Treatments General Principle
The main pillars of your breast cancer therapy are Surgery , Chemotherapy , Hormonal Therapy and Radiation Therapy. You may require all these therapies at various stages of your cancer treatment. The decision is made by discussing your disease burden, cancer type , stage , your willingness of breast conservation and cosmetic results in a Tumour Board consisting of all the subspecialties like cancer surgeon, plastic surgeons, medical oncologist, radiation oncologist , radiologist and pathologist. As no two individuals are same, their cancers are different ; So their treatments too. The treatment design is always tailormade and is the safest and the most effective for yourself. ( for more details see :Tumour Board )
The rationale for the treatment of patients with breast cancer has changed considerably over the last 20 years. The management of the disease must now involve an integral approach taking into consideration the many developments that have occurred and how these have affected orthodox therapy. However, techniques have had to take into account a number of developments which have materially changed our concepts of what needs to be accomplished: 1) treatment must ensure local control of disease; 2) it must give full information on axillary node status 3) it must supply sufficient tumour tissue for histological and biochemical analysis 4) it must be compatible with the use of adjuvant therapy:
Till recent past, only the radical mastectomy or its modified version ( complete removal of entire breast and armpit nodal tissue ) had been proved to be effective whilst fulfilling all these criteria for treatment.
Nevertheless new conservation techniques are now tested safe oncologically which may allow the breast to be conserved whilst at the same time safely treating the patient and providing the surgeon with all the information needed for future management.
Oncoplastic surgical techniques have been invented to maintain good shape, size, volume and symmetry of the breasts after cancer surgery.
With the help of these new oncoplastic surgical approaches , Breast conservation is now possible not only in early Breast Cancers but also in Locally advanced cancers, multicentric tumours ( where the cancer in evident at more than one site in same breast). If tumor to Breast ratio is large due to relatively larger tumor size in a smaller breast, it can be downsized by chemotherapy before surgery ( Neoadjuvant chemotherapy) and definitive surgery can be planned later safely after chemotherapy cycles. If you are in a situation where breast are not conservable, then don’t get upset. There are various plastic reconstruction techniques where whole breasts can be reconstructed at same surgery or later as a secondary procedure after completion of your cancer therapies. ( see; Whole Breast Reconstruction )
Another integral part of Breast Cancer surgery is axillary staging / clearance .( armpit nodal staging and clearance ). Breast Cancer usually spread to locoregional Lymph nodes like axilla ( armpit ) of same side / internal mammary Lymph nodes ( lymph nodes inside chest cavity on same side). They are evident on clinical examination , imaging like Ultrasound, digital mammography , CT scans / PET CT scans. Its usually proven by biopsy ( Fine Needle Aspiration Cytology) before initiation of therapy. If its proven to metastatic ( i.e involved by cancer) , then it’s important to do complete clearance of affected nodal basin – called as axillary clearance. In some cases, when these Lymph nodes are not seen involved ( like in early Breast cancers) before surgery during clinic radiological examination, then its mandatory to prove that your axillary lymph nodes are really free from cancer before taking a decision to skip its clearance. The technique is known as Sentinel Lymph Node Biopsy. Its processed during your main surgery. ( to know more see; Axillary Staging- Sentinel Lymph Node Biopsy, Axillary Sampling and Axillary Clearance )
You might have be given an option of chemo port insertion during surgery. It’s a device to give venous access during your chemotherapies to be given after surgery. Its for your future convenience during adjuvant therapies ( for more details see- Chemoport and PICC Lines )
Once you are recovered from surgical intervention , you are guided to complete further non-surgical therapies. They are called as Adjuvant therapies. These therapies are tailormade as per your disease burden ( which is evident on your final histopathology report of specimen sent to pathology after surgery ) and your response to therapies in case if given to you prior to surgery. The adjuvant therapy usually includes chemotherapy , hormonal therapy, targeted therapy and radiotherapy
Breast Cancer Staging
The final stage of your cancer is determined by - Your complete histopathology report after definitive surgery and few imaging to confirm distant spread