In its initial stage, breast cancer is hard to detect. This is why doctors suggest regular breast examination. Breast cancer symptoms may include:

• Breast lump or lump in the armpit that is hard and has uneven edges
• Any change in the size, shape, or feel of the breast
• Fluid coming out of the nipple
• Bone pain
• Breast pain or discomfort
• Skin ulcers
• Swelling of one arm
• Weight loss

There is no specific cause of breast cancer. However, most common causes include:

• Age and gender - Over a period of time, the chances of developing breast cancer increases
• Family history of breast cancer
• Genes
• Menstrual cycle - Women got their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer
• Childbirth - Women who give birth after the age of 30 are more likely to develop breast cancer
• Alcohol use - Consuming more than 1-2 glasses increases your chances of breast cancer

Surgery for Breast Cancer

Surgery is one of the most important aspect of breast cancer treatment. Surgery for breast cancer is usually done to

• Remove the cancer in the breast : Mastectomy or Breast conservation surgery(BCS)
• Find out if the cancer is spread to the lymphnodes under the arm : Sentinel lymph node biopsy (SLNB) or Axillary lymph node dissection(ALND).
• Restore the shape of the breast after the cancer is removed (Oncoplasty).
• Reconstruct or restore the whole breast if it is removed completely (Breast Reconstruction).
• Relieve symptoms of advanced cancer

Surgery to remove breast cancer

There are two main types of surgery to remove breast cancer:

Breast-conserving surgery (also called lumpectomy, /quadrantectomy, /partial mastectomy, or segmental mastectomy)

In breast conservation surgery the whole of the cancer is removed alongwith a border of normal tissue.How much of the breast is removed depends on the size and location of the tumor and other factors.

• Mastectomy – A surgery in which the entire breast is removed, including all of the breast tissue ,nipple ,areola and skin over the breast. There are several different types of mastectomies. Modified radical Mastectomy(MRM) : Modified radical mastectomy is removal of entire breast nipple, areola and skin over the breast alongwith the lymph nodes under the arm. Skin Sparing Mastectomy (SSM): Sometimes the skin over the breast can be preserved if it is free while removing the breast tissue with the nipple. The defect can then be reconstructed. Nipple sparing mastectomy (NSM) : In NSM the skin, nipple and areola can be saved with removal of the breast tissue as well as restore the shape and volume of the breast with implant or native tissue.
• Prophylactic double Mastectomy : Some women may have both the breasts removed with or without reconstruction.

In early-stage cancers ,one can choose between breast-conserving surgery (BCS) and mastectomy. The main advantage of BCS is that a woman keeps most of her breast. But in most cases she will also need radiation. Women who have mastectomy for early stage cancers are less likely to need radiation.

For some women, mastectomy may be a better option, because of the type of breast cancer, the large size of the tumor, previous treatment history, or certain other factors.

Some women might be worried that having a less extensive surgery might raise their risk of the cancer coming back. But the fact is, in most cases, mastectomy does not give you any better chance of long-term survival or a better outcome from treatment. Studies following thousands of women for more than 20 years show that when BCS can be done along with radiation, having a mastectomy instead does not provide any better chance of survival. Surgery to remove nearby lymph nodes

To find out if the breast cancer has spread to axillary (underarm) lymph nodes, one or more of these lymph nodes will be removed and looked at under the microscope. This is an important part of figuring out the stage (extent) of the cancer. Lymph nodes may be removed either as part of the surgery to remove the breast cancer or as a separate operation.

The two main types of surgery to remove lymph nodes are:

• Sentinel lymph node biopsy (SLNB) – A procedure in which the surgeon removes only the lymph node(s) under the arm to which the cancer would likely spread first. Removing only one or a few lymph nodes lowers the risk of side effects from the surgery such as lymphedema.
• Axillary lymph node dissection (ALND) – A procedure in which the surgeon removes many (usually 10 to 15) lymph nodes from under the arm. ALND is not done as often as it was in the past, but it might still be the best way to look at the lymph nodes in some situations.

Any women undergoing surgery for breast cancer may have the option of breast reconstruction.In the case of a mastectomy, a woman might want to consider having the breast mound rebuilt to restore the breast’s appearance after surgery. In some breast-conserving surgeries, the breast shape might require restoration by mobilizing tissue in and around the breast.

Oncoplasty

Oncoplasty is mobilizing local tissue in and around the breast to restore the shape and volume of the breast after cancer removal is done. Based on the location, size and number of cancers the type of oncoplasty may differ. Sometimes both the breasts might require oncoplasty to restore symmetry.Awoman may consider havingfat grafting in the affected breast to correct any dimples left from the surgery. The options will depend on each women’s specific situation.

Whole breast reconstruction :

There are several types of reconstructive surgery, although your options may depend on your medical situation and personal preferences. You may have a choice between having breast reconstruction at the same time as the breast cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction).

For whole breast reconstruction, either implant or autologous method is used. Implant based reconstruction : The whole breast can be removed sparing the skin and or nipple and a suitable implant can be inserted into the skin envelope. Both Saline and Silicon based implants are available. Implant based reconstruction is suitable in the young women with thin or moderate built. However in certain cases where skin or nipple cannot be spared additional skin or flap cover needs to be given.

Autologous Tissue Reconstruction :

Sometimes tissue from elsewhere in the body can be used to rebuild the breast (flap based or microvascular).Tissue based reconstruction is better in certain ways that it is permanent and does not require revision procedures unlike implants. The abdomen, thigh and back are common donor sites for tissue transfer.

Surgery for advanced breast cancer

Although surgery is very unlikely to cure breast cancer that has spread to other parts of the body, it can still be helpful in some situations, either as a way to slow the spread of the cancer, or to help prevent or relieve symptoms from it. For example, surgery might be used:

• When the breast tumor is causing an open wound in the breast (or chest)
• To treat a small number of areas of cancer spread (metastases) in a certain part of the body, such as the brain
• When an area of cancer spread is pressing on the spinal cord
• To treat a blockage in the liver
• To provide relief of pain or other symptoms

If your doctor recommends surgery for advanced breast cancer, it’s important that you understand its goal—whether it’s to try to cure the cancer or to prevent or treat symptoms. Wire localization to guide surgery

Sometimes, if the cancer in your breast can’t be felt, is hard to find, and/or is difficult to get to, a mammogram or ultrasound may be used to place a wire in the cancerous area to guide the surgeon to the right spot. This is called wire localization or needle localization. If a mammogram is used you may hear the term stereotactic wire localization. Rarely, a MRI might be used if the mammogram or ultrasound are not successful.

After your breast is numbed, a mammogram or ultrasound is used to guide a thin hollow needle to the abnormal area. Once the tip of the needle is in the right spot, a thin wire is put in through the center of the needle. A small hook at the end of the wire keeps it in place. The needle is then taken out. The surgeon uses the wire as a guide to the part of the breast to be removed.

The surgery done as part of the wire localization may be enough to count as breast conserving surgery if the margins are negative. If cancer cells are found at the edge of the removed tissue (also called a positive margin), more surgery may be required.

It should be noted that a wire-localization procedure is sometimes used to perform a surgical biopsy of a suspicious area in the breast to determine if it is cancer or not.

Radiation therapy - to destroy cancerous tissue. Radiation therapy involves the use of high energy X Rays that destroy cancer cells and shrink tumors. About half of all people with cancer are treated with radiation therapy, either alone or in combination with other types of cancer treatment. There are mainly three types of radiation therapy done at Max Cancer Centre to treat cancer – 3DCRT (three-dimensional conformal radiation therapy), IMRT, and IGRT (image-guided radiation therapy). At Max, we use the most advanced NOVALIS TX with EXACT-TRAC & ROBOTIC ON-BOARD IMAGER which is used to track tumors online to enable highly accurate treatments.

Hormonal therapy - is suggested to women with ER-positive breast cancer to block certain hormones that trigger cancer growth.