Breast Cancer Care During COVID19 outbreak

At present, almost half the world is in lock-down due to the corona virus outbreak and it is difficult to predict for how long this situation might remain the same. In India, it is almost certain that the lock-down due to COVID 19 will be extended till at least end of April. Even though we are in a state of lock-down but our body is still functioning and that means diseases like cancer might still be growing inside our system. So how does one deal with a problem like breast cancer/ breast lump during this period.

Tips for existing breast cancer patients

  1. Remain in touch with your treating breast cancer surgeon/ breast cancer oncologist. They will outline the treatment protocol during this period
  2. If you have an early stage breast cancer which is curable, you should not defer your treatment during this period, as it can lead to progression of the cancer.
  3. If you are suffering from cancer which has spread to the body (metastatic breast cancer), then discuss with your doctor if the chemotherapy frequency can be reduced or if you can be shifted to hormonal therapy/ oral treatment for the time being.
  4. Corona virus infection is usually severe in patients who are suffering from pre-existing conditions like cancer, diabetes, hypertension. So, please take all precautions to prevent infections
  • Eat a healthy/ balanced diet. Avoid outside food.
  • Make sure you take your daily dose of  vitamin C. This can either be in the form of a supplement or just a glass of lemonade
  • If you are undergoing chemotherapy (which can lead to reduced immunity and white blood count), please monitor the blood counts and if they are low, consult your breast cancer doctor immediately
  • Wear a mask whenever you are venturing out of your home, especially, when you are going to the hospital
  • Maintain strict hand hygiene. Wash your hands multiple times a day and use a hand sanitizer liberally

 

 

 

 

Recently detected a breast lump – what should you do during this period?

During the lock-down, lot of ladies are taking out time to carry out breast self examination and they are picking up new breast lumps. If you are one of them, I would advise that you consult a breast lump surgeon immediately. This consultation can either be an online consultation or a physical visit to the hospital. In an online consultation, if the doctor feels the need to carry out a physical examination, he/she would call you to the hospital.

A breast lump should not be ignored because if it is cancerous, it can increase in size during this period. A mammography or an ultrasound should be done after physical examination and if the lump is suspicious, a biopsy/ needle test should be done to confirm the diagnosis. If the breast lump turns out to be non cancerous (benign), then the treatment can be deferred till the time COVI19 situation improves. Your doctor can provide you medicines during this period to deal with the problem/ breast pain associated with the lump.

If the lump turns out to be breast cancer, as I have highlighted above, please consult your doctor and make a treatment plan which is suitable to you.

These are testing times for everyone, including patients. One has to be cautious about not getting infected by the virus as well as make sure that their breast cancer/ breast lump treatment doesn’t suffer. If you follow the tips which I have highlighted above, you can tide over this phase without compromising your health.

 

 

This information has been provided by

Dr. Rohan Khandelwal

Breast Cancer Surgeon

CK Birla Hospital, Gurgaon

To book an online consultation with Dr. Rohan Khandelwal, click here

 

What does BIRADS on your mammography/ ultrasound report mean?

Lot of times in my Breast Clinic at CK Birla Hospital, Gurgaon, I get patients who come and tell me that they are suffering from stage III breast cancer. When I ask them how do they know about that, the answer which I usually hear is that “my mammogram/ ultrasound report shows BIRADS III.” Not only patients but I have also seen some doctors getting confused with the BIRADS reporting.

BIRADS (Breast Imaging Reporting and Data Systems) is a standardized way of reporting breast radiology reports.  This helps radiologists categorize patients from a score of 0-6 and it helps breast cancer surgeons in taking decisions based on this score. Having a uniform reporting system is useful because patients might get their radiology and breast disease treatment done at different places.

The score doesn’t imply the stage of cancer and patients should be aware of this to avoid unnecessary anxiety after seeing the radiology report.

  • BIRADS 0 means an incomplete investigation – This usually occurs when a mammogram is done in a patient with a dense breast and it does not yield any meaningful information. In such a case, usually an ultrasound or MRI Breast is done

 

  • BIRADS 1 is a negative scan, which basically implies that there is no lesion in the breast and everything is normal. In these patients we advise them to follow up after 1 year

 

  • BIRADS 2 is suggestive of a benign lesion, which has essentially a 0% risk of cancer and these lumps don’t require a biopsy. They can be followed up in a year’s time. Simple cysts, most typical fibroadenomas fall under this category.

 

  • BIRADS 3 lesions are probably benign and these breast lesions/ lumps should be followed up every 6 months (short term follow-up). These lumps do not require a biopsy/ FNAC but if you have a family history of breast cancer, then the clinician might be inclined to do more tests/ biopsy at this stage rather than wait for 6 months.  Fibroadenomas, duct ectasias can fall under this category of lesions.

 

  • BIRADS 4 breast lumps/ lesions are suspicious lesions and they need to be biopsied to confirm the diagnosis. They are further sub-divided into 4a, 4b, 4c which implies low, medium and high risk for cancer. These patients should be counselled accordingly and a tru-cut/ core needle biopsy should be scheduled as soon as possible. Atypical fibroadenomas, suspicious microcalcifications, duct papillomas usually fall under this category of lesions

 

  • BIRADS 5 lesions are highly suggestive of malignancy and the risk of cancer in these breast lumps is more than 95%. All patients with these breast lumps should be subjected to the tru-cut biopsy, which is preferred over a FNAC (fine needle aspiration cytology)

 

  • BIARDS 6 lesions are when a radiological test is done after confirming the diagnosis of breast cancer.

 

The table below summarizes the BIRADS score and the action which needs to be taken in each category.

The Radiology Assistant : Bi-RADS for Mammography and Ultrasound 2013

 

So the next time you receive your mammography / breast ultrasound report, don’t be surprised to see the BIRADS score. Discuss the report with your radiologist and breast cancer surgeon and take action accordingly. Remember, that all breast lumps are not cancerous and all of them don’t even require a biopsy/ FNAC test.

 

This information has been provided by

Dr. Rohan Khandelwal

Principal Consultant,

The Breast Centre

CK Birla Hospital, Gurugram

World Cancer Day 2018

On the occasion of #worldcancerday, I would like to share the picture of the youngest #breastcancer patient I have treated till now.

She is a 25 year old, mother of a 2 year old who came to me with a small breast lump which she picked up after reading a Hindi article on breast cancer.

Few things which I would like to highlight through this case:

1. Age at diagnosis is reducing. This was my third patient in the 20’s over the last 3 months. Majority of my breast cancer patients are in their 30’s.

So, if anyone you know is suffering from a breast lump, please get it checked.

2. Awareness is increasing, which is an excellent thing. I am seeing a lot of patients with stage 1 and 2 disease, which leads to better survival.

To help create more awareness, each one reading this post should tell one more person about breast cancer and it’s symptoms (painless breast lump, recent change in shape of the breast, bloody discharge from the nipple)

3. Another heartening point is the change in the society’s attitude towards these patients. Friends and family members are becoming more accommodating towards the needs of cancer patients.

Please share this message to create more awareness.

This message has been shared in public interest by Dr Rohan Khandelwal, who is a Breast Cancer Surgeon at Gurgaon / Delhi NCR

Fibroadenoma – clinical presentation & surgery

Fibroadenomas are the most common cause of a breast lump, especially in young ladies. Due to increased awareness, more and more ladies are getting scans done, on which fibroadenomas are detected. In this video, I have explained the presentation and the surgical management of fibroadenomas in Hindi.

 

If these breast lumps are very small, they can be managed conservatively (without surgery) but if they are causing pain, increasing in size or there is a family history of cancer, it is best to get these lumps removed by a minor breast surgery.

As these lumps occur in young patients, it is important that the surgeon removes them without leaving a scar behind. In case you are detected with a breast lump, which is suggestive of a fibroadenoma, it is best to consult an expert breast surgeon, who is routinely performing such surgeries.

For more details regarding fibroadenoma surgery, please click here

 

Importance of Breast Cancer Support Groups

The incidence of breast cancer in India is increasing at an alarming rate and more and more ladies are being detected with this disease in their 30’s and 40’s. 

Breast cancer not only affects the physical appearance of the patient but also has a huge impact on their mental and psychological well being. In addition to the patient, the family also becomes part of the treatment.

Once patients finish their treatment, it is important for them to get back to their daily routine, so that they can keep their mind off the disease. Family, friends and strong support group play a huge role in this aspect of a breast cancer warrior’s journey.

To celebrate these warriors, we recently organised a support group meeting at W Pratiksha Hospital, Gurgaon, which was well attended by many breast cancer patients and their families. 

Greenish Nipple Discharge

 

 

 

Nipple discharge is a common problem with which ladies present to our Breast Clinic. Nipple discharge can be of many types ranging from clear fluid to frank blood.

Greenish nipple discharge is commonly seen in ladies between the ages of 40-55 years. It is common in ladies who smoke and those are suffering from diabetes.

Breast Cancer should be ruled out in all these patients by doing a triple assessment, i.e. clinical examination, imaging & biopsy. Once cancer has been ruled out, patient should be re-assured and if there is any inflammation, antibiotics can be given. In case of persistent discharge and a lump, the implicated ducts can be surgically removed.

 

 

Breast Cancer Treatment Completion

We don’t remember days, we remember moments

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It’s always a delightful moment to see the smile on a patient’s face, when they conquer breast cancer.