Before modern advances in cancer treatment, surgery was always the first line of treatment. However, in spite of removing the tumor and in the case of breast cancer, the breast itself, the recurrence of the cancer at another site, had doctors befuddled. Interestingly, as breast cancer treatment evolved over the years, it led to the understanding of the metastasis of the cancer near and away from the primary location. Today advanced imaging technology and targeted treatment has improved to such an extent that Breast Cancer related deaths are significantly less. Dr. Surendran J – Senior Consultant Radiation Oncology (at Dr. Kamakshi Memorial Hospitals ) discusses the mode of treatment when approaching Breast Cancer.
Q: What are the symptoms of Breast Cancer and how can it be detected?
Ans: Any noticeable change in shape, size or texture of the breast, is a red flag. Thickening of the skin or a lump on the breast or armpit, calls for a medical examination. Diagnosis starts with a thorough physical examination, and then a mammogram or an MRI scan to get a visual of the growth. If cancer is suspected, a biopsy is next in line - where some tissue or fluid from the breast is taken to be further tested. Early detection of Breast Cancer makes all the difference in its treatment and cure.
Q: Who is at risk for Breast Cancer?
Ans: By and large, Breast Cancer is a hormone mediated disease and much has been spoken about late menopause, early menarche and obesity increasing the risk. Also, women with a family or personal history of breast/ ovarian cancer are at risk. Certainly, inherited genetic mutations also increase the risk for Breast Cancer.
Q: What is the first step towards treating Breast Cancer?
Ans: Perspicacity of the nuances in Breast Cancer management can/will be achieved by establishing an MDT, which is a Multidisciplinary Team before initiating treatment for every Breast Cancer patient. The MDT preferably involves the referring practitioner, surgeon, pathologist, radiologist, nuclear physician, surgical, medical and radiation oncologist. The natural course of no two Breast Cancers is the same. Inclusion of all factors of pathology, extent of the breast cancer and general comorbidities, logistics and even the socioeconomic background of the patient is important to create a personalized mode of treatment to maximize its efficiency.
Q: Is removal of the Breast the best option to ensure Breast Cancer does not recur?
Ans: Not anymore. The size and spread of the cancer, directs the course of surgery. Generally, a female patient with a small walnut size mass in breast when investigated can reveal a histopathological report as invasive carcinoma of breast. After a work-up of the extent of spread and prognostication the MDT may decide if a patient is suitable for Breast Conservation surgery. This means that the surgery will involve removing only the tumor and some surrounding tissue, and not the whole breast. Radiation therapy to ensure there are no microscopic remnants of the disease will follow surgery. In our Indian scenario, most women prefer mastectomy, even when presented with the option of Breast Conservation Surgery because they are apprehensive about radiotherapy.
Q: Are there any risks in undergoing Radiotherapy for Breast Cancer?
The modern state-of-art Linear Accelerator, which is being commissioned at Dr. Kamakshi Memorial Hospitals comes inbuilt with a facility that controls and monitors the chest wall movement of the patient through Active Breathing Coordinator (ABC) and by adopting moderate deep inspiration breath hold technique (mDIBH). This facilitates breathing control and in spite of this if the lung or heart move into the area of exposure, radiation is immediately cut off. This superior technology is very relevant as while the radiation is targeted at the primary tumor location in the breast and to the adjacent lymph nodes, it prevents collateral damage to healthy cells in both the heart and lungs. Hence, after the tumor is removed, radiation can be very safely targeted at the primary tumor location. With this advanced technology, the risk of undergoing Radiotherapy for Breast Cancer is greatly reduced.
Q: What are the chances that Breast Cancer will recur after surgery and radiation?
Generally speaking, today the survival rate after Breast Cancer has increased to 20 years without local or distant metastasis thanks to modern chemotherapy and targeted pharmaceutical drugs. Chances for the cancer to recur are very slim, thanks to the advanced technology in Radiotherapy post-surgery. While surgery treats the macroscopic disease or the visible tumor, radiotherapy targets the microscopic disease or that which cannot be seen. This is done to ensure that there are no cancer cells left behind in the vicinity of the tumor site as well as the whole breast after the surgery. Thanks to this modern equipment and the high level of precision, we are going to see good recovery rates and much increased survival rates, as well for breast cancer.
Dr. Surendran from Dr. Kamakshi Memorial Hospitals is the Senior Consultant in Radiation Oncology with 25 years of experience in Cancer treatment and care. Next week he will take us through the basics of Lung & Liver Cancers and how effectively Radiotherapy can help treat the disease. To view other FAQs by Dr. Surendran, click on the link belowBrain Cancer
You can mail your queries related to Radiotherapy to: kv@drkmh.com
