Following the right procedure

First the moment when you find the lump. You make an appointment to see your GP. But how will he know if it is benign or malignant - and if he suspects cancer, what next?

GPs have clear guidelines, developed by the Department of Health and the Cancer Research Campaign, to help them decide which patients should be referred as soon as possible. At hospital, a doctor will take your medical history before doing an examination. He will examine your breasts and feel for any enlarged lymph nodes under your arms and at the base of your neck. A chest X-ray and blood test may also be taken to check your health.

A number of others tests are used to diagnose breast cancer and you may have one or more. These include a mammogram or ultra-sound investigation.

If the lump is easy to find, the doctor may insert a fine needle to draw off fluid and a sample of cells from the lump. These will be sent for laboratory examination. If the lump turns out to be a benign cyst it generally disappears after the fluid has been drained and all you will need is a follow-up consultation a few weeks later.

If the lump is bigger or hard to find, you may be given a needle biopsy, possibly in conjunction with ultra-sound, to make sure tissue is taken from the right place. Sometimes it is necessary to have the lump taken out in a procedure known as excision biopsy, performed under general anaesthetic.

You will normally be asked to return for the results of the tests: some places can give results the same day, elsewhere it can take up to a fortnight.

If the tests show you have breast cancer your surgeon will outline treatment options. He might want to do a lumpectomy combined with chemotherapy and/or radiotherapy. He might suggest a mastectomy. He may want to do further tests to see if there has been any spread of the disease. These might include a liver ultrasound scan or a bone scan.

You should also ask to meet a breast care nurse, if this is not automatically suggested. She will be able to explain and discuss the treatment you have been offered and provide practical and emotional help and support. She may also arrange for you to talk to other women who have had breast cancer.

If you are having a mastectomy she will talk to you about a reconstruction or a prosthesis. The time you spend in hospital after surgery depends on whether you had a lumpectomy or a mastectomy. You may have to return for radiotherapy and/or chemotherapy.

On your first visit to the radiotherapy department you may be asked to lie under a machine which takes X-rays of the area to be treated. Marks may be drawn on your skin to show the radiographer where the rays need to be directed.

Chemotherapy drugs are usually given intravenously. Chemotherapy may be given as out-patient treatment or it may mean spending a few days in hospital.

After your treatment is completed - this could take six to nine months - you will be asked to go back for regular check-ups and X-rays.