Axillary Lymph Node Biopsy

Axillary Lymph node (underarm gland) enlargement is a common problem among Indian women.

Patient usually present with complaints of pain in the armpit and/or lumps in the underarm area.

Majority of the times these lumps are reactive in nature, that means they enlarge due to non specific causes like mild hair follicle infection, which can occur after shaving or waxing of hair.

On the other hand, these glands can also become enlarged due to:

  1. Infections like tuberculosis, which can be associated with weight loss & fever
  2. Cancers – commonest cancer which gives rise to underarm nodes is breast cancer. Axillary lymph nodes are the first point of spread from breast cancer.

 

An ultrasound can confirm the diagnosis of axillary lymph node enlargement and if these glands do not resolve after a course of antibiotics, they require a FNAC (fine needle aspiration cytology or in simple terms a ‘needle test’).

If FNAC is inconclusive, then an axillary lymph node biopsy is required to confirm the diagnosis. Axillary lymph node biopsy is a minor procedure, which can be performed as a day care surgery.

 

If you or anyone whom you know has underarm pain or lumps, it is best to get yourself examined by a surgeon.

 

 

Information provided by:

Dr. Rohan Khandelwal

Breast Cancer Surgeon

W Pratiksha Hospital

Gurgaon

 

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 

Changing trend of Breast Cancer incidence in India

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Breast Cancer and the age wise distribution in India

This graph depicts the changing trend in the age wise distribution of breast cancer in our country. Over the years, the incidence of breast cancer has increases dramatically and there has been a higher increase in the incidence between 30-40 years of age. This is mainly attributable to the lifestyle changes visible in the Indian society. Another major factor, which is difficult to quantify is the increase in pollution levels.
It is important we realise this change and encourage patients to take corrective measure to control the modifiable risk factors like smoking, alcohol consumption, obesity. Also increased awareness is required, so that these cancers can be detected early.

Is your waist putting you at risk of Breast Cancer?

Since last decade breast cancer has been on a steady rise in India. It is now the most common cancer in many cities and 2nd common cancer in rural areas, accounting to 25% of all female malignancies. Increased incidence of breast carcinoma has been attributed to a variety of factors including obesity, decreased breastfeeding, alcohol consumption and smoking etc.

 

Though obesity has been long associated with the prevalence of breast cancer, it has traditionally been measured in BMI, ie the average distribution of fat all through the body. What BMI fails to do is to identify where the fat is actually accumulating.

 

According to a study published in BMJ, a woman’s waist size is a better predictor of breast cancer than BMI. The fat tissue around waist though more metabolically active, increases the production of estrogen in the body which accelerates the growth of breast tumor.

 

What does the research say?

Researchers from UCL University college, London studied 98,324 women of >50 postmenopausal age who had no history of breast cancer. These women were made to fill questionnaires detailing their history of health, height, weight, lifestyle and also their skirt sizes. The participants were followed up subsequently over years and their health, lifestyle and skirt sizes were documented. During the follow up 1090 women developed breast cancer.

 

The result showed that “Between 25 and postmenopausal age, an increase in Skirt Size by one unit every decade increased the risk of postmenopausal breast cancer by 33% while decrease in Skirt Size was associated with lowering of risk.”

 

The Impact

Expanding waist has been associated with other forms of cancer in the past including that of pancreas, prostate, ovaries and cervix. It’s no surprise that the belly fat also plays a role in breast cancer.  But this result showed that the increase in skirt size, independent of BMI, increased the risk of breast cancer and that fat accumulated around waist is more dangerous than fat accumulated on other parts of the body.

 

This visceral fat can do more harm to a person’s body than the subcutaneous fat. Causing increased levels of estrogen, insulin resistance and fatty liver.

 

The Implication

Increase in waist size can be linked with the sedentary lifestyle and unhealthy food habits of this generation. With obesity emerging as a global epidemic, women now have a simple method to check their health and take action against it. Instead of going through the hassle of measuring their weight and height to measure their BMI, women can just measure the size of their waist.

 

With the discovery of this association between waist size and breast health, women now have the power to change the course of their health. They not only have to be made aware of the importance of their breast health but also informed that they can now take charge of their health and change the course of it.

 

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The Intervention

The only way to reduce belly fat is by doing regular exercise and burning it off. Regular exercising not only reduces the risk of breast cancer but also of other cardiovascular diseases. 30 mins of exercise 3-4 days a week is what is recommended for women.

 

By simple interventions like regular exercising, abstaining from alcohol and smoking and maintaining a healthy weight a woman can reduce her breast cancer risk by 20%-30%.

 

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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Endopredict vs Oncotype Dx for Breast Cancer

A new test, called EndoPredict, can predict the risk of a woman’s breast cancer spreading within 10 years of diagnosis more accurately than the current Oncotype Dx test. Also, research found that the results can be made available more quickly.
 
A study, published in the Journal of the National Cancer Institute, compared EndoPredict with Oncotype DX. Both tests can predict whether breast cancer will spread in women with oestrogen receptor positive, HER2 negative (ER+/HER2-) disease. This is a sub-type of breast cancer that accounts for about two-thirds of all cases.
 
The new EndoPredict test analyses eight different genes found in a sample of a patient’s tumour. This information, as well as the size of the patient’s tumour and their nodal status – whether the cancer has spread from the breast to their lymph nodes – are then used to determine the patient’s risk of their breast cancer spreading in the next 10 years.
 
An ‘EPclin’ score categorises patients into low- and high-risk groups. Patients placed in the high-risk group would be recommended to have chemotherapy, but those in the low-risk group could be spared this treatment – and the debilitating side effects associated with it.
 
In the study it was found that EndoPredict was more accurate and the results were available faster as compared to the conventional Oncotype Dx test.
 
Points to remember:
1. EndoPredict is meant for early breast cancers which are ER, PR positive (same as Oncotype Dx)
2. It analyses 8 genes as compared to 21 in Onctoype Dx

8 simple tips to reduce your risk of developing breast cancer and aid in early detection

Recent data has indicated that breast cancer is the now the most common cancer among Indian women. One in 22 Indian women will be affected from this cancer during their lifetime. A healthy lifestyle can help in reducing one’s risk of getting this disease.
I am sharing 8 simple tips, which can help in reducing your risk of developing this disease and also help in early detection.
1. Regular exercise – at least 30 mins of exercise 4 times a week
2. Avoid smoking
3. Avoid alcohol consumption
4. Over-weight and obese individuals have a higher incidence of breast cancer. Maintain your weight in the normal range
5. Be breast aware – do regular self examinations
6. Clinical breast examination by an experienced breast surgeon after the age of 35 years (annually)
7. Regular mammograms after 40 years of age. Although they just take 10 mins, ladies often decide to skip them. The simplest way to remember this is to ‘gift yourself a mammogram’ on your birthday.
8. If there is a family history of breast cancer, do consult your oncologist to discuss your risk of breast cancer.
#BreastCancer #WorldCancerDay #Cancer
breastcancer
Consultant, Breast Onco-Surgeon
Gurgaon, India