Cancer occurs when changes or mutations in the genes trigger cell growth. The mutations allow cells to divide and multiply uncontrolled, forming a lump. Breast cancer can develop in the lobules (milk-producing glands), ducts (structures that carry the milk from the lobule to the nipple) or in the intervening connective disease.

Breast cancer can spread either by lymphatic route to lymph nodes or by vascular route to distant organs such as the lung or liver.

Breast cancer treatment is done in the Oncology department, which is where various medical professionals and specialists work together to create a treatment plan that tackles the various breast cancer stages. The surgeons and specialists work together to bring the disease into remission and prevent it from spreading further.

How to prevent Breast cancer ?

While there may be many risk factors that are out of your control, you can follow a healthy lifestyle that includes eating wholesome and nutritious food, avoiding alcohol and cigarettes, and following a consistent workout regime.

Go for regular mammogram screenings, as breast cancer can go undetected in the initial stages. Mammograms help reduce the chances that it will go undetected.

Some women have an increased risk of developing breast cancer because of genetic factors. For example, if your mother or father ever had the BRCA1 or BRCA2 gene mutation, you are at high risk of breast cancer. If you’re at risk of the gene mutation, then talk to your doctor about various diagnostic or preventive measures.

Breast cancer symptoms

The most common symptoms of breast cancer include the following:

A breast lump or thickening that feels different from the surrounding tissue

Change in the size, shape or appearance of a breast

Changes to the skin over the breast, such as dimpling

A newly inverted nipple

Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin

Redness or pitting of the skin over your breast, like the skin of an orange- Peau de’ orange

Now, it’s important to understand that having any of these signs doesn’t necessarily mean you have breast cancer. However, if you notice any of these changes, please visit an oncologist immediately for a proper diagnosis.

Breast cancer diagnosis/ How to diagnose Breast Cancer?

When you visit the hospital (outpatient department) with specific symptoms, your oncologist will proceed with a thorough clinical examination. This may be followed by a diagnostic test such as:

Mammogram or an ultrasound of the breast: A mammogram is an X-ray of the breast. This is the first and most common test for breast cancer.

An ultrasound of the breast may also be performed to gather additional information.

Biopsy of the Breast: If the lesion appears suspicious on clinical or radiological evaluation, you may also be advised to go ahead with a biopsy. A biopsy is a procedure done under local anaesthesia in the outpatient department to remove a few cells or a small piece of tissue for histological evaluation. This test confirms the diagnosis of cancer and forms the basis for further evaluation.

MRI: Occasionally, an MRI of the breast may be performed, especially in young women or women with a strong family history of cancer.

Breast cancer stages

Breast cancer can be divided into stages based on the size of the tumour, spread to lymph nodes in the armpit on the same side or distant organs, such as the lungs, liver, or brain. Staging can either be clinical or pathological. Clinical staging is primarily based on physical examination by a medical professional. Pathological staging is done by histological examination of tissue removed during surgery. For staging, the following information is used:

Whether the cancer is invasive or non-invasive

The size and extent of the tumour in the breast

Spread to lymph nodes in the local area (axillary or armpit, supraclavicular or neck, and or internal mammary nodes)

Spread or metastases to distant organs

There are five breast cancer stages- from 0 to 5:

Breast Cancer Stage 0

In this stage, the cancer cells remain in the breast ducts and have not spread to the surrounding tissue.

Breast Cancer Stage 1

1A is when the tumour is less than or equal to (≤) 2cm without any spread to the lymph nodes in the armpit

1B is when the cancer is found in the lymph nodes, but the size of this spread is more than 0.2mm but less than 2mm and the tumour in the breast is less than or equal to (≤) 2cm.

Breast Cancer Stage 2

2A is any of one of these following conditions - There is no evidence of a tumour in the breast, but the cancer has spread to 1 to 3 axillary lymph nodes, or the tumour is less than or equal to 2cm and has spread to 1 to 3 axillary lymph nodes or the tumour is larger than 2cm but not larger than 5cm and has not spread to the axillary lymph nodes

2B is any one of these conditions - The tumour is larger than 2cms but not larger than 5cm and has spread to 1 to 3 axillary lymph nodes, or the tumour is larger than 5cm but has not spread to the axillary lymph nodes (T3, N0, M0).

Breast Cancer Stage 3

3A is when cancer has spread to 4 to 9 axillary lymph nodes or the nodes next to the breastbone (internal mammary nodes) or if the tumour in the breast is more than 5cm and has spread to 1 to 3 axillary lymph nodes and the tumour is large enough to be felt as a lump in any of the breastbone nodes.

3B is when the tumour has involved the muscles of the chest wall or caused ulceration of the overlying skin with or without the involvement of the lymph nodes in the local area.

3C indicates a tumour of any size in the breast, or no tumour present at all. Either way, the cancer has spread to ten or more axillary lymph nodes, lymph nodes near the collarbone or some underarm lymph nodes and lymph nodes near the breastbone.

Breast Cancer Stage 4

This stage includes a tumour of any size in the breast, which has spread to distant organs in the body, such as the lung, liver, or brain, or bones.

Treatment for Breast Cancer

The breast cancer unit at Narayana Health has a multidisciplinary team (Tumour Board) to ensure timely, accurate diagnosis. Once the diagnosis has been made, a dedicated team works to formulate a treatment plan. Treatment decisions are made by a team that comprises a surgeon, medical and radiation oncologists, and various other specialities.

The breast cancer stage and the type of tumour play a huge role in deciding a suitable treatment plan. First, the doctor determines the details of your cancer and then discusses suitable treatment options.

Surgery for Breast Cancer:

Here are some of the common surgery options for breast cancer:

Lumpectomy - This process involves excising only the tumour without removing the breast.

Mastectomy - This procedure removes the entire breast.

Sentinel node biopsy - In patients who are clinically and radiologically node negative (no evidence of the tumour spreading to the armpit), a sentinel node evaluation is done during surgery. If this comes negative for cancer spread, the remaining nodes in the armpit are not removed, avoiding long-term sequelae of lymph node removal in patients.

Axillary lymph node dissection - In cases where there is definite evidence of the cancer having spread to the axillary nodes, these nodes are removed during the surgery for the breast.

Targeted axillary dissection - It is an advanced procedure in which a sentinel node procedure is coupled with the removal of the clipped node to avoid axillary node dissection in patients undergoing surgery who have received prior treatment like chemotherapy.

Oncoplastic surgery for Breast Cancer - Different remodelling techniques are employed so that the breast contour is maintained post conservation surgeries.

Whole breast reconstruction - Patients also have the option of undergoing a whole breast reconstruction after a mastectomy where an entire new breast is reconstructed using either breast implants or autologous tissue. This can be coupled with either skin-sparing or nipple-sparing mastectomies.

Radiation therapy for Breast Cancer:

Radiation therapy is when high-powered beams are used to target and kill off cancer cells that cause the breast tumour. Most treatments will use external beam radiation, which makes use of a radiation source placed outside the body. Recent advances in cancer treatments have allowed doctors to focus radiation to limited/smaller areas of the breast called brachytherapy, thereby reducing the side effected associated with whole breast radiation.

Hormone therapy for Breast Cancer:

If your breast cancer is sensitive to hormones, the oncologist suggests hormone therapy. Two of the primary female hormones, estrogen and progesterone, stimulate the growth of breast cancer tumours. Hormone therapy works in a way that blocks the body’s production of said hormones and slows down, or stops, the growth of cancer.

Targeted therapy and immunotherapy for Breast Cancer:

Certain medications are designed to attack abnormalities or mutations within cancer cells. For instance, Trastuzumab is used to block the body’s production of the HER2 protein, this protein helps the breast cancer cells grow and taking the medication will slow the production of HER2 and help slow the cancer growth as well.

Ensure that you visit the best breast cancer hospital in India so that you receive treatment from experienced oncologists.

Breast Oncology & Oncoplastic Surgery