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The multidisciplinary approach to breast cancer patients: Breast cancer patients are discussed in detail in a multidisciplinary tumor board consisting of medical oncologist, radiation oncologist, surgeon, pathologist, radiologist, nuclear physician and palliative team. Every patient’s treatment is individualized following the international and national protocols of breast cancer management.

Specialists related to breast oncology: All specialists required to treat breast cancer are available under a single roof. Our breast surgeon, medical oncologist, radiation oncologist, pathologist, breast radiologist, nuclear physicians, breast care nurse, palliative team, physiotherapist work together for the best possible outcomes.

Breast cancer statistics – the extent of the problem: Breast cancer is the most common cancer among urban women in India, and the incidence is set to increase steadily with increasing urbanization. As per the published data from the Indian Council for Medical Research, there were 14.5 lakh new cases in 2016. This number is projected to increase to 17.3lakhs in 2020.

Overview

Breast cancer is the most common cancer among urban women in India, and the incidence is set to increase steadily with increasing urbanization. When found and treated early, breast cancer is most often curable. October has been internationally designated as the breast cancer awareness month, in recognition of the magnitude of the problem.

What is breast cancer in simple terms?
Breast cancer arises when normal cells in the breast change and grow out of control to form an enlarging lump (tumour). These abnormal cells then grow and invade healthy areas of the breast. In later stages, the tumour cells can spread to the lymph nodes in the armpit and also to other parts of the body.
At what age can you get breast cancer?
Breast Cancer is commonly seen in women 45 and above, but it can occur in young women too. Particularly in India, it is seen a decade earlier than the west.
How does Breast Cancer Start?
A painless lump or swelling is the most common symptom of breast cancer. As these lumps are painless most women neglect it thinking it is harmless. In some women, it can present as thickening of the skin over the breast, bloody nipple discharge, retraction of the nipple or occasionally pain in the breast.
How long can you have Breast Cancer without knowing?
A lump may be present for two to five years before it is big enough to be felt.
Where is the first place Breast Cancer spreads?
Breast cancer commonly spreads to the lymph nodes in the armpit or axilla on the same side of the tumour. If left untreated it can spread to different parts of the body, commonly to the bones followed by lungs and liver.
What are the stages of Breast Cancer?
In early stages of breast cancer, the tumour is confined to the breast alone, in the second stage it is localized to the breast and the axillary lymph nodes located in the armpit, in the third stage it is little more aggressive than stage 2 and in the fourth stage, it has spread to other distant parts of the body like bones, lungs, liver, brain etc.
What are pre-cancerous lesions of the breast?
Some lesions like ductal carcinoma in situ, lobular carcinoma in situ and Paget’s disease of the breast are pre-cancerous lesions which have not breached the milk duct lining and have high potential to break open the walls and transform into breast cancer. These are conditions which have the potential to transform into breast cancer.
Breast Cancer Types

There are different types of Breast Cancer. The most common is the invasive ductal cell carcinoma

  • Invasive ductal carcinoma: It is the most common type and constitutes 70 to 80% of all breast cancers. It arises from the milk ducts and spreads to the surrounding breast tissue.
  • Invasive lobular carcinomas: It constitutes 10-15% of breast cancer and arises from the milk-producing lobules of the breast. These tumours are multiple and sometimes patients can have simultaneous lesions in the opposite breasts.

Other Rare Types

  • Tubular carcinomas: It constitutes 1to 5 % of breast cancer
  • Mucinous carcinomas: It comprises 1-2 % of breast cancers and has a good prognosis
  • Medullary (seen in BRCA1 mutation)
  • Invasive papillary carcinomas
  • Inflammatory breast cancer: It is an aggressive variant with poor prognosis in which the entire breast is swollen and red because of the blockage of the lymphatics
  • Metaplastic carcinoma

Classification of Breast Cancer: Molecular Subtypes

Determining the molecular subtype of the cancer is essential for formulating the treatment plan.  After confirming the diagnosis of breast cancer by doing a biopsy, further analysis has to be done on the biopsy sample to check for the following receptors.

  • Estrogen receptors (ER)
  • Progesterone receptors (PR)
  • HER2/neu receptors
  • Ki-67: Proteins to assess how fast the tumour is growing

These molecular details are essential to understand biology, to plan treatment and to assess the overall prognosis of breast cancer. Based on these molecular details the breast cancer is subdivided into luminal types.

Luminal A: These breast cancers are estrogen receptor and progesterone receptor-positive (ER/PR positive) with low Ki-67 (slow-growing) and are HER 2neu negative. These tumours constitute the majority (50%), are slow-growing and have a good prognosis.

Luminal B: These breast cancers are ER/PR positive with high Ki-67 (rapid-growing) and are either HER 2 positive or negative. These tumours grow slightly faster and are slightly aggressive.

Triple-negative or basal-like: These tumours are negative for ER/PR/ HER 2 receptors. These tumours are aggressive and have a poorer prognosis.

HER 2 enriched: These breast cancers are positive for HER 2 and negative for ER/PR receptors. These tumours are aggressive but respond to drugs like trastuzumab/pertuzumab.

Causes and Risk Factors of Breast Cancer
It is difficult to pinpoint the exact cause of cancer in most patients, but certain risk factors increase the chances of getting breast cancer. Risk factors include older age, being overweight or obese, alcohol use, a history of radiation, hormonal therapy, earlier age at menarche, later age at menopause and a family history of breast cancer. About 5 to 10% of breast cancers may be linked to genetic mutations such as BRCA1 and 2.

Diagnosis For Breast Cancer

How can I test myself for Breast Cancer?
Being breast aware and performing a breast self-examination at least once a month (preferably done 5 to 10 days after periods) will help in early detection. Any new onset lumps (typically painless) in the breast or armpits, thickening of the skin, recent deviation or pulling in of the nipple, bloody nipple discharge, nipple excoriation etc has to be brought to the notice of your doctor.

How Does a Doctor Diagnose Breast Cancer?
Breast cancer is usually suspected when a lump or other change in the breast or armpit is found by a woman herself or by her doctor. If a breast lump is found, a mammogram and a breast ultrasound are usually performed. A biopsy is performed in case the mammogram or ultrasound hints at cancer. A biopsy is a procedure wherein your surgeon gives a local anaesthetic and inserts a small needle to take a few cells to be examined in detail, under a microscope by the pathologist.

Mammography: It is a soft tissue X-ray of the breast, and helps in identifying the suspicious lumps in the breasts. These lumps are characterized using breast imaging reporting and data system classification (BIRADS). Lumps labelled as BIRADS 4a and above need needle biopsy and have a progressive risk of cancer.

Staging of Breast Cancer

Once a diagnosis of cancer is confirmed by biopsy, the next step is to assess the extent of the spread of cancer. The following tests are usually done to look for the spread of breast cancer, depending on the stage of breast cancer.

  • PET-Scan (positron emission tomography) of the whole body
  • Bone scan
  • Ultrasound abdomen
How Is Breast Cancer Treated?
Most people with breast cancer will require one or more of the following forms of treatment depending on the stage of breast cancer

Surgery

      • Mastectomy involves removing the entire breast along with an assessment of the armpit lymph nodes. This is indicated when the lumps are multiple or large.
      • Breast-conserving surgery removes just the cancerous area and a small amount of surrounding normal tissue, along with the armpit lymph nodes for assessment. The remaining breast has to be radiated to prevent the local recurrence. This procedure is suitable for small single lumps in the breast.
      • Radiation therapy – Radiation is given in locally advanced cancers, in patients with lymph nodal involvement and in patients undergoing breast-conserving surgery.
      • Chemotherapy: Some women require medicines before surgery to shrink cancer and make it easier to remove while others require it after surgery to prevent the spread or recurrence of cancer.
      • Hormone therapy: Some form of cancers grows in response to estrogen and progesterone, and medications are given to block the action of these hormones
      • Monoclonal antibody: Some forms of breast cancer which are HER 2 enriched respond to drugs like trastuzumab/ pertuzumab.

It is best to consult your doctor if you find a lump or any other change in your breast, as early detection is the key to successful management. Fortunately, treatment outcomes for patients with breast cancer are improving with good survival rates, largely due to advances in treatment modalities and a better understanding of the disease.

Self Breast Examination

Some Important Tips to Remember

  • Examine your breasts once a month (best done 5-10 days from the first day of your period)
  • If you no longer have periods, choose one fixed day each month.
  • Visit a doctor if there are any changes
  • Remember, most breast changes are NOT cancer, but DO checkup to be sure!

Breast Cancer Specialist in Hyderabad

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