BREAST CANCER: FROM DETECTION TO TREATMENT

BREAST CANCER: FROM DETECTION
TO TREATMENT
1. What are the symptoms of breast cancer and how can it be detected early?
Any of the following breast cancer (https:/
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be an indicator:
Lump in breast or armpit that grows with time and is usually painless
Bloody or straw coloured nipple discharge
Recent inversion, ulceration or destruction of nipple
Dimpling of skin
Thickening of skin to give an appearance of orange peel
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Certain approaches can help in early detection (https:/
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examination every month around five days after the periods are over (or a certain day of every month for
postmenopausal women) starting at the age of 20; Annual breast examination by a trained doctor after the age of
20; and Regular mammogram after the age of 45.
2. How to diagnose breast cancer and its extent (staging)?
Diagnosis is usually confirmed by a needle biopsy, which can be performed at the OPD in 10-15 minutes after the
mammogram is done. Sometimes MRI and ultrasound may also be needed. Patients with larger lumps, those
having enlarged glands in the armpit or symptoms suggestive of distant organ involvement (bone pain,
breathlessness, headache, enlarged liver etc) need additional tests to rule out the spread of disease to other
organs.
3. How are the various stages of breast cancer treated?
There are four stages of breast cancer.
Stage I & II (Early cancer) – Usually treated by surgery (https:/
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care/) first. A requirement of additional treatment is decided after the final biopsy results are obtained.
Stage III (Locally advanced) – Usually requires chemotherapy first followed by surgery and radiation. Hormone
and other targeted therapy are needed in the select group of patients who have certain markers present on their
tumours.
Stage IV (Distant organ spread)– Usually treated either with chemotherapy or hormone therapy or both.
Symptom directed therapies like surgery for an ulcerated mass in the breast, radiation for pain relief / bony
disease, pain medicines, fluid removal etc. are required in some situations.
4. What are the different types of treatments and their side effects?
The different types of breast cancer treatment options available are:
Breast Conservation Surgery (BCS) – Most of the ladies with the early disease can have their breast conserved.
BCS is possible even for larger tumours after reducing them with chemotherapy. Sometimes, the help of plastic
surgical techniques is required to maintain adequate shape and size of the breast (Oncoplasty).
Breast removal (Mastectomy) – Those who undergo mastectomy do not necessarily have advanced disease.
Sometimes, even in early disease, there are precancerous changes in a wide area of the breast or multiple
tumours being present wide apart from each other (multicentric disease). The breast can be reconstructed using
the patient’s own tissues with or without synthetic implants.
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Systemic (Chemo, Hormone or Targeted) Therapy
Certain markers on tumour cells help in deciding the need for hormone and targeted therapy. Chemotherapy
usually consists of 6-8 cycles administered in daycare at an interval of 15-21 days. Hormone therapy, in form of
tablets, continues for five years or more. A type of targeted therapy may be needed and is typically given for a
year. Chemotherapy may have side effects like hair loss, nausea, vomiting, weakness and most of these can be
well taken care of by modern medicines. Hairs grow back after chemotherapy is stopped.
Radiation
All patients who undergo BCS, those with large tumours or with involved lymph glands require radiation therapy
in addition to surgery and systemic therapy. With modern techniques of radiation, it is possible to minimize the
side effects on skin, lungs and heart. A typical course of radiation usually lasts for 30-35 days and is done as an
outpatient. Newer techniques have made it possible to shorten the duration further in the select group of
patients.
Follow-up Check-ups
Regular follow-up checks (https:/
/healthcheckup.manipalhospitals.com/) are needed to monitor for side-effects
of treatment and detect the recurrence of disease if any. Initial follow up visits are more frequent and the interval
between the checks increases as the time passes by with only annual checks required after 5 years.
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