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Breast cancer (female)

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Breast cancer (female)


 



Breast cancer is one of the most common type of cancer in the EU.

In 2011, just under 50,000 women were diagnosed with invasive breast cancer. Most women who get it (8 out of 10) are over 50, but younger women, and in rare cases, men, can also get breast cancer.



If it's treated early enough, breast cancer can be prevented from spreading to other parts of the body.

 

The breasts are made up of fat, connective tissue and thousands of tiny glands called lobules, which produce milk. When a woman has a baby, the milk is delivered to the nipple through tiny tubes called ducts, which allow her to breastfeed.

The body is made up of billions of tiny cells, which usually grow and multiply in an orderly way. New cells are only produced when and where they're needed. In cancer, this orderly process goes wrong and cells begin to grow and multiply uncontrollably.

 

Symptoms of breast cancer

Breast cancer can have a number of symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.

Most breast lumps aren't cancerous, but it's always best to have them checked by your doctor. You should also see your GP if you notice any of the following:


a change in the size or shape of one or both breasts

discharge from either of your nipples (which may be streaked with blood)

a lump or swelling in either of your armpits

dimpling on the skin of your breasts

a rash on or around your nipple

a change in the appearance of your nipple, such as becoming sunken into your breast


Breast pain isn't usually a symptom of breast cancer.

After examining your breasts, your GP may refer you to a specialist breast cancer clinic for further tests. This might include a mammography (breast screening) or a biopsy.

 

Types of breast cancer

There are several different types of breast cancer, which can develop in different parts of the breast. Breast cancer is often divided into non-invasive and invasive types.

Non-invasive breast cancer

Non-invasive breast cancer is also known as cancer or carcinoma in situ. This cancer is found in the ducts of the breast and hasn't developed the ability to spread outside the breast.

This form of cancer rarely shows as a lump in the breast that can be felt, and is usually found on a mammogram (see below).The most common type of non-invasive cancer is ductal carcinoma in situ (DCIS).

Invasive breast cancer

Invasive cancer has the ability to spread outside the breast, although this doesn't necessarily mean it has spread.

The most common form of breast cancer is invasive ductal breast cancer, which develops in the cells that line the breast ducts. Invasive ductal breast cancer accounts for about 80% of all breast cancer cases and is sometimes called "no special type".


Other types of breast cancer

Other less common types of breast cancer include invasive lobular breast cancer, which develops in the cells that line the milk-producing lobules, inflammatory breast cancer and Paget's disease of the breast.

It's possible for breast cancer to spread to other parts of the body, usually through the lymph nodes (small glands that filter bacteria from the body) or the bloodstream. If this happens, it's known as "secondary" or "metastatic" breast cancer.

 

Breast cancer screening

About one in eight women are diagnosed with breast cancer during their lifetime. There's a good chance of recovery if it's detected in its early stages. For this reason, it's vital that women check their breasts regularly for any changes and always get any changes examined by their GP.

Mammographic screening (where X-ray images of the breast are taken) is the best available method of detecting an early breast lesion. However, you should be aware that a mammogram might fail to detect some breast cancers. It might also increase your chances of having extra tests and interventions, including surgery.

Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition.

As the risk of breast cancer increases with age, all women who are 50-70 years old are invited for breast cancer screening every three years.

Women over 70 are also entitled to screening and can arrange an appointment through their GP or local screening unit.

 

Treating breast cancer

If cancer is detected at an early stage, it can be treated before it spreads to nearby parts of the body.

Breast cancer is treated using a combination of surgery, chemotherapy and radiotherapy. Surgery is usually the first type of treatment you'll have, followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments.

The type of surgery and the treatment you have afterwards will depend on the type of breast cancer you have. Your doctor will discuss the best treatment plan with you.

Read a document listing the one-year net survival estimates by CCG for breast cancer

In a small proportion of women, breast cancer is discovered after it's spread to other parts of the body (metastasis). Secondary cancer, also called advanced or metastatic cancer, isn't curable, so the aim of treatment is to achieve remission (symptom relief).

They play a major role in achieving good health outcomes for the local population that they serve.

You can now check how your local CCG compares against others for breast cancer survival (PDF, 900 Kb).

 

Preventing breast cancer

As the causes of breast cancer aren't fully understood, it's not possible to know if it can be prevented altogether.

If you're at increased risk of developing the condition, some treatments are available to reduce the risk.

Studies have looked at the link between breast cancer and diet and, although there are no definite conclusions, there are benefits for women who maintain a healthy weight, exercise regularly and who have a low intake of saturated fat and alcohol.

It's been suggested that regular exercise can reduce your risk of breast cancer by as much as a third. If you've been through the menopause, it's particularly important that you're not overweight or obese. This is because being overweight or obese causes more oestrogen to be produced, which can increase the risk of breast cancer.

 

Living with breast cancer

Being diagnosed with breast cancer can affect daily life in many ways, depending on what stage it's at and what treatment you're having.

How women cope with their diagnosis and treatment varies from person to person. You can be reassured that there are several forms of support available, if you need it. For example:


your family and friends can be a powerful support system

you can communicate with other people in the same situation

find out as much as possible about your condition

don't try to do too much or overexert yourself

make time for yourself



OPERA

If you're concerned about your risk of developing inherited breast cancer, you can use Macmillan's online interactive assessment tool, known as OPERA (Online Personal Education and Risk Assessment).

OPERA is based on the National Institute for Health and Care Excellence (NICE) guidelines for the classification and care of women at risk of familial breast cancer.

The tool can be used to assess a person's risk of developing the condition based on their family history of breast cancer and ovarian cancer. This is because the genes that are mainly responsible for breast cancer are also linked to ovarian cancer.


Symptoms of breast cancer 

The first symptom of breast cancer most women notice is a lump or an area of thickened tissue in their breast.

Most breast lumps (90%) aren't cancerous, but it's always best to have them checked by your doctor.

You should see your GP if you notice any of the following:


a lump or area of thickened tissue in either breast

a change in the size or shape of one or both breasts

discharge from either of your nipples (which may be streaked with blood)

a lump or swelling in either of your armpits

dimpling on the skin of your breasts

a rash on or around your nipple

a change in the appearance of your nipple, such as becoming sunken into your breast


Breast pain isn't usually a symptom of breast cancer.

 

Breast awareness

It's important to be breast aware, so you can pick up any changes as soon as possible. Get to know what is normal for you. For instance, your breasts may look or feel different at different times of your life. This will make it much easier to spot potential problems.

Want to know more?


Breast Cancer Care: Your breasts, your health: throughout your life (PDF, 1.9Mb)

Breast Cancer Care: Your breasts, your health: a quick guide to being breast aware (PDF, 3.12Mb)

Breakthrough Breast Cancer: Signs and symptoms of breast cancer


 

Causes and risk factors 

The causes of breast cancer aren't fully understood, making it difficult to say why one woman may develop breast cancer and another may not.

However, there are risk factors that are known to affect your likelihood of developing breast cancer. Some of these you can't do anything about, but there are some you can change.

 

Age

The risk of developing breast cancer increases with age. The condition is most common among women over 50 who have been through the menopause. About 8 out of 10 cases of breast cancer occur in women over 50. Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit.

 

Family history

If you have close relatives who have had breast cancer or ovarian cancer, you may have a higher risk of developing breast cancer. However, because breast cancer is the most common cancer in women, it's possible for it to occur in more than one family member by chance.

Most cases of breast cancer aren't hereditary (they don't run in families), but particular genes, known as BRCA1 and BRCA2, can increase your risk of developing both breast and ovarian cancer. It's possible for these genes to be passed on from a parent to their child. A third gene (TP53) is also associated with increased risk of breast cancer.

If you have, for example, two or more close relatives from the same side of your family, such as your mother, sister or daughter, who have had breast cancer under the age of 50, you may be eligible for surveillance for breast cancer or for genetic screening to look for the genes that make developing breast cancer more likely. If you're worried about your family history of breast cancer, discuss it with your GP.

 

Previous diagnosis of breast cancer

If you've previously had breast cancer or early non-invasive cancer cell changes in breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast again.

Previous benign breast lump

A benign breast lump doesn't mean you have breast cancer, but certain types of lump may slightly increase your risk of developing it. Certain benign changes in your breast tissue, such as atypical ductal hyperplasia (cells growing abnormally in ducts), or lobular carcinoma in situ (abnormal cells inside your breast lobes), can make getting breast cancer more likely.

 

Breast density

Your breasts are made up of thousands of tiny glands (lobules), which produce milk. This glandular tissue contains a higher concentration of breast cells than other breast tissue, making it denser. Women with dense breast tissue may have a higher risk of developing breast cancer because there are more cells that can become cancerous.

Dense breast tissue can also make a breast scan (mammogram) difficult to read, because it makes any lumps or areas of abnormal tissue harder to spot. Younger women tend to have denser breasts. As you get older, the amount of glandular tissue in your breasts decreases and is replaced by fat, so your breasts become less dense.

 

Exposure to oestrogen

The female hormone, oestrogen, can sometimes stimulate breast cancer cells and cause them to grow. The ovaries, where your eggs are stored, begin to produce oestrogen when you start puberty, to regulate your periods.

Your risk of developing breast cancer may rise slightly with the amount of oestrogen your body is exposed to. For example, if you started your periods at a young age and experienced the menopause at a late age, you'll have been exposed to oestrogen over a longer period of time. In the same way, not having children, or having children later in life, may slightly increase your risk of developing breast cancer because your exposure to oestrogen is uninterrupted by pregnancy.

 

Being overweight or obese

If you've experienced the menopause and are overweight or obese, you may be more at risk of developing breast cancer. This is thought to be linked to the amount of oestrogen in your body, because being overweight or obese after the menopause causes more oestrogen to be produced.

Being tall

If you're taller than average, you're more likely to develop breast cancer than someone who's shorter than average. The reason for this isn't fully understood, but it may be due to interactions between genes, nutrition and hormones.

 

Alcohol

Your risk of developing breast cancer can increase with the amount of alcohol you drink. Research shows that for every 200 women who regularly have two alcoholic drinks a day, there are three more women with breast cancer, compared with women who don't drink at all.

 

Radiation

Certain medical procedures that use radiation, such as X-rays and computerised tomography (CT) scans, may slightly increase your risk of developing breast cancer.

If you had radiotherapy to your chest area for Hodgkin lymphoma when you were a child, you should have already received a written invitation from the Department of Health for a consultation with a specialist to discuss your increased risk of developing breast cancer. See your GP if you weren't contacted, or if you didn't attend a consultation.

If you currently need radiotherapy for Hodgkin lymphoma, your specialist should discuss the risk of breast cancer before your treatment begins.

 

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is associated with a slightly increased risk of developing breast cancer. Both combined HRT and oestrogen-only HRT can increase your risk of developing breast cancer, although the risk is slightly higher if you take combined HRT.

It's estimated that there will be an extra 19 cases of breast cancer for every 1,000 women taking combined HRT for 10 years. The risk continues to increase slightly the longer you take HRT, but returns to normal once you stop taking it.

 

Contraceptive pill and cancer risk

Research has shown that women who use oral contraception (the pill) have a slight, but significant, increased risk of developing breast cancer.

However, the risk starts to decrease once you stop taking the pill, and your risk of breast cancer is back to normal 10 years after stopping.

 

Diagnosing breast cancer 

You may be diagnosed with breast cancer following routine breast screening, or you may have symptoms that you've seen your GP about.

 

Seeing your GP

See your GP as soon as possible if you notice any symptoms of breast cancer, such as an unusual lump in your breast or any change in the appearance, feel or shape of your breasts.

Your GP will examine you and, if they think your symptoms need further assessment, they'll refer you to a specialist breast cancer clinic.

The National Institute for Health and Care Excellence (NICE) has issued guidance for GPs about referring patients with cancer to specialist services. If you need to be referred urgently, you'll usually be seen within two weeks.




 
Biopsy

A biopsy is where a sample of tissue cells is taken from your breast and tested to see if it's cancerous. You may also need a scan and a needle test on lymph nodes in your armpit (axilla) to see whether these are also affected.

Biopsies can be taken in different ways, and the type you have will depend on what your doctor knows about your condition. Different methods of carrying out a biopsy are discussed below.

Needle aspiration may be used to test a sample of your breast cells for cancer or to drain a benign cyst (a small fluid-filled lump). Your doctor will use a small needle to extract a sample of cells, without removing any tissue.

Needle biopsy is the most common type of biopsy. A sample of tissue is taken from a lump in your breast using a large needle. You'll have a local anaesthetic, which means you'll be awake during the procedure, but your breast will be numb.

Your doctor may suggest that you have a guided needle biopsy (usually guided by ultrasound or X-ray, but sometimes MRI is used) to obtain a more precise and reliable diagnosis of cancer and to distinguish it from any non-invasive change, particularly ductal carcinoma in situ (DCIS).

Vacuum-assisted biopsy, also known as mammotome biopsy, is another type of biopsy. During the procedure, a needle is attached to a gentle suction tube, which helps to obtain the sample and clear any bleeding from the area.

 






Scans and X-rays

Computerised tomography (CT) scans, or chest X-ray and liver ultrasound scans, may be needed to check whether the cancer has spread to your lungs or liver. An MRI scan of the breast may be needed to clarify or to assess the extent of the condition within the breast.

If your doctor thinks that the cancer could have spread to your bones, you may need a bone scan. Before having a bone scan, a substance containing a small amount of radiation, known as an isotope, will be injected into a vein in your arm. This will be absorbed into your bone if it's been affected by cancer. The affected areas of bone will show up as highlighted areas on the bone scan, which is carried out using a special camera.

Tests to determine specific types of treatment

You'll also need tests that show whether the cancer will respond to specific types of treatment. The results of these tests can give your doctors a more complete picture of the type of cancer you have and how best to treat it. The types of test you could be offered are discussed below.

In some cases, breast cancer cells can be stimulated to grow by hormones that occur naturally in your body, such as oestrogen and progesterone.

If this is the case, the cancer may be treated by stopping the effects of the hormones, or by lowering the level of these hormones in your body. This is known as "hormone therapy".

During a hormone receptor test, a sample of cancer cells will be taken from your breast and tested to see if they respond to either oestrogen or progesterone. If the hormone is able to attach to the cancer cells (using a hormone receptor), they're known as "hormone receptor positive".

While hormones can encourage the growth of some types of breast cancer, other types are stimulated by a protein called human epidermal growth factor receptor 2 (HER2).

These types of cancer can be diagnosed using a HER2 test, and treated with medication to block the effects of HER2. This is known as "biological" or "targeted" therapy.

 





Stage of breast cancer

When your breast cancer is diagnosed, the doctors will give it a stage. The stage describes the size of the cancer and how far it has spread.

Ductal carcinoma in situ (DCIS) is sometimes described as Stage 0. Other stages of breast cancer describe invasive breast cancer (see below).


Stage 1 – the tumour measures less than 2cm and the lymph nodes in the armpit aren't affected. There are no signs that the cancer has spread elsewhere in the body.

Stage 2 – the tumour measures 2-5cm or the lymph nodes in the armpit are affected, or both. There are no signs that the cancer has spread elsewhere in the body.

Stage 3 – the tumour measures 2-5cm and may be attached to structures in the breast, such as skin or surrounding tissues. The lymph nodes in the armpit are affected. However, there are no signs that the cancer has spread elsewhere in the body.

Stage 4 – the tumour is of any size and the cancer has spread to other parts of the body (metastasis).


This is a simplified guide. Each stage is divided into further categories: A, B and C. If you're not sure what stage you have, ask your doctor.

 
TNM staging system

The TNM staging system may also be used to describe breast cancer, as it can provide accurate information about the diagnosis. T describes the size of the tumour, N describes whether cancer has spread to the lymph nodes, and M gives an indication of whether the cancer has spread to other parts of the body.

Grade of breast cancer

The grade describes the appearance of the cancer cells.


Low grade (G1) – the cells, although abnormal, appear to be growing slowly.

Medium grade (G2) – the cells look more abnormal than low-grade cells.

High grade (G3) – the cells look even more abnormal and are more likely to grow quickly.









 


Breast cancer symptoms

Not all breast changes mean breast cancer, but some do. Know what to look out for, such as changes in shape










 


Faulty genes and breast cancer

The genes associated with breast cancer, what it means to have a faulty gene, and who gets tested










 


Cancer: your test results

If you're waiting for your test results, find out how you can prepare for your consultation

 






Treating breast cancer 

If you have cancer you should be assigned a multidisciplinary team (MDT) – a team of specialists who work together to provide the best treatment and care.

The main treatments for breast cancer are:


surgery

radiotherapy

chemotherapy

hormone therapy

biological therapy (targeted therapy)


You may have one of these treatments, or a combination. The type or combination of treatments you have will depend on how the cancer was diagnosed and the stage it's at.

Breast cancer diagnosed at screening may be at an early stage, but breast cancer diagnosed when you have symptoms may be at a later stage and require a different treatment. Your healthcare team will discuss with you which treatments are most suitable.

Choosing the right treatment for you 

When deciding what treatment is best for you, your doctors will consider:


the stage and grade of your cancer (how big it is and how far it's spread)

your general health

whether you've experienced the menopause


You should be able to discuss your treatment with your care team at any time and ask questions.

 


Treatment overview  hide



Surgery is usually the first type of treatment for breast cancer. The type of surgery you undergo will depend on the type of breast cancer you have.

Surgery is usually followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. Again, the treatment you'll have will depend on your type of breast cancer.

Your doctor will discuss the most suitable treatment plan with you. Chemotherapy or hormone therapy will sometimes be the first treatment.

Secondary breast cancer

Most breast cancers are discovered in the condition's early stages. However, a small proportion of women discover that they have breast cancer after it's spread to other parts of the body (known as metastasis).

If this is the case, the type of treatment you have may be different. Secondary cancer, also called "advanced" or "metastatic" cancer, isn't curable and treatment aims to achieve remission (where the cancer shrinks or disappears, and you feel normal and able to enjoy life to the full).






 



Psychological help show



Dealing with cancer can be a huge challenge, for both patients and their families. It can cause emotional and practical difficulties. Many women have to cope with the removal of part or all of a breast, which can be very upsetting.

It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness.

There are various ways to find help and support. Your hospital doctor, specialist nurse or GP can refer you to a counsellor. If you're feeling depressed, talk to your GP. A course of antidepressant drugs may help, or your GP can arrange for you to see a counsellor or psychotherapist.

It can help to talk to someone who's been through the same thing as you. Many organisations have helplines and online forums. They can also put you in touch with other people who've had cancer treatment.

 





Complementary therapies show



Complementary therapies are holistic therapies that can promote physical and emotional wellbeing. They're given alongside conventional treatments and include relaxation techniques, massage, aromatherapy and acupuncture.

Complementary therapy can help some women cope with diagnosis and treatment, and provide a break from the treatment plan.

Your hospital or breast unit may be able to provide access to complementary therapies or suggest where you can get them. It's important to speak to your breast cancer specialist nurse about any complementary therapy you wish to use, to make sure it doesn't interfere with your conventional treatment.






 






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Hair loss is a potential side effect of chemotherapy. Jessica, who was diagnosed with breast cancer in 2009, talks about her experience with chemotherapy and describes how the hair loss affected her. Also, an expert gives advice on how to cope with hair loss and where to find support.


 






Living with breast cancer 

Breast cancer can affect your daily life in different ways, depending on what stage it's at and what treatment you're having.

How women cope with their diagnosis and treatment varies from person to person. There are several forms of support if you need it. Not all of them work for everybody, but one or more of them should help. You could:


talk to your friends and family; they can be a powerful support system

communicate with other people in the same situation

find out as much as possible about your condition

avoid doing too much or overexerting yourself

make time for yourself


 



Recovery

Most women with breast cancer have an operation as part of their treatment. Getting back to normal after surgery can take some time. It's important to take things slowly and give yourself time to recover.

During this time, avoid lifting things – for example, children or heavy shopping bags – and avoid heavy housework. You may also be advised not to drive.

Some other treatments, particularly radiotherapy and chemotherapy, can make you very tired. You may need to take a break from some of your normal activities for a while. Don't be afraid to ask for practical help from family and friends.

Follow-up

After your treatment has finished, you'll be invited for regular check-ups, usually every three months for the first year.

If you've had early breast cancer, your healthcare team will agree a care plan with you after your treatment has finished. This plan contains the details of your follow-up. You will receive a copy of the plan, which will also be sent to your GP.

During the check-up, your doctor will examine you and may carry out blood tests or X-rays to see how your cancer is responding to treatment. You should also be offered a mammogram every year for the first five years after your treatment.

 
Long-term complications

Although it's rare, your treatment for breast cancer may cause new problems, such as:


pain and stiffness in your arms and shoulders may occur after surgery, and the skin in these areas may be tight

lymphoedema (a build-up of excess lymph fluid which causes swelling) – this may occur if surgery or radiotherapy damages the lymphatic drainage system in the armpit


Talk to your healthcare team if you experience these or any other long-term effects of treatment.

 






Dealing with changes to your body

A diagnosis of breast cancer may change how you think about your body. All women react differently to the bodily changes that happen as a result of breast cancer treatment. Some women react positively, but others find it more difficult to cope. It's important to give yourself time to come to terms with any changes to your body.

 
Early menopause

Although most cases of breast cancer occur in women over 50 who gave experienced the menopause, some younger women have to cope with an early menopause brought on by cancer treatment.

Symptoms can include hot flushes, vaginal dryness and loss of sexual desire. Talk to your healthcare team about any symptoms you have and they'll be able to help.

 
Prosthesis

A breast prosthesis is an artificial breast, which can be worn inside your bra to replace the breast that's been removed.

Soon after a mastectomy, you'll be given a lightweight foam breast to wear until the area affected by surgery or radiotherapy has healed. After it's healed, you'll be offered a silicone prosthesis. Prostheses come in many different shapes and sizes, and you should be able to find one that suits you.

 
Reconstruction

If you didn't have immediate breast reconstruction (carried out at the time of a mastectomy), you can have reconstruction later. This is called a delayed reconstruction.

There are two main methods of breast reconstruction – reconstruction using your own tissue and reconstruction using an implant. The type that's most suitable for you will depend on many factors, including the treatment you've had, any ongoing treatment and the size of your breasts. Talk to your healthcare team about which reconstruction is suitable for you.






 
Your sex life

Breast cancer and its treatment can affect your sex life. It's common for women to lose interest in sex after breast cancer treatment. Your treatment may leave you feeling very tired. You may feel shocked, confused or depressed about being diagnosed with cancer. You may be upset by the changes to your body or grieve the loss of your breasts or, in some cases, your fertility.

It's understandable that you may not feel like having sex while coping with all this. Try to share your feelings with your partner. If you have problems with sex that aren't getting better with time, you may want to speak to a counsellor or sex therapist.

 





Money and financial support  show



If you have to reduce or stop work because of your cancer, you may find it difficult to cope financially.

If you have cancer or you're caring for someone with cancer, you may be entitled to financial support, for example:


if you have a job but can't work because of your illness, you're entitled to Statutory Sick Pay from your employer

if you don't have a job and can't work because of your illness, you may be entitled to Employment and Support Allowance

if you're caring for someone with cancer, you may be entitled to Carer’s Allowance

you may be eligible for other benefits if you have children living at home, or if you have a low household income


Find out what help is available to you as soon as possible. The social worker at your hospital will be able to give you the information you need.

 
Free prescriptions

People being treated for cancer are entitled to apply for an exemption certificate, giving them free prescriptions for all medication, including medicine for unrelated conditions.

The certificate is valid for five years, and you can apply for it through your GP or cancer specialist.

 





Talk to other people show



Your GP or nurse may be able to answer any questions you have about your cancer or treatment. You may find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have information on these.

Some people find it helpful to talk to other people who have breast cancer, either at a local support group or in an internet chatroom.




 



 









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If you have cancer, talking to your kids about your condition can help reassure them










 


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