Breast Cancer: Causes, Symptoms, Diagnosis & Treatment in Delhi NCR, India

Overview

Breast cancer has become the number one cancer among women in metropolitan cities. The cases are rapidly rising, with 1 in 25-30 urban women likely to suffer from breast cancer during their lifetime. This is much lower than the US (1 in 8 women) or UK (1 in 12 women). However, it is much higher than that in rural India (1 in 70 women). The other disturbing fact is that it is rising in the younger age group (between 35 - 45 years).

Every woman has some chance of developing breast cancer during her lifetime. The risk increases with age with approximately 77% of women being over the age of 50 at the time of diagnosis. It doubles if there are first or second-degree relatives with breast cancer. However, family history contributes to only 5-10% of breast cancers.

Breast Cancer does not spell doom anymore, especially now, with modalities to detect the disease early; however, one should never disregard any lump in the breast that they come across. The earlier the disease is picked up, the better the treatment options are and the outcome.

Problems related to the breast are many and range from benign diseases to cancer. At the Max Breast DMG Clinics in Max Institute of Cancer Care, it is a close-knit unit which has world-class care by the best specialists in surgery, radiation oncology and medical oncology, supported efficiently by a well-equipped Nuclear Medicine and Radiology Department along with a dedicated team of pathologists. The Breast DMG's Surgical Unit specializes in the entire range of breast surgeries including breast conservation surgeries with Type 1 and II oncoplasties, mastectomies (simple, skin-sparing, nipple-sparing), sentinel lymph node biopsies, axillary dissections, etc. The doctors make it possible to detect breast cancer with the help of MRI mammograms and X-Ray Mammograms to detect breast lumps at an early stage, and Breast Biopsy for not only detecting the type of tumour but also receptor status. They specialize in Breast-Conserving Surgeries, Whole Breast reconstruction for patients who undergo mastectomy, and Conservative Axillary Dissection to prevent lymphedema onset. They have the latest radiation techniques such as Accelerated Partial Breast Radiation (APBI), IGRT and Brachytherapy for treating breast cancer tumours.

The Max Breast Clinics provides a world of comprehensive breast care catering to the treatment of benign conditions like mastalgia, nipple discharge, infectious conditions, benign lumps on the one hand to breast cancer on the other. The clinics are under the Department of Surgical Oncology, Max Institute of Cancer Care, which has vast experience in carrying out all possible breast cancer surgical procedures.

Tumor Board

At Max Institute of Cancer Care (MICC), a team of our experts from surgical oncology, radiation oncology, medical oncology, pathology, imaging and related disciplines come together in the Tumor Board meetings to discuss various cases and form a customized/ joint decision and a treatment plan.

We believe that each patient and his/her disease is unique, hence our team of oncology experts prepare a 'personalized treatment plan' based on the discussions in Tumor Board conferences. We constantly review and improve our protocols and encourage the participation of our patients as well as caregivers to understand the disease and its treatment process.

At Max Institute of Cancer Care, we are committed to recuperating our patients as soon as possible. We firmly believe in delivering quality care, support and reassurance to our patients. Our dedicated team of leading Breast Cancer Oncologists provides the most advanced cancer treatments using cutting edge technology, based on International Standards. Breast cancer care requires medical professionals from different specialities to execute an individualized patient care plan for best results collectively.

Diagnosis

A multi-pronged approach is mandatory for an accurate diagnosis:

Screening Mammogram: Regular mammograms after the age of 40 years reduces the risk of dying from breast cancer by early detection of the disease. Low-dose X-ray of the breast useful in evaluating palpable as well as non-palpable masses.
Breast Self-Examination: Helps you to be breast-aware, best done every month, 4-5 days after your periods or on a fixed day if you are post-menopausal.
Clinical Breast Examination: Yearly visit to a breast surgeon for a thorough breast examination after the age of 40 years.
Breast Ultrasound: required sometimes
Pathological Assessment
Fine Needle Aspiration Cytology (FNAC): A fine needle is inserted into the lump to aspirate a few cells and spread on a glass slide and studied on the microscope to arrive at a diagnosis. FNAC is mandatory for all breast lumps irrespective of the age of the patient.
Trucut Biopsy: If FNAC is negative in the background of a high index of suspicion. Cores of tissue give us a pathological diagnosis more reliably than an FNAC.

Now that an accurate diagnosis and proper staging of your disease is complete, it is time for us to plan your treatment.

At Max Institute of Cancer Care, we are committed to recuperating our patients as soon as possible. Our dedicated team of leading oncologists provides the most advanced cancer treatments using cutting edge technology, based on international standards. Cancer care requires medical professionals from different specialities to collectively execute an individualized patient care plan for best results. The various treatment offered are as follows:

A) Surgery

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

Breast-conserving surgery (also called lumpectomy), quadrantectomy, partial mastectomy or segmental mastectomy)
Mastectomy / Prophylactic Double Mastectomy
Sentinel lymph node biopsy
Modified Radical Mastectomy with reconstruction

B) Radiation therapy: The radiation oncologist will plan your treatment and your chest /Breast area will be marked with ink or markers. CT scan is then taken in the treatment position for planning Radiotherapy. This CT scan is then transferred to dedicated computers for radiotherapy planning. The radiation oncologist defines and identifies the target volume (breast/chest wall and lymph glands) to be treated and normal body organs like lung heart etc to be saved. Treatment plan is then generated and optimized.

C) IMRT (Intensity Modulated Radiation Therapy): This technology has contributed significantly in reducing complications of Radiation Therapy. In many situations, this allows a relatively higher dose of radiation to be delivered to the tumour, thus increasing the chance of cure.

D) IGRT (Image Guided Radiation Therapy): The breast/chest wall moves with breathing and setup position can vary from day to day. Since the radiation dose is more and more confined to the tumour, the change in position of the tumour can be tracked with a CT image (called Cone beam CT), just before the treatment delivery and the Modified Radical Mastectomy (MRM) is recommended when:

Cancer is found in more than one part of the breast.
Breast is so small that a wide excision of a lump can severely deform the breast.
A woman prefers MRM over breast conservation.

Following either surgery you will have a drain placed in the axilla and another drain placed under the flaps after mastectomy. This will be removed in the outpatients after 7-14 days depending on the amount of fluid that is draining out. Stitches are removed after two weeks of surgery.

Radiation therapy may be recommended if lymph nodes in the armpit (axilla) are reported positive in the final histopathology report.

E) Chemotherapy: Many patients after surgery for breast cancer may require chemotherapy. A combination of drugs is usually used. The medical oncologist will plan therapy according to your individual case. Chemotherapy may be administered as:

Neoadjuvant Chemotherapy – prior to definitive treatment (surgery)
Adjuvant Chemotherapy- following surgery
Palliative Chemotherapy- in a metastatic setting

F) Targeted therapy: It is aimed at targeting only the cancer cells. In breast cancer the Her-2-neu oncoprotein is overexpressed on the cancer cells. Drugs are now used to target these receptors and prevent multiplication of these cells.

G) Hormonal treatment: In patients whose tumour expresses the estrogen and progesterone receptors, hormonal therapy is recommended. This treatment is available in tablet form to be taken once daily.