BREAST CANCER TREATMENT
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Breast Cancer Treatment
The treatment of Breast Cancer depends upon the stage of the diseases. Stage of the disease in turn, depends on the size of the tumour and its spread to the nearby glands called lymph nodes or to other parts of the body. Based on the investigations which the specialists advise, first the diagnosis of breast cancer is established.
These investigations are ultra sound of the breast with or without x-ray mammography, FNAC (FINE NEEDLE ASPIRATION CYTOLOGY) or biopsy of the tumour and some other tests like PET scan or MRI. These tests, along with the clinical examination are most slightly to conclude whether the tumour in the breast is cancerous or not and it is also able to find out whether the disease has spread to some other parts of the body or not. Based on these preliminary examinations and investigations a provisional staging of the diseases is done and based on the provisional stage, the treatment is planned. The decision of whether a surgery will be required or whether a chemotherapy followed by a surgery will be required or a chemotherapy will be required or a combination treatment with radiotherapy will be required, the various combinations that may be possible is taken only after the doctors have a joint consultation with you.
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Breast Cancer surgery
Regarding the breast cancer surgeries there are two important surgeries which are commonly performed. The first one is where the whole breast is removed along with the glands in the axilla where the cancer cells frequently spread to . This standard technique is called Modified Radical Mastectomy or MRM. There is another surgery which can preserve the breast and does not remove the whole breast. It is called Breast Conservation therapy (BCT). This that can be an option for some patient with not very big tumour. In this surgery only the cancerous lump along with adjacent margins are removed (so has to get a free margin which does not harbour any cancer) along with the glands in the axilla. The only important thing to remember in the breast conservation treatment is that post-operative radiotherapy to the rest of breast which has been left behind, is required.
In normal case, the radiotherapy may or may be not required depending in what is the final report of histopathology. Based on the histopathology the decision is also taken whether the patient requires chemotherapy or hormone therapy or any other therapy. But in breast conservation surgery radiotherapy is definitely required irrespective of the histopathology or the final pathology report.
There are other much more aggressive surgeries which are used on some patients if the tumour is much bigger in size. Sometimes the tumour is shrunk before by chemotherapy and then a surgery is performed. There is an option of sentinel lymph node biopsy surgery also in patients with small cancers (in which the first tier of lymph node is removed based on the special technique of sentinel lymph node biopsy). Sentinel lymph node is removed and it is sent for frozen section assessment by pathologist. If it harbours a tumour, then further glands are removed. If it does not harbour, further glands are not removed. This can be less morbid surgery and can be applied to a subset of patients.
Reconstruction options for the breast is always available whether it is a small tumour which is removed or whether the whole breast is removed. In either case the breast shape can be given by the present techniques of reconstruction. Today’s advancements are able to give less morbid reconstructions which are much less painful than they were before. So, if the ladies are interested in having the contour restored, reconstruction options are given and many younger women opt for it.
In the end surgery remains the standard treatment of breast cancer if the cancer is amenable to surgery.
Medical Oncology and Radiotherapy
Other types of treatment of Breast Cancer includes Chemotherapy, hormone therapy, molecular therapy and radiotherapy. Chemotherapy is treatment by injections or medicines which are given to patients depending upon the stage and the type of disease. These injections are given by medical oncologists. There are different types of regime which the medical oncologists follow depending on how the disease is progressing, aggressiveness of the disease, age of the patient, and any other associative comorbidities & illness of the patient. It is tailor made for each patient. Many of the times, hormone treatment is also given because many breast cancers are receptive to female hormonal manipulations and such treatments are very effective . The decision to give which type of treatment depends again on the histopathology of the breast tissue and receptor studies. After studying the genetic predisposition of the patient, Herceptin or sometimes targeted therapy are also given which can help in the patients to modulate or cure the disease. These are new advances and the medical oncologists are the best person to advice them. In many of the patients, radiotherapy is required and that is also dependent on the stage and the spread of the disease. Radiation therapy can be given by many means, nowadays, like linear accelerator, IGRT or by cyber knife. Radiotherapy can also be given to patients who are having advanced disease where there is life threatening situations like for the spread to vertebra or other parts of the body where they shrink the tumour and relieve the patient of the agony. Radiotherapy forms an important part of the treatment. Whether it is Brachytherapy or Teletherapy, the radiation oncologists are the best suited to advice you regarding them.