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SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… While all this continued as the standard of care for the first 65 years of the 20th century, some smart minds in the medical field started questioning the necessity of performing such radical surgeries to get optimum results. Trials got underway to compare mastectomy versus breast conservation surgery in the 1970s. A pathologist turned surgeon, Dr Umberto Veronesi, pioneered the most convincing trial in Milan. He was able to show that breast conservation surgery (removal of the lump with a surrounding 1 cm margin of normal breast tissue) followed by radiation therapy to the rest of the breast in properly selected patients yielded the same results as a complete removal of the breast. I am quite convinced that it is the pathologist in this surgeon who urged him to go for this trial. He had probably seen while looking at the breast as a pathologist that far too much was being done to address small cancers in the breast. Finally, women with breast cancer had a choice…. For more information on breast cancer, please contact Dr Geeta Kadayaprath, Breast Surgeon, Max Cancer Centre, Delhi, India
SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… ………..And that brings us back to Neena. An MR mammogram was done keeping in view her age and dense breasts. The MR mammogram showed a solitary 2cm lump in upper half of the breast with no significant lymph nodes in the armpit. With this newfound information, I opined that I would offer her breast conservation surgery with oncoplasty (surgical technique to restore shape to the breast) and sentinel lymph node biopsy (few nodes in the armpit sampled guided by radio-isotope and blue dye, sent to pathologist to check for any spread of disease). Her joy knew no bounds and she opted to go ahead with breast conservation surgery. The surgery went off well and fortunately for her, the sentinel node biopsy came back as negative for spread. She did not require all the nodes in the armpit to be removed with its attendant 20% risk of developing arm swelling. Her risk of arm swelling is probably less than 5% now. She was discharged the next day, without any tubes coming out of her body. She was complete in a sense………….and there was really no way to tell she had undergone surgery for breast cancer! For more information on breast cancer, please contact Dr Geeta Kadayaprath, Delhi, India
It was Breast Support Group meeting on Thursday, 18.12.14.The Champions who had been through the journey of breast cancer had come in to encourage the ones who had just started treatment. What is exceptional about this interaction is that the conviction of being able to go through treatment goes up manifold when the ones who have gone through the process and have recovered completely, counsel the new kids on the block. I believe it is the fear of the unknown and the feeling of isolation that puts you on the back foot. The interesting methods of coping with the situation related by the champions, is very encouraging. The smiles, laughters, jokes...... all give the impending process of treatment, the much desired sanity!!! For more information on breast cancer, please contact Dr Geeta Kadayaprath, Delhi, India
Breast cancer is a growing problem in India and all of Asia and threatens to deluge our health services by 2030.What is worrisome is that we do not have the resources to match the growing incidence. We have to start looking for indigenous solutions to our problem of breast cancer. We do have a good pool of talent especially in the autonomous institutions and the private sector, doing good work but there is very little support to encourage them to pool together data and make sense of it. The numbers that we see every year should, ideally, have provided us with a lot of answers, had we pooled our data and presented it to the world. In an attempt to push this possibility, I brought together like minded surgeons and created a group, the Delhi Breast Oncology Group (DBOG), on 6th November, 2014.We are in the process of giving it a formal shape and the first step in this direction will be taken on the 3rd of January 2014, when we meet again. Max Cancer Centre will host this meeting and the first CME(case discussions) as well on 3.1.15. All clinicians with an interest in breast cancer ( Surgeons, medical oncologists, radiation oncologists, radiologists, pathologists etc.)are cordially invited to attend this program. For further information, please contact Dr Geeta Kadayaprath, Head , Breast Surgical Oncology, Max Cancer Centre, Patparganj, Delhi, India
Breast conservation is better than before. With oncoplastic surgery, it is possible to restore the shape of the breast after surgery for breast cancer. Dr Geeta Kadayaprath, Head, Breast Surgical Oncology, Max Cancer Centre, Patparganj, Vaishali, Noida
Yesterday I visited my niece and was on the phone talking to my patients, sorting things for them. When I finished, she asked me, ‘Isn’t your profession stressful?’ I was quick to say NO. The conviction in my tone has taken many years to come. I recall my early days as an oncologist and in particular, this vivacious young lady who had a relatively advanced colorectal cancer with involvement of her ovaries. She had undergone surgery elsewhere, 4 weeks prior to coming to our unit. Her abdominal wound lay open and was pouring out fecal matter and abrasive intestinal juices, consuming her skin.I could not come to terms with the unfairness of the situation, then. Why was this young lady with the most sparkling, hopeful eyes dealing with this horror? I wanted to pull her out of this mess and diligently did my best to improve her nutrition, take care of her wound and her medication. She and I would talk a lot- her dreams, her aspirations, her twins, her loving husband, her family...we became good friends! Her surgery was planned and executed well. She was recovering well and she wanted to be home to celebrate her twins’ birthday. I assured her she would. And then that day arrived, when she walked. She walked for the first time after 8 weeks. I was thrilled and went home thinking she would be out of the ICU the next day. I was going up to the hospital the next day when I got a call that she had had a cardiac arrest. I thought I had heard wrong. I ran up to the ICU and before I reached, she was gone. Pulmonary embolism had taken her away. I was distraught and I cried, rather howled, like I had lost one of my own.An elderly physician put an arm on my shoulder and said, ’ This is certainly not the last time you will have to deal with this. Don’t get attached to the outcome of what you do. Do your best but remain detached from the outcome’. Those words have stuck and I have grown since. My focus is entirely on what I can do for the person who sits across the table and entrusts his or her life to me. I do my best to understand the problem, execute treatment, handhold them and try and do whatever I can to make the experience as seamless as possible. Cancer outcomes are never a 100%. You do lose some at the end of the day but if I have contributed to making their life easier through their suffering, I have done something worthwhile. While it is easy to be overwhelmed by these difficult situations, I need to remain detached from them so that I can do more for those who need help. I have come a long way since, but it is not as if I am not affected by what happens to my patients, anymore. It is just that I have taken better charge of the emotional me and replaced it, not entirely, with the professional me!
THE ART OF SELFLESSNESS OF PURPOSE Three weeks ago, a thin built lady from a remote village in UP walked in with her sister and her nephew, who lived in Delhi. While they poured her story of being diagnosed with breast cancer, I could sense an underlying anger. The sister burst forth with the information that her elder sister’s husband is a farmer and had thrown her out on knowing the diagnosis. He refused to get her treated and had said that she was as good as dead to him. The sister was vehement and was certain that she would get her elder sister treated. That is exactly what she did. I operated upon the lady. On receiving the pathology report, I shared with her that her sister would require both chemotherapy and radiation. The patient’s husband also came for that consult and asked me if he could take his wife home before she started chemotherapy, to which I said he could. Hardly had they left the room, that the younger sister returned to my room, furious. She said, ‘ How did you even suggest that he could take her back home? He will not spare her. How could you undo the effort that I am putting in, to treat her?’ I was stumped!She went on to say that she would look after her and make sure she had her complete treatment. She told me that she was a person of modest means with a one room flat but she would arrange accommodation for her sister and get one of her nieces to look after her while she underwent treatment. There was that intense look of determination in her eyes when she said, ’ Doctor, no way am I going to let her go- I take her full responsibility!’ How many times do you come across such unsung heroes in your life? This young lady is a hero, championing the cause of her older sister who has no voice. Her sister has a husband who has only used her but refuses to stand by her as she readies herself for her biggest battle, yet. She has found an unlikely knight in shining armour in her younger sister, who, I am sure will brave the storms lying in store for her. It is not the money in your pocket that makes the world go round but it is the desire and the will to help that makes the world go round. I love the spunk of this lady and have loads to learn from her. Selflessness of purpose is what makes her so inspiring and restores my faith in humanity!!
WHEN YOUR HELP GOES OUT OF ACTION..... The joy of becoming Director, Breast Surgical Oncology, dissipated into thin air when my help did not turn up for work citing an excruciating back ache. And then all hell broke loose, at least for me, as I realised that a whole new vista of mountains of work had piled up in front of me. My mother in law who is past 75 did her best to restore order but at that age, speed is not on your side. The morning hours between 6 and 7.30 am is nothing short of high speed roller coaster with three people with contrasting needs, rushing off to their respective places of work. One of these people is also me but I was the only one riding the roller coaster. Now I know why the goddesses have multiple arms, symbolic of the multitasking geniuses women are. I had exactly an hour and a half in which to don the cape of Superwoman! I would have to conjure up six dishes. Each of us would eat a different thing and carry yet another thing for lunch. Spoilt brats, each one of us 😯but blame it on the ever complying help. If this variety in dishes was not enough, my obsessive mind with a fetish for cleanliness would go about setting the house right, ironing out the last crease on the bed and cleaning the bathroom, till the tiles gleamed and the arms hurt. 😱My husband and daughter would look on trying to tell me that my obsession was not their problem-meaning, they would not help!🤨 Out of breath and sweating, I would now get ready for that job, I am trained for and love doing.I would arrive in hospital, without a trace of the battle that I was embroiled in not too long ago. Nobody wants to know that you have just completed a day’s work before coming to the hospital. I am not looking for compassion but this is my tribute to all the women who strive endlessly to make the lives of their loved ones better and then go to work and excel there as well. Breathe ladies and take good care of yourselves!While I love being a woman, I really hope my help comes back soon!
I was talking to this gentleman who sat across me in the OPD a month ago.His mother has been diagnosed with breast cancer and I was going over the details of treatment with him. He wanted to know how much the entire process would cost and how his mother was morbidly scared about the whole process, considering the fact that his father had recently completed treatment for Cancer of the voice box.During the conversation, I gathered he was their only son, working as a lecturer in an Engineering college and taking care of his parents. He had a sister, who lived in another city. What amazed me was his cool demeanour, his highly organised approach to the problem, his intense concern for his parents and the urge to get things done at the earliest. I could not help but ask him if this situation did not stress him out.He had a job to perform, his own young family to look after and if that was not enough, two ageing parents with cancer. His response was, to say the least, like a whiff of fresh air, in times where many old parents are left to fend for themselves in Old People’s’ Homes. He said, ‘Doctor, I look at this as my good fortune. I see this as a blessing as not many get the opportunity to serve their parents. I feel no stress’. He meant every word of it as I saw him handhold his mother lovingly throughout the process of treatment. I am honoured to know this gentleman. I thank him for restoring my faith in humanity and epitomising the real meaning of ‘Sevabhav’! #Breast Cancer #Max Hospital #Patparganj #Vaishali #East Delhi #Sevabhav
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