Breast tissue is present in both men and women. Most of the breast cancers are seen in women. Breast tissue consists of fat tissue, fibrous tissue, glands (sacs or lobules) and fine ducts. Most breast cancers originate in the ducts (ductal cancer). The minority of cancers commence in the lobules (lobular cancers). Based on the behavior, breast cancer can again be divided into benign and malignant. Their treatment varies based on the type of cancer it is. Breast cancer can sometimes extend even beyond the breast, to the lymph nodes of the arm pit and other parts of the body such as liver and bones.
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 bean shaped 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 as follows.
- Genetic causes and BRCA mutations
- Personal history of breast cancer
- Exposure to Radiation
- Hormone replacement therapy
- Early menarche and late menopause
- 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
When you should see a doctor ?
If you notice any of the warning signs or other changes in your breast, chest, or nipple, consult a doctor immediately. The warning signs include a recent or a growing lump, skin changes, nipple changes like a blood-stained discharge or an inversion of nipple or a rash on a nipple/ breast. A change in the size, shape of breast or a painful area is also a warning sign.
How is breast cancer diagnosed ?
The diagnosis is based on information obtained from a battery of tests. These will include a mammogram, an ultrasound, Computed tomography scan (CT-Scan), the clearer magnetic resonance imaging scan (MRI Scan) and finally a biopsy.
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
- MRI Breast
- Bone scan
- Radio Immuno Guided Occult Lesion Localisation
- Sentinel Lymph Node Biopsy
- PET scan
- Genetic testing for BRCA mutations
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.
How is breast cancer treated ?
The first treatment for breast cancer is usually surgery on the breast, removing the tumor in its entirety and the armpit glands (otherwise known as the axillary lymph nodes). Under circumstances, if you are affected with breast cancer, you can opt between complete removal of a breast (mastectomy) or else only a removal of the tumor whilst conserving the breasts (lumpectomy). Lumpectomy will have to be followed by radiation, to kill the remaining/ microscopic tumor cells. After the surgery, several draining plastic tubes are inserted into the surgical site, to ensure removal of pooled lymph. This is done as the lymph nodes which perform this function will be removed along with the breast tissue.
Examination of the resected cancer and the removed lymph nodes will then be done by a pathologist, post the operation, and will point towards the need for any further treatment.Further treatment, if required, may be chemotherapy or radiation therapy or a combination of both. A multi-disciplinary team of doctors decides upon the treatment plan.
A specialist breast cancer surgeon or an oncosurgeon will choose the type of surgery that will best treat your cancer. Breast cancer surgery has been performed since 4-5 decades and has greatly helped increasing breast cancer survival rates over recent years.
What is microvascular breast reconstruction surgery ?
Typically, breast reconstruction takes place during or soon after mastectomy, and in some cases, lumpectomy. Breast reconstruction also can be done many months or even years after mastectomy or lumpectomy.In the recent times there have been great advancements in breast reconstruction surgery techniques. A lot of progress has been made in decreasing donor site morbidity and the total number of operations necessary in the reconstructive process. Surgery that is performed under the operating microscope and using specialized micro-instruments is called Microsurgery. In a microsurgical breast reconstruction, tissue from the abdomen, inner thighs or elsewhere on the body is transferred to the chest area. The new techniques in microsurgical reconstruction and refinement of skin sparing mastectomy techniques have helped to provide completely natural reconstructions with minimal scarring. Latest advances and procedures in breast reconstruction are offered at our network cancer hospitals in India. The breast cancer surgeons have vast experience and skills in doing complex nipple-sparing mastectomy with single-stage immediate reconstruction and additional options in microsurgical breast reconstruction. Our network cancer hospitals in India offer affordable breast cancer surgery and reconstruction packages.
What are the treatment options available at our network cancer hospitals in India for treating Breast Cancer?
- 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
- Dorsi & Extended LD FLAP
- Medical Oncology-Chemotherapy
- Radiation Therpay-IMRT,IGRT,
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 breast cancer 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 breast cancer 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 breast cancer 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 any of the following.
- 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 breast cancer 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 breast cancer recurrence?
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, what you should know ?
Breast cancer is the most common type of cancer among women. 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. Following are some of the 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.
Surgical measures : 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 mastectomy : 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.
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