Breast Cancer

Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death in women after lung cancer.

Advances in screening helps in early diagnosis of Breast cancer and advances in treatment have improved survival rates.

• Breast Lumps can be either benign or malignant.
• More than 90% of Breast lumps are usually benign. ( not cancerous)
• The management for the disease and further therapy and follow up depends on the same.

Benign Breast Diseases

• The most common Benign Breast Lumps are Fibroadenoma and Breast cysts. Benign Breast Lumps are evaluated and diagnosed by High Resolution Ultrasound. Small cysts or Fibroadenoma require no intervention and are kept under observation. Larger Fibroadenomas can be removed surgically in a day care procedure by scarless surgery or by Vacuum assisted Biopsy.

Diagnosing breast cancer

Tests and procedures done to diagnose breast cancer include Full Field Digital Mammogram, USG of Both Breast and Biopsy from the Breast Lump.

After diagnosis, patient may need further scans (PET scan, CT chest, Bone scan) to stage the patient as early or advanced or metastatic Breast cancer.

Surgery for early breast cancer

The surgical options for Early Breast cancers are

• Breast Conservation Surgery – Wide Local excision of Breast lump with adequate margins- Frozen section analysis and Oncoplastic Breast Reconstruction.

• Management of Axillary nodal metastasis
  • Axillary occult nodal metastasis can be addressed by State of the art Sentinel Lymph node biopsy using Radio-active sulphur colloid and Gamma camera.
  • Avoids unwanted axillary dissection and associated morbidity
  After Breast conservation surgery, the residual Breast is reconstructed. This is called as Onco-plastic Breast Reconstruction
• Onco-Plastic Breast Reconstruction is performed with
  • Local oncoplastic procedures
  • Pedicled LD flap
  • Micro vascular free flap reconstruction like DIEP
  • Breast Silicone Implants
• Modified Radical Mastectomy

OTHER treatments for breast cancer

Hormone Therapy

• Hormone therapy is used to treat breast cancers that are sensitive to hormones.
• Commonly used hormone therapy in Breast cancers is directed against estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.
• Hormone therapy can be used before or after surgery or other treatments to decrease the chance of cancer returning.
• Treatments that can be used in hormone therapy include:
• Medications that block hormones from attaching to cancer cells (selective estrogen receptor modulators)
• Medications that stop the body from making estrogen after menopause (aromatase inhibitors)

Targeted Therapy

• Targeted drug treatments attack specific abnormalities within cancer cells.
• As an example, several targeted therapy drugs focus on a protein that some breast cancer cells overproduce called human epidermal growth factor receptor 2 (HER2).
• The protein helps breast cancer cells grow and survive. By targeting cells that make too much HER2, the drugs can damage cancer cells.

Chemotherapy

• Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells.
• If the cancer has a high risk of spreading to another part of the body, the patient may be recommended to undergo chemotherapy, after surgery to decrease the chance of recurrence.
• Chemotherapy is sometimes given before surgery in women with larger breast tumours to downstage tumours. The goal is to shrink a tumour to a size that makes it easier to remove with surgery.
• Chemotherapy is also used in women whose cancer has already spread to other parts of the body.

Radiotherapy

• Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells.
• External beam radiation of the whole breast is commonly used after a lumpectomy.
• Breast brachytherapy may be an option after a lumpectomy if patients have a low risk of cancer recurrence.
• Radiation therapy to the chest wall might be needed after surgery for larger breast cancers or cancers that have spread to the lymph nodes.
• Breast cancer radiation can last from few days to six weeks, depending on the treatment

It is complete surgical removal of Breast and all axillary lymph nodal tissue. With recent advances in Management, nowadays this is being done in a select few patients with advanced Breast cancer and who are not eligible for Conservative Breast Surgery.