Dr. Vedant Kabra, breast surgeon from Gurgaon talks about breast cancer in four easy questions and explains the way to prevent and cure it.
1. What are the symptoms of breast cancer and how can it be detected early?
Any of the following may be an indicator of breast cancer:
- Lump in breast or armpit that grows with time and is usually painless
- Bloody or straw-colored nipple discharge
- Recent inversion, ulceration or destruction of nipple
- Dimpling of skin
- Thickening of skin to give an appearance of orange peel
The three-pronged approach helps in early detection, which is the key as cure rates are very high in the early stages. Breast self-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 outpatient clinic in 15 minutes after the mammogram is done. Sometimes MRI and ultrasound are also needed. Patients with larger lumps, those having enlarged glands in 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. There are four stages of breast cancer depending upon the size and extent of spread of the tumor.
Click here to learn in detail of the self-examination techniques.
3. How are the various stages of breast cancer treated?
Dr. Vedant Kabra, breast surgeon in Gurgaon also tells about the treatment plan and the sequence of modalities to be used are dependent upon the stage of the disease as well as the need to conserve the breast. Surgery forms the mainstay of the curative treatment of breast cancer and is ably supported by chemotherapy, radiation, hormone therapy, and targeted therapy.
Stage I & II (Early cancer) – Usually treated by surgery first. The 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 tumors.
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 select situations.
4. What are the different types of treatments and their side effects?
It is possible to conserve the breast while getting rid of cancer the majority of the time. However, a careful assessment of the disease, the patient’s wish and her understanding of the disease are essential before embarking on such a plan.
Breast Conservation Surgery (BCS) – Most of the ladies with an early disease can have their breast conserved. BCS is possible even for larger tumors 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 tumors are present that are wide apart from each other (multicentric disease) – these warrant mastectomy. Most breast Surgeon in Gurgaon tells that Breast can be reconstructed using the patient’s own tissues with or without synthetic implants.
Lymph glands in the armpit also need to be addressed during surgery. Patients whose glands are not involved by the disease can be identified by a technique called sentinel lymph node biopsy, which requires removal of only a few glands. If these are free of disease, a patient need not undergo removal of the remaining glands thereby significantly reducing the short and long term consequences of this procedure like arm numbness, arm swelling (lymphedema) and shoulder dysfunction.
Systemic (Chemo, Hormone or Targeted) Therapy
The requirement of these is decided by the stage and aggressiveness of the disease. Certain markers on tumor 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 the form of tablets, continues for five years or more. 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.
According to the breast surgeon in Gurgaon, All patients who undergo BCS, those with large tumors 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 a select group of patients. Regular follow-up is needed to monitor for side effects of treatment, detect and treat the recurrence if any.
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Dr. Vedant Kabra MBBS, MS, DNB, MRCS(Edin), FIAGES
Head, Department of Surgical Oncology
Manipal Hospitals Dwarka, Delhi