Incontinence falls into two quite different groups. Firstly, there is loss of control of urine or faeces coming through the normal passages. Secondly, there is loss of control of urine or faeces because it is coming away through a passage that doesn’t normally exist. This may be a passage created by your cancer (a fistula) or an artificial opening made surgically (a stoma).

Let’s talk first about incontinence where urine or faeces is coming through the normal passages. This can basically develop for three different reasons, one or more of which could be operating in your case. Firstly, when you can’t tell when your bladder or bowel is full. Secondly, when you can’t control the muscles that empty the bladder or bowel. Thirdly, when the lining of the bladder or bowel is so inflamed that the muscle responsible for emptying it goes into spasm which you cannot control (urge incontinence).

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Bilateral oophorectomy

This operation is possible for women who have not reached their menopause. It involves the removal of both ovaries and can lead to regression of tumours in about one-third of cases for between 1 and 3 years. Although a woman who has undergone this operation can no longer conceive, pregnancy should always be avoided by young women with breast cancer as it can cause tumours to recur. The ovaries can be removed surgically or by radiotherapy. Oophorectomy is being considered as an adjuvant to primary treatment for pre-menopausal women who have high-risk disease.

Adrenalectomy

The adrenal glands are two tiny glands, each situated in the fat just above a kidney. They produce many hormones, including adrenalin, Cortisol, and sex hormones. Removal of both these glands – bilateral total adrenalectomy – can lead to regression of recurrent breast cancer in about 50 per cent of cases, which can last for between 15 months and 5 years. Relapse may be due to the tumours becoming hormone independent or to synthesis of the hormone oestrogen (which stimulates tumour growth) being re-started at some unknown site in the body. Metastases in the bones and skin respond better to this treatment than do those in the brain and liver.

Adrenalectomy was carried out together with oophorectomy in women before the menopause. It must be followed by lifelong treatment with cortisone, and it is an obsolete operation nowadays as there are medicines which can achieve the same effect without surgery.

Hypophysectomy

This operation involves the removal of the pituitary gland in the brain and gives slightly better results than adrenalectomy. However, it is a difficult operation for various reasons and is not widely used anymore. Again, following hypophysectomy, women must continue cortisone treatment for the rest of their lives.

Choosing a treatment

All women should have a say in what form of treatment – if any – they receive, and an opportunity to discuss their options with their family before making a decision. They should be aware of all the options available to them, and take account of the advice their specialists give them.

In most areas, some form of counseling is available for women with breast cancer and for their families. Many hospitals now have specially trained breast care nurses who will be able to provide valuable support and information.

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