Treatment Pathways
Treatment Pathways
Understanding Breast Cancer Journey !Treatment for breast cancer is complex and multipronged. Even though the terminology used is same for all women with cancer of the breast, it varies from lady to lady. And knowing this individual variation is important in order to ensure a highly personalized and selective treatment is given for each individual patient.
Further like any other cancer, breast cancer has a tendency to spread and the treatment of breast cancer is dependent on the stage of the disease. The combinations of treatment used also vary depending on the outcomes of various tests done, age and general condition of the patient.
The treatment of breast cancer needs to be done by a specialist focused on breast care in a specialist breast center with all the necessary equipment and human resources. Successful treatment of breast cancer mandates implementation of diagnostic and treatment protocols in a rigid and systematic way for the best outcomes.
Hyderabad Breast Clinics is an exclusive and focused center for breast care and the group of doctors follow the steps rigidly for every lady needing cancer care. The following steps represent the path that needs to be taken with the tests done in the designated sequence to avoid mis interpretation and the timely marker tests and genetic tests as needed allows formulating the best possible treatment plan as per current standard of care followed world over.
Doctor Consultation
Most women present with a Painless lump of short duration, detected incidentally during bath and some may present instead with a swelling in the armpit. Occassionally , few women experience just discharge from the nipple which can be blood or watery in texture.
Doctors after their detailed elicitation of history and examination of the breast, would form an opinion about the lump based on their experience and expertise.
Investigations
Most women present with a Painless lump of short duration, detected incidentally during bath and some may present instead with a swelling in the armpit. Occassionally , few women experience just discharge from the nipple which can be blood or watery in texture.
Doctors after their detailed elicitation of history and examination of the breast, would form an opinion about the lump based on their experience and expertise.
Tests for Staging of disease
Modern breast cancer management is complex and tailored to the stage of the disease. Liver and lung are the common organs along with bone where the cancer can spread. Hence CT scan of the chest, abdomen along with Bone scan could be done else a PET CT can do the job of all the above tests. These staging tests are done conditionally based on the physical examination findings.
Personalisation of the Diagnosis
Immunohistochemistry As discussed earlier, the breast cancer varies from lady to lady and to know the exact type we order Molecular & Bio Marker tests like ER, PR, Her2neu tests. These tests are done on the biopsy specimen which has confirmed the presence of cancer. Based on the results of these tests breast cancer will fall into of the four groups - Luminal A, Luminal B, TNBC and Her2neu. This information helps the specialists at Hyderabad Breast Clinics to decide on the sequence of treatment – Chemotherapy to be given before or after the surgery, type of chemotherapy molecule that can be used and so on.
Surgery – Options to be chosen
Breast Oncoplasty based on the molecular markers’ surgery can be done upfront or following few cycles of chemotherapy. The goal of the surgery is to remove the cancer tissue and identify if the nodes in the armpit are involved by cancer or not. Traditionally this was achieved by removal of the entire breast along with axillary lymphnode dissection (ALND). Breast oncoplasty is a specialist surgical technique offered by the experts of Hyderabad breast clinics which allows the safe removal of cancer tissue while retaining the breast. The women are left with normal looking breasts while the cancer is completely removed. Sentinel Lymph node biopsy is another special technique done by our experts that can assess the nodes in the armpit with minimal discomfort in comparison to ALND.
Chemotherapy & Radiotherapy
Even though surgery is a primary treatment for Breast cancer, it is necessary to add additional treatment methods based on the report following surgery. This additional treatment reduces the chances of disease coming back.
Followup
Women who have completed treatment are expected to visit their breast surgeon on a regular basis. A schedule is handed over to the patient at the end of treatment and at these followup visits the specialist will examine the patient and order investigations to look if the disease has come back. Further the other breast is also examined and mammogram is done to look for any new cancers.
Clinical Evaluation
- Medical History: Includes symptoms (e.g., lumps, pain, nipple discharge), family history of breast cancer, and risk factors.
- Physical Examination: A clinician checks for lumps, changes in breast shape, skin dimpling, or other abnormalities.
Imaging Studies
- Mammogram: An X-ray of the breast, often the first imaging test for suspected breast cancer.
- Ultrasound: Used to evaluate suspicious lumps or abnormalities detected in a mammogram.
- MRI (Magnetic Resonance Imaging): Used in high-risk cases or for detailed imaging when other methods are inconclusive.
Tissue Sampling
- Fine-Needle Aspiration (FNA): A thin needle extracts cells from the lump for cytological examination.
- Core Needle Biopsy: A larger needle removes a core of tissue for histological analysis.
- Surgical Biopsy: Removes part or all of a suspicious area for thorough examination.
Pathological Analysis
The tissue sample is analyzed to determine:
- If cancer is present.
- Type of cancer (e.g., ductal or lobular carcinoma).
- Grade of the tumor (how abnormal the cells look).
- Hormone receptor status (ER, PR) and HER2 status.
Additional Tests
- Genetic Testing: For individuals with a strong family history or early onset, tests for BRCA1/BRCA2 or other mutations may be conducted.
- Blood Tests: To assess overall health and organ function.
Staging and Evaluation
If cancer is diagnosed:
- CT Scans, PET Scans, or Bone Scans: To check for metastasis.
- Tumor Marker Tests: Help monitor the progression or recurrence.