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Breast Cancer Disease Management Group
Breast Cancer Disease Management Group

Max Institute of Cancer care (MICC) offers comprehensive state of the art services for early diagnosis, staging, treatment and hospital-based care of Disease management group (DMG) – Breast Oncology. An individualised treatment plan is made for each patient by a specialist multidisciplinary team of medical oncologists, radiation oncologists, surgeons, histopathologists, molecular pathologists, gastroenterologists, interventional radiologists, nuclear medicine, dietitians, physiotherapists and geneticist. There is a constant cross chat between the various specialities at the Respective DMG Tumour Board meeting, The main concept behind the DMGs at MICC is to make the best skills available to our patients. Site-specific oncology allows the clinicians involved in patients care to focus only on certain cancers at which they become world experts. Meetings are held once a week to discuss all patients diagnosed with DMG specific cancer and arrive at the best possible management for the patient. The Surgical Medical and Radiation specialists of the respective DMG along with the Pathologists, Radiologist and Molecular Oncologists attend these meetings. All patients seen between these meetings are, however, discussed in the common tumour Boards held once a week.

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Breast Cancer Disease Management Group
Breast Cancer Disease Management Group

Max Institute of Cancer care (MICC) offers comprehensive state of the art services for early diagnosis, staging, treatment and hospital-based care of Disease management group (DMG) – Breast Oncology. An individualised treatment plan is made for each patient by a specialist multidisciplinary team of medical oncologists, radiation oncologists, surgeons, histopathologists, molecular pathologists, gastroenterologists, interventional radiologists, nuclear medicine, dietitians, physiotherapists and geneticist. There is a constant cross chat between the various specialities at the Respective DMG Tumour Board meeting, The main concept behind the DMGs at MICC is to make the best skills available to our patients. Site-specific oncology allows the clinicians involved in patients care to focus only on certain cancers at which they become world experts. Meetings are held once a week to discuss all patients diagnosed with DMG specific cancer and arrive at the best possible management for the patient. The Surgical Medical and Radiation specialists of the respective DMG along with the Pathologists, Radiologist and Molecular Oncologists attend these meetings. All patients seen between these meetings are, however, discussed in the common tumour Boards held once a week.

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YTD 3159 12099.065 2884 9379.155 808 3865.69 266 668.705 5505 2530.94 12622 28543.555
Home >> Our Specialities >> Breast Cancer

Breast Cancer

Breast cancer is the most common type of cancer among women in India and has overtaken Cancer of the cervix to gain the top spot. It is slowly crawling into almost every household with 150, 000 new cases being diagnosed every year in India.

According to research, many women in India who are detected with breast cancer usually do not have any knowledge about their condition. Moreover, even if they suspect it, they do not feel free to talk about it openly due to the stigma attached to breast cancer and also because of the strong sense of denial. It is not surprising; therefore, that the tumor gets detected in advanced stages, which is drastically affecting the survival rate and treatment options for the patients.

It is possible to detect breast cancer using MRI mammograms and X Ray Mammograms to detect breast lumps at an early stage, and Breast Biopsy for not only detecting type of tumor but also receptor status. There are Breast Conserving Surgeries, Whole Breast reconstruction for patients who undergo mastectomy, and Conservative Axillary Dissection to prevent lymph oedema onset. There are latest radiation techniques such as Accelerated Partial Breast Radiation (APBI), IGRT and Brachytherapy for treating breast cancer tumors.

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.

Breast Cancer

Breast Cancer At

Team That Cares

Cancer Care / Oncology
Dr. S. VEDA PADMA PRIYA
Senior Consultant
Cancer Care / Oncology
Dr. Vaishali Zamre
Senior Consultant - Surgical Oncology
Cancer Care / Oncology
Dr. Shubha Garg
Associate Consultant
Cancer Care / Oncology
Cancer Care / Oncology
Dr. Bhawna Sirohi
Director - Medical Oncology
Cancer Care / Oncology
Cancer Care / Oncology
Cancer Care / Oncology
Cancer Care / Oncology
Dr. Rashi Agarwal - Max Hospital
Senior Consultant
Cancer Care / Oncology
Dr. Tripti Saxena
Senior Consultant
Cancer Care / Oncology
Dr. Harit Chaturvedi_new_0 - Max Hospital
Chairperson, Max Institute of Cancer Care
Cancer Care / Oncology
Cancer Care / Oncology
Cancer Care / Oncology
Cancer Care / Oncology
Dr Charu - Max Hospital
Associate Director
Cancer Care / Oncology
Dr Vineeta Goel - Max Hospital
Associate Director
Cancer Care / Oncology
Dr.Sachin Gupta_2 - Max Hospital
Associate Director
Cancer Care / Oncology
Dr. Nitesh Rohatgi_0 - Max Hospital
Associate Director
Cancer Care / Oncology
Dr Gopal Sharma (onco) - Max Hospital
Associate Director
Cancer Care / Oncology
Dr_Rajesh_Vashistha
Associate Director
Cancer Care / Oncology
Dr. Devavrat Arya - Max Saket
Senior Consultant
Cancer Care / Oncology
Dr Gautam Goyal - Max Hospital
Senior Consultant
Cancer Care / Oncology

WHAT WE DO

  • The Max Breast DMG is a close- knit unit which accords world-class care by the best specialists in surgery, medical oncology and radiation oncology supported efficiently by a well-equipped Radiology and Nuclear Medicine department along with a proficient, dedicated team of pathologists.
  • An efficient support staff facilitates, all processes aimed at completing the ‘Triple Assessment” effortlessly, be it imaging (Digital mammogram, Ultrasound breast, MR mammogram ) image-guided biopsies, or other investigations.

Surgical Unit

The Surgical Unit of the Breast DMG specializes in the entire array of breast surgeries that are known, including mastectomies (simple, skin-sparing, nipple sparing), breast conservation surgeries with Type 1 and II Oncoplasties, Sentinel lymph node biopsies, axillary dissections, etc. All options are discussed during a preoperative counselling session and the best modality is agreed upon. The Option of inserting a central venous access device is also broached during these discussions, for ease of chemotherapy.

  • Vacuum- assisted biopsies and scarless lumpectomies for benign conditions are also practiced in the unit.
  • Reconstructive surgeries spearheaded by a dedicated Plastic and Reconstructive team offers a wide array of options in the form of implant assisted LD flap reconstruction, subpectoral implants, free flaps like DIEP, S-GAP etc.

Medical Oncology Unit

The Medical Oncology Unit offers expertise in adjuvant chemotherapy and targeted therapy for breast cancers for the treduction in recurrence rates.

Neoadjuvant chemotherapy with or without targeted therapy in appropriately selected cases allows for breast conservation surgery after downsizing the tumor. The medical oncologists keep upgrading their expertise and introduce newer hormonal drugs, targeted therapies and immunotherapies into their treatment arsenal. Advanced stage diseases are dealt with efficiently with the judicious use of palliative chemotherapy and metronomic chemotherapy. This is supplemented by the efforts of a dedicated unit for pain control and palliative care. The presence of a molecular oncologist has not only allowed for detecting inherited cancer syndromes but has also allowed to mutation directed tailor- made treatments. The Unit is also an active participant in ongoing trials to evaluate newer drugs in advanced stage disease.

The Radiation Oncology Unit

The radiation oncology unit offers state of the art treatment options for breast cancer. Individualized planning and execution of the plan is done for each woman under a dedicated team of radiation oncologists, medical physicists and technologists. The unit at MICC treat large number of women in all age groups keeping up with the international protocols. We offer Conventional (5 weeks), Hypo fractionated (3 weeks), partial breast radiation and specialised treatment for left sided breast cancers. The radiation oncology department has a rich experience in treating large numbers of left sided breast cancer with specialised technique known as “Gating” or “Deep Inspiratory Breath Holding” (DIBH) technique. Wherein the patient is coached to breath in a certain fashion and then the planning in done in a way where the beam is fired only when the heart moves away from breast/chest wall. The main goal is to treat cancers cells and keep the nearby organs safe. Stringent quality control, online and off line reviews, weekly review of the patients undergoing radiation treatment offer personalized care.

Clinical Meetings

Relevant tumour boards

Max Super Speciality Hospital, Saket

  Breast Oncology - Monday - 4:00 pm - 5:00 pm

  Central Tumour Board - Monday - 8:30 - 9:30 AM

  Central Tumour Board - Friday - 8:30 - 9:30 AM

Max Smart Super Speciality Hospital, Saket

  Breast Oncology - Monday - 4:00 pm - 5:00 pm

  Central Tumour Board - Monday - 8:30 - 9:30 AM

  Central Tumour Board - Friday - 8:30 - 9:30 AM

Relevant tumour boards

Max Super Speciality Hospital, Patparganj

  Breast Oncology & Gynaecology Oncology - Monday - 4:00 pm - 5:00 pm

  Central Tumour Board - Friday - 4:00 pm - 5:00 pm

Max Super Speciality Hospital, Vaishali

  Breast Oncology & Gynaecology Oncology - Monday - 4:00 pm - 5:00 pm

  Central Tumour Board - Friday - 4:00 pm - 5:00 pm

Max Super Speciality Hospital, Shalimar Bagh

  Breast Oncology - Monday - 4:00pm-4:30 pm & 8:30am-9:30am

  Breast Oncology - Thursday - 8:30am-9:30am

PAN MAX

  Virtual Tumour Board PAN INDIA - Wednesday - 3:00 PM - 4:00 pm

  Virtual Tumour Board PAN INDIA - Saturday - 9:00 AM - 12:00 AM

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