What is Breast Cancer?
Breast cancer is a disease in which the normal cell becomes malignant (cancerous) and multiplies to form a lump or tumour in the breast. The breast is made up of ducts and peripheral lobes. Each breast has 15 to 20 lobes, which have many smaller sections called Lobules. These lobules are tiny bulbs that produce milk. The lobes with lobules are connected to the nipple by thin tubes called ducts. Each breast is supplied and drained by blood vessels and Lymphatics. The lymph vessels carry lymph to the draining lymph nodes Lymph nodes are small beanshaped

structures that are found throughout the body. They filter lymph and store cells that help fight infection and disease. These lymph nodes are found near the breast in the armpit. Breast cancer is also known as malignant breast neoplasm. Breast Cancer is a type of cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Breast Cancers originating from ducts are known as ductal carcinomas and those originating from lobules are known as lobular carcinomas.

What are the common risk factors?

Some of the common risk factors associated with Breast Cancer are:

• Obesity
• Genetic causes and BRCA mutations
• Personal history of breast cancer
• Exposure to Radiation
• Hormone replacement therapy
• Early menarche and late menopause
• Alcohol
• Exposure to prolonged Estrogen intake
• Women over 45 years of age

What are the symptoms of Breast Cancer?

• Lump in the breast or axilla
• Breast Enlargement
• Dimpling of Surface of Breast
• Retraction of Nipple
• Orange peel appearance of Breast
• Breast Pain
• Tenderness in Breast
• Weight loss
• Ulceration or nodules on the Breast
• Enlarged Lymph Nodes in the Armpit

What are the tests and investigations that are carried out at our network cancer hospitals in India in order to confirm the diagnosis and stage of cancer?

• Blood Test (CBC, PT, PTT, INR)
• Liver function tests
• Renal function tests
• X-ray Chest
• Ultrasound – abdomen and pelvis
• Mammogram with Ultrasound
• TRU CUT biopsy /FNAC
• Stereotactic biopsy- mammography guided
• ER, PR and HER2 analysis

SPECIAL TESTS

• MRI Breast
• Bone scan
• Mammoscintigraphy
• Radio Immuno Guided Occult Lesion Localisation
• Sentinel Lymph Node Biopsy
• PET scan
• Genetic testing for BRCA mutations
• CEA-15-3
• Ductoscopy
• Elastography

Multidisciplinary expert medical team for treating Breast Cancer at our network cancer hospitals in India

• Oncoplastic Breast Surgeons
• Plastic Surgeons
• Breast Navigator
• Medical Oncologist
• Radiation Oncologist
• Pain and Palliative Care Specialist
  
  

This multidisciplinary approach helps you get the best from appropriate experts. The team will answer any questions you may have and will help you through each of the steps you’ll take before, during, and after treatment. A member of our team will let you know which tests are being done and review the results with you. The team will also guide you in making treatment decisions. Usually treatment for breast cancer begins within 2 days after a diagnosis. That gives you time to do the following.

• Get more tests, if required.
• Discuss with your doctor about treatment choices.
• Get a second opinion, if you want one.
• Decide about treatment.
• Prepare yourself and your loved ones.

What are the treatment options available at our network cancer hospitals in India for treating Breast Cancer?

• Surgery
• Breast Conservative Surgery
• Lumpectomy & Sentinel Node Biopsy
• Modified Radical Mastectomy
• Radical Mastectomy
• Extended Radical Mastectomy
• Skin Sparing Mastectomy
• Subcutaneous Mastectomy
• Nipple Sparing Mastectomy
• Reduction And Augmentation Mammoplasties
• Nipple And Areolar Reconstructions
• Use Of Implants
• Breast Reconstruction Surgery- DIEP FLAP (Tummy Tuck-in), S-GAP FLAP, I-GAP FLAP, LAT THIGH ,FLAP, FREE TRAM FLAP
• Lat. Dorsi & Extended LD FLAP
• Medical Oncology-Chemotherapy
• Radiation Therpay-IMRT,IGRT,
• Brachytherapy

Can Breast Cancer return after the treatment?

Women who have been through breast cancer treatment are usually worried about this serious question. During treatment, women often feel empowered, cared for, well-monitored, and protected during treatment. But after completing treatment these thoughts keep coming into their minds.

What is recurrence?

Once breast cancer has been treated, there will be a cancer free period. A woman may never again get that particular type of cancer. But if the same cancer is detected later [after 6 months], she is said to have had a recurrence.

How can you reduce the chance of getting a recurrence?

Consult your breast surgeon, medical oncologist, and radiation oncologist regularly. Once you and the Tumor board have chosen the treatments that are appropriate for your specific situation, make sure to follow the recommendations closely. Keep all of your scheduled follow-up appointments. Consider making various healthy lifestyle choices like exercise methods to reduce stress like prayer, yoga and meditation, music, gardening, having a pet etc.  Losing weight also helps.

What happens if you have recurrence?

Recurrence does not mean that it is fatal. If one treatment does not work for you, another might. New and better treatments continue to be found, addressing various types of recurrence. Have faith that, depending on the details of your recurrence, there may well be a number of options to stop its progression.

A RECURRENCE CAN BE:

Localized: Occurs in and around the initial tumor in the remaining breast, skin or chest wall.

Regional: In the same axilla or arm pit or supra clavicular nodes

Distant:Occurs in the lung, bone, liver or brain, If cancer reoccurs within 6 months it is called residual disease. This could mean progression or treatment failure.

To be classified as a recurrence, the cancer must reemerge at least 6 months after completion of a successful cancer treatment.

What are the chances of recurrence?

Every women getting a cancer does not develop a recurrence especially those diagnosed at an early stage But there are so many other factors that figure into a woman’s risk of recurrence, like the type of cancer, the biological behavior of the disease, the stage of the cancer, the type of treatment given and where it is given. Most of the recurrences occur within five years of initial treatment. After five years, the more time that passes without a recurrence, the less likely that a woman will experience one.

What are the signs and symptoms that you should look for to suspect a recurence?

Getting yourself checked regularly is important. Inform your Doctor if you see any of the following- Any Skin changes- like color, swelling, scaling, warm area, tenderness or “orange skin” appearance Any lump, or thickening in the remaining breast tissue, chest wall, or in your arm pit. Changes in the nipple areolar complex include, retraction of the nipple, redness, scaling, or bloody discharge. Other possible symptoms, include‑

• Weight loss, cough or shortness of breath
• Bone pain, change of voice
• Abdominal pain or a palpable mass
• Headaches, fits or vision changes
• Yellow eyes or skin

Breast Cancer Prevention
Breast cancer is the most common type of cancer among Indian women. In India women get breast cancer around the age of 49 years. One out of every 22 women will develop Breast Cancer. The numbers of new cases of breast cancer have increased compared to the west. Breast cancer also occurs in men, but the number of cases is small. You ”prevent“ to lower the chance of getting cancer. By preventing cancer, the incidence is lowered. Hopefully, this will lower the number of deaths caused by cancer. To prevent a new cancer we look at risk and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.

Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting genes are risk factors for some types of cancer, but only smoking  can be avoided. Regular exercise and good nutritious food may be protective factors. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer.

Some methods to prevent Breast Cancer

• Avoiding factors known to cause cancer
• Taking certain drugs to prevent cancer from starting
• Changing lifestyle or eating habits
  
  

Increasing protective factors and avoiding risk factors may help in preventing breast cancer.

Avoiding smoking, controlling diet and weight, and regular exercise may help prevent certain cancers. Talk to your doctor about how you might lower your risk of cancer.

Protective factors that decrease the risk of Breast Cancer

EXERCISE

Exercising 30-40 minutes per day may decrease hormone levels and help lower breast cancer risk. The effect is more in pre-menopausal women with normal or low body weight.

DECREASED EXPOSURE TO ESTROGEN

Decreasing the period of exposure of a women’s breast to estrogen may help prevent breast cancer. Exposure to

estrogen is reduced in the following ways:

Pregnancy

Estrogen levels are lower during pregnancy. The risk of breast cancer appears to be lower if a woman has her first

full-term pregnancy before she is 20 years old.

Breast-Feeding

Estrogen levels may remain lower while a woman is Breastfeeding. It should be done for a minimum period of one year to have the benefit.

OTHER SURGICAL MEASURES USED IN PREVENTION PROPHYLACTIC MASTECTOMY

Some women who have a high risk of breast cancer may choose to have both breasts removed prophylactically. The risk of breast cancer is lowered in these women. However, it is very important to have a cancer risk assessment and explain all the options for possible prevention before making this decision. In some women, prophylactic mastectomy may cause psychological problems, and concerns about her body image.

PROPHYLACTIC OOPHORECTOMY

Women with high risk of breast cancer may choose to have their ovaries removed instead. This decreases the amount of estrogen produced in the body and lowers the risk of cancer. However, it is very important to have a risk assessment and counseling before taking this decision. The sudden drop in estrogen levels may cause the onset of menopausal symptoms, like hot flashes, loss of sleep, anxiety, and depression. Long-term effects include decreased sex drive, a dry vagina, and osteoporosis. These symptoms vary greatly among women.

Present recommendation for screening for breast cancers

Age [IN YEARS]                                                  Recommendation

30-40                                                                   Clinical breast examination by a Breast specialist

40 -70                                                                 Clinical Breast yearly

                                                                             Mammogram to be done once in 2 years

                                                                             Breast ultrasound yearly

70-80                                                                  Clinical breast examination with ultrasound once in two years

To get in touch with some of the top Breast Cancer Specialists in India, please write to us at medical@taindia.info or call us anytime at +91-9900244323.