BREAST CANCER

WHAT IS BREAST CANCER?

Breast cancer is caused by the uncontrolled growth and spread of cells in the milk ducts of the breast.

Breast cancer is the most commonly diagnosed caner in women worldwide accounting for 21% of all cancers diagnosed in women.

HOW DOES BREAST CANCER SPREAD (METASTASIS)?

LOCAL SPREAD

The tumour increases in size and invades other parts of the breast. It tends to involve the skin and penetrates the chest muscles and even the chest wall if diagnosed late.

SPREAD THROUGH LYMPH

The cancer spreads to the lymph nodes n the armpit.

SPREAD THROUGH BLOOD

The cancer may spread to distant organs like the bones (vertebral column, thigh bone, ribs and skull), liver, lungs and brain.

INVESTIGATIONS

Investigations are done to assess the tumour such as biopsy of the tumour and whole body MRI or CT scan. Also, investigations like blood and urine tests, ECG etc are required to assess your fitness for surgery.

INVESTIGATIONS

Investigations are done to assess the tumour such as biopsy of the tumour and whole body MRI or CT scan. Also, investigations like blood and urine tests, ECG etc are required to assess your fitness for surgery.

TREATMENT OF BREAST CANCER

It is important to start the treatment as early as possible to improve the outcome of breast cancer.

LOCAL TREATMENT

BREAST CONSERVATION SURGERY (BCS)

This is performed in a solitary tumour less than 4 cm in size and far away from the nipple to obtain a cosmetically acceptable breast after surgery. This is combined with surgery of the lymph nodes in the armpit, that is, either

• Sentinel node biopsy – biopsy from the first lymph node that drains the tumour area (3-4 nodes).
• Axillary sampling – level 1 dissection (removal of 10-12 nodes)
• Axillary clearance – full axillary dissection (complete removal of 20-25 nodes).

BCS is almost always followed by radiotherapy.

ABOUT BCS

• This procedure removes the tumour and a surrounding margin of normal tissue. Axillary surgery is performed.
• The surgery performed under general anaesthesia and takes about an hour.
• The BCS specimen and the axillary nodes are sent for histopathological analysis.
• A drain is kept at the surgical site to help remove excess fluid.
• The wound is closed with staples.

AFTER SURGERY

• You are discharged from the hospital on the next day.
• Postoperatively, you are given antibiotics and pain-killers.
• The histopathological report is available after 3-4 days. Consult your doctor regarding further course of treatment depending on its outcome.
• The drain at the operated site is removed after about 5 days.
• You make take a bath only after the drain is removed.
• The staples are removed after 14 days.
• You can resume normal activities within a day or two, including driving, walking up stairs, light lifting, and regular housework. Early mobilization of the arm is encouraged.

MODIFIED RADICAL MASTECTOMY (MRM)

Performed in case of large (in relation to the size of the breast) tumours, central tumours beneath or involving the nipple, multifocal disease or local recurrence.

ABOUT MRM

• All the breast tissue from the affected breast and lymph nodes from the armpit on the affected side are removed.
• This surgery includes the removal of the nipple and areola.
• Surgery is performed under general anaesthesia and takes about 2 hours.
• One or more drains are kept at the surgical site to help remove excess fluid.
• The wound is closed with stitches or staples.

AFTER SURGERY

• You are discharged from the hospital 2 days after surgery with the drains in place.
• Antibiotics and pain killers are given.
• The drains at the operated site are removed after about 5 days.
• You may take a bath only after the drains are removed.
• Fluid may collect at the operated site after all the drains are removed and may need to be drained by aspiration.
• The skin staples are removed after 14 days.

Is excision of the whole breast as in MRM a better option as compared to breast conservation surgery (BCS)?

No. Clinical trials have shown equal efficacy in terms of local disease control and a 10-year survival rate between BCS followed by radiotherapy and MRM.

A trial at NCI (National Cancer Institute) showed the following

ABOUT A MONTH AFTER SURGERY

The swelling of the arm on the operated side does not completely vanish. 5%-10% of the swelling remains forever. Do not worry about this. Also, there is some decreased sensitivity or tingling/burning at the operated site and around the inner aspect of the arm on the same side. This could last for about 6 months.

Consult your doctor if

• The swelling of the arm increases unduly.
• There is redness, pain or hardening over the arm or operated site.