Operative Video of Chemoport Insertion

Chemoport is a vascular access device which helps in administering chemotherapy with relative ease. The port device is anchored to the upper part of the chest and the catheter is usually placed in one of the large veins.

 

Advantages of a port:

  • Needle is inserted in the port system and not the vein. This avoid puncturing of the vein and complications like thrombophlebitis, which are very common in patients where chemotherapy is given through a peripheral line.
  • In many patients it is difficult to insert an IV line as their veins are either very thin or deep seated. Chemoport are kept in the subcutaneous plane and they are easily felt. This results in a safer and more efficient access than an IV line.
  • Chemotherapy medications can sometimes extravasate through a peripheral IV line (cannula) and cause permanent damage to the tissue and skin. Such events are very rare with a port.
  • Chemoports can be utilized for delivering chemotherapy, IV fluids, blood, medications. It can also be used for drawing labs and injecting contrasts during PET/CT
  • A port needle can remain in situ for upto 7 days, if handled properly whereas an IV line usually needs to be changed after 3-4 days.
  • Chemoports can be kept for 2-3 years and they are quite handy in patients who require prolonged chemotherapy sessions. IV lines are temporary and need to be inserted every time a procedure is to be carried out.

Disadvantages of a port:

  • Chemoport should be flushed every four weeks to prevent it from getting blocked
  • Chemoport placement requires a  minor surgical procedure; IV access does not.

Both chemoports and IV lines are associated with certain risks but the incidence of the complications is quite low:

  • Infection
  • Occlusion or blockage of line
  • Dislodgement of port or line
  • Damage to the port

 

In our Breast Cancer unit, we encourage patients to get a chemoport inserted for chemotherapy as it makes their life easier. Another reason for advocating chemoports in breast cancer patients is that the ipsilateral arm (same side as the breast cancer) cannot be used for IV access, as it increases the risk of lymphedema in them.

 

 

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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%.

 

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. 
mondorscords2
Pic Courtesy: http://www.cosmeticsurgeryforums.com

Breastfeeding – a simple way to keep breast cancer at bay!

Breastfeeding has been known to reduce the risk of breast cancer and this effect is more pronounced in pre-menopausal women.

In an analysis of 47 studies, mothers who breastfed for a total duration of more than one year (all pregnancies combined) had a lower chance of developing breast cancer as compared to those who never breastfed.

Mothers who breastfed for more than two years got about twice the benefit as compared to those who breastfed only for one year.

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Interesting Mammogram #2

Case: 45 year old lady that presented with a painless, progressive breast lump on the left side of 7 months duration.

On examination: A10x10 cms firm, mobile lump involving the entire left breast was palpable. There were dilated veins overlying the lump with no palpable axillary lymphadenopathy.

Mammogram is shown below:

image

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Mammogram was suggestive of an encapsulated lesion with smooth margins, probably a phyllodes tumor.

Tru-cut : Phyllodes tumor
HPE: Benign phyllodes

Learning objective: Benign encapsulated tumor on mammogram suggestive of phyllodes. Capsule is visualized as a radiolucent halo around the lump.

 

Information provided by:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital