Cancer in these places causes headaches by increasing the pressure on the brain. These headaches are often accompanied by nausea, vomiting, and blurred vision. They tend to be worst when you have been lying down for a while and better when you are up and about. Cancer in the brain is a likely reason for headaches that are accompanied by double vision, pins and needles or numbness down one side or weakness in one side. Cancer in the CSF may be accompanied by a stiff back and neck, pains shooting into the arms and legs, and pins and needles, numbness or weakness in any or all limbs.

If you have headaches your doctor should examine you, including looking into your eyes to see whether the pressure on the brain is high. This is not a foolproof test—the back of the eye can look perfectly normal when the pressure on the brain is raised. A brain scan or CT scan will probably be needed in order to be sure of the reason for your headaches. A lumbar puncture will also be necessary if cancer in the CSF is suspected.

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There has been a trend over the last few years to move away from the very radical operations performed at the beginning of this century and well into the 1950s and 1960s. These operations included removal not only of the breast but also of the muscles of the chest wall and all the draining lymph nodes. It was thought that removal of all the lymphatic drainage gave a better chance of cure. With the introduction of radiotherapy and the realization that such excision was not necessary for all women, there was a trend towards much smaller operations including conservation of the breast. Nevertheless, there is a very wide spectrum of treatment from a surgeon’s point of view – and many conflicting ideas.

Wide lump excision

A modification of this operation used to be known as a segmental quadrantectomy.

A wide lump excision involves the removal of the cancerous lump together with at least a 2-cm (3/4-inch) margin of normal breast tissue, and usually an ellipse of skin from over the lump. Some lymph nodes are also removed from the armpit for staging to give some idea of whether the disease has spread beyond the breast. A separate incision may be needed for this.

Wide lump excisions are really only useful for small cancers, up to 2 cm (3/4 inch) in size, in the upper outer quadrant of the breast. This method tends to have rather poor cosmetic results for the removal of larger lumps, or lumps in other quadrants of the breast.

The operation performed on its own with no adjuvant treatment is associated with a high rate of recurrent cancer in the wound or around the scar. It has, however, been shown unequivocally that this operation combined with ‘field’ radiotherapy to the remaining breast tissue and to the lymphatic drainage in the armpit, above the collar bone and by the breastbone, is equivalent to doing a mastectomy. Conservative treatment of this sort can leave a very acceptable result, with a normal-looking and normal-feeling breast and nipple.

When wide lump excisions are performed for lumps in the centre or in the lower or inner half of the breast, they can give very disfiguring cosmetic results, except perhaps in a very large breast.

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