BREAST CANCER
INTRODUCTION
Up to 1 in 28 Indian women may be at risk of developing the disease. Yet, with advances in treatments, a woman can be cured if diagnosed early.
ABOUT BREAST CANCER
Cancer denotes cells that have acquired ability of uncontrolled growth & spread. In the case of Breast Cancer, it spreads through the Auxiliary Lymph Nodes or through the blood stream.
SYMPTOMS
Common complaints include a painless lump in the breast, nipple discharge, skin redness / warmth, swelling and mass. As these symptoms are similar for a variety of conditions, all breast masses need to be investigated by a physician, a gynecologist or a breast surgeon. NEVER try to self-diagnose your condition, as you may lose critical time.
MYTHS
Breast cancer is not one single disease. It is a term that encompasses hundreds of different subtypes at a molecular level, each with its own behavior. Breast cancer treatments are now personalized where the treatment is offered based on the specific characteristics of a patient’s tumor. It is hence very likely that the treatment offered to a friend or family member for a breast cancer will not be the same that you need for yours.
RISK FACTORS
Most cancers are not genetic or hereditary, and do not run in families. Our cells can acquire defects over our lifetime that can make them cancerous. So never neglect a symptom because you do not have a family history of cancer.
SELF EXAMINATIONS
Keep Breast Self Exams simple, with these 2 instructions: 1. Once a month in the shower, while applying soap, feel your breasts and look into the mirror to get familiar with what is normal for you.
2. If you find anything new that you didn’t feel before, like a lump, nipple discharge, skin changes etc.; seek specialist consultation.
DIAGNOSIS
If you have a breast lump, do not guess - be safe and get a complete triple test. A Clinical breast exam + Mammography/ Ultrasound + Needle Biopsy should be performed for thorough evaluation of breast masses. When all three components are used under guidance of a specialist, chances of diagnostic errors are minimized. Most breast lumps are non-cancerous, but all breast lumps need to be investigated.
BIOPSIES
An image-guided breast core-needle biopsy is the most accurate way to sample breast masses. It only takes 10-15 minutes. Ultrasound guidance helps target the exact area to be sampled. It is more accurate than FNAC and helps avoid unnecessary surgery for diagnosis. In cases of breast cancer, molecular details on the tumor can be obtained to formulate the complete treatment plan.
TREATMENT
Surgery options include Mastectomy (+/- reconstruction) or Lumpectomy and Lymph node sampling or removal. Radiation treatment (after lumpectomy involves the whole breast (5-6 weeks) or the partial breast (1 week). Radiation after a mastectomy is given only if needed. Medical Therapies (Before or after surgery) include Chemotherapy, Endocrine Therapy and Biologic Therapy.
PSYCHOLOGICAL IMPACT
Separating “worry” from the word “cancer” is hard to do and an unreasonable expectation. The goal is to help a person live through this worry, get past it and be there in the journey. If you want help a cancer patient who is worried and afraid, (a) be there to listen when they want to talk about it, (b) allow them to cry when they have to, (c) it’s ok to be real and say “That sucks…. but I’m here for you”.
LIFE BEYOND CANCER
After completing treatments, cancer survivors often have lingering complaints that cause worry about recurrence and affect quality of life. Our cancer survivorship program will help you assess whether your concerns are: (a) Suspicious for recurrence and need to be investigated. E.g. new shortness of breath or new bone pain, (b) Expected from the treatment and will improve with time. Eg stretching pain at the surgical scar or © Treatable with appropriate medicines or therapy. E.g. Arm swelling can be controlled with decongestive therapy.
PREVENTION
Lifestyle changes can help reduce the risk. The risk can be reduced through several modifiable factors – exercise, avoidance of alcohol, smoking and intake of excessively fatty foods. It is recommended to maintain normal weight and avoid Hormone Replacement Therapy.
EXPERT’S MESSAGE
“Women facing a cancer diagnosis, often believe that removal of the whole breast (mastectomy) is safer than removing a part of it (lumpectomy). However, when combined with radiation, a lumpectomy can enable a woman preserve her breast without adversely affecting survival. Chemotherapy can often be done prior to surgery, to shrink larger tumors before operating and thus enable breast conservation.” – Dr Pranjali Gadgil (MBBS, ABS Certified Surgeon, Fellow in Diseases of the Breast)
RECOMMENDED READING
www.cancer.org/cancer/breastcancer
www.punebreastcare.wordpress.com

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