Breast Cancer
What is the breast? Where is it located?
The breast is a soft organ attached to the muscles on the rib cage.
It is present in both males and females.
However, it is more developed in females.
In women, it contains milk-producing glands and ducts.
These ducts carry milk to the nipple.
Fat and fibrous tissue support the glands and give the breast its shape.
What is breast cancer?
Breast cancer is a disease in which the cells in the breast grow uncontrollably. These abnormal cells can form a lump or mass and may eventually spread to other parts of the body.
There are different types of breast cancer, depending on which cells in the breast become cancerous.
It can occur in both men and women, but it is far more common in women.
Why have I developed breast cancer?
The exact cause of breast cancer is unknown, but several risk factors increase the chances of developing it.
These include genetic mutations, a family history of breast cancer, age, hormonal imbalances, and lifestyle factors like alcohol use and obesity.
Having one or more of these risk factors does not guarantee that you will get breast cancer, but it may increase your risk.
What are the symptoms of breast cancer?
The presence of breast cancer can be varied. The following symptoms should raise awareness and one must see a doctor for the same:
- New – onset change in the size of one breast
- Lump in the breast
- Skin thickening or ulceration
- Redness in the breast
- Nipple discharge
- Nipple inversion
- Puckering or dimpling, particularly while raising the arms above the head
- Lump in underarm area
- Any new or unusual change in the breast
In western countries, owing to the higher incidence of breast cancer, screening strategies are employed. By this, all patients above the age of 40-50 years are advised to have a mammogram either yearly or once in two years. In India, while a formal screening program does not exist, it is advisable for adults above the age of 40 years, especially those with a family history of breast cancer, to get themselves tested with a baseline mammogram and then a decision of how frequently it needs to be done can be discussed on a case-by-case basis with your doctor.
What investigations will I be subjected to?
To diagnose breast cancer, doctors may recommend a combination of physical exams, mammography, ultrasound, and MRI.
If a suspicious area is found, a biopsy may be done to examine the tissue under a microscope.
These tests help determine the type, size, and stage of cancer.
Are there different types of breast cancer?
Yes, breast cancer can be categorized into different types based on the cells affected.
The most common types include invasive ductal carcinoma and invasive lobular carcinoma.
Some cancers are hormone receptor-positive, while others are HER2-positive or triple-negative.
At what stage is the cancer?
Breast cancer is staged from 0 to 4, depending on its size and spread.
Stage 0 means it is non-invasive, while Stage 4 indicates that cancer has spread to other parts of the body.
Staging helps guide treatment decisions and estimate prognosis.
Now that I have been diagnosed to have breast cancer, how will I be treated?
Different types of treatment are available for patients with breast cancer. There are usually six components to the treatment and based on the stage and characteristics of the diseases, options from these six are chosen. Surgery is usually required for all patients(unless cancer has spread to other parts of the body) and the other parts of the treatment are chosen based on the type of cancer that one has.
- Surgery
- Chemotherapy
- Targeted therapy
- Radiotherapy
- Hormone therapy
- Bisphosphonate therapy
Some patients may be given chemotherapy or targeted after surgery to kill any cancer cells that are left. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells either by killing the cells or stopping them from dividing. Targeted therapy uses drugs or substances to identify and attack specific cancer cells without harming normal cells. Radiation therapy is a ‘light or X-ray therapy’ given to the breast and surrounding areas to prevent the disease from coming back locally. Hormone therapy is given as a tablet for 5-10 years and is given for cancer that is hormone-positive (ER/PR positive). Bisphosphonate therapy is an injection of zoledronic acid which is given to post-menopausal women (usually every six months for three years) for bone health, and it also has a positive outcome for breast cancer.
What kind of surgery is done for breast cancer?
Surgery for breast cancer can be divided into two parts – surgery for the breast and surgery for the axilla (axillary lymph glands)
Surgery for the breast:
Breast preserving operation– Tumour size, breast size, presence of more than one tumour in the breast and stage of the disease, all help to determine if the breast can be preserved during surgery. If you are a candidate for a breast preserving option and are offered this, you should know that the survival (longevity of life) is not affected by preserving the breast and that it is a safe surgery. One must note that if you choose to have a breast preserving surgery, it must be followed up with radiation.
Mastectomy (removal of the whole breast) – When it is not possible to save the breast, or the patient chooses to have her breast removed, then a mastectomy is done. The skin is put together after the surgery and there is no raw area. At the end of the surgery, there is a flat straight surgical scar.
Oncoplasty – Sometimes when a large area of the tissue has to be removed during a breast conservation surgery, the gap to fill is large and just closing it as it may give an ugly result. Therefore, tissue and fat from the neighbouring areas like the back or side fat or breast tissue itself is remoulded to fill in the gap and give a better outside.
Reconstruction– There are options to create a new breast with one’s own tissue (commonly the tummy fat) or with an implant (made of silicon) to make a new breast after a mastectomy. This can either be done at the time of the first surgery itself or as a second surgery anytime in the future.
Surgery for the axilla is always part of the treatment for any breast cancer. If done with the mastectomy, there is no separate scar; but if done with breast conservation there may be a separate scar in the area of the armpit.
Sentinel lymph node biopsy– This is a procedure where the first set of lymph nodes draining the breast in the axilla are marked out by special techniques and they are removed and sent for testing. If cancer has spread to these lymph nodes, then an axillary clearance is usually done and if the nodes do not have cancer, then there is no further surgery done in the axilla. All this usually happens when one is under anaesthesia itself (frozen section for the lymph nodes) and does not need to be done as a separate procedure.
Axillary clearance– This is a surgery to remove all the lymph nodes in the armpit and is also done in the same anaesthesia as the breast surgery. If we know prior to surgery that the lymph node is involved or if there was a positive node on sentinel lymph node biopsy, then this procedure is performed. At the end of a mastectomy and/or an axillary clearance, a drain is placed, and these come out below the wound and are left in place for 7-10 days. They are meant to drain the fluid from the wound, and this may be a little blood-tinged. Once the amount coming out reduces, the drain is removed.
