Breast Cancer – What now?
Posted by Xanit Internacional Xanit Internacional | Posted in ALL ABOUT CANCER | Posted on 19-10-2016
Tags: Breast Cancer
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Today, in connection with World Breast Cancer Day, Dr Carabantes from our Vithas Xanit Oncology Institute, would like to give us an overview of the protocol followed from the time that the specialist suspects that a patient may have a malignant tumour, up to the time that the diagnosis and possible treatment are confirmed. It is important to remember that early detection is fundamental for the effective treatment of breast cancer and that a quality healthcare service is fundamental to provide the patient with the necessary support and information from the very beginning. With this in mind, at the Vithas Xanit Oncology Institute we always aim to provide high quality, scientifically based, diagnosis and treatment of cancer along with a caring, empathetic approach. The Institute’s multidisciplinary teamwork in this area can make it is possible for the patient to receive their diagnosis, see the oncologist and undergo resulting surgery and treatment within one week. The most important steps are outlined below.
When a woman discovers a suspicious breast lesion it is important that a biopsy is performed as soon as possible to confirm the nature of the lesion. If the diagnosis is breast cancer, a targeted action protocol will be implemented for treatment of the disease and support provided to deal with the emotional impact associated with the diagnosis.
Current advances in biological knowledge relating to breast cancer have shown us that it is not a single disease but a group of diseases, with differences clinically, therapeutically, and from prognostic point of view. As a result more individualised treatment is increasingly necessary. However a multidisciplinary approach is also required involving pathologists, radiologists, nuclear medicine physicians, surgeons, medical and radiotherapy oncologists, psychologists, volunteers… Effective coordination between them is essential, for this reason the successful functioning of a tumour committee with representation from all specialities is highly important. In our hospital this committee provides support to enable the appropriate decisions to be taken, always offering the patient the best solution, specifically adapted to their requirements.
Within this team every specialist has an important role, both in the final diagnosis as well as in the treatment to be followed. For example, the pathologist has to define the histological characteristics of the disease: type of tumour, size and histological grade, lymph node involvement, hormone receptors, etc.
Along with the clinical, pathological and radiological information, both the locoregional and systemic treatment to be followed will be decided, with the aim of finally achieving successful treatment of the tumour.
Treatment
Conservative breast surgery with Sentinel lymph node biopsy or axillary emptying will always be preferred if possible, depending on the axillary involvement. In many cases nowadays axillary emptying can be avoided, without compromising survival rates, and with the great advantage of reducing the risk of lymphoedema and swelling produced in the arm after axillary emptying. When mastectomy is necessary (due to tumour size or poor aesthetic result with conservative surgery), it is often feasible to start the breast reconstructive process during the same operation. An expander can be sited which allows insertion of a permanent prosthesis afterwards, especially if radiotherapy is not required after surgery.
Not all breast cancer patients require radiotherapy or systemic treatment (chemotherapy, hormone therapy or biological therapy) after surgery. This depends on the pathological characteristics of the disease, its clinical progression (lymph node or distant) and its biological characteristics based on the analysis of expression of multiple tumour genes (genome platforms).
Radiotherapy consists of the administration of ionising radiation targeted at a selected volume (breast and lymph nodes) to eliminate tumour cells in these areas. It is delivered using linear particle accelerators and is indicated after conservative surgery or, in some cases, after mastectomy depending on the tumour size and lymph node involvement.
Systemic treatment includes chemotherapy, hormone therapy and biological therapy. Chemotherapy may be given after surgery when the cancer is infiltrating (when it has had contact with the blood and lymphatic system) depending on the pathological, clinical and biological characteristics of the disease, to destroy disseminated tumour cells via the blood and lymphatic system. It can also be administered prior to surgery with the aim of reducing the disease to enable resection and allow breast conservation. These drugs can often be administered intravenously (some are oral) over 21 day cycles, usually with a duration of 3 to 6 months.
Treatment may also be necessary with hormone therapy when the tumour expresses hormone receptors. This is given over a period of 5 to 10 years. In the cases of HER-2 positive tumours, monoclonal treatment with monoclonal antibody (trastuzumab) is also recommended for 1 year, it can be given alongside chemotherapy and hormone therapy. In the case of metastasis there are more known biological treatments available such as antiHER2.
During treatment it is important to keep patients informed of all the possible side effects which may occur, enabling them to face the entire process, drug side effects are different for example, to those of chemotherapy.
Throughout treatment and afterwards we always advise patients to follow a healthy lifestyle including stopping smoking, consuming moderate amounts of alcohol, following a balanced diet rich in fruit and vegetables, moderating fat and sugar consumption, and avoiding a sedentary lifestyle. Physical exercise is recommended, including during chemotherapy treatment, but carefully, adapting it to the patient’s physical condition.