Breast Cancer Treatment India

Breast cancer is a cancer that starts in the cells of the breast. Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% of all cancer incidence, both sexes counted) and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).

Breast cancer is about 100 times as frequent among women as among men, but survival rates are equal in both sexes.

Breast cancers are described along four different classification schemes, or groups, each based on different criteria and serving a different purpose:

• Pathology - Each tumor is classified by its histological (microscopic anatomy) appearance and other criteria.
• Grade of tumor - The histological grade of a tumor is determined by a pathologist under a microscope. A well-differentiated (low grade) tumor resembles normal tissue. A poorly differentiated (high grade) tumor is composed of disorganized cells and, therefore, does not look like normal tissue. Moderately differentiated (intermediate grade) tumors are somewhere in between.
• Protein & gene expression status - Currently, all breast cancers should be tested for expression, or detectable effect, of the estrogen receptor (ER), progesterone receptor (PR) and HER2/neu proteins. These tests are usually done by immunohistochemistry and are presented in a pathologist's report. The profile of expression of a given tumor helps predict its prognosis, or outlook, and helps an oncologist choose the most appropriate treatment. More genes and/or proteins may be tested in the future.
• Stage of a tumor - The currently accepted staging scheme for breast cancer is the TNM classification. This considers the Tumor itself, whether it has spread to lymph Nodes, and whether there are any Metastases to locations other than the breast and lymph nodes.

Breast cancer is usually, but not always, primarily classified by its histological appearance. Rare variants are defined on the basis of physical exam findings. For example, inflammatory breast cancer (IBC), a form of ductal carcinoma or malignant cancer in the ducts, is distinguished from other carcinomas by the inflamed appearance of the affected breast. In the future, some pathologic classifications may be changed. The first symptom, or subjective sign, of breast cancer is typically a lump that feels different from the surrounding breast tissue. According to the The Merck Manual, more than 80% of breast cancer cases are discovered when the woman feels a lump.[8] According to the American Cancer Society, the first medical sign, or objective indication of breast cancer as detected by a physician, is discovered by mammogram.[9] Lumps found in lymph nodes located in the armpits can also indicate breast cancer.

Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues. When breast cancer cells invade the dermal lymphatics—small lymph vessels in the skin of the breast—its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange.

Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget's advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast.

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain.[12] Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are "non-specific", meaning they can also be manifestations of many other illnesses.

Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.

Diagnosis and Treatment :

While screening techniques discussed above are useful in determining the possibility of cancer, a further testing is necessary to confirm whether a lump detected on screening is cancer, as opposed to a benign alternative such as a simple cyst.

In a clinical setting, breast cancer is commonly diagnosed using a "triple test" of clinical breast examination (breast examination by a trained medical practitioner), mammography, and fine needle aspiration cytology. Both mammography and clinical breast exam, also used for screening, can indicate an approximate likelihood that a lump is cancer, and may also identify any other lesions. Fine Needle Aspiration and Cytology (FNAC), which may be done in a GP's office using local anaesthetic if required, involves attempting to extract a small portion of fluid from the lump. Clear fluid makes the lump highly unlikely to be cancerous, but bloody fluid may be sent off for inspection under a microscope for cancerous cells. Together, these three tools can be used to diagnose breast cancer with a good degree of accuracy.

Other options for biopsy include core biopsy, where a section of the breast lump is removed, and an excisional biopsy, where the entire lump is removed. The mainstay of breast cancer treatment is surgery when the tumor is localized, with possible adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor), chemotherapy, and/or radiotherapy. At present, the treatment recommendations after surgery (adjuvant therapy) follow a pattern. This pattern is subject to change, as every two years, a worldwide conference takes place in St. Gallen, Switzerland, to discuss the actual results of worldwide multi-center studies. Depending on clinical criteria (age, type of cancer, size, metastasis) patients are roughly divided to high risk and low risk cases, with each risk category following different rules for therapy. Treatment possibilities include radiation therapy, chemotherapy, hormone therapy, and immune therapy.

In planning treatment, doctors can also use PCR tests like Oncotype DX or microarray tests that predict breast cancer recurrence risk based on gene expression. In February 2007, the first breast cancer predictor test won formal approval from the Food and Drug Administration. This is a new gene test to help predict whether women with early-stage breast cancer will relapse in 5 or 10 years, this could help influence how aggressively the initial tumor is treated. Radiation therapy is also used to help destroy cancer cells that may linger after surgery. Radiation can reduce the risk of recurrence by 50-66% (1/2 - 2/3rds reduction of risk) when delivered in the correct dose.

Follow up care:

Women who have had breast cancer are at risk for a second episode of new breast cancer in the opposite breast. This risk is estimated at 0.5 to 1 percent per year. The risk is higher in women who first have cancer at a younger age and those with inherited forms of breast cancer. The following are recommendations for follow-up care for women who have already been treated for a breast cancer:

• A regular history and physical examination by a doctor every 3-6 months for 3 years, then every 6-12 months for 2 years, then annually.
• Breast self examination monthly.
• Have a Mammogram annually.
• Pelvic examination annually.
• Routine blood laboratory testing is not recommended.
• Routine X-ray testing, bones scans, CAT scans are not recommended.
• Screening for other cancers (e.g., colon cancer) are according to recommended guidelines for the general population. (Exception would be those women at risk for inherited forms of breast or ovary cancer syndromes who might require additional surveillance for cancer of the ovary, including pelvic ultrasound and measurement of blood CA-125 levels.)

After patients have completed treatment for early stage breast cancer, one of the common questions is "How should I best be monitored?" At the current time, the standard approach for monitoring patients is a physical exam and a review of symptoms anywhere from every three to six months for the first two to three years, then every six months until year five, and annually thereafter. You should continue to have annual mammograms of the other breast. In some cases following a lumpectomy, we recommend a mammogram of the involved breast every six months for two to three years and then yearly thereafter. We also ask you to report any new or unusual symptoms so that we can determine whether any further testing needs to be done. In terms of screening for the spread of breast cancer (metastases), the routine use of chest X-rays and blood tests for patients who have no symptoms is generally not recommended. Even though these tests may pick up a recurrence earlier, it is not clear that the earlier therapy for advanced breast cancer will ultimately lead to a better long term result. This is because when patients have metastatic recurrence, the focus of therapy is to keep the cancer under control but our ability to cure cancer is limited.

In addition, screening tests such as X-rays and blood tests can appear abnormal when in fact there is no spread of cancer and more invasive testing, such as a biopsy, may be required to sort this out. For these reasons, most experts conclude that these types of screening tests for the spread of cancer are not warranted.

Please refer to the American Society of Clinical Oncology (ASCO) Guidelines for a more detailed explanation of the recommendations for following patients after treatment for early stage breast cancer. The American Society of Clinical Oncology (ASCO) is a nonprofit organization that represents more than 10,000 cancer professionals worldwide. The society offers scientific and educational programs and a wide range of other initiatives intended to foster the exchange of information about cancer. ASCO has developed guidelines for medical care following treatment for breast cancer to help you and your doctors make decisions about your continuing health care.Final decisions about your care will be made by you and your doctor.

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