Research advances over the past two decades have changed the landscape of breast cancer care. Genetic testing, targeted treatments and more precise surgical techniques have helped boost survival rates in some cases while helping to support breast cancer patients’ quality of life.
Conditions and Cancer Types
Depending on the pathological / histological condition of the breast tumour, breast cancer can be classified as under :-
Ductal carcinoma in situ (DCIS)It is the earliest form of breast cancer. When cancer cells are in the ducts of the breast but they’re contained (in situ) and haven’t spread into normal breast tissues. Mammography is the best way to diagnose DCIS.
Lobular carcinoma in situ (LCIS)Lobular carcinoma in situ (LCIS) is a term that can be misleading. It is not cancer. It is when there are changes in the cells lining the breast lobes, which increases a woman’s risk of breast cancer later in life. Most women with LCIS don’t get breast cancer. They are monitored with regular breast examinations and mammograms.
Invasive breast cancerMost breast cancers are invasive. This means the cancer cells have spread outside the lining of the ducts or lobes of breast into the surrounding breast tissue.
Invasive ductal breast cancer - Most invasive breast cancers (80%) are this type.Invasive lobular breast cancer - About 1 in 10 invasive breast cancers (10%) are lobular. This type is sometimes be difficult to diagnose on a mammogram.
Further tests are done on the dissected breast, to help decide which treatments are best for the patient. Pathologists look at whether the cells have receptors (proteins) for hormones or a protein called HER2 (HER2 positive breast cancer).
HER2 positive breast cancerHER2 positive breast cancer is diagnosed in women whose breast cancer cells have a large number of a protein called HER2 on their surface. This protein can affect how some cancer cells grow. About 1 in 7 women (15%) with early breast cancer have HER2 positive cancer.
Triple negative breast cancerTriple negative breast cancer gets its name because it doesn’t have receptors (proteins on the surface of cells) for the hormones oestrogen and progesterone, or for a protein called HER2. Triple negative breast cancer occurs in up to 1 in 5 women (15–20%) and is more common in younger women.
Uncommon types of breast cancerInflammatory breast cancer
Inflammatory breast cancer is when cancer cells grow along and block the tiny channels (lymph vessels) in the skin of the breast. The breast then becomes inflamed and swollen.
Paget’s disease of the breast
This shows as a red, scaly rash (like eczema) on the skin of the nipple. Women with Paget’s disease may have DCIS or invasive breast cancer.
Rare types of breast cancer
Other rare types of breast cancer include:
Medullary Breast Cancer- Mucinous Breast Cancer
- Tubular Breast Cancer
- Malignant Phyllodes Tumour
Surgery is used to diagnose, stage and treat cancer, and certain cancer-related symptoms. Dr. Soumitra Chandra has performed hundreds of procedures and will discuss the surgical options that are best suited to your individual needs.
Whether a patient is a candidate for surgery depends on factors such as the type, size, location, grade and stage of the tumor, as well as general health factors such as age, physical fitness and other medical co-morbidities. For many patients, surgery will be combined with other cancer treatments such as chemotherapy, radiation therapy or hormone therapy. These may be administered before surgery (neoadjuvant) or after surgery (adjuvant) to help prevent cancer growth, spread or recurrence.
Early in the treatment planning process, doctor plans for and proactively manage any side effects from surgery. Nutritionists, rehabilitation therapists and naturopathic clinicians work together with your surgical oncologist, Dr. Soumitra, to support your healing and quality of life. Reconstructive surgeons perform procedures to restore the body's appearance and function, often at the time of surgery or following surgery.
Surgeries for Breast Cancer
Most women with breast cancer have some type of surgery as part of their treatment. Depending on the situation, surgery may be done for different reasons. For example, surgery may be done to:
- Remove as much of the cancer as possible (breast-conserving surgery or mastectomy)
- Find out whether the cancer has spread to the lymph nodes under the arm (sentinel lymph node biopsy or axillary
- lymph node dissection)
- Restore the breast’s shape after the cancer is removed (breast reconstruction)
- Relieve symptoms of advanced cancer
There are two main types of surgery to remove breast cancer: Breast-conserving surgery (also called a lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy) – in which only the part of the breast containing the cancer is removed. The goal is to remove the cancer as well as some surrounding normal tissue. How much of the breast is removed depends on the size and location of the tumor and other factors.
Mastectomy – in which the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. There are several different types of mastectomies. Some women may also get a double mastectomy, in which both breasts are removed.
Choosing between breast-conserving surgery and mastectomyMany women with early-stage cancers 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 clearly be a better option, because of the type of breast cancer, the large size of the tumor, previous treatment history, or certain other factors.
Surgery to remove nearby lymph nodesTo 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 can be removed either as part of the surgery to remove the breast cancer or in a separate operation.
Breast reconstruction after surgeryAfter having a mastectomy (or some breast-conserving surgeries), a woman might want to consider having the breast mound rebuilt to restore the breast’s appearance after surgery. This is called 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 mastectomy (immediate reconstruction) or at a later time (delayed reconstruction).
If you are thinking about having reconstructive surgery, it’s a good idea to discuss it with your breast surgeon, Dr. Soumitra Chandra and a plastic surgeon before your mastectomy. This gives the surgical team time to plan out the treatment options that might be best for you, even if you wait and have the reconstructive surgery later.
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
You need to understand the goal of surgery for advanced breast cancer —whether it’s to try to cure the cancer or to prevent or treat symptoms.
What are the side effects of breast cancer surgery?Surgical procedures for breast cancer can cause short-term pain and tenderness in the treated area. Also, the skin in the breast area may feel tight, and the muscles of the arm may feel stiff or weak. Surgery involving the lymph nodes can sometimes cause swelling in the arm, a condition called lymphedema. Rarely there are situations when additional surgery may be necessary to achieve complete removal of the cancer.
Doctor Soumitra’s Tips & SupportDesigned especially for the patients and their loved ones, the supportive resources Dr. Soumitra offers will help you take care of the many important medical and non-medical aspects of your care, both during and after your breast cancer treatment.
CaregiversAs a caregiver, you are doing whatever you can to help your loved one make the best decisions possible about their care. Doctor includes you in discussions about your loved one's treatment plan and gives you and your family helpful information about cancer, treatment options, managing side effects and overall health.
Quality of lifeThroughout your care, Dr. Soumitra helps you manage side effects and maintain your quality of life. He also offers counseling and support groups to help you and your family cope with the personal challenges of cancer.
Nutritional supportFrom your first visit to Dr. Soumitra and throughout your care, he will recommend nutrition interventions, including nourishing meal plans and dietary supplementation, to keep you strong, combat side effects and prevent treatment interruptions before they arise.
Survivorship supportLed by Dr. Soumitra, a Survivorship Support Program is designed to help you maintain your health and improve your quality of life once your hospital treatment is complete.
