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

 

Role of a Breast Cancer Husband

Western statistics reveal that nearly seven out of ten marriages touched by breast cancer do not survive and ultimately lead to divorce. With the incidence of breast cancer increasing in young Indian women, this problem will soon be evident here as well. In fact, during my tenure in Bangalore, I did come across a few patients who were deserted by their families after their diagnosis of Breast Cancer.

Although there is no magic formula for a couple to weather this difficult period, but some of these points can help husbands support their wives during their Breast Cancer treatment.

  1. Stand by her during the treatment & tell her that you ‘love’ her

In a marriage or any intimate relationship, silence is not golden. The strong silent type need not apply for the position of husband, lover, best friend, confidante and supporter of a woman with breast cancer. Your bride, your wife, needs and wants to hear from you. Actions may speak louder than words, and you may take all the right actions, but speaking words brings comfort, reassurance and knowledge of your inner feelings. She cannot read your mind. Being there for her is more than physical or economic security. Words have meaning. And the three most important words in the English language at this time, at this moment, when together you are facing her mortality, are: “I love you.”

  1. Involve her in the decision making

It is not easy for a lady to deal with the diagnosis of breast cancer. Often it has been seen in India that husbands and family members make clinical and personal decisions on their behalf. Although these ladies appreciate some of the decisions but they would love to be part of others, which involve their future.

A simple example is deciding between a mastectomy & breast conservation surgery. Family members err towards the side of mastectomy but in reality a lot of young patients actually want breast conservation surgery. It always helps to consult them in private and then take a collective decision.

  1. Go to Her Appointments

It is not what you do when you accompany her to treatment, but rather the act itself that speaks volumes to her. It also gives you some sense of empowerment. You are more than a helpless spectator cursing the damned disease. You have joined the battle.

  1. Sometimes humor helps

Funny, it does. There’s even a study to prove it, by psychologist Sharon Manne of the Fox Chase Cancer Center in Philadelphia. Couples who laughed at cancer coped better with the stress of treatment. We know that the act of laughing is itself healing. It makes us feel better and helps us get better.

  1. Continue to enjoy as a couple – she is NOT invalid

Treatment can be grueling and tiring, but you both need to live your life as fully as possible. Continue to enjoy what you enjoy individually and as a couple, particularly the latter. Don’t let cancer put an end to your personal and social life.

 

If you follow these simple steps, you can also become a Proud Husband of a Breast Cancer Survivor

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Article By:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital

Twitter chat on Stigma associated with Breast Cancer In India

We are starting a series of twitter chats, which will focus on the issues faced by breast cancer patients and survivors in India. This is a first of its kind initiative, which will highlight the ‘Indian scenario.’ This chat is going to be hosted by @realtalkies on twitter.

The details of the chat are mentioned in the images. Feel free to join in and contribute in this important discussion.
Follow me during this chat on Twitter: @docrohan

I will be discussing some the issues raised by me in the blog post – “Is cancer diagnosis a social death sentence in India”

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Details of #BCIndia Twitter chat

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Midline breast cancer without a lump in the breast: an extremely rare case

Sometimes breast cancer tends to surprise us and present in an unusual manner. In India, due to lack to awareness and a stigma attached with breast cancer, females from the rural set-up tend to present with locally advanced breast cancers. I happened to encounter one such case couple of years back and managing this case turned out to be quite challenging. We managed to publish this case in the Breast Disease Journal and it generated quite a discussion in all the forums where it was discussed. [Breast cancer presenting in the midline without a lesion in the breast: a therapeutic dilemma. Khandelwal R, Poovamma CU, Shilpy C, et al. Breast Dis. 2013 Jan 1;34(2):57-9.]

A 48- year- old post-menopausal lady presented to the Breast Clinic with complaints of a rapidly enlarging chest swelling for the last 8 months. The lesion had ulcerated one month back and she complained of a foul smelling discharge from the growth. There were no complaints of any lumps in the breast or axillae.

On examination, a 14 x 10 cms ulcero-proliferative lesion was seen over the midline of the chest extending 4 cms on either side of the midline. The lump had restricted mobility over the underlying chest wall. In addition, the patient had multiple, enlarged lymph nodes in both the axillae. No enlarged lymph nodes were felt in the supraclavicular fossa. No organomegaly was palpable in the abdomen.

Lesion over anterior chest wall

Lesion over anterior chest wall

A provisional diagnosis of soft tissue sarcoma of the chest wall was made but the presence of bilateral, hard axillary lymph nodes raised a suspicion of a breast carcinoma. Patient was then subjected to a CECT of the chest, which revealed a fungating soft tissue mass over the chest with bilateral axillary lymphadenopathy. MRI of the breasts failed to pick up any lesions in the breast. CT abdomen was unremarkable. A PET-CT done to look for distant metastasis, revealed a mildly hyper-metabolic anterior chest wall mass [SUV max 4.8] with bilateral axillary lymphadenopathy [SUV max 5.1]. There was no evidence of involvement of supraclavicular or internal mammary lymph nodes. No distal metastasis was observed on PET.

Following the imaging tests, an incisional biopsy of the lesion was performed, which to our surprise revealed an invasive ductal carcinoma (grade II) with DCIS. Immunohistochemistry revealed the tumor to be ER and PR positive but HER2 negative.

The case was extensively discussed in the tumor board and a decision was taken to treat the patient with neo-adjuvant chemotherapy. Patient received weekly Paclitaxel for six weeks, which was associated with a good response and the tumor regressed in size. A PET scan done following NACT revealed a residual lesion in the midline with bilateral axillary lymph nodes. PET scan did not reveal any lesions in the breast.

Following a good response to NACT, the patient was taken up for a wide local excision of the tumor with bilateral axillary dissection. As none of the breasts had any lesions, they were not addressed during the surgical procedure.  Patient had an uneventful post-operative period and three weeks later she was started on adjuvant chemotherapy, which was followed by radiotherapy to the chest wall.

Post Surgery

Post Surgery

Following completion of radiotherapy, the patient was started on Letrozole and was kept under regular follow-up. The patient remained symptom free for 1 year after surgery, after which she was lost to follow-up.

This was an extremely rare presentation of breast cancer and managing this patient was a therapeutic dilemma.