Changes in 8th AJCC Classification of Breast Cancer

Recently, the eighth edition of the TNM classification of AJCC (American Joint Commission of Cancer) was released. This had a few notable changes from the 7th edition, which have been highlighted below:

  • Immunohistochemically detected tumor markers (ER, PR, HER 2 neu) that are known to have great practical treatment importance are now incorporated into the staging system to refine prognosis of breast cancer
  • The eighth edition of the staging system also uses genomic assays (Oncotype Dx, Mammaprint, PAM 50) when available to downstage some estrogen receptor-positive, lymph node-negative tumors.
  • Lobular carcinoma in situ is removed from the staging system because it is not a malignancy but a risk factor. It is no longer considered Tis.
  • The expert panel clarified that the postneoadjuvant therapy pathological T category (ypT) is based on the largest focus of residual tumor, if present. Treatment-related fibrosis adjacent to residual invasive carcinoma is not included in the ypT maximum dimension.

 

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The magic of a healthy doctor-patient relationship

The relationship between doctors and their patients has received philosophical and spiritual attention since the time of Hippocrates and still remains a keystone of care. But, unfortunately over the years, this special relationship has undergone a drastic transition. The onus for this actually lies on both the parties. On one hand, increasing number of litigations and the irrational use of social media has made the doctor fraternity more cautious while on the other, many patients claim that doctors treat them as consumers and the healing touch and warmth has gone.

Bobby Fischer once said “Nothing is so healing as the human touch”. As a doctor, it’s very important to counsel & interact with patients, so that their fears regarding the disease can be alleviated.

As a cancer surgeon, I feel that a healing touch is as important as a good surgical hand. Every doctor should make a sincere effort to strike a healthy relationship with their patients.

May the force be with you!!

 

 

 

(This was a card I recently received from one of may patient’s, whom I had treated for cancer)

Is it sexual harassment? 

Just got a very interesting message from a patient of mine:
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Should I call it sexual harassment ? Whenever I tell people I have breast cancer👙 they look at my breasts and keep guessing which one 🤔
While I do not bother to look at others kidney, prostate or rectum.

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These warriors are already battling this dreaded illness and they need our full support but the society just makes them more conscious of their disease.
Would love to know your views regarding this.

Interesting Mammogram #5

41 year old lady with a left breast lump since last 6 years with rapid increase in size since the last 4 months. Patient was concerned that she is suffering from breast breast cancer and therefore got a mammography done and presented to my clinic.


A tru- cut biopsy was done and it revealed it to be a phyllodes tumor, which after resection turned out to be a malignant phyllodes tumor with Liposarcomatous differentiation. 

Case uploaded by:

Dr. Rohan Khandelwal

Breast Cancer Surgeon

W Pratiksha Hospital, Gurgaon 

International Women’s Day 2017

Women are truly the real architects of society – I am fortunate to know so many courageous women, who continue to fulfil their personal & professional responsibilities despite battling breast cancer. Hats off to their fighting spirit!! Wishing all these beautiful women a very happy International Women’s Day

 

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Interesting Mammogram #4 

47 year old lady with complaints of bilateral breast pain since 3 months. Pain was non cyclical and relieved by oral paracetamol. She had a hysterectomy 6 years back and she was a known asthmatic.

On examination, she has multiple tender nodules in both the breasts, localised in the peri-areolar region. 

Mammogram revealed multiple, well defined, rounded densities in both the breasts with a rim of calcification around them (refer to figures). 

Multiple round densities in the breast


Ultrasound done revealed dense fibroglandular tissue with multiple sub-centimetric cysts in the breasts. 

Differential – 1. Multiple oil cysts with calcification 

2. Cysts secondary to fibroadenosis

Case managed by:

Dr Rohan Khandelwal

Consultant, Department of Breast Diseases and Cancer Care

W Pratiksha Hospital, Gurgaon  

Breast Conservation Surgery for Early Breast Cancer

Breast Cancer Surgery has undergone a lot of change in the last few years. Earlier, mastectomy (full breast removal) was the norm for breast cancer management, but nowadays if the cancer is detected early, Breast Conservation Surgery (BCS) can be carried out.

In breast conservation surgery (BCS), only the cancerous lump and some portion of normal breast tissue around it is removed, preserving the rest of the breast, thereby leading to a better cosmetic outcome for the patient. BCS is also psychological and physically better for a patient suffering from breast cancer. The overall survival, whether the patient undergoes BCS or mastectomy for breast cancer treatment, remains the same.

 

Breast conservation surgery should be carried out by a trained breast cancer surgeon (breast onco-surgeon). A frozen section analysis should be done at the time of surgery to confirm that the tumor has been adequately removed.

 

 

 

Information provided by:

Dr. Rohan Khandelwal

W Pratiksha Hospital

Gurgaon