Breast Cancer Conquerors

Breast cancer treatment is a long drawn battle for the patient and her family and it is always a joyous moment when they finish their breast cancer treatment.

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This special day when they finish their treatment, marks an important phase, when they transition from being a patient to a cancer conqueror/ survivor. In India, despite so many myths surrounding cancer treatment, it is good to see some ladies determined to fight the disease despite all odds. Hats off to their fighting spirit!!

 

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Mondor’s Disease

Mondor’s Disease
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1. Type of superficial thrombophlebitis (inflammation of the veins_  which involves the veins of the anterior chest wall & breast
2. Presents like a painful, cord like structure just below the breast (image)
3. Most commonly involved vein is the lateral thoracic vein. Other veins involved are – thoraco-epigastric & rarely superficial epigastric
4. Clinical features – pain along the lateral chest wall and below the breast. Patients may also complain of a cord like structure. Some patients present with just breast pain and the cord is detected by the breast surgeon
5. Benign, non cancerous lesion, which is self-limiting
6. Management – Consult a breast surgeon and get imaging done to rule out any other breast lump.
7. Treatment involves warm compresses and anti-inflammatory medicines. It usually resolves in 4-6 weeks. 
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Pic Courtesy: http://www.cosmeticsurgeryforums.com

Why do we need a Mentor?

Years ago a school teacher saw a child playing games in the bushes. The child was no extraordinary, he was a simple child, playing games that kids of his age did. But it was that teacher who recognised the extraordinary and nurtured him to become one of the greatest Kings this land ever saw. It was the under the mentor ship of Chanakya that Chandragupta Maurya was able to establish the Kingdom of Magadha. Without the mentor, the king would have been nothing.

A mentor is a term derived from an old Greek legend in which a king who was heading for a war had to leave his son in the care of his very close friend, instead of leaving him to his wife and Mentor grew up to be a very wise and noble king.

You don’t need a mentor to gain knowledge. You have books and online sources for that. You need a mentor to learn the practical details and proper implementation of knowledge. These intricacies and working knowledge can only and only be taught by a guru or a mentor.

So why do we need a Mentor?
1) Recognising and achieving your potential: Had it not been for Chanakya, Chandragupta would have never realised his potential as a king. It was only after his mentor recognised his true potential, he became what he was. Similarly in life we can achieve what we want by perseverance and hard work, but we need a mentor to know our potential and bring out the best in us.

2) They know the right doors:
Dipa Karmakar made our country proud with her Produnova vault, had it not been for her mentor she would have never known what a Produnova vault is and the intricacies of landing it. She had the talent, but it was her mentor who shaped it and guided her on the path to reach the Olympics.
A teacher knows whats important and what are the shenanigans. They can show you correct ways and the right doors. This makes our journey to success more efficient and easy.

3) Use their pool of experience:
Your mentor knows more than you. They have been around longer and have seen things that you have’t. This means their experiences can tell you the mistakes that have been committed before and guide you towards the correct direction. Our life is too short to make all the mistakes ourselves and learn, it’s better to learn from the past and make a better future. They have walked the walk that you are walking, learn from them.

In the end I would like to quote the famous couplets by Kabir,
Guru govind dono khade, kaake lagu paaye. Balihari guru aapno, govind diyo bataye
“Teacher and Lord are both there, whom to be adore. but teacher you are great, who told us that god is greater”

DEAD POETS SOCIETY, Robin Williams, 1989

Image Source: Firstpost.in

This article was written in collaboration with Dr Prerna Motwani, Medical Content Manager, Curofy- India’s largest community of verified doctors and Dr Rohan Khandelwal.

Importance of maintaining a pain diary in Breast Pain

Breast pain (or mastalgia) is common problem faced by women at least once during their lifetime. It can range from mild pain to a chronic debilitating condition, which can even push a patient to the verge of depression. In fact, in the last one month, I have encountered two such patients, who have stopped socializing because of excruciating breast pain.

Mastalgia has varied causes and it can broadly be divided into cyclical & non cyclical causes. Cyclical mastalgia (breast pain) usually occurs because of hormonal fluctuations and the intensity of pain varies according to the menstrual cycle. On the other hand non-cyclical mastalgia usually occurs because of musculo-skeletal causes and the pain persists all throughout the month.

For the correct diagnosis and management of breast pain, it is important for the doctor to know certain points regarding the pain like:

  1. duration of pain
  2. location – restricted to one point or spread over the entire breast
  3. intensity of pain
  4. fluctuation in intensity of pain over a few days
  5. Radiation of the pain – is the pain running to some other site from the breast
  6. Is there a lump associated with the pain? Usually breast cancer does not lead to pain in the initial phases
  7. what makes the pain better
  8. what makes the pain worse

 

These facts along with clinical examination and an ultrasound/ mammography help the doctor in determining the cause of breast pain. The above mentioned points can easily be maintained in a “pain diary”, which is something which I ask all my patients to maintain.

Following is a format which I hand over to them and ask them to maintain it regularly for a period of 30-40 days.

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This information helps me in:

  • Assessing the cause of pain
  • Judging the response to therapy

So the next time you visit your doctor with complaints of breast pain, make sure you maintain a ‘pain diary’, so that your treatment can proceed smoothly.

 

Article by:

Dr. Rohan Khandelwal

Consultant, Department of Breast Diseases & Cancer Care

W- Pratiksha Hospital, Gurgaon

 

How to interpret an ER/PR report in Breast Cancer

All human cells have some receptors present on their surface. Normal human breast cells respond to the female hormones i.e. estrogen & progesterone, therefore they carry estrogen (ER) and progesterone receptors (PR).

Like healthy breast cells, majority of the breast cancer cells also possess ER & PR receptors. Every breast cancer is different and knowing the fact whether the breast cancer is positive for ER, PR receptors, has an important bearing on the management of the patient’s disease. If a patient’s breast cancer shows these receptors, then they can be subjected to hormonal therapy, which can control the tumor growth by blocking these receptors.

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Sometimes during the course of treatment, the breast cancer cells which are ER, PR positive initially can lose the receptors and become ER, PR negative and they stop responding hormonal therapy. Rarely, the opposite of this is true as well.

Considering this background, it is important that a lady knows how to interpret the hormone receptor status report & understand the implications in breast cancer management based on this report.

Most laboratories used a special method to stain these receptors known as IHC (immunohisto-chemistry). Each lab has their own way of analyzing these receptors, which is why I am covering the most commonly used methods:

  • A percentage that tells you how many cells out of 100 stain positive for hormone receptors.You will see a number between 0% (none have receptors) and 100% (all have receptors).

 

  • Allred score between 0 and 8. This system looks at what percentage of cells test positive for hormone receptors along with the intensity of staining. This information is then combined to score the sample on a scale from 0 to 8. The higher the score, the more receptors were found and the easier they were to see in the sample.

 

  • Positive or negative report

 

Different labs have different cutoff points for calling the cancer either positive or negative. For example, if less than 10% of your cells — or fewer than 1 in 10 — stain positive, one lab might call this a negative result. Another lab might consider this positive, even though it is a low result. Some studies have shown that even cancers with low numbers of hormone receptors may respond to hormonal therapy. A score of “0” means that the patient is hormone receptor negative and will not benefit from hormonal therapy.

Some points to remember

Once the report is declared, your oncologist with discuss your hormone receptor report with you and these are some points, which will help you in understanding your report:

  • ER+/PR+:Majority (65%) of the Breast cancers are ER, PR positive and these patients are candidates for hormonal therapy.
  • ER positive but PR negative OR ER negative but PR positive:Around 10-13% patients fall in these two categories. Despite one of the receptors being negative, these patients are still candidates for hormonal therapy.
  • ER-/PR-:Around 20% patients fall in this category and they are not considered to be candidates for hormonal therapy.

 

If your test result is positive for ER/ PR, you should discuss the role of hormonal therapy with your oncologists. Hormonal therapy helps in preventing the recurrence of disease in patients with localized breast cancer whereas it keeps the tumor growth under control in patients with metastatic breast carcinoma.

 

Article by:

Dr. Rohan Khandelwal

Consultant, Breast Onco-Surgeon

W Pratiksha Hospital,

Gurgaon, India

Girl Power 

Proud of you #SakshiMalik. The six minutes in the ring were just a small part of the fight, which started right from birth in a state where the incidence of female foeticide is extremely high and a girl child is looked down upon. Your grit and determination to overcome all odds and win this medal is really commendable. Hats off to you! #SaveTheGirlChild

From scratch to becoming one of the top 100 Oncology blogs in the world

After a hectic day of work in Bangalore, I was having a casual discussion with Dr. Sumer Sethi, who is one of the most influential doctors on the internet & a great motivator. During our discussion, he encouraged me to start writing a blog about my experiences as a Breast Surgeon. Breast Surgery was a relatively new branch at that time and Dr. Sethi was of the opinion that a blog would be a great medium to create awareness about Breast Cancer & my experiences as a Surgeon. That is when ‘Random Reflections of a Breast Surgeon‘ was born.

Initially, it was quite difficult for me to take out time to write blogs but gradually it became a habit and I started enjoying it. In due course of time, the blog became really popular among patients suffering from Breast diseases and medical students aspiring to become surgeons.

Every now and then, encouraging messages from patients, well-wishers and students have motivated me to keep on pushing the boundaries of my blog. The latest recognition by Feedspot of nominating my blog as one of the Top 100 Oncology Blogs in the World has just strengthened my resolve to continue spreading my experiences with the world.

In the last few months, I have started encouraging patients/ students/ doctors to share their experiences on my blog and if anyone is interested in highlighting their work, you can email it to me on rohankhandelwal@gmail.com. Also for patients, I have also launched by new website – http://www.breasthealth.in , which provides details about all Breast Diseases & their management.

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