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Anil Cancer Clinic

Breast Cancer

What is Breast Cancer?

Breast Cancer is now one of the most common diseases happening in the country today. Do you know an estimated 1,50,000 women suffer from breast cancer every year? It is the highest cancer incidence in women and 1% of all breast cancer patients are men too. So men are not free from developing breast cancer.

How does Breast Cancer start?

The earliest symptom of breast cancer is just a lump in the breast. It is painless, no fever, no bleeding, no dramatic symptom, just a lump in the breast. If someone does not pay attention to the lump in the breast, then it keeps on increasing in size, inwards the skin. Sometimes opens through the skin creating a open wound. It can also develop nodes in the armpit. There can also be bloody discharge from the nipple and the whole breast can become swollen or hard if no attention is paid to the painless lump in the breast. If it spreads to other organs like the lungs, then it creates symptoms according to which organ is affected. For example: if it spreads to the liver than you can have loss of appetite or jaundice, if it spreads to the lungs, the person can have breathlessness or cough, if it spreads to the brain, the person can have headache, vomiting or even seizures.

Treatment

Once the lump is detected, the person should visit a doctor immediately. Let the doctor asses whether the lump is cancerous or non cancerous i.e. benign lump. If it is a benign lump then the doctor might just advise you to do a sonography just to be sure whether it is non cancerous. But if the doctor thinks it is cancerous lump then they may advice you to do a mammography. A mammography is a specialized x-ray and sonography of the breast. It can detect up to 90% of all lumps in the breast. Second investigation advised is a biopsy. A biopsy is taking a small sample of the tumor and investigation whether it contains cancer cells or not. Biopsy does not cause any spread of the cancer as it is commonly believd. Then if it turns out to be cancerous, further investigations are done like a PET scan. PET scan is done in order to see whether the cancer is limited to the breast or it has spread to the other parts of the body. There are other tests done, like routine blood investigations, ECG, x-ray chest, and 2D echo in order to know whether the cancer can be treated with surgery, chemotherapy, radiation and that if the patient is fit to undergo these treatments.

The normal treatment for chemotherapy is either surgery followed by chemotherapy and radiation or chemotherapy followed by surgery followed by chemotherapy and radiation. There is also an option of hormonal therapy in certain patients. In surgery we have 2 options, either conserving the breast or removing the breast completely which is called modified radical mastectomy. In a modified radical mastectomy, the entire breast and the lymph nodes in the armpit are removed. When the lymph nodes in the armpit are removed, there are certain consequences to the procedure. Which means the person may have a little heaviness on the inner side of the arm. There may also be a fluid which may collect on the space. In order, to drain that fluid the surgeon may leave a drain in order to remove that fluid. This drain will be removed when the content of the fluid will come down to a certain level as decided and advised by the surgeon.

The chemotherapy is advised after surgery and sometimes chemotherapy is advised after the surgery. Why is it advised before the surgery? It is advised before the surgery in order to reduce the size of the lesion so that a lesion which requires a potential mastectomy will be converted into a a breast conservation surgery and the patient will be saved of removing the entire breast. Sometimes chemotherapy is given in certain cases in order to determine if the response is going to be great and thereby it is a predictor whether the patient will have a better survival or not. Chemotherapy, when it is given after surgery starts after 3-4 weeks once the wound is completely healed. There are certain side effects if chemotherapy, which are like loss on hair, little bit of nausea, vomiting and little bit of weakness. In some patients these side effects can be very severe leading to oral ulcers and drop in immunity which can cause severe infections leading admission. However now it is with great supportive treatment, vomiting and nausea have reduced to a considerable extent. Even the chances of counts dropping and developing severe infection is now very low because there ae good growth factors available which ensure that the blood counts go up once these medicines are given. Hence severe side effects of chemotherapy are now well controlled and most patients can complete the chemotherapy even in the age of 65+.

What are stages of Breast Cancer?

Every cancer has 4 stages. These are points in evolution of the tumor from being very small entity to a large monster which can devour the entire body. When it is a small tumor which is less than 2 cm in size and not spread anywhere, or it is between 2-5 cm but there are no lymph nodes it is described as early breast caner or large operable breast cancer. When it involves the skin, there are lot of lymph nodes which are present, nipple is retracted, skin is puckered, then we consider it to be a locally advance breast cancer or third stage of breast cancer. When it has spread to all other organs of the body, then it is generally stage 4 breast cancer. In an early stage breast cancer, the treatment is surgery followed by chemotherapy and radiation if breast is conserved or as the treating doctor sees fit. Some patients may require hormonal therapy as well. The overall results of stage 1 and 2 breast cancer are very very encouraging and more than 95% of the patients can be cured.

In an advanced stage of breast cancer i.e stage 3 breast cancer, normally we prefer to give chemotherapy upfront. This chemotherapy helps to reduce the size of the tumor and makes is aminable to surgery. The patients also require radiation in the post operative period. Normally the results of locally advanced breast cancer are less encouraging than early breast cancer. However, cure is possible now in majority of patients.

In metastatic breast cancer, it depends on the severity of the metastasis. If the number of metastasis is less than 3, we still go and treat the patient aggressively with a curative option. However if it is an extensive mets than the intent of treatment is solely palliative. Chemotherapy is the main stay of treatment of breast cancer at this stage. Surgery is done only as the palliative option where the tumor is painful, has ulcerated through the skin, or the tumor is now causing some other symptoms which are difficult for the patient to handle.

Do we need chemo for Stage 1?

In stage 1 breast cancer, chemotherapy maybe required in a select group of patients who are triple negative breast cancers. This is a molecular characteristic of the tumor where it lacks estrogen and progesterone receptors. These are aggressive tumors and hence they require chemotherapy irrespective of the stage.

How long can you live with untreated breast cancer?

If someone chooses not to take treatment for breast cancer, it is difficult to say how long they would survive. It depends upon the health of the patient, the growth of the tumor and the aggressiveness of the tumor. The patient can survive anything between 6 months to i have seen patients living in a very sorry state of affairs for 2- 2 and a half years. Lot of times the local symptoms then becomes so troublesome that the patient is left in great agony. Hence is is always better to take treatment when it is available irrespective of the stage of cancer.

At what age can you get breast cancer?

Breast cancer can be found in patients at almost any age. The youngest recorded patient of breast cancer was in UK in a girl who was 9 years old. So what I have seen is normally patients who are as young as 21 developing breast cancer to as old as 93. There is no perfect age where breast cancer is diagnosed. It is more commonly seen in the 5th, 6th, 7th decade of life.

Do we need chemo for Stage 1?

In stage 1 breast cancer, chemotherapy maybe required in a select group of patients who are triple negative breast cancers. This is a molecular characteristic of the tumor where it lacks estrogen and progesterone receptors. These are aggressive tumors and hence they require chemotherapy irrespective of the stage.

How long can you live with untreated breast cancer?

If someone chooses not to take treatment for breast cancer, it is difficult to say how long they would survive. It depends upon the health of the patient, the growth of the tumor and the aggressiveness of the tumor. The patient can survive anything between 6 months to i have seen patients living in a very sorry state of affairs for 2- 2 and a half years. Lot of times the local symptoms then becomes so troublesome that the patient is left in great agony. Hence is is always better to take treatment when it is available irrespective of the stage of cancer.

At what age can you get breast cancer?

Breast cancer can be found in patients at almost any age. The youngest recorded patient of breast cancer was in UK in a girl who was 9 years old. So what I have seen is normally patients who are as young as 21 developing breast cancer to as old as 93. There is no perfect age where breast cancer is diagnosed. It is more commonly seen in the 5th, 6th, 7th decade of life.

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