Breast Cancer

Types of Cancer

In India, breast cancer is the most common cancer in females. Though it typically occurs in females, it can also occur in males. It is very common in old age,but it can affect any age group. Only 5 to 10% of breast cancers, run in families and appropriate investigations should be done to look for signs of cancer in those families.

Risk Factors
  • Old age
  • Nulliparous
  • Early puberty and late menopause
  • Age of first child above 35 years
  • Family history of breast cancer
Clinical features
  • Painless lump in breast or armpit
  • Skin irritation or dimpling
  • Nipple retraction
  • Redness, scaliness, or thickening of the nipple or breast skin
  • Nipple discharge
Evaluation
1.Bilateral Digital Mammogram

It helps to find out of size, character and extent of lump and also helps in identifying any lump in opposite breast. It is a must, when breast conservation surgery is contemplated.

2. Biopsy

Depending upon the lump one of the following techniques is used for biopsy

  • Ultrasound guided needle biopsy
  • Stereotactic needle biopsy
  • Incision biopsy
  • Excision biopsy

3.special marker studies like er(estrogen receptor), pr(progesterone receptor) and Her2 receptor. This will help in guiding chemotherapy and also tell about the aggressiveness of disease.

In early stages of disease there is only a minimal chances for the disease to spread beyond breast. But in advanced stages it can spread to any part of body, hence a PET CT scan or suitable staging investigations like CT scan of abdomen, chest and bone scan is done.

Stage of Disease

To decide the treatment, first we have to stage the disease

  • Very early stage – tumor less than 2cm and no lymph nodes in armpit
  • Early stage – tumor 2 to 5 cm and minimal disease in armpit nodes
  • Advanced stage – tumor more than 5 cm and huge disease in armpit nodes
  • Very advanced stage – tumor spread in areas other than breast like bones, liver, lungs, brain.
Treatment

If the disease is in early stage a direct surgery is done. If the disease is in advanced stage, chemotherapy is given first to shrink the size of cancer and then surgery is done(neoadjuvant therapy).

Depending on size of tumor, size of breast, mammogram findings, patient preference we can offer either breast conservation surgery or mastectomy. With advances in surgical, chemo radiation techniques the survival and local recurrence rates are almost the same.

Depending on the spread of disease in armpit,we can do axillary node dissection or sentinel node biopsy(for clinically node negative patients). This latest technique helps in reducing arm swelling, less sensory deficit and increased range of movements.

In patients where we have to do a mastectomy , patients have the option of reconstruction of breasts.

Depending on tumor size, nodal disease in armpit, special markers patient receives 6-8 cycles of chemotherapy, some times up to a year. There is a special device called chemoport which helps in better chemotherapy delivery and causes minimal pain to patient.

Depending on tumor size, nodal disease and type of surgery radiation therapy is given. Conventional radiation therapy may take up to 45-50 days. But there are latest techniques which reduces the treatment duration significantly.

Followup

Often, once the treatment of cancer is completed, patients do not give importance for routine follow up. Follow up is of paramount importance, as it helps in identifying disease at an early stage. The follow up protocol for most of the cancers is

  • Once in 3 months for first 2 years
  • Once in 6 months between 2 and 5 years
  • Once a year after 5 years.

Clinical examination, USG abdomen and CXR is done during every visit.