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Breast cancer Treatment

Breast diseases include various types of conditions, such as cysts, infections, other growths, etc. Most of these conditions are non-cancerous (or benign) and some are cancerous (or malignant). Breast diseases are common among women, but they occur in men too. The fluctuating hormone levels in women frequently cause changes in the breast tissues. Majority of women experience these changes at some point in their lives. Although these changes are not life-threatening, they are associated with increased risk of breast cancer later in life.

Women must be aware of how their breasts feel and look. If they notice any changes, which may not be a reason for panic, but they must get it checked to be on a safer side. The changes might be an early sign of breast cancer; early detection increases the chance of success of breast cancer treatment. Women between ages 50 to 74 are recommended to have a mammogram every two years.

Types of Breast Diseases

Breast diseases can be broadly categorised as benign breast diseases and breast cancer.

Benign breast diseases

Benign breast diseases are a group of conditions that are characterised by changes in breast tissue and are non-cancerous. Some types of benign breast diseases occur due to growth of abnormal cell or an increase in the number of cells in the breast ducts or lobes. A few common benign breast diseases are discussed below.

Fibrocystic breast changes:

Fibrocystic breast changes involve development of fluid-filled cysts due to fluctuating hormone levels. These changes may make the breasts feel dense, lumpy, and tender, particularly before periods. The changes may occur in one or both breasts, along with the areas of fibrosis. Fibrosis refers to thickening of the breast tissue felt through the skin. Fibrocystic breast changes are common, which usually do not require any treatment.

Intraductal papilloma:

Intraductal papillomas are small, wart-like noncancerous growths that form in the milk duct near the nipple or away from it. These papillomas may cause clear or bloody nipple discharge, formation of a lump that can be felt through the skin or nipple, and usually do not cause pain. This condition is common among women between the ages 30 to 50 years. If an individual has five or more papillomas at one time, the risk of breast cancer increases. Intraductal papillomas can be removed through a minor surgery.

Mastitis:

Mastitis is the inflammation of the breast tissue that may be caused by an infection. It is usually caused by clogged milk ducts, incomplete emptying of the milk from the breast or bacteria entering from the broken skin on the nipple. Apart from inflammation, mastitis may result in pain, redness, tenderness, warmth and nipple discharge. Mastitis is common among breastfeeding women, but it can also occur in men and women who aren’t breastfeeding. Mastitis is generally treated with a course of antibiotics. If an abscess develops, the pus may be drained using a needle or via surgery.

Phyllodes Tumours:

Phyllodes tumours are rare breast tumours that develop in the breast connective tissue but can also involve glandular tissue as well. These tumours cause pain, tenderness, swelling and lump formation. These are usually benign; however, they can occasionally be cancerous (about 10%). This type of tumour is most common in women who are in their 40s. Phyllodes tumours are usually treated by a lumpectomy, and in rare cases by mastectomy.

Breast cancer

In breast cancer, the cells in the breast grow out of control. It is one of the most common cancers in women; it can also occur in men. There are different types of breast cancer, depending on the cells in the breast that are affected. This cancer can spread to other parts of the body through blood vessels and lymph vessels; this is known as metastasis. 

Common symptoms of breast cancer include a breast lump, change in size, shape or appearance of a breast, a newly inverted nipple, changes to the skin over the breast, such as redness, dimpling, peeling, scaling, flaking or crusting. The treatment of breast cancer depends on its type, size, stage, grade and whether the cancer cells are sensitive to hormones. The treatment options include surgery, chemotherapy, radiation therapy, hormone therapy and targeted therapy; which may be  given alone or in combinations. Each case is individualised.

Surgical procedures for Benign breast diseases

Benign breast diseases often require no treatment. Treatment may be recommended in case of pain, discomfort, or increased risk of breast cancer. The following are some of the surgical procedures used to treat benign breast diseases.

Fine needle aspiration for fibrosis and cysts: Usually, fibrocystic breast changes do not need surgery. However, sometimes, the lumps in the breast should be evaluated to diagnose breast cancer. The fluid in the cysts is withdrawn using a thin, hollow needle. This procedure may collapse the cyst and relieve discomfort.

Surgical excision for intraductal papilloma: Intraductal papilloma is treated by surgical excision and complete removal of the papilloma. Surgical excision can be performed under local or general anaesthesia. The papilloma is removed using a scalpel or any other surgical instrument. The tissue removed will be observed under a microscope; this can help confirm the diagnosis.

Intraductal papillomas can also be treated by surgically removing the milk ducts under the nipple. This approach can cause scarring. Nevertheless, minimally invasive techniques are now available that may cause little to no scarring.

Drainage and excision of abscess: If mastitis is not treated quickly, pus may build up in the breast; this is known as abscess. The pus is often removed byincision anddrainage. For this, the abscess is cut open with a scalpel to release the infected fluid. Sometimes, a drain is inserted into the incision to help release the fluid, otherwise it is left open to drain naturally. In case of lactational abscesses or if the abscess is smaller than 3 cm, needle aspiration may be used to drain the fluid.

Lumpectomy and/or mastectomy for phyllodes tumour: For all types of phyllodes tumour, the tumour (or the lump) is surgically removed along with at least 1 cm of surrounding normal breast tissue. This procedure is known as lumpectomy. If the breast size is small or the phyllodes tumour is large, it may be tough to preserve healthy breast tissue and its natural look. In such cases, partial or total mastectomy with or without reconstruction may be recommended. Partial or segmental mastectomy involves removal of the portion of the breast that contains the phyllodes tumour. Total or simple mastectomy involves removal of the entire breast, but not the muscles or the lymph nodes.

Surgical procedures for Breast Cancer

For breast cancer treatment, surgery is the preferred option. It may be combined with additional treatments. The following are some of the surgical procedures used in the diagnosis and treatment of breast cancer.

Biopsy: Biopsy is used to determine the characteristics of a lump or any other abnormality found during screening or an imaging test. This procedure helps to make a diagnosis. In biopsy, a small amount of tissue is removed, which is examined for the traits of cancer.

There are different types of biopsies:

Fine needle aspiration biopsy: This is the least invasive biopsy, where a sample of cells are obtained using a thin, hollow needle.

Core needle biopsy: A slightly larger needle is inserted three to six times to remove a sample of cells.

Incisional biopsy: In this procedure, a small portion of a tissue is removed and sent for further studies.

Excisional biopsy: This is the most invasive form of biopsy, where the entire lump or suspicious area is removed and sent for further studies.

Lumpectomy: Lumpectomy, also called ‘breast conserving’ surgery, involves removing the tumour and a small portion of the surrounding healthy breast tissue. The remaining breast tissue is preserved. The amount of tissue removed depends on the size of the tumour and the extent of its spread. If the cancer is advanced, mastectomy may be performed. When a breast conservation surgery is suggested, she will require post-operative radiotherapy.

Mastectomy: Mastectomy involves the removal of the entire breast. This procedure is recommended for patients with advanced breast cancer. There are different types of mastectomy based on the type and extent of breast cancer.

Simple or total mastectomy: In this procedure, the entire breast is removed, but the underlying muscles and axillary lymph nodes are preserved.

Modified radical mastectomy: This involves removal of the entire breast as well as many axillary lymph nodes, but the underlying muscles are left alone.

Radical mastectomy: This is the most extensive form of mastectomy, where the entire breast, most axillary lymph nodes, and the underlying muscles are removed.

Skin-sparing mastectomy: Where the entire breast is removed, but as much skin as possible is retained, including the nipple and areola. When the nipple areola is safe to preserve, it is called a nipple sparing mastectomy.

Lymph node removal: When the breast cancer cells migrate to the lymph nodes, they can spread more easily. Hence, it is important to remove the lymph nodes that have the cancer cells.

Lymph node removal are of two forms:

Axillary lymph node dissection: In this procedure, between five to 30 lymph nodes are removed under the arm are removed.

Sentinel lymph node dissection: In this procedure, the first lymph node that receives the lymphatic fluid from the breast, the sentinel node, is removed instead of removing many lymph nodes. If the sentinel node does not contain cancer cells, the remaining nodes are likely clean. This procedure is a less invasive than axillary lymph node dissection. It is recommended for women with small breast cancers, where tumors are less than 5 cm.

The surgical options most appropriate for a patient depend upon the types of breast disease and the patient’s general condition. A breast specialist would be the best person to decide the best suitable treatment, in consultation with the patient.

References:

Surgical Options for Breast Diseases

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