Breast Cancer Treatment and Surgery in India

Overview

The term Breast Cancer refers to a malignant tumor that has developed from cells in the breast. The breast is composed of two main types of tissues: glandular tissues and stroma (supporting) tissues. Worldwide, breast cancer comprises 10.4% of all cancer incidences among women, making it the most common type of non-skin cancer in women and the fifth most common cause of cancer death. Breast cancer is about hundred times more common in women than in men, although males tend to have poorer outcomes due to delays in diagnosis. The Breast Cancer Surgery removes localized cancer that hasn't spread to other areas of the body by removing the tumor itself and a portion of surrounding tissue, while conserving as much of the breast as possible.

What is Breast Cancer?

Breast Cancer (malignant breast neoplasm) is a cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas. Breast cancer is the one of the commonest malignancies afflicting women. In some parts it is the most common malignancy. It is currently estimated that one in 14 of all female children born will develop breast cancer in their lifetime.

Types of Breast Cancer

Breast Cancer is mainly of two types:

• Ductal carcinoma- occurs in milk ducts
• Lobular carcinoma- occurs in the milk secreting breast lobules

Categorically breast cancer can also be divided into following types:

• In-situ breast cancer- cancer cells remains confined within their place of origin and do not attack surrounding breast tissue.
  
  
• Invasive or metastatic breast cancer- cancer cells break free of their place of origin, and spread to different parts of the body.

Like all cancer types, breast cancer also progresses through different stages. Breast cancer stages are based on the size of the breast lump or tumor, whether the cancer is in-situ type or malignant, and whether the cancer has spread beyond the breast tissue.

Causes of Breast Cancer

The exact cause of Breast Cancer is still unknown and there are no fixed causes for breast cancer. Myths in identifying the causes of breast cancer are more prevalent than the real cause. However, some of the causes that have been collectively associated with breast cancer are:

• Age: The chance of breast cancer depends on age, as the person gets older the chances of it are more.
  
  
• Inheritance: Family history of close relative like mother, sister and daughter who has been diagnosed with breast cancer increases the risk factor.
  
  
• Early menses or menopause: Early start onset of menses and early menopause are also associated with breast cancer.
  
  
• Radioactivity: Exposure to radioactive rays is carcinogenic and increases the chances of breast cancer.
  
  
• Hormone Replacement Therapy: Using hormone replacement therapy might also cause it.
  
  
• Exposure to harmful chemicals: Working in a chemical factory that uses harmful chemicals like Organochlorines.
  
  
• Nullyparity or Late childbearing: Nullyparity or Late childbearing also appear to be a minor risk factor in the development of breast cancer.

Symptoms of Breast Cancer

In early stages, breast cancer usually has no symptoms. As the tumor progresses, you may note the following signs:

• Swelling in the armpit
  
  
• Pain or tenderness in the breast
  
  
• A lump in the breast, is often the first apparent symptom of breast cancer, breast lumps are usually painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
  
  
• A noticeable flattening or indentation on the breast which may indicate a tumor that cannot be seen or felt
  
  
• Any change in the contour, texture or temperature of the breast, reddish, pitted surface like the skin of an orange (called peu de orange) is symptomatic of advanced breast cancer.
  
  
• A change in the nipple, such as an indrawn or dimpled look, itching or burning sensation, or ulceration, scaling of the nipple is symptomatic of Paget's disease, a localized cancer.
  
  
• Unusual discharge from the nipple that may be clear, bloody or of another color, usually caused by benign conditions but possibly due to cancer

Diagnosis of Breast Cancer

• Mammogram: The first diagnostic tool to identify breast cancer is Mammogram. It is an X-ray of the breast that can show the presence of abnormal growth lumps in the breast area.5
  
  
• Ultra-Sonography: Use of high frequency sound waves often identifies whether the lump is filled with liquid or solid for further investigation.18
  
  
• Aspiration: Fine needle is inserted in the lump to take the tissue or liquid out from the lump and then a biopsy is performed to test for carcinoma.19
  
  
• Surgical Biopsy Surgical biopsy removes a small part of lump by surgery and then the lump is tested for further diagnosis.

Preparing for Breast Cancer Surgery

Preparing for surgery can be an immensely stressful time. You can try the following tips given as under:

• Meet with your surgeon to discuss how the surgery will be performed, how long it will take to heal and what treatment may be required after surgery. Obtain a second opinion. It is not unusual to seek a second opinion, and may be necessary for your insurance carrier. The second surgeon may confirm the advice you have already received, or you may be given a different option.
  
  
• Ask questions. Learn as much as you can about breast cancer in general and your particular situation. Ask the stage of your cancer and what that means in terms of treatment options, side effects and recurrence of the cancer. Discuss the benefits and risk of breast-sparing surgery (lumpectomy) or total removal of the breast (mastectomy). Ask your surgeon's advice on removing your unaffected breast in anticipation of a second tumor.
  
  
• Explore your options for breast reconstruction before your surgery, if you choose to have a mastectomy. It may be difficult to think beyond removal of the tumor, but reconstruction is an important component of emotional healing for some women. Ask how the breast reconstruction will be performed and the expected length of the recovery period.

Breast Cancer Treatment

• Surgery

• Sentinel lymph node biopsy followed by surgery

• Radiation Therapy

• Chemotherapy

• Hormone Therapy

• Targeted Therapy

Common Procedures of Breast Cancer Surgery

• Lumpectomy: This is also referred to as breast-conserving therapy. The surgeon removes the cancerous area and a surrounding margin of normal tissue. A second incision may be made in order to remove the lymph nodes. This treatment aims to maintain a normal breast appearance when the surgery is over. After the lumpectomy, a five- to eight-week course of radiation therapy is often used to treat the remaining breast tissue. The majority of women who have small, early-stage breast cancers are excellent candidates for this treatment approach. Women who are not usually eligible for a lumpectomy include those who have already had radiation therapy to the affected breast, have two or more areas of cancer in the same breast that are too far apart to be removed through one incision, or have cancer that was not completely removed during the lumpectomy surgery. After a lumpectomy, the woman is moved to a surgery recovery room for a short time. Most women go home with home care instructions the same day, but a few have to stay in the hospital for one to two days. Preventing infection is usually an emphasis of the doctor's home care instructions. Post surgical factors depend on the size and location of the tumor removed the general health of the woman, and the preferences of the patient and her doctor. An ice bag over the incision (on top of the bandages) for the first 24 hours may help to relieve the pain.
  
  
• Partial or Segmental Mastectomy or Quadrantectomy: This kind of surgery removes one quarter of the breast and is considered to be a breast conserving procedure. It is considered to be a partial mastectomy. Your surgeon will remove the tumor and 2-3 centimeters of breast tissue that surrounds it, to be sure that the margins around the tumor are clear of cancer. Skin that is lying over that quarter of your breast will also be removed, and some of the muscle of the chest wall, beneath the tumor may also need to be taken out. The lymph nodes that are closest to the tumor will be removed and tested for cancer cells, as will the skin and the tissue around the tumor. A Partial or Segmental Mastectomy or Quadrantectomy will result in a change of size and shape of your breast, and after you recover from surgery, you may want to put some additional padding in your bra to even out your appearance. You may wish to have a plastic surgeon remodel the breast into a smaller size with a natural shape, and this is best done before any other treatments, such as radiation or chemotherapy, are done. Radiation will change the texture of the skin in the surgery area, and during chemotherapy your body may not have the resources to heal properly from surgery. The skin at the incision will have a scar, and will change in texture, but if you give the incision good care, it will fade into a small line with time.
  
  
• Simple or Total Mastectomy: With a Simple or Total mastectomy, the entire breast is removed, but no lymph nodes are removed in this procedure. Simple mastectomy is most frequently used for further cancer prevention or when the cancer does not go to the lymph nodes. A simple or total mastectomy is appropriate for women with multiple or large areas of ductal carcinoma in situ (DCIS) and for women seeking prophylactic mastectomies-that is, breast removal in order to prevent any possibility of breast cancer occurring. The basic indication for a total mastectomy is the presence of cancer, or a high risk of cancer that prompts consideration of a prophylactic mastectomy. At the time of the surgery, physicians can remove a single breast (unilateral) or both (bilateral). Candidates for a simple mastectomy usually don't show an indication of cancer spreading to the lymph nodes, or the modified radical procedure is considered instead. From a surgical standpoint, total mastectomy is common and usually a simple procedure. Skin-sparing variants use different incisions and may take a little more finesse, but are performed often. An uncomplicated surgery without reconstruction takes a couple of hours to perform, and the last step is typically placement of a drain in the breast that helps siphon off fluid accumulation. This is removed in a few days once drainage tapers off, and women typically go home from the hospital two to three days after surgery, though they may need to stay longer if chemotherapy or other treatments are initiated. The fact that total mastectomy is common doesn’t mean it is easy. While the surgery isn’t associated with high physical pain levels, it can be uncomfortable and emotionally daunting.
  
  
• Modified Radical Mastectomy: The surgeon removes all of the breast tissue along with the nipple in a modified radical mastectomy. Lymph nodes in the armpit are also removed. The chest muscles are left intact. For many patients, mastectomy is accompanied by either an immediate or delayed breast reconstruction. This can be done quite effectively using either breast implants or the patient's own tissue -- usually from the lower abdomen. A modified radical mastectomy is a type of mastectomy that combines the removal of all breast tissue from the affected breast with lymph node removal from the armpit on the affected side of the body. This surgery typically includes the removal of both the nipple and areola, but the surgery can be performed using skin and nipple sparing techniques. Like a simple mastectomy, the procedure is performed using an elliptical incision 6 to 8 inches in length that begins on the inside of the breast, near the breast bone, and extends upward and outward toward the armpit. The incision can also be altered to remove scar tissue from previous procedures, which can improve the cosmetic outcome if reconstruction is desired. Once the breast tissue is removed, the incision is closed with either absorbable sutures or staples that are removed during an office visit 10 to 14 days after surgery. There may also be drains in place to decrease the amount of swelling in the area. These drains are covered with bandages to protect the incision site and the drain placement. The drains are typically removed after discharge from the hospital by the surgeon during a routine office visit after surgery.
  
  
• Radical Mastectomy: When a radical mastectomy is used to treat breast cancer, the surgeon removes all of the breast tissue along with the nipple, lymph nodes in the armpit, and chest wall muscles under the breast. This procedure is rarely performed today because modified radical mastectomy has proved to be as effective, and is less disfiguring. You may be asked to give blood before breast cancer surgery, in case a transfusion becomes necessary. You should thoroughly discuss these surgical options with your physician to achieve the best outcome. Whichever type of surgery is your best option, you will be able to return home after a short stay in the hospital. Like other types of mastectomy, a radical mastectomy removes all of the breast tissue of the affected breast. It also removes all of the lymph nodes under the arm on the affected side and the muscle that lies under the breast. Only the skin required to close the incision is left in place. This procedure is not considered necessary for patients whose cancer has not invaded the muscle. This surgery is considered the most disfiguring of the mastectomy procedures, leaving very little tissue other than skin over the rib bones. The scar left after this surgery is 6 to 8 inches long, with enough skin left to close the incision with sutures or staples. The surgeon may also place drains in the areas of surgery which, as in the other procedures, will be covered for protection and then later removed by the surgeon during a routine office visit.

Life after Breast Cancer Surgery

After a breast cancer surgery to your armpit, Your nurse will show you exercises to help you recover. Do them until you have full movement back in your arm and shoulder.

Don't lift or carry anything heavy, or drive while your scars heal up. Until your surgeon has given you the okay, don't do any housework (such as vacuuming, mopping or cleaning) with your affected arm. If you have had a mastectomy, you'll have a lightweight artificial breast shape (prosthesis) to put inside your bra. After about 4 to 6 weeks you will be ready for your permanent prosthesis. Many types of artificial breast shapes are available free on the NHS. Your artificial breast shape sits inside your bra. Women who have had part of a breast removed can use a partial prosthesis or shell prosthesis.

Don't lift or carry anything heavy, or drive, while your scars heal up. After wide local excision this is likely to be after about 2 weeks. After mastectomy this may take longer. Check with your surgeon or breast care nurse when it is okay to do heavier work (such as vacuuming or shopping) with your affected arm. But do carry on with your arm exercises and some light exercise. It will help you to get better more quickly. What you can manage will vary, depending on how much surgery you've had. Some women find even filling a kettle too heavy at first. The main thing is to take it carefully and stop if you feel any strain.

Recovery after Breast Cancer Surgery

The procedures for Breast Cancer Surgery are typically an outpatient procedure. You will be instructed to do the following:

• Keep the surgical area clean and dry.
  
  
• Keep a bandage over the surgical site and may have one or more tubes to drain blood and fluids that collect during the healing process. You must empty the drains, measure the fluid, and report any problems that your doctor may tell you to watch out for.
  
  
• Avoid vigorous activity for about four weeks, or as directed by your doctor.
  
  
• Try not to lift anything heavier than five pounds for about a week, or longer if directed by your doctor.
  
  
• Wear a well-fitting, very supportive bra 24 hours a day for the first week.

Breast Cancer Treatment and Surgery in India

India has been recognized as a new medical destination for Breast Cancer Treatment and Surgery. Thousands of global patients from all across the world fly to India for various medical treatments and surgeries of high quality delivered as practiced in the developed nations like the US, UK and that too within their budget costs.

The Indian Oncologists performing different procedures of Breast Cancer Treatment and Surgery in India are highly qualified, skilled with many years of experience and are affiliated with many renowned medical organizations. India provides the services through most leading doctors and cancer surgeons.

The Cancer Hospitals in India are well equipped with the most advanced medical treatment and methodologies. They have the most extensive diagnostic and imaging facilities including Asia’s most advanced MRI and CT technology. These are available in the following cities at reasonable costs in the following cities:

Cost of Breast Cancer Treatment and Surgery in India

India offers incredible cost saving in various procedures of Breast Cancer Treatment and Surgery, which goes to around 80% less than prevailing USA or UK rates. Even with travel expenses taken into account, the comprehensive medical tourism packages still provide a savings measured in the thousands of dollars for major procedures. A cost comparison of various medical treatments can give you the exact idea about the difference:

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