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Breast Cancer Surgery

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Overview

Breast is an organ that is formed by three types of tissues, namely adipose tissues, connective tissue and secretory glands; breasts produce milk and enable breastfeeding in women, but, they are rather premature and dysfunctional in men. There is a major milk duct that runs to the nipple at the middle zone of each breast. Smaller ducts of mammary lobes drain to the major duct, usually just before the nipple. A breast lobe is formed by lobules that contain milk-producing glands.

 

In addition to above mentioned tissues, breasts also have lymphatic ducts that are connected to lymph nodes of the armpit through lymphatic vessels.

 

Breast cancer is the uncontrolled growth of breast cells. Although breast cancer can also occur in men, the incidence of the condition in women is beyond comparison.

 

Recently, campaigns to raise awareness of breast cancer, screening methods that allow early diagnosis and advancements in treatment methods have both increased chance of cure and decreased deaths caused by this disease.

 

Risk Factors:

It is not clearly known what causes the breast cancer. The underlying mechanism is that some cells grow and divide faster than usual and they form a mass or a lump in the breast, as they continue living when healthy cells die. Moreover, these cells may spread to other organs and tissues through lymphatic circulation, blood circulation and the anatomic proximity.

 

It is estimated that inherited genes account for approximately 10% of all breast cancer cases. A family history of breast cancer is a potent risk factor.

 

Breast cancer usually starts in milk ducts. Studies show that incidence of breast cancer is increased by a number of factors, such as hormones, environmental conditions and lifestyle.

 

The risk factors of breast cancer are listed below;

    • Female gender,
    • Age,
    • Exposure to radiation,
    • Health history of breast cancer (presence of cancer in one breast increases the risk of cancer in the other breast)
    • Family history of breast cancer,
    • Genetic predisposition,
    • Exposure to high-dose radiation,
    • Early onset of menstrual cycles
    • Late menopause,
    • Having first child at an older age,
    • Obesity, alcohol
    • Having never been pregnant.

 

 

Types:

There are two common classifications in the breast cancer; non invasive or not spreading (in situ) cancers and invasive or spreading cancers.

 

Invasive breast cancers

  • Invasive ductal carcinoma
  • Paget’s disease
  • Inflammatory breast cancer
  • Invasive lobular carcinoma.
  • Others (rare types)

 

Non-invasive breast cancers

  • Ductal carcinoma in-situ
  • Lobular carcinoma in-situ

 

*Invasive ductal carcinoma is responsible for approximately 90% of all breast cancer cases.

 

 

Symptoms

Breast cancer has many symptoms.  In some patients with no symptom, breast cancer is discovered in mammography that is ordered upon a suspicious finding or that is part of routine screening.

 

Signs and symptoms of the breast cancer are as follow;

 

    • Palpable mass, solid lump or space occupying lesion in breast and/or armpit,
    • Discharge from nipple
    • Changes in the nipple (size, shape or appearance)
    • Changes in the skin of nipple,
    • Peeling and scaling in the skin of the breast or the darker skin that surrounds the nipple.
    • Edema, swelling and dimpling in the skin of breast,
    • Redness and texture of orange peel in the skin of breast

 

 

Prevention

As is the case for all other cancers, prevention of breast cancer is also to eliminate or minimize manageable risks. The first step of treatment should be to alleviate risk factors that help onset of the disease. Weight control, healthy eating habits and regular exercise are preventive measures that should be applied by everybody.

 

The texture and hardness of breast tissue varies from one person to the other. On the other hand, breast tissue of the same person shows some variations due to aging, pregnancy and lactation. Therefore, self-examination of breast at regular intervals is a very important screening method.

 

 

 

Diagnosis:

As is the case for all cancers, detection of breast cancer in early stage not only increase the chance of treatment, but also number of treatment options.

 

Clinical breast examination: Your doctor will examine both breasts and your armpit to check if there is a mass or lump.

 

Mammogram: It is a frequently used to diagnose and screen breast cancer.

 

Breast Ultrasound

 

Imaging-guided biopsy: The biopsy specimen that is taken with ultrasound guidance is the principal method to make the definitive diagnosis of breast cancer. A small metal marker may also be inserted into the suspicious areas for the future use in surgery or imaging studies.

 

Magnetic Resonance Imaging

 

Treatment

There are various options for treatment of breast cancer, depending on stage of the disease and the patient-related factors. These are hormone therapy, chemotherapy, radiotherapy and surgery. Your doctor will determine the optimum option for you in the light of these findings.

 

Among the treatment options of the breast cancer are chemotherapy, targeted therapy, hormone therapy, radiotherapy and surgery. These treatments can directly be used to treat the tumor or they are instituted to increase quality of life and relieve symptoms in advanced stage cancers. Moreover, treatment options can be used alone or in combination.

 

Chemotherapy

Chemotherapy uses drugs to treat the cancer. The active substances of drugs kill the cancerous cells. Chemotherapeutic agents can be given into a vein or be taken by mouth. In case of intravenous administration, a thin tube, called catheter, is inserted into a great vein and the chemotherapeutic agent is administered through this catheter throughout the treatment period.

 

One or more than one chemotherapeutic agent can be administered depending on the type of cancer and response to treatment. Active chemotherapy maintained for a particular time is followed by an “off” period. After the “off” period expires, the treatment resumes. Each of these sequential active and “off” periods is called a cycle.

 

In the early stage breast cancers, chemotherapy may be instituted before or after the surgery.

Side effects of the chemotherapy are a function of the chemotherapeutic agent and the dose. Most common side effects of chemotherapeutics include; fatigue, nausea, vomiting, mouth sores, hair loss and inflammation of the digestive system. Side effects caused by chemotherapy will also be treated by your doctor. If these side effects are severe enough to threaten your health, your doctor may advise to suspend the treatment or to switch you to another chemotherapeutic agent.

 

Targeted Therapy

Targeted therapies are newer anti-cancer treatments compared to chemotherapy. These medicines target specific abnormalities that are present in cancerous cells. Before these medicines are started, cancer cells are first analyzed in laboratories to determine whether they have particular mutations or not. In breast cancer, some cancer cells overproduce a substance called epidermal growth factor receptor 2 (HER2) in comparison to healthy cells. When drugs that specifically target these cells are used, cancer cells can be killed, while healthy cells are spared.

 

Radiotherapy

Radiation therapy aims to kill cancer cells by using high-powered energy beams.  

 

If the radiation source is out of the body and the beams are directed to cancer, this treatment is called external radiotherapy.  On the other hand, if the radioactive agent is placed at the locus of the tumor through a needle or a catheter, method is called internal radiotherapy (brachytheraphy).

 

Radiotherapy is mostly combined with chemotherapy and this modality is also called chemoradiotherapy.  In breast cancer, the adverse effects of radiation therapy include fatigue, skin rash and swelling of the breast treated with radiation therapy.

 

Hormone therapy

It is often used in the treatment of hormone-sensitive breast cancers. It is instituted before and after the surgery to prevent recurrence or to reduce size of masses that have spread to the body.

 

Side effects of hormone therapy include hot flashes, night sweats, vaginal dryness and blood clotting, though not an exhaustive list. Your doctor will plan not only management of the side effects, he will also follow up said side effects throughout the treatment.

 

Surgery

Surgery is the most common treatment method for breast cancer. If the patient is operated on by experienced surgeons, the success rate of surgery is higher in breast cancer than the other cancers.

 

Modified radical mastectomy is the most common surgical technique in the breast cancer. The surgery is usually carried out under general anesthesia. The entire breast is removed along with the lymph nodes located at unilateral armpit. This increases the success of treatment, but aesthetic results are not so promising. Therefore, breast-conserving mastectomy is performed, where skin of breast and the nipple are untouched, as long as tumor- and patient-related factors allow.

 

If the tumor is benign, your surgeon may remove the tumor and some surrounding healthy tissue (lumpectomy).

 

Sentinel lymph node biopsy: Your surgeon removes some lymph nodes located nearby your breast in order to determine the extent your tumor spread. If it is determined that the cancer spreads to nearby tissues, after lymph nodes are examined, it can be decided to remove all surrounding lymph nodes (axillary lymph node dissection).

 

 

Possible postoperative complications of breast cancer surgery are pain, bleeding, infection and abnormal swelling of arm (lymphedema). After you undergo a breast surgery, it is necessary to protect hand, forearm and arms against impacts and external conditions and to work out in line with the exercise program instructed by your doctor.

 

Asking your questions about the treatment of breast cancer, your life after treatment, rehabilitation, pain management, clinical studies and all the questions in your mind about the breast cancer to your doctor will help you for an informed participation to your treatment and alleviating your concerns.