All about Breast Cancer

Breast Cancer is the commonest cancer in women in most of India’s metros. Each year, more than 80,000 women in this country develop breast cancer. Breast cancer is the uncontrolled growth of breast cells. Cancer occurs as a result of mutations, or abnormal changes in the genes responsible for regulating the growth. Normally, the cells replace themselves through an orderly process of cell growth, healthy new cells take over as old ones die out. But over time mutations can ‘turn on’ certain genes and ‘turn off ‘ others in a cell. The changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumour. A tumour can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumours are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumours are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumour to other parts of the body. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include fatty and fibrous connective tissues of the breast. Over time, cancer cells can invade nearby healthy breast tissue and spread to the underarm lymph nodes and to ther parts of the body.

Breast cancer is always caused by a genetic abnormality. However, only 5-10% of cancers are due to an abnormality inherited from mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process of life in general.

DIAGNOSIS

When a woman finds an abnormal mass on examination or an abnormal area is detected by screening mammogram, a careful history and physical examination should be carried out. A thorough physical examination of the breast should be done by a doctor. The specialists at Apollo who treat breast cancer include surgical oncologists, medical oncologists and radiation oncologists.

TREATMENT

Breast cancer is considered to be a systemic disease to start with, in majority of the cases. This does not mean that there is an obvious cancer at different sites. It only means that while the primary disease in the breast is obvious, there is the possibility of microscopic disease elsewhere, which is not detectable, but all the same needs treatment. Hence treatment is required for local area and distant sites. Local treatment is removal or destruction of the local tumour by either surgery or radiation. The treatment of distant sites is either by chemotherapy or hormonal treatment. Patients may need one form of treatment or require four forms of treatment either simultaneously or in sequence.

SURGERY

Surgery is the most common treatment for cancer, where the breast or part of it is removed. Reconstructive surgery can be by an artificial implant between the skin and chest wall or by the woman’s own tissues. The tissues can be taken either from the abdomen or from the back. Other procedures include sentinel lymph node biopsy (SLNB) where the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present.

RADIATION THERAPY

In common terms it is called ‘heat’ therapy where a high-energy x-ray beam is used to damage cancer cells. Radiation is also of two types:

• External radiotherapy and
• Implantation radiotherapy (also called Brachy therapy)

When external radiotherapy to the breast or chest wall is given post operatively the treatments are usually given for 5 days a week for 5 or 6 weeks. At the end of this an extra boost is usually given at the site of the breast tumour removal. The boost may be external or by using an implant.

CHEMOTHERAPY

Drugs are used to kill cancer cells. In the current setting drugs by themselves will not cure breast cancer. Usually more than two drugs are used. Usually these drugs are given by injections. The injections can be given in outpatient sitting day care or after short admission to the hospital depending on which drugs are used. General condition of the patient also dictates a short stay in the hospital. When chemotherapy is given after surgery and is called adjuvant chemotherapy and in this setting it is used to take care of microscopic disease elsewhere. When it is given before surgery is called Neoadjuvant chemotherapy and in this setting the purpose is to reduce the size of a large tumour, and make it surgically removable. Whether it is adjuvant or Neo-adjuvant – it is administered several times over a period of months with breaks between treatments.

HORMONAL THERAPY

Hormonal therapy is used as oral tablets such as Tamoxifen, Raloxifen or Letrazole which block the cancer cell from taking up oestrogen from the blood. Oestrogen promotes the growth of breast cancer. This is usually given to those patients in whom cancer cells are hormone receptor positive (oestrogen and or progesterone receptor positive). Sometimes the same effect is obtained by removing the source of oestrogen (overies). Like chemotherapy, hormonal therapy is also given to control systemic disease elsewhere.