Breast Cancer Treatment

Is it dangerous to life?

Cancer is a disease which can be treatable. It is not a death sentence. Hence it is important to know about the seriousness of your disease which the specialist (breast surgeon) will help you go through.

I know someone who didn’t make it through cancer – will that happen to me?

The outcome of cancer treatment depends on the type of cancer and how advanced it is. Hence a patient with stomach cancer cannot be compared with that of a breast cancer patient for example. Treatment plans also differ for different patient profiles. Breast cancer when picked up in the early stage has fairly good outcome with holistic treatment.

Do I have to Lose my breast?

Surgical options can be discussed with the Dr Radhika. Depending on the size of the tumour relative to the breast size, option of removing the tumour and not the breast can be exercised. However in some women this will not be an option should the tumour be too large or other factors which do not favour breast conservation. Surgical advancements such as oncoplastic surgery which blends both cancer surgery and plastic surgical techniques have proved to improve the rates of breast conservation.

Is surgery adequate to treat my cancer?

Breast cancer treatment is multi-disciplinary. Successful treatment depends on the follow-through of combination of surgery followed by chemotherapy, radiotherapy and hormonal tablets. The variation in treatment will be tailored according to each individual patient profile. Not all breast cancers are treated the same way. Discussion of detailed treatment will be in conjunction with the different sub-specialties such as the breast surgeon, medical oncologist and radiation oncologist.

Breast Cysts

What are breast Cysts?

Breast cysts are fluid filled sacs. They are like little water balloons which develop naturally as the breast ages and change with the menstrual cycles. They are outpouchings of milk ducts and have a lining. These lining cells secrete the fluid. The fluid can be clear or coloured: yellow, greenish or black.

They can develop at any age but are most common in women above 35 years old. They occur more frequently as women reach menopause and tend to disappear after that. However, they continue to be present in women on hormone replacement treatment (HRT).

How are cysts detected?

Cysts usually become noticeable when they present as a lump in the breast or found by chance during routine breast examination or ultrasound screening.

How do cysts present?

A large cyst can appear overnight. Smaller cysts are not palpable. Some cysts are painful or tender, especially aggravated in the days before period. It is common to have more than one cyst and they can be in both breasts as well. This is not a cause of worry.

How are cysts diagnosed and what tests are done?

Cysts cannot be diagnosed by physical examination only and rarely by mammography. Cysts are best detected by ultrasonography. Depending on the symptoms of the patient; the doctor may recommend withdrawing the fluid by inserting a needle into it.

The fluid drawn from the cyst may sometimes be sent to a laboratory for testing. Cysts that are small and not causing any symptoms to the patient can be left alone. Complex cysts are those with some solid component within the fluid-filled sac, in which case further tests and follow-up may be required.

Can cysts come back?

Many women have recurring cysts. They are treated the same way as the first cyst.

Do cysts have a risk of becoming cancerous?

Simple cysts do not turn into cancers. It is however important to be aware of any new changes in your breasts and consult the doctor. Breast screening is advised as for the usual age groups

Breast Pain

Breast pain is very common. Almost 80% of women will experience this sometime in their lives. It is reassuring to know that more than 90% of breast cancers are on the contrary painless on presentation.

Causes of Breast Pain

There are 2 main types of breast pain. Cyclical & Non-cyclical

Cyclical Breast Pain

Breast pain that is part of a normal menstrual cycle is known as “cyclical breast pain”. Women may experience fullness, discomfort, tenderness in their breast a week or so prior to their period. This often goes away once the menses start. The pain can affect one or both breasts and can spread to the armpit, down the arm and the shoulder blade.

This is linked to changing hormone levels during the menstrual cycle, which mainly affects pre-menopausal women. The hormonal changes make the breasts more sensitive, which in turn cause pain. Pain can also be associated with consuming contraceptive pills, certain anti-depressant drugs, herbal remedies like ginseng, or even stress.

Non-cyclical Breast Pain

There are also two types of non-cyclical breast pain.

  • True non-cyclical breast pain comes from the breast and is not related to the menstrual cycle.

  • Chest wall pain appears to be felt over the breast but actually comes from the muscles or rib bones.

Both types can result in continuous pain or pain that comes intermittently and can affect women both before and after menopause. It may feel like a burning, prickling, stabbing pain or sensation of tightness. This can last from a few minutes to a few days. It can affect either one breast or both at the same time.

Causes Of Non-Cyclical Breast Pain

Most cases of non-cyclical breast pain are idiopathic, meaning that there is no identifiable cause. Sometimes it can be due to inflammation of the breast, non-cancerous breast lumps or breast infections. Rarely it is due to cancer.

Chest Wall Pain

Occasionally, pain in the chest wall can imitate breast pain as the breast “sits” on the chest wall. Any new or extensive physical activity can bring on muscle ache. Women are also prone to developing costochondritis, inflammation of the rib cartilage around the breast bone. Anti-inflammatory medication can help alleviate this self-limiting condition.

Diagnosis

Your doctor will examine your breasts and requests for the appropriate breast imaging. If the pain is linked to your menstrual cycle, you may be asked to keep a record on when the pain occurs.

Treatment for cyclical breast pain

If you have cyclical breast pain, your doctor will reassure you that this is normal.

Dietary and lifestyle changes have shown to benefit women although there is no absolute evidence in the medical literature. Reducing intake of caffeine, nicotine, chocolate, red wine and fatty food helps some women overcome this.

Lifestyle changes to reduce stress such as relaxation therapy to promote the overall well-being may also be helpful. Wearing a supportive bra of a proper fit is important.

Treatment for non-cyclical breast pain

Occasionaly, pain from other conditions such as heart attack or gallstones can be felt in the breast. This is known as referred pain. If this happens, your doctor will advise you on the most appropriate treatment.

Breast pain can be very distressing as most women fear that it is a sign of cancer. Understanding more about the changes in the breast can be reassuring to most women although it may not alleviate it completely. Having breast pain does not increase your risk of breast cancer, however, it is still important to be aware and consult the doctor if there are any new changes in the breast.

Fibroadenoma

What is Fibroadenoma?

Breast tissue is made up of lobules (milk producing glands) and ducts (tubes that carry milk to the nipple), which are surrounded by glandular, fibrous and fatty tissue. Fibroadenoma develop from a lobule. The glandular tissue and ducts grow over the lobule, forming a solid lump. Fibroadenoma are non-cancerous lumps in the breast and they do not increase the risk of developing breast cancer.

How do they occur?

They develop due to increased sensitivity to the female hormone, oestrogen. Hence it is commonly found in the adolescent age groups and young adults, although they can occur in women of any age group. Fibroadenomas are common and it is not unusual to be present in both breasts and to have multiple lumps in each breast as well.

How are they detected?

Fibroadenomas can feel rubbery and hard to touch. Sometimes they feel tender or painful especially nearing the period. Some are too small to be detected on clinical examination and increasingly found on screening ultrasonography of the breasts.

What is the natural history of fibroadenomas?

Fibroadenomas can range in size from less than a centimeter to more than 3cm in diameter. Some can increase in size, especially in teenager; others will regress in size and disappear as well. They are also expected to get bigger in size during pregnancy and breastfeeding.

How are fibroadenomas diagnosed and what tests are done?

The doctor will organize breast imaging (ultrasonography and mammography) as necessary. A needle biopsy may be done in a clinic, where a sample of cells is taken from the lump. Sometimes a core biopsy may be done instead where a larger bore needle is used to obtain tissue samples of the lump: this gives more detailed information. These samples are then sent to the laboratory to be looked under the microscope. The result takes about 2 to 5 working days to return. A local anaesthetic will be given before either of the procedures.

FOLLOW-UP & TREATMENT

There is no medication to remove the fibroadenomas. Most fibroadenomas do not need to be removed unless they are increasing in size or you request to have it excised by minor surgery. Small fibroadenomas may be removed by vacuum-assisted excision, hence avoiding surgery if required. Your doctor will discuss the treatment options in detail with you.

Chemotherapy For Breast Cancer

What is Chemotherapy?

Chemotherapy is used to describe medications which help fight cancer. The medications can be administered in different ways. In breast cancer the common way is via your veins. A small plastic tube will be inserted into the vein to allow this method called intravenous chemotherapy. There are different groups of anti-cancer drugs, the main type in breast cancer is known as cytotoxic drugs. There is another type called targeted agents like Herceptin which may be beneficial for selected patients only, The type of drugs best suited for you will be discussed in detail with your specialist doctor in charge of deciding your chemotherapy regiment, who is a medical oncologist.

How does it work?

Cytotoxic means toxic to cells. Chemotherapy works by stopping or slowing the growth of cells. It affects both normal cells in your body and cancerous cells as well. It is given in blocks, called cycles, to allow the normal cells to recover their function.

Who requires chemotherapy

Breast cancer treatment involves a multi-disciplinary approach including surgery followed by adjuvant treatment in the form of chemotherapy, radiotherapy and/ or endocrine treatment. Your breast surgeon will tailor your treatment plan according to your disease state which is personalized for each individual patient. You will then have discussions with the respective specialist involved, such as the medical oncologist and radiation oncologist for a detailed treatment plan.

Adjuvant Chemotherapy refers to chemotherapy required after surgery to minimize the risk of cancer relapsing in future.

Neoadjuvant Chemotherapy is chemotherapy given to shrink the tumour prior to surgery.

Palliative Chemotherapy is given in patients with cancer which has spread to other organs other than the breast and the lymph nodes. It aims to slow the growth of the cancer and sometimes help to relief the symptoms of the advanced cancer.

Is Chemotherapy the same for all cancer types?

Chemotherapy works differently for different cancer types eg treatment for a lung or stomach cancer patient is different from a breast cancer patient. The treatment outcome and benefits also differ greatly in different cancer types. Hence it is not advisable to compare the benefits based on experience of different individuals. It is best to understand it from your trusted breast cancer specialist, medical oncologist or established support groups such as the breast cancer foundation if required.