BREAST CANCER: FROM DETECTION TO TREATMENT
1. What are the symptoms of breast cancer and how can it be detected early?
Any of the following may symptoms 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
Certain approaches can help in early detection - 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 OPD in 10-15 minutes after the mammogram is done. Sometimes MRI and ultrasound may also be 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.
3. How are various stages of breast cancer treated?
There are four stages of breast cancer.
Stage I & II (Early cancer) – Usually treated by surgery first. 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 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 breast, radiation for pain relief / bony disease, pain medicines, fluid removal etc. are required in some situations.
4. What are the different types of treatments and their side effects?
The different types of treatment options available are:
Breast Conservation Surgery (BCS) – Most of the ladies with early disease can have their breast conserved. BCS is possible even for larger tumors after reducing them with chemotherapy. Sometimes, 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 being present wide apart from each other (multicentric disease). Breast can be reconstructed using patient’s own tissues with or without synthetic implants.
Systemic (Chemo, Hormone or Targeted) Therapy
Certain markers on tumor cells help in deciding the need for hormone and targeted therapy. Chemotherapy usually consists of 6-8 cycles administered in day care at an interval of 15-21 days. Hormone therapy, in form of tablets, continues for five years or more. A type of targeted therapy may be needed and is typically given for a year. 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.
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 select group of patients.
Regular follow-up checks are needed to monitor for side-effects of treatment and detect the recurrence of disease, if any. Initial follow up visits are more frequent and the interval between the checks increases as the time passes by with only annual checks required after 5 years.