Breast Cancer: An Oncologist’s Treatment Plan By Dr. Rajshekhar Jaka
In this video, Dr. Rajshekhar C. Jaka, Surgical Oncologist and Breast Surgeon talks about the treatment options for breast cancer and how doctors arrive at the treatment plan.
One specific test which is pertinent to breast cancer, in the core biopsy, is ER, PR and HER2/neu.
- ER is Estrogen receptor
- PR is Progesterone receptor
- HER2/neu is a protein receptor
This study is very important as it will determine the type of tumor and helps in planning the treatment. Once the diagnosis confirms that it is cancer, the doctors need to assess the extent of breast cancer spread.
If the doctors feel that it is an early stage cancer then they prescribe some blood tests such as a liver function test, and certain minimally sufficient tests. Although, if they feel that the cancer stage is even slightly advanced then they may ask for a bone scan, a CT scan, or sometimes a PET-CT scan.
Once the diagnosis is complete and the extent of the disease is known, they plan the treatment.
Treatment consists of 4 modalities
- Hormonal therapy
or a combination of all these options.
First Modality In Treating Breast Cancer: Surgery
- Breast Conservative Surgery, in which the entire breast is not removed
- Mastectomy, in which the entire breast is removed
Breast conservative surgery is a kind of surgery where there is preservation of the breast and only the cancerous part with a little bit of surrounding normal tissue is removed. This is usually done when the tumor size is smaller in comparison to the breast size.
Dr. Rajashekhar says that most of his patients who undergo the breast conservative surgery do not even see the scar after 6 months. The scar is usually very small or minimal in size and hardly visible after 6 months.
He further explains that breast conservation surgery is cosmetically really good but if one opts for breast conservative surgery, the patient should definitely also take radiotherapy.
Mastectomy is another kind of surgery which is performed when the doctors feel that the tumor size is big enough and they have to remove the whole breast. Although, the doctors can reconstruct the breast at the same time or at a later date.
Next part in the surgery is to determine wether the cancer has spread to the armpits or if there is swelling in the armpits/underarms. If swelling is present then the doctors need to remove the cancerous nodes through a surgical procedure known as Axillary Lymph Node Dissection. Also, doctors may prescribe the patient to undergo a specialised test called Sentinel Lymph Node Biopsy. It is during the surgery itself that they send the lymph node for testing. This is a frozen test, and if it confirms that the cancer has spread then the doctors would remove the lymph nodes. But, if the test returns negative then the doctors will not remove them.
Second Modality In Treating Breast Cancer: Chemotherapy
Chemotherapy can be given by injecting the patient with a drug through the intravenous route to the body. It is not harmful and most often, not painful either. It is the thrombophlebitis of the peripheral veins which causes pain. But, this can be avoided by inserting a chemoport and then giving chemotherapy through it.
The benefits of chemotherapy far outweigh the side effects. Although, which patients need chemotherapy depends on the tumor size and certain other parameters. Typically a tumor of a very small size or a patient who is at a very early stage of cancer may not need chemotherapy at all. It is not a norm that if cancer is diagnosed then chemotherapy is a must.
Third Modality In Treating Breast Cancer: Radiotherapy
Radiotherapy is given to the cancer affected parts only and not to the whole body. Also, when the rays pass through the body, the patient can notice that there is no increase in the body temperature. Usually radiotherapy is given after 3 weeks of completing either chemotherapy or surgery. This typically goes on for 3 weeks to 5 (or 5 and a half) weeks.
Fourth Modality In Treating Breast Cancer: Hormonal Treatment
It is an important treatment option, benefitting patients in cases where the cancer tumor has tested positive for ER/PR test (mentioned earlier). In this treatment there is one tablet prescribed by the doctors which needs to be taken daily for 5 -10 years.
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