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.

Cataracts are one of the most commonly occurring eye problems, currently affecting more than 50% of the population, particularly those over the age of 65 as prevalence increases with age.

If a person has cataracts their vision becomes blurred and their night time vision deteriorates. Other symptoms that sufferers have to live with include sensitivity to light and the need to change lens prescription frequently, seeing colours less vividly whilst requiring good light for reading. These symptoms often lead people to consider undergoing cataract surgery.

If you are considering cataract surgery, you should first find out if it is appropriate in your case and whether or not it might improve your eyesight.

Today Dr. Cilveti, Head of the Ophthalmology Department at Vithas Xanit International Hospital, is going to provide some answers to the most common questions relating to cataract surgery.

What are the symptoms that show someone might need cataract surgery?

Blurred vision or refractive changes, lights appearing too bright or glaring, an unexpected improvement in near vision, difficulty with reading or driving, colours appearing less vivid etc.

And when is the right time to have surgery for this condition?

Years ago surgery was only performed for cataracts when the patient was no longer able to see. Currently due to technological improvements, as well as improvements in safety and outcomes, surgery tends to be performed earlier than this. Today we operate when the patient starts to have cataract related sight difficulties and we take activity, age and visual markers into account.

Is there a minimum age for surgery?

No, currently cataract surgery is even performed in children, there are several types of cataracts, each one affecting a particular age group.

What surgical techniques are available nowadays?

The majority of cataract surgeries performed today are performed with phacoemulsification. This technique involves breaking up the lens within the eye with a small incision and very little manipulation. In the last 2-3 years we have been using a new technique at Vithas Xanit International Hospital: the Femtosecond Laser.

This laser makes the incisions without manual intervention from the surgeon, it performs the most delicate part of the surgery with a precision which is difficult to achieve manually. This technique is called Femtosecond laser-assisted cataract surgery.

Why is this type of laser better and what benefits does it have?

As mentioned, this computer assisted technique further increases surgical precision, it also allows a quicker recovery time whilst providing a better quality of sight.

The Femtosecond laser also guarantees maximum safety, possible errors are eliminated due to individual programming.

Other advantages of Femtosecond laser cataract surgery in comparison to the manual technique are as follows:

• Precision incisions, generating less astigmatism.
• Precision capsulorhexis, perfectly centred with the size required by the surgeon.
• Fragmentation of the lens into the number of desired parts.
• General reduction of post-operative inflammation with faster sight recovery. It is ideal for cataracts when refractive surgery is required.

How long does the operation take?

The average time for a case is usually about 20 minutes, sometimes up to 30, as long as there are no complications (which are uncommon). There are some cataracts which may require more time due to being particularly hard. However in each case the patient is advised before surgery commences.

What is the recovery time after surgery and what treatment will I need?

After surgery we review the patient on the same or following day depending on the individual case. If everything is fine then there is usually another follow-up appointment at 15 or 30 days.

Regarding treatment, the only thing that the patient needs to do is follow the eye drop regime as prescribed. Normally patients can already notice an improvement in sight after 24-48 hours and sight is usually very good for everyone after 7 days. If the patient requires glasses they will not be prescribed until 30 days after surgery.

For more information on our new refractive surgery system you can contact the Ophthalmology Department at the hospital by phone on 647 789653 or by email at: info@vision1-2-3.com