Breast cancer is the second leading cause of cancer death in women after lung cancer. In this Blog, you will get to know about Different Types of Breast Cancer Surgeries and treatments. However, on a positive note the death rate from breast cancer has declined a bit in recent years, perhaps due to greater awareness and screening for this type of cancer.
Breast Cancer can be cured if detected in the early stages. Hence, it is important to understand the symptoms. The most common symptom for breast disease is a lump in the breast. It may or may not be associated with pain in the breast. Some of the other symptoms can be either a nipple discharge or any change in size, shape or texture of the breast, and lump in the armpit or any unusual change in the breast which was not there before. If you notice any of these symptoms, it is recommended to go to your nearest doctor and get it checked. Majority of these symptoms begins through conditions which are non-cancerous at first. In fact, almost 90% of all breast lumps are non-cancerous, so it is very important to get them checked, you have to get them investigated. Don’t be fearful about the investigations or going to the doctor. The most common investigations that will be done are mammography or a sonography of the breast.
Mammography is usually done in older women above 40-50 years of age and sonography in younger women. This is because their (young women) breast are very dense and does not allow any small lesions to be picked up on a mammogram. That’s the reason they are advised a sonography first. So, mammography becomes the first line of investigation for older women. In today’s digital world a digital mammography is considered to be better than a routine film screen mammography. There are several reasons for that, there is better contrast resolution, minute details can be picked up, images can be zoomed in, images can be digitized, and overall the sensitivity of digital mammography is much better than of the routine, old, traditional film screen mammography.
After the mammography, many patients would be advised to undergo sonography also. This is because the information given by mammography and sonography can be different and can be complementary to each other. Hence, both the tests might be required. Ultrasonography along with an elastography is preferred investigation to get a better diagnosis. Once these investigations are done your doctor will tell you whether or not you need a core needle biopsy. It is a small procedure done under local anesthesia on an OPD basis. It takes barely about 5 minutes to do. Here you are given a little injection of local anesthesia and the whole area becomes numb, then the core needle is inserted into the breast lump and few cores of tissues are taken. There are no cuts or stitches. The results are available in generally 3-4 days. Then based on your result the doctor will advise you the treatment that may be required for you. Amongst the results the most common diagnosis would be a fibroadenoma, it could be complex, hamartomas, sclerosing adenosis, fat necrosis or radial scars. These are all medical terms, but they are all benign lesions that means they are all non-cancerous lesions. Getting the correct diagnosis is important. In the rare case if it turns out to be cancer then your doctor will advise you the right treatment for you, depending upon the stage of your disease.
If diagnosed with breast cancer, it is important to understand the types of breast cancer and breast cancer surgeries.Breast cancer surgeries are of 2 types, breast conservation surgery or mastectomy. Thus, the types of breast cancer surgeries are explained further. Breast conservation surgery means that only the tumor is removed along with clear margins, however, in mastectomy, the complete breast is removed. So different patients require different surgical procedures. The patients who need breast conservation surgery are the ones who have a unifocal tumor, that means a small tumor only in one quadrant of the breast. A good tumor to breast ratio, that means the tumor can be removed easily without affecting the cosmesis of the breast.
The cosmesis outcome has to be good to do a good breast conservation surgery and there should be no multifocality. Obviously, tumors should not be there in other quadrants of the breast, and in some cases, if the tumor is large and the breast is small, the breast conservation surgery can be done by giving neoadjuvant that means giving primary chemotherapy to reduce the size. Then the tumor can be removed along with clear margins and the breast can be conserved. So, similarly, mastectomy is suitable for the patients in which there are multiple tumors in different quadrants of the breast or there is one large tumor. In cases where it is not possible to conserve the breast, mastectomy or complete removal of the breast is required. In fact, it is mandatory. All the patients who undergo breast conservation surgery need to undergo radiation therapy to the breast. This is to destroy any isolated tumor cells which may be present in the breast in other quadrants. However in the case of a mastectomy, since the whole breast is getting removed, the post-operative radiation may not be required, but in some cases, approximately 10% of cases post-operative or post-mastectomy radiation may still be required depending upon the histopathological stages of the tumor of the patient.
Ladies who need to undergo a mastectomy due to various tumor factors as mentioned need not really be discouraged. Because even after mastectomy completely new breasts can be made with reconstruction. This can be done with autologous flap reconstruction that means the patient’s own tissues are harvested from other parts of the body and shaped into a breast. Another method of reconstruction is putting silicone implants, this is a very old and widely acceptable method which gives quite good cosmetic results.
Breast cancer actually spreads from breasts in a very orderly fashion to the lymph nodes, which are there in the armpits or the axilla. All the cases who have breast cancers may not spread to the lymph nodes in early disease. Here it is necessary to check whether the lymph nodes have the tumor or not and the procedure to do that is sentinel lymph node biopsy. Sentinel lymph node biopsy is a new technique in which a small injection of a radioactive isotope and blue dye is given around the tumor and it passes into the lymph nodes. Frozen section is a technique in which these lymph nodes are checked immediately and the pathologist is able to tell us whether they have the tumor cells or not. If the tumor cells are not there then all the cells in the axilla need not be removed.
Pet central node biopsy is a very good technique because it can avoid complete axillary node dissection. This is important because a complete dissection can cause a lot of morbidity to the patient. The nerves which go from the armpit to the arm, the upper inner arm can get cut. Leading to numbness, tingling and different sensation on the upper inner part of the arm. The lymphatics sect cut leading to lymphedema which is a swelling of the arm. This could be mild, moderate or severe and this could be a permanent side effect of the breast surgery. In order to avoid all these complications, a sentinel lymph node biopsy is a very good option and can easily be done for the patients who have a very early disease and who have less likelihood of having positive lymph nodes in the armpit. In a nutshell breast cancer surgery can be a combination of any of these procedures. It can be a lumpectomy, along with a sentinel node biopsy, it can be a lumpectomy along with axillary lymph node dissection. It can be a complete mastectomy or removal of the breast along with sentinel lymph node biopsy or it can be a mastectomy along with complete axillary lymph node dissection.
At Deccan clinic, you can be assured of the best consultation and unmatched expertise in delivering world-class surgical results.