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)

Gynaecomastia Surgery

Gynaecomastia or male breasts is a common cosmetic problem among young males. In majority of the patients no particular cause can be found for this condition.

Surgery for Gynaecomastia/ male boobs involves a combination of liposuction and excision of the gland using a small incision made below the nipple.

At our center, we perform a day care procedure in which the patient goes home the same day after surgery and is fit to resume his work from the next day.

A compression garment has to be worn after male boob surgery for at least 2-3 weeks and it helps in shaping of the tissue after surgery and prevents accumulation of fluid. 

Video uploaded by:

Dr. Rohan Khandelwal

Consultant, Breast Surgeon

W Pratiksha Hospital 

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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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

 

Free Breast Cancer OPD – Early detection is the best protection!!

 

 

Early detection is your Best Protection!!

 

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Initiative by:

Dr. Rohan Khandelwal

Department of Breast Diseases & Cancer Care

W Pratiksha Hospital, Gurgaon

Fat Grafting – a novel technique for breast augmentation

Autologous fat grafting (fat transfer) is a technique in which fat is harvested from the patient using liposuction and after centrifuging, this fat is introduced in the sub-dermal and retro-glandular portions of the breast to augment the breast.

This technique has also been used to fill up post lumpectomy defects following breast conservation surgery for breast cancer.

Advantages of the procedure:

  1. No foreign material or implant is used
  2. Double benefit of liposuction from the donor site
  3. Relatively cheap as compared to an implant based reconstruction
  4. Day care procedure
  5. Natural feel & contour of the breast

 

Potential Drawbacks:

  1. Only 70-80% of fat cells transferred by this technique survive, therefore, there is some amount of volume reduction after the procedure. In some cases, multiple sittings might be required to achieve the desired results.
  2. As these fat cells die, they can sometimes give rise to calcifications, which can be confused for malignant/benign lesions on a mammogram
  3. Haematomas & bruising in the immediate post-op period

 

The following video demonstrates a case of primary breast augmentation using fat grafting: