What Is Breast Cancer Treatment And Surgery:
An abnormal growth of cells in the mammary or adipose tissues of the breasts is termed as breast cancer; the specialty of gynecology combined with surgery pertaining to the diagnosis and treatment planning of the same condition falls under the treatment strategy and surgical approach. Various types of breast cancers can occur in females, both of the benign and malignant types, in the age range of 18 to 60 years. As per the diagnosis, the treatment plan can be executed.
Causes Of Breast Cancer:
- Extreme stress, psychological distress can be one of the factors responsible for bringing about changes in the hormonal levels
- Oral contraceptives
- Excessive exposure to UV radiation, alcohol, smoking can act as carcinogenic agents for the breast tissues
- An undiagnosed bacterial/viral/fungal infection in the breast causing cyst may progress into tumor depending upon the host’s environment
- Breast cancer may also have a genetic influence, for example there are 50 percent chances of a daughter getting breast cancer if her mother at some stage in her life had been diagnosed with the same
- However, in certain cases the etiology maybe totally unknown and uncertain
Signs And Symptoms Of Breast Cancer:
An abnormality in the breast is always first noticed by the female herself with the help of self examination. Signs and symptoms include:
- A lump in the breast or para breast region, mainly in the armpit region
- Heaviness in the breasts
- Cyanosis, which is a bluish appearance of the breasts as a result of engorged blood vessels
- Discharge from the nipples
- Bleeding from the nipples
- Pain, swelling, itchiness and dryness around the nipple areas
- Dimpling of skin of the breast
- Referred pain in the neck, shoulders and arms
The staging of breast cancer:
Cancer of the breast may be staged based on TNM staging (Tumour, Node, Metastasis) and is very popularly used worldwide. The staging is as follows:
1) T stage:
- T0 - No tumour
- Tis – Tumour in situ
- T1 - =<2cm
- T2 - >2cm but <5cm
- T3 - =>5cm
- T4A: involvement of the chest wall (serratus anterior muscle, ribs, intercostal muscles)
- T4 B – involvement of the skin (peaud’orange, satellite nodules, ulceration)
- T4 C – involvement of both chest wall and skin
- T 4 D – Inflammatory breast cancer (aggressive type and carries the worst prognosis of all breast cancers)
2) N stage:
- N0 – No Lymph nodes involved
- N1 – Mobile axillary lymph nodes
- N2 A - Fixed or matted axillary lymph nodes
- N2 B – Internal mammary lymph nodes in the absence of axillary lymph nodes
- N3 A - Infra-clavicular lymph nodes
- N3 B – Internal mammary lymph nodes and axillary lymph nodes
- N3 C – Supra-clavicular lymph nodes
3) M stage:
- M0 – No distant metastases
- M1 – Presence of distant metastases
Based on the above staging criteria, any tumour is given three elements of description. These may be further categorised under three main leads to plan on the management and they include:
|Type of breast cancer
|Early Breast Cancer
|Locally Advanced Breast Cancer
|Metastatic Breast Cancer
||T1, T2, T3, T4
||N0, N1, N2, N3
The treatment depends on this clinically categories; and hence staging by clinical assessment, histopathology and imaging is of prime importance in management of breast cancers
Diagnosis Of Breast Cancer:
- Self examination: It is always the female patient who first notices the changes or the abnormalities in the breast region. These could be best noticed while bathing. A lump felt anywhere in the breast region calls for a total insight to the reason behind it.
- Physical examination: This is done by the general surgeon or the gynecologist in the clinical setup. The unclothed breasts are first observed for any changes in the size, shape, nipple swelling and discharge, the skin is observed carefully for any cyanotic patches, recessions or dimpling. Palpation is done mainly to check for the lumps, cysts and infected lymph nodes. Palpation is done both with the arms in the rest position and also with the arms stretched in order to determine the location and mobility of the pathology.
- Mammography/Mammogram: It is an x ray done exclusively for the breast region wherein the entire anatomy of the mammary region can be studies. The adipose tissues, glandular tissues and mammary glands can be appreciated well in the x ray film. Any pathology in the form of abnormal growth, be it a cyst or a tumor can be seen as a radiolucent mass in the mammogram.
- Biopsy: It is a procedure in which a part of the cancer mass or the entire mass is removed surgically for the purpose of studying the type and nature of progression of the cancer. It can also be used as a treatment method in which the entire small mass of cancer is removed along with a small normal margin so that chances of recurrence are minimal.
- Fine needle aspiration cytology: A cystic mass in the breast region is usually aspirated with the help of a long tubular fine needle. The liquid contents are examined in the labs for their nature and type.
- Ultrasound: A USG of the breast is done to study the glandular and the mammary tissues particularly. It also helps in the estimation of number of cystic and tumor masses present in the mammary areas.
- Magnetic resonance imaging MRI: This is a non ionizing radiation technique which gives insight into the soft tissues of the breast such as the nerves, venous plexus and the blood vessels. It defines the margins of the tumor, locates exactly where it is present in the breast region and gives the exact number of tumor masses present.
Types Of Breast Cancer:
A cancer of any type is largely classified as benign and malignant depending upon its invasive nature. A benign tumor is limited to a particular area, does not invade the surrounding tissues and is also known as a non invasive cancer. A malignant one is more aggressive in nature and tends to spread to the adjacent tissues, also known as an invasive cancer.
Breast cancers are also classified depending upon the tissues they involve. These are as follows:
- Ductal Carcinoma In Situ (DCIS): Cancer of the ducts of the nipple region
- Invasive Ductal Carcinoma (IDC): Cancer of the ducts of the nipple region which has spread to the adjacent areas
- Tubular Carcinoma of the Breast: Cancer spreading to the entire tubular system in the breast region
- Medullary Carcinoma of the Breast: Cancer involving the glandular tissues of breast
- Mucinous Carcinoma of the Breast: Cancer developing in the sebaceous and mucus glands of the skin of the breasts
- Papillary Carcinoma of the Breast: Cancer developing in the epithelial lining of the breasts
- Invasive Lobular Carcinoma (ILC): Cancer involving the lobular structure in the breasts
Treatment Procedures For Breast Cancer:
Preventive: There are no vaccinations available for the prevention of breast cancer. However certain other preventive methods can be adopted. These are as follows:
- Timely self examination and with a surgeon or a gynecologist
- Especial attention to be given if you have a history of breast cancer running in the family
- Screening for breast cancer should be done once in every 6 months
- Even if a slight chance of cancer is suspected, mammogram should be done once in every two years
- Radiation therapy: This procedure makes use of ionizing radiation beams targeted towards the cancer mass. This therapy brings about disintegration of the cancer cells and curbs the condition. However a certain normal cells may also get killed in the process. The radiation beam is not cancer specific and cannot distinguish between cancer and normal cells. A breast cancer may require a number of radiation therapy sessions as advised by the oncologist. The oncologist also decides the intensity and frequency of the dosage.
- Chemotherapy: It is a procedure in which various combinations of anti cancer drugs are administered to the patient. An oral medication, intravenous or subcutaneous injection can be the choice of administration. The anti cancer drugs bring about a decrease in the metabolism of the cancer cells causing a deficiency of oxygen and nutrients from the surroundings. As a result of this, death of cancer cells occurs thereby eradicating the tumor. Chemotherapy similar to radiation therapy is not specific to cancer cells and can bring about disintegration of normal healthy cells too.
- Lumpectomy: This is a conservative approach in which only the part of breast infected with cancer is removed. Since only the lump is removed, the procedure is known as lumpectomy. To prevent recurrence of the cancer, a part of normal lining of the breast tissue is also removed along with the lump. It is mostly the choice of treatment for benign breast tumors where the margins are well defined; also when radiation and chemotherapy sessions fail to subside the cancer symptoms.
- Mastectomy: It is the complete removal of the breast. This is the option in cases of malignant invasive and aggressive types of cancers where cancer has spread to the entire mass of breast and may pose a threat to further tissues if not acted immediately upon. A mastectomy is always followed by a breast reconstruction or a breast augmentation procedure.
- Lymph node dissection: In this procedure, the lymph nodes present in the axillary region are removed prior to their infection with the cancer. In a sentinel type of lymph node surgery, 2 to 3 lymph nodes in the axilla are removed. In a complete lymph node surgery, as the name suggests, all the lymph nodes present in the axilla or the armpit region are removed.
- Microdochectomy: In this method, a cancerous lactiferous duct is removed completely by making a small incision.
Complications And Risk Factors Associated With Breast Cancer:
- A hematoma may develop at the site of surgical incision which may or may not grow in size
- Hair loss may occur as a result of damage to the sensitive hair follicles when radiation and chemotherapy are the treatments done
- Tenderness and pain may persist after the surgical treatment
- Scarring of the tissues may also be seen around the sutures
- Wound infection and bleeding may occur if proper care is not taken.
Am I Good Candidate For Breast Cancer treatment?
You can consider yourself as an ideal candidate for breast cancer treatment, if you are experiencing any of the below symptoms:
- Pain, tenderness and heaviness in the breast region
- Bleeding and discharge from the nipple region
- A feeling of constant lump in the breast or the axillary region which may move with pressure or on palpation
- Change in the shape, size of one or both the breasts
- A blue color appearance of the breasts
- A surgical resection of the breasts requires a hospital stay of 3 to 4 days
- Complete recovery takes about 20 to 25 days time which also requires regular check ups with the gynecologist and the onco surgeon
- A surgical removal has a 90 percent chance of success, performed at any stage and at any age
- Radiation and chemotherapy carry a 5- percent chance of success and a 50 percent chance that the cancer may recur
Benefits of Breast Cancer Treatment:
Treatment of breast cancer at the correct age will achieve the following things:
- Boost the self confidence and morale of the female
- If the cancer is in benign stage, it can be prevented from progressing to the malignant stage by removing or treating it at an early stage
- An early detection and treatment also prevents the chance of performing a mastectomy procedure
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