Skip to main content

Treatment

SURGERY – 

Breast Lumpectomy

Many Cancers of the Breast are cured by a simple excision of the tumour with a healthy margin all aound. This is checked with a “frozen section” on table by a Pathologist to confirm that there is a good clearance of the tumour. Often this excision is accompanied by simple rotation of the surrounding Breast tissue to give a good cosmetic result. Sometimes a more complex Breast Oncoplastic procedure ay be required for the needful.

Breast Reconstruction

It is our belief at Prashanti Cancer Mission that no woman should lose her Breast to Cancer. Often we are forced to resort to a Mastectomy for various reasons. We counsel and offer such patients immediate Breast reconstruction. This may be in the form of a “Muscle flap” borrowed from the back or a Breast implant or occasionally both. Depending on the size of the tumour  in the overall background of the Patients build and structure , this decision is taken. The other advantage of immediate Breast reconstruction is that ,both excision and reconstruction can be achieved in a single sitting with minimum psychological stress to the patient.

Bilateral Mastectomy  and Preventive Mastectomy

Often women present with tumors in both the breasts which require Mastectomy on both the sides. It is our endeavor to reconstruct the breasts on both the sides with either Muscle Flap or Implants or both as the case may be. In a few instances some patients or their family members suffer from a very rare but definite “Familial Breast Cancer”. If the genetic analysis in these predisposed patients indicates impending risk of Cancer ,we can offer a “prophylactic Mastectomy on one or both sides “ and reduce the risk of developing a Cancer by upto 97% . Such patients will also be given the option of immediate Breast reconstruction for all the reasons mentioned above.

CHEMOTHERAPY –

Chemotherapy is the kind of treatment where drugs or medicines are introduced in the body, which are toxic enough to kill the tumour cells. These drugs are given on saline over a period of 3-4 hours.

Chemotherapy has developed over time to become a much smoother process with minimal side effects. Earlier, nausea was a recurring problem and patients would vomit frequently. Now, however, patients rarely experience nausea. Heavily discomforting side-effects like burning pain or infections have completely stopped.

There remain certain side-effects like occasional reduced blood count, amenorrhea, or other irregularities in menstruation.The chemotherapy needs to be administered in an extremely clean, friendly and positive environment in a day care facility.Chemotherapy is given in cycles and each treatment cycle is followed by a recovery period.

Chemotherapy can be given:
  • Before surgery in cases when cancer size has to be reduced for surgery or
  • After surgery (Adjuvant Therapy) to improve survival outcomes.

VACUUM ASSISTED BIOPSY (VAB) –

he VAB device (a mammotome) is an extremely useful instrument which is used for diagnosing very small lesions with 100% accuracy and is also used to remove benign lumps/lesions without a surgery. It is a painless, stitchless and scarless procedure and is done under local anesthesia. It is done in the OPD (in-house), therefore requiring no hospitalisation, and is done in 5 minutes, after which the woman can go home. This process actually allows us to biopsy very tiny lesions of 0.2mm-0.3mm in size or even calcifications* in the breast which may be indicators of very early cancer or precancerous lesions. This also gives the opportunity to remove benign lumps like fibroids, papillomas and complexcysts without a scar, under local anesthesia in a day care or an OPD setup. This procedure gives nearly 100% accuracy in diagnosing breast diseases.

Calcifications* – Accumulation of calcium salts in the breast.

SENTINEL NODE BIOPSY –

Breast cancer can spread through lymph vessels , to structures called lymph nodes, which are present in the axilla. Lymph is a clear-to-white fluid, unlike our red coloured blood, and is responsible for carrying white blood cells that provide protection to our bodies against bacterial infections. This lymph is filtered in the lymph nodes, which are located in various areas of the body, one of which is the axilla or armpit. They are also present in the neck, which you can feel when you have tonsillitis. These nodes are a part of our immune system and there is always a possibility that the tumour in the breast will spread to the axillary nodes.
Removal of tumour from the axilla has neither been easy nor free of lasting damage. In the past, women not only underwent mutilating breast surgeries or total mastectomies, but also endured radical surgeries to remove all the nodes from the axilla. And with the axilla having 40-50 nodes, one can only imagine how precise and careful the surgery had to be done.
However as of today, there has been tremendous change in the recommendations for handling the axilla. There have been major studies to identify a single node in the axilla. This node is called the sentinel node, also referred to as the watchman of the axilla. The significance of this node is that it is the first lymph node to encounter cancer cells. Therefore, identification of this node allows quick biopsy and accelerated diagnosis.
Sentinel node biopsy is performed during the same surgery on the breast. This process involves injection of a radioactive nuclear dye in the breast under the areola. This dye travels through the lymphatic system, first into that single node, that is, the sentinel node. The sentinel node is then identified with a special instrument called the (gamma camera picks up the radioactive dye containing lymph node) It is then biopsied and sent to a histopathologist, who provides the diagnosis within 15 minutes.
This technique is useful because, if the node is diagnosed as negative, it would mean that the patient has no disease, thus saving her from extensive surgery where the rest of the nodes would have to be removed. And being a biopsy, it is painless as well as scarless, therefore the patient neither bears scars, nor has to undergo surgery.

HORMONE THERAPY –

There are two types of breast cancers – hormone positive and hormone negative. To make this identification, biopsy samples are sent for certain special tests to assess the status of oestrogen receptors (ER), progesterone receptors (PR) and HER2 receptors. Receptors are special proteins present on the cell surface which give the cell a special quality.
An ER or PR positive tumour means the hormones oestrogen and progesterone in the body of the woman are actually acting on those tumour cells and propagating them.
Hormonal therapy uses drugs to block the action of these hormones on cancer cells. As a result, the cancer cells begin to decline.

There are two types of drugs involved in hormone therapy:

  1. SERMs (Selective Oestrogen Receptor Modulators)
  2. AIs (Aromatase Inhibitors).

Drugs like Tamoxifen (SERM), Anastrozole (AI) and/or Letrozole (AI) which are anti-oestrogens, are given to the patients to reduce the chances of recurrence. They are extremely effective treatments and virtually prevent the recurrence. They also prevent occurrence of breast cancer in the contralateral/other breast by 50%. Tamoxifen is the most commonly used drug.
This therapy is used to help reduce the risk of cancer coming back after surgery. It can also be used for breast cancer that has spread or come back after other treatment.

What are the side effects of Tamoxifen?

  • Women who are pre-menopausal suffer from hot flushes
  • They may become amenorrheic or their periods may reduce/thin out.
  • There is a very small possibility that, in less than 3 out of 1000 women, Tamoxifen may cause a very low grade uterine cancer. The woman needs to be examined every year with an ultrasound to prevent such a possibility. In our experience, we have never actually seen a breast cancer turning into a uterine cancer after taking Tamoxifen.
  • In a very small percentage of patients, Tamoxifen might cause eyesight problems which are reversible.
  •  If there is change in the thickness of the lining of the uterine cavity, Tamoxifen needs to be withdrawn and other drug needs to be given.

What are the side-effects of Aromatase Inhibitors?

  • AIs are responsible for causing osteoporosis in women who have undergone hormone therapy with this drug.

This is a very important side-effect since patients have complained about bone aches.

 

TARGETED THERAPY

Presence of Human Epidermal Growth Factor Receptor 2/Neu Protein (HER2/Neu Protein) in cancer cells makes the tumour more aggressive. Targeted drugs are aimed specifically towards these proteins to reduce the aggressiveness of cancer. Targeted drugs are not effective as a single treatment agent, but can be used along with chemotherapy.
Trastuzumab is the most commonly used targeted drug. It has reduced the mortality of breast cancer by more than 50% in the patients which have HER2 positive cancer.
Trastuzumab is administered in a day care facility. It requires half an hour to one hour to administer it intravenously and the procedure is painless. However, Trastuzumab regimen is a prolonged one, sometimes lasting upto a year or so. If the treatment is working, it can be intermittently stopped as well.
This drug has virtually no side effects like nausea, vomiting, hair loss, etc., and is extremely safe in women. But it needs to be given under the supervision of a trained medical oncologist.

What are the risks with Trastuzumab?

The only side effect of Trastuzumab can be a very minor allergic reaction to the drug which needs to be ascertained before administration. However, it can also cause cardiotoxicity in patients with heart conditions. Therefore, it is necessary to assess the heart condition of the patient before beginning the regimen, and it is also necessary to monitor her/him intermittently, that is, if the regimen is for a year, she/he needs to be monitored every six months.

RADIATION

Radiation therapy or Radiotherapy is a treatment method wherein radiation is given to the affected breast after the breast conservation surgery (breast has been saved) or in cases where the breast has been removed entirely. The therapy involves exposing the cancerous breast tissue to high energy x-rays; wherein the x-rays are very collimated and directed by dedicated machine known as Linear Accelerator. Radiotherapy is important to reduce the risk of recurrence of cancer after surgery. It is effective and safe in treating all stages of breast cancer, from stage o to stage III of breast cancer, after the surgery. Radiation therapy is a painless procedure and will not cause the patient to be radioactive, nor increase their chance of getting breast cancer, as that would defeat its purpose.

Typically, the radiation regimes are given over 5 days, 15 days or 25 days. It takes only a few seconds to give radiotherapy and the patient does not need hospitalization for the same.

The common side effects of radiation therapy are:-

  • Pigmentation of skin
  • Hardening of skin over the radiated area
  • Eczema