“What Cancer Cannot Do”
Cancer is nothing more than a speed-breaker, it does not define the entire journey of life. Once you are past it, it can become a faint memory, only if you return to life more spiritedly than ever before!
Cancer management is often multimodality. Once the diagnosis is confirmed, and the tumour biology determined, investigations to rule out systemic spread are conducted before moving on to the planned management. This could involve an ultrasound abdomen, X-ray chest and/or bone scan or a CECT chest/abdomen and bone scan or a PET CT.
The sequence of treatment i.e Surgery first or Systemic treatment first will depend not only on the stage of the disease but importantly, also on the biology of the disease.
Breast Surgery for cancer addresses two main aspects- Surgery to the breast and of the armpit or axilla. Surgery to the breast would entail either mastectomy (breast removal) or breast conservation surgery (breast preserved). Surgery of axilla would be either Sentinel Lymph Node Biopsy (SLNB) in those in whom no nodes are felt in the axilla or in those where an FNAC of the lymph node does not show evidence of disease or Axillary dissection, wherein the node in the armpit is involved by the disease.The decision on the type of surgery will vary from patient to patient and is decided on the basis of clinical findings, imaging, genetic testing, co-morbidities, availability of radiation facility etc. A detailed discussion with the patient and family to understand the pros and cons of the procedures offered, reconstructive options etc. will help arrive at a consensus.
Radiation therapy for breast cancer uses high-energy X-rays, protons or other particles to kill cancer cells. The X-rays or particles are painless and invisible. Radiation therapy is a form of local treatment and adds to the benefit accrued from surgery and reduces the risk of local recurrence. Radiation therapy is administered as an adjuvant treatment and is delivered after the completion of surgery and radiation therapy.Radiation therapy is mandatory after breast conservation surgery but is also administered after breast removal for tumours larger than 5cm, those with extensive skin involvement, node-positive disease, close or involved margins etc.Radiation therapy for breast cancer may be delivered through External radiation or by means of partial breast irradiation ( after breast conservation). With advancements in the technology for delivering radiation therapy, it is possible to limit radiation dosage to the vital organs and also to reduce the duration of radiation therapy, without compromising on the effectiveness of the treatment.