Breast Cancer
Overview
Breast cancer is the most common malignancy among women around the globe. In India, breast cancer has now become the first common cancer among women and it accounts for around 13.5% of all cancers. Over the last 25 years, the incidence of breast cancer in females has increased by around 40%.
There is a recent trend pointing towards a higher proportion of breast cancer in younger women especially in major cities like Chennai, Bhopal, and Delhi. The overall survival of the patients diagnosed with breast cancer depends on the stage at initial presentation.
The survival rate of patients with breast cancer is comparatively poor in India when compared with Western countries, which accounts for delayed presentation to hospitals leading to delays in initiation of definitive management due to logistic issues, fear of cancer, and social embarrassment and isolation. According to a World Cancer report the most efficient way of controlling breast cancer is by early detection and initiation of early treatment. Consequently, earlier detection can lower treatment costs to a significant extent and can make breast cancer treatment more simpler.
Signs and symptoms
- Painless lump in the breast or armpit
- Changes in the breast size and shape
- Nipple retraction
- Nipple discharge (blood-stained or spontaneous discharge)
- Skin changes (dimpling, puckering, skin that looks like an orange peel)
- Breast pain may also be an occasional symptom
Breast cancer Diagnosis
- Clinical examination by an expert
- Digital mammogram with ultrasound correlation
- Guided Biopsy from the lump (when there is a radiological suspicious of malignancy or any indeterminate lesion)
- Prognostic markers (estrogen and progesterone receptors ER/PR, HER2, and Ki-67 once the Biopsy confirms malignancy by pathological examination)
- Metastatic workup: it's done to look out for the spread of the disease after confirmation of malignancy (includes either whole-body PET CT, Bone scan, ultrasound, or CT of abdomen and pelvis)
Stages of Breast Cancer
- Stage I: Early stage: Cancer confined to breast tissue will spread to breast tissue in a small area
- Stage II: Localized: Tumour confined to breast with size between 2-5 cm with no Lymph nodes involved
- Stage III: Locally advanced with regional spread: Tumour size larger than 5 cm with skin or underlying muscle or multiple axillary node involvement
- Stage IV: Distant spread: Cancer has spread beyond the breast to other parts of the body (like the liver, bone, lungs, or brain)
Management of Breast Cancer
- Breast cancer treatment involves a multimodality treatment that includes Surgical, Chemotherapy, Hormonal therapy, and Radiation.
- The type and combination of treatment depends on every individual based on various factors that include the age of the patient, stage at presentation, and hormone receptor status.
- A single modality of breast cancer treatment is ineffective.
SURGICAL MANAGEMENT
Modified Radical Mastectomy (MRM)
Removal of the entire breast along with complete axillary nodal dissection (removal of nodal tissue along with an axillary pad of fat from the armpit)
Breast conservative surgery and oncoplasty
- Wide local excision of breast lump (Breast conservation) with axillary lymph nodal dissection followed by radiation to the whole breast.
- This surgery is an option for women with a lump that is small and is confined to one area. Usually, this option is given to women with early-stage breast cancers.
- Based on how much of the breast is removed, reconstruction (oncoplasty) is planned to improve the cosmetic outcomes at the same time as breast-conservative surgery.
- Oncoplasty makes it easier to produce symmetrical breasts.
- There are different oncoplastic techniques depending on the desired outcome.
Sentinel Node Biopsy
- Sentinel Lymph Node Biopsy (SLNB) is a procedure in which the first draining (sentinel) node is identified in the axilla, removed, and examined for cancer cells.
- SLNB is usually done at the same time when the primary tumors are removed.
- Removing only the sentinel lymph node avoids the major risk of lymphedema associated with traditional axillary nodal dissection (including removal of all axillary nodes along with axillary fat).
- Sentinel nodes are usually offered to patients with early-stage breast cancer who have clinically no palpable or non-significant nodes.
MEDICAL MANAGEMENT
Chemotherapy
- It uses anti-cancer drugs that may be given intravenously or by mouth.
- Chemotherapy can be administered upfront (prior to surgery) to downstage the disease or after surgery (to address any microscopic cells left behind).
- The type and dosage of chemo are dependent on the hormone receptor status and based on individual patient tolerance.
Hormone therapy
- It is only used for breast cancer patients who are found to have hormone receptors [estrogen receptor(ER) and progesterone receptor (PR)] positive.
- It is administered after the completion of all the other treatments.
- HER2-positive tumors are treated with targeted therapy.
- It helps in reducing the risk of cancer recurrence.
Radiation therapy
- Radiation is used as an adjuvant breast cancer treatment after completion of surgery for locoregional control.
- Various forms of radiation are available, which include External beam radiation, Brachytherapy (Internal radiation therapy), or Proton beam therapy.
- In Metastatic setting radiation can be used for pain palliativ
For further information regarding cancer treatment
Trusted Breast Cancer Treatment in Chennai
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