BREAST CANCER

Overview

Facts

What is Breast Cancer ?

Any abnormal growth in breast which has a potential to spread elsewhere is breast cancer. Almost every women feels some kind of changes in her breast during her life, some type of lumps and bumps but fortunately most of them are harmless, however every lump in breast warrants a careful clinical examination and further investigations if required.

Signs and Symptoms of Breast Cancer

Most of the breast cancers present as a painless lump which is slowly increasing in size over a period of weeks and months. Since it is painless to start with therefore it is neglected for a long time and patients present late. Other features include retraction of nipple, nipple discharge, eczematous lesion on nipple and areola. dimpling of skin or orange peel like appearance. In advanced stage the lady may present with a large mass with ulceration, bleeding and pain. She may also present with a mass in armpit due to enlarged lymph nodes.

Screening and Diagnosis of Breast Cancer

How to diagnose Breast Cancer ?

“It’s a MYTH that biopsy spreads Cancer”

Once the diagnosis of breast cancer is made , now it is the time to stage the disease which tells us whether it has spread to other parts of body or not. It determines the plan of treatment and the outcome of disease.

How to Stage Breast cancer ?

 “ PET CT Scan does not diagnose cancer but stages it”

Stage I – Small tumor localized to breast only                                             

Stage II – Tumor in breast and axillary nodes on the same side                 

Stage III – Locally advanced Breast cancer ( LABC)- Large tumor in breast which may involve skin or chest wall or multiple fixed nodes in axilla, neck or inside the chest.

Stage IV – The cancer has spread to other parts of body like liver, lung, bone, brain etc.

‘Breast Cancer can spread to any part of the body’

Treatment of Breast Cancer

Breast cancer management is MULTIMODALITY, all methods of treatment– Surgery, Radiation and Medical oncology are required to treat breast cancer optimally. The sequencing of treatment is the most essential part to get the best outcome.

Surgery

It is the mainstay of treatment for early stage breast cancer . It removes the tumour with adequate margins along with removal of lymph nodes from axilla. In today’s era, the breast can be conserved and reconstructed with good cosmesis in majority cases. Mastectomy is occasionally required these days, unless patient demands it.
“There is no difference in overall outcome in Mastectomy and Breast Conservation” Different types of oncoplastic surgeries are available to reconstruct the breast as near normal as possible without any additional problems.
Sentinel node biopsy can also be performed when indicated in breast cancer, it avoids the chance of swelling of the arm(Lymphedema).

Radiation therapy

Radiotherapy has withstood the test of time and has become part and parcel of overall treatment. Radiotherapy adds onto the benefit both in terms of progression free survival and overall survival. Radiation treatment nowadays is meticulously planned on planning CT scans and delivered with daily imaging conformations of the planned areas to be treated leaving very little chances for toxicities. Radiation oncologists have been able squeeze the treatment to 3 weeks rather than the conventional 5 weeks with equivalent results both in terms of tumor control as well as from toxicity point of view.

Chemotherapy/ Hormonal therapy/ Targeted Therapy

Breast cancer is not one disease but it includes variety of histopathological malignancies that requires different approaches to treatment. The research is continuously ongoing in medical field with newer agents being added to the treatment armamentarium every year increasing the chances of survival and responses. New additions in targeted therapies include not only novel oral therapies like Cyclin dependent kinase (CDK) inhibitors, PIK3CA inhibitors and small molecule tyrosine kinase inhibitors but also various parenteral molecules in form of monoclonal antibodies and antibody drug conjugates(Discuss the drug details with your treating doctor). Early stage breast cancer is mostly subjected to loco-regional treatment in form of surgery and radiation while chemotherapy is contemplated to control micro metastatic disease and prevent recurrences. However, all early breast cancers may not require chemotherapy. Some of the early cancers like hormone negative may be treated with chemotherapy first followed by surgery. In some of triple negative subset of breast cancer addition of immunotherapy (Atezolizumab/Pembrolizumab) has changed entirely the way in which patients were previously counseled for outcome and now the survival of this dismal subset has also improved even in metastatic stage.
No discussion is complete without considering cost of treatment and the sad side of story is the cost of these newer molecules which is mostly unaffordable for majority of the general population. Even though characterized as ‘low-cost’ by global standards, it still remains unaffordable for the majority of the population.

Risk Factors of Breast Cancer

There are certain risk factors which you can not change while some life style changes may protect you from Breast cancer

Non Modifiable:

“ Having Breast cancer gene does not mean that the lady will have breast cancer surely, it is just that there is a higher chance of getting breast cancer and some other cancers than the risk in general population”.
“Your father may also carry the breast cancer gene, so Paternal history is equally important.”

Modifiable:

How Breast cancer is different in India ?

The Outcomes in Breast Cancer

The outcome or prognosis in breast cancer depends on –

The outcome is individualized, no two cancers behave similar, so the treatment is customized for each and every patient.

Prevention & Cure of Breast Cancer

Ways to reduce your breast cancer risk (WHO)

Ways to reduce your breast cancer risk (WHO)

20—39 Yrs age—Breast self examinatio

Clinical breast examination every 3 years.

40yrs onwards—Annual screening Mammogram

Genetic Testing

Genetic counselling is done before these tests.
Lifetime risk of developing breast and ovarian cancer in BRCA ½(mutated)is very high, so prophylactic surgery is recommended after the age of 35 -40 yrs.

How is RGCI Different

At RGCIRC we see around 1800 breast cancer patients every year. The facilities include-

At RGCIRC we see around 1800 breast cancer patients every year. The facilities include-

All the patients are seen by dedicated Breast cancer management team which includes Surgical , Medical and Radiation oncologists along with Radiologist, Pathologist and Nuclear medicine specialist. The cases are discussed in TUMOR BOARD to decide the best treatment protocol for them and then they are explained the treatment plan.

DO’s after Surgery

DON'Ts after Surgery

Questions patient would like to ask to doctor

Questions to ask about surgery

Questions to ask about radiation therapy

Questions to ask about Chemotherapy, hormone treatment?

Clinical Service

Opportunity to Help

DONATE FOR CANCER CARE

As a society, RGCIRC is looking forward to get support from generous people

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DONATE BLOOD

It is a fact that there are absolutely no substitutes to replace human bloo...

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DONATE TIME (VOLUNTEER)

Volunteers play an important role in today’s hospitals. They help the hos...

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Rajiv Gandhi Cancer Institute and Research Centre is today counted amongst Asia’s premier exclusive cancer centres that offer unique advantage of cutting edge technology, put to use by renowned super specialists. This potent combination of man and machine ensures world-class cancer care to not only patients from India, but also from the neighboring SAARC countries and others.

Sir Chotu Ram Marg, Sector - 5, Rohini Industrial Area, Rohini, New Delhi - 110085, India | +91-11-47022222
OPD Timings: 09:00 am to 05:00 pm (All weekdays except Sunday and Holiday)
Emergency Services: 24x7 All weekdays

Squadron Leader Mahendra Kumar Jain Marg, Block K, Niti Bagh, New Delhi - 110049 | +91-11-45822222
OPD Timings: 09:00 am to 05:00 pm (All Weekdays except Sunday and Holiday)
Emergency Services: 24x7 All Weekdays

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