Diarrhoea due to malabsorption can often be corrected by a special diet and medications to help the bowel break down and absorb fats. If the malabsorption is due to blockage of the tubes running from the liver or pancreas to the bowel, it may be possible to correct this surgically. Just because it is possible does not necessarily mean it is best. Check the likely costs and benefits carefully.

Whether or not the cause of your diarrhoea is being tackled, you should take something to control it in the meantime. Anti-diarrhoea drugs work by slowing down the bowel muscle ^nd/or making the motions more solid. Chemical names of some good ones include kaolin, pectin, codeine phosphate, aluminium hydroxide, loperamide hydrochloride and diphenoxylate hydrochloride. It should be possible to improve diarrhoea greatly within less than a day with these drugs. If anti-diarrhoea treatment is not offered to you while the cause of your diarrhoea is being looked for or treated, ask for it.

It is important to make sure that you don’t get dehydrated while you have diarrhoea. If it is severe or accompanied by nausea and vomiting, you might need intravenous fluids until it is brought under control.

If you have malabsorption, you could become deficient in certain vitamins (such as vitamins A, D and K) and minerals (such as calcium). Make sure your doctor checks these. You may need to take extra of some things, either by mouth or in injection form.

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Cells from the primary tumour can spread to other parts of the body to produce secondary tumours. This spread is known as metastasis and can occur via the blood or lymph vessels. The secondary tumours are called metastases. Spread may also be local, to areas around the breast, or even across the abdominal or pleural cavities.

Breast cancer most commonly metastasises to bone, lung, liver, ovaries and brain. Lymph node metastases are the first to occur and are the most commonly seen. The malignant cells become lodged in these areas and multiply to form further tumours.

Although both breasts can be affected simultaneously, it is more usual for the second breast to become involved after a period of years, if at all. Rarely, spread to the second breast occurs via the lymph vessels.

Differentiation of tumours

Tumours can be well differentiated, containing easily identifiable cells which clearly resemble the tissue from which they were derived; poorly differentiated, with a mixture of cells which it is difficult to identify; or moderately differentiated, an intermediate form. The prognosis for a well-differentiated tumour is always better than for a poorly differentiated one.

Staging

There are various methods of classifying the development of breast cancer, known as staging. The TMN method, used until quite recently, is now generally considered unhelpful as it relies on subjective observation and has a high inter-observer variation.

Staging of cancers of the breast is now based on factors such as the following.

*    Has the tumour infiltrated into a large area (i.e. what size is it) or is there evidence of lymphatic or blood vessel invasion?

*     Is it well differentiated, i.e. does it look like normal breast tissue that has gone out of control?

*     Are the auxiliary lymph nodes involved?

*     Is the tumour confined to the ducts of the breast (intraductal cancer)?

This last factor is important because tumours which are completely contained within a duct can usually be cured by surgical removal of tissue containing the duct and the growth within it. Intraductal tumours, once removed, do not tend to recur.

A commonly used system stages cancers on a scale of I to IV, tumours at stage I (confined to the breast) having the best prognosis; stage IV denotes metastatic cancer at distant sites within the body.

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