku?
11. Kei te mōhio koe ki ētahi pukapuka ka taea e au te pānui e pā ana ki te matepukupuku o ngā ū?
12. Ka pēhea te āhua o te mātānawe?
13. E āhei ana au ki te whai hanganga hou mō ngā ū
14. Ā hea au āhei ki te taraiwa waka anō?
15. E hia te utu mō tētahi prosthesis, he māraurau anō au mō te prosthesis kore utu?
16. Ka puta anō he mōrea mō te lymphoedema?
Page 94
17. Ki te hoki au ki ngā mahi maimoatanga, whakamārama mai he aha te āhua o aua mahi, hei āhea ka tīmata?
18. Ka taea tonu taku whakawhānau tamariki?
19. Ka tau mai te koero ki ahau? He aha ngā putanga i te taha o te koero?
20. Ka puta anō he pānga ki aku mahi onioni?
21. Āhea au hoki ai ki te mahi?
22. Ka pēhea te auau o ngā arowhi i a au, he aha ngā mahi ka puta.
Ki te kore e pai ki a koe ngā whakautu ki ō pātai, kaua e māharahara ki te kī atu:
"Tēnā whakamārama mai anō?"
"Kāore au i te mārama ki ō kōrero."
"Tēnā homai he tauira, me tuhi ranei?"
adjuvant chemotherapy – treatment of cancer with drugs to aid or assist another treatment.
atypical hyperplasia – the milk ducts contain increased numbers of abnormal cells.
Benign – a tumour that is not malignant, not cancerous, and won't spread to another part of your body.
Biopsy – when the specialists remove a small amount of cells or tissue from your body, so that it can then be examined under a microscope.
bone scan – a picture of the bones that can show cancers, other abnormalities such as arthritis, and infection. When a mildly radioactive substance is injected, cancerous areas in the bone pick up more of the substance than normal bone.
cells – the 'building blocks' of the body. A human is made of millions of cells, which are adapted for different functions. Cells are able to reproduce themselves exactly, unless they are abnormal or damaged, as are cancer cells.
CT scan – a scan done with X-rays to create a detailed image of the body and its organs.
ducts – a small tube in the body. In the breast, the milk ducts carry milk from the milk sacs to the nipple.
genes – a biological unit of DNA able to pass on a single characteristic from parent to offspring. Genes are found in every cell of the body.
Page 96glands – an organ or group of organs that make certain fluids.
hormone receptors – indicators on the surface of some cancer cells that suggest the cancer depends on hormones to help it grow, and it may thus respond to hormone treatment.
hormone receptor tests – laboratory tests that are done on a sample of tissue, to find out whether the cancer is likely to respond to hormone treatment. Hormone blood tests are also done to see if women are post-menopausal.
lymph glands or nodes – small kidney bean-shaped sacs scattered along the lymphatic system. The lymph nodes filter the lymph fluid to remove bacteria and other harmful agents, such as cancer cells. There are lymph nodes throughout your body, including in your abdomen, neck, armpit, and groin.
lymphoedema – swelling caused by a build-up of lymph in the tissues. It is caused by an obstruction of the lymph flow usually following surgery or other cancer treatment, such as radiation treatment.
malignant – a tumour that is cancerous and likely to spread if it is not treated.
mammogram – an X-ray of the breast that can be used to examine a breast lump. Mammograms are also used for women without any breast changes because they may detect a breast cancer before a lump can be felt.
mastectomy – the surgical removal of the breast.
Page 97metastasis (plural = metastases) – a cancer that has grown in a different part of the body because of spread of cancer cells from the original site. For example, someone with breast cancer may have metastases in their bones–also called secondary cancer.
milk sacs – the glands in a woman that produce milk. Each breast consists of a number of lobes (divisions) which contain milk sacs where the milk is produced.
MRI – a scan that uses magnetic resonance to detect abnormalities in the breasts, or of other body parts.
neo-adjuvant chemotherapy – chemotherapy given before surgery to improve the effectiveness of the treatment.
ovaries – a woman has two ovaries, which produce the female sex hormone oestrogen and, once a month, release an egg (ovum).
partial breast irradiation – irradiation technique under development covering the site of the (removed) tumour and margin of normal breast; given by a number of techniques.
primary – a malignant tumour starts in one site of the body where it is known as the primary tumour.
prosthesis – an artificial substitute for a missing part of the body such as a breast. It may help with balance and improve appearance.
Page 98recurrence – when a disease comes back again after what seemed to be a cure. This may be a local recurrence in the original site, or be distant metastases.
secondary – the same as metastasis.
sentinel node – this is the first lymph node to receive lymphatic drainage (and, potentially, cancer cells) from a tumour.
stereotactic core biopsy – a technique that uses three-dimensional X-ray to pinpoint a specific target area. It is used in conjunction with needle biopsy on non-palpable breast abnormalities.
tumour – a swelling or lump. Tumours can be benign (not cancerous) or malignant (cancerous).
ultrasound – sound waves of a very high frequency used to examine structures within the body.
Page 99
Dr Susan Love's Breast Book – Susan M. Love. MD. 5th ed. Da Capo Press, Cambridge, USA. 2010.
For further suggestions phone the cancer information nurses on the Cancer Information Helpline 0800 CANCER (226 237).
Cancer Society of New Zealand www.cancernz.org.nz
Cancer Australia www.canceraustralia.gov.au.
Breast Cancer Care (UK) www.breastcancercare.org.uk
The suggested websites, not including the Society's, are not maintained by the Cancer Society of New Zealand. We only suggest sites we believe offer credible and responsible information, but we cannot guarantee that the information on such websites is correct, up-to-date, or evidence-based medical information.
We suggest you discuss any information you find with your cancer care health professionals.
This booklet, Breast Cancer/Te Matepukupuku o ngā Ū, is part of a series titled Understanding Cancer, which is published by the Cancer Society. These booklets and booklets from the Living with Cancer series can be viewed and downloaded from our website, www.cancernz.org.nz.
Page 100 - 102
You may wish to use this space to write down any questions for, or advice given by your doctors, nurses, or health providers at your next appointment.
Box:
Tērā pea ka pirangi koe ki te whakamahi i tēnei wāhi wātea hei tuhi pātai e hiahia ana koe ki te pātai i tō rata, ngā tapuhi, ngā kaiwhakarato hauora rānei mō tō hokinga atu ki te kite anō i a rātou.
End of Box
PO Box 12700, Wellington 6011
Telephone: (04) 494-7270
PO Box 1724, Auckland 1023
Telephone: (09) 308-0160
Covering: Northland
PO Box 134, Hamilton 3216
Telephone: (07) 838-2027
Covering: Tauranga, Rotorua, Taupo, Thames, and Waikato
PO Box 5096, Palmerston North 4410
Telephone: (06) 364-8989
Covering: Taranaki, Wanganui, Manawatu, Hawke's Bay, and Gisborne/East Coast
Page 104
52–62 Riddiford Street, Wellington 6021
Telephone: (04) 389-8421
Covering: Marlborough, Nelson, Wairarapa, and Wellington
PO Box 13450, Christchurch 8011
Telephone: (03) 379-5835
Covering: South Canterbury, West Coast, and Ashburton
PO Box 6258, Dunedin 9016
Telephone: (03) 477-7447
Covering: Urban and rural Otago and Southland
Cancer Information Helpline
0800 CANCER (226 237)
www.cancernz.org.nz
Page 105
We would like to read what you thought of this booklet: whether you found it helpful or not. If you would like to give us your feedback please fill out this questionnaire, cut it out, and send it to the Information Manager at the address at the bottom of the following page.
Transcriber's Note: where tick boxes are given in this form there will be the text "Tick Box". Where space is left for you to fill out a comment there will be the text "Enter Text". End of Note.
1. Did you find this booklet helpful?
Yes Tick Box
No Tick Box
Please give reason(s) for your answer. Enter Text
2. Did you find the booklet easy to understand?
Yes Tick Box
No Tick Box
Please give reason(s) for your answer. Enter Text
3. Did you have any questions not answered in the booklet?
Yes Tick Box
No Tick Box
If yes, what were they? Enter Text
Page 1064. What did you like the most about the booklet? Enter Text
5. What did you like the least about the booklet? Enter Text
6. Any other comments? Enter Text
Personal information (optional)
Are you a person with cancer, or a friend/relative/whanau? Enter Text
Gender:
Female Tick Box
Male Tick Box
Age Enter Text
Ethnicity (please specify): Enter Text
Thank you for helping us review this booklet. The Editorial Team will record your feedback when it arrives, and consider it when this booklet is reviewed for its next edition.
Please return to: The Information Manager, Cancer Society of New Zealand, PO Box 12700, Wellington 6011.
Page 107
E hiahia ana mātou ki te pānui i ōu whakaaro e pā ana ki te pukapuka nei: Mehemea i pai ki a koe ngā āwhina ō roto, i kore rānei. Mēnā e pirangi ana koe ki te whakahoki kōrero, whakakīia tēnei rārangi pātai, tapahia mai, ka tuku mai ki te Kaiwhakahaere Pārongo ki te wāhi tau kei te mutunga o te whārangi ka whai i tēnei.
1. He āwhina i roto i tēnei puka?
Aē Tick Box
Kāo Tick Box
He aha te take i whakautu pēnei ai koe: Enter Text
2. I mārama ki a koe ngā kōrero o te puka nei?
Aē Tick Box
Kāo Tick Box
Homai he kōrero mō te take i whakautu penei ai koe. Enter Text
3. He pātai anō āu kāore i whakautua i roto i te puka nei?
Aē Tick Box
Kāo Tick Box
Mena ai, he aha aua pātai? Enter Text
Page 108
4. He aha te mea pai rawa atu o te puka nei? Enter Text
5. He aha tētahi mea koretake rawa e pā ana ki te puka nei? Enter Text
6. He kōrero atu anō? Enter Text
Pārongo Whaiaro (kei i a koe te tikanga ki te whakautu). He tangata whai matepukupuku koe, he hoa/whanaunga/ whanau ranei? Enter Text
Ira Tangata:
Wahine Tick Box
Tāne rānei Tick Box
Tō pakeke (ō tau): Enter Text
Momo iwi (kōrerohia mai): Enter Text
Ngā mihi nui ki a koe mō tō arotake i te puka nei. Ka pūrongohia ō whakahoki kōrero ka tae mai ana, ā, ka tirohia anō i te wā ka arotakenga anō te puka mō tana whakaputanga anō.
Tēnā koa whakahokia mai ki: Te Kaiwhakahaere Pārongo, Te Kāhui Matepukupuku ō Aotearoa, Pouaka Poutāpeta 12700, Te Whanganui a Tara 6011.
Page 109
The Cancer Society of New Zealand offers information and support services to people with cancer and their families. Printed materials are available on specific cancers and treatments. Information on living with cancer is also available.
The Cancer Society is a major funder of cancer research in New Zealand. The aim of research is to determine the causes, prevention, and effective methods of treating various types of cancer. The Society also undertakes health promotion through programmes such as those encouraging SunSmart behaviour, eating well, being physically active, and discouraging smoking.
We appreciate your support
The Cancer Society receives no direct financial support from Government. Funding comes only from donations, legacies, and bequests. You can make a donation by phoning 0900 31 111, through our website, or by contacting your local Cancer Society.
This booklet has been adapted for New Zealand from the Cancer Council of Victoria's publication Breast Cancer. The Cancer Society of New Zealand gratefully acknowledges the Council's assistance.
The Cancer Society would like to thank for their reviews, advice, and contributions:
Dr Birgit Dijkstra
Breast Surgeon, Department of Surgery, Christchurch Hospital
Dr Carol Johnson
Radiation Oncologist, Blood and Cancer Centre, Wellington Hospital
Professor Bridget Robinson
Medical Oncology Service, Christchurch Hospital and School of Medicine in Christchurch
Dr David Porter
Medical Oncologist, Lead Clinician, Medical Oncology Breast Team, Auckland Regional Cancer and Blood Services
Janice Wood
Breast Nurse Specialist, Waitemata DHB Breast Service, Auckland
Associate Professor Chris Atkinson
Oncologist, St George's Hospital, Christchurch and the Cancer Society of New Zealand's Medical Director
Meg Biggs, Julie Holt, and Michelle Gundersen-Reid
Cancer Society Information Nurses
Sarah Stacy-Baynes
Information Manager
We also thank the women who have experienced cancer, reviewed editions, and offered many valuable suggestions.
We also thank the Cancer Society volunteers who agreed to be photographed for our booklet.
Photography
Cancer affects New Zealanders from all walks of life, and all regions of our beautiful country. This cover photo of New Zealand Bush Clematis flowers (Clematis Paniculata); Puawananga was taken by Rob Suisted.
Cancer Society of New Zealand Inc. (2011)
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher.
Back CoverCancer Society – Te Kāhui Matepukupuku o Aotearoa
www.cancernz.org.nz
Any Question, Any Cancer
0800 CANCER (226 237) Cancer Information Helpline
End of Breast Cancer Booklet.