Cancer: What it means
Cancer is a group of diseases in which cells in the body grow, change, and multiply out of control. Breast cancer refers – growth and proliferation of cells that originate in the breast tissue. Rapidly dividing cells may form a lump or tumour: Tumours can either be cancerous (malignant) or non-cancerous (benign).
Malignant tumours grow and destroy healthy body tissues. A group of cells within a tumour may also break away and spread to other parts of the body. Cells that spread from one region of the body into another are called “Mestastases”.
How Cancer Spreads
A malignant tumour can invade surrounding tissue and destroy it. Cancer cells can also break away from a malignant tumour and enter the bloodstream or the lymphatic system. This is how cancer spreads within the body. When cancer spreads outside theprimary affected oragan it is called metastatic cancer, cancer cells often are found in the lymph nodes Cancer cells may spread beyond the breast such as to other lymph nodes, the bones, liver and lungs.
What is known
-You should not feel guilty. You have not done anything wrong in your life that caused breast cancer.
-You cannot “diagnose” breast cancer from other women who have the disease. It is not contagious.
-Breast cancer is not caused by stress or by an injury to the breast.
-Most women who develop breast cancer do not have any known risk factors or a history of the disease in their families.
Types of cancer
1) Breast cancer
2) Head and neck cancers
3) Ovarian cancer
4) Cancer of the cervix
5) Cancer of the abdomen
6) Cancer of the liver
7) Cancer of the bones
8) Pancreatic cancer
9) Blood cancer
10) Danger Signals of Cancer
11) Cancer often causes insignificant symptoms. Be alert and watchful if you have any of these symptoms for more than 2 weeks – you need to consult an expert. The word CAUTION can remind you of the most common warning signals of cancer:
12) Change in bowel or bladder habits (frequency of motions, alternating constipation and diarrhoea, frequency of passing urine, difficulty in passing urine),
13) A sore that does not heal (in oral cavity, tongue or skin),
14) Unusual bleeding or discharge from natural orifices (bleeding from rectum, blood in urine, blood in sputum, etc; intermenstrual bleeding, postmenopausal spotting/bleeding, white discharge per vagina, etc.),
15) Thickening or lump in the breast or any part of the body (painless lump in the breast or elsewhere),
16) Indigestion or difficulty swallowing (loss of appetite, nausea, inability to swallow solids, etc.),
17) Obvious change in a wart or mole (increase in size, pigmentation, oozing, itching),
18) Nagging cough or hoarseness (cough, change in voice).
Breast cells contain a variety of genes that normally work cooperatively with a woman’s natural hormones, diet and environment to keep her breasts healthy. When these genes become altered, changes occur and a cell no longer can grow correctly.
Genetic changes may be inherited from a parent.
Who gets Breast Cancer
Every woman has come chance of developing breast cancer during her lifetime. As women get older, their chances increase. Even though breast cancer is more common in older women, it also occurs in younger women and even in a small number of men.
Danger Signals of Cancer
Cancer often causes insignificant symptoms. Be alert and watchful if you have any of these symptoms for more than 2 weeks – you need to consult an expert. The word CAUTION can remind you of the most common warning signals of cancer:
Change in bowel or bladder habits (frequency of motions, alternating constipation and diarrhoea, frequency of passing urine, difficulty in passing urine),
A sore that does not heal (in oral cavity, tongue or skin),
Unusual bleeding or discharge from natural orifices (bleeding from rectum, blood in urine, blood in sputum, etc; intermenstrual bleeding, postmenopausal spotting/bleeding, white discharge per vagina, etc.),
Thickening or lump in the breast or any part of the body (painless lump in the breast or elsewhere),
Indigestion or difficulty swallowing (loss of appetite, nausea, inability to swallow solids, etc.),
Obvious change in a wart or mole (increase in size, pigmentation, oozing, itching),
Nagging cough or hoarseness (cough, change in voice).
Screening and Prevention
Screening for cancer means examination of normal healthy individuals for cancer before there are symptoms.
Treatment is likely to be more effective when cancer is detected early.
Screening examinations can result in the detection of cancer of the breast at earlier stages. Self examinations for cancers of the breast also results in early detection.
Early Detection Guidelines
Specific recommendations for cancer checkups and for the early detection of breast and uterus cancers are set out below.
Recommendations for Cancer Checkups
Site Recommendation
Cancer Checkup Recommended every 3 years for people aged 30-40 and every year for people aged 40 and older. This exam should include health counseling.
Breast Women 40 and older should have an annual mammogram, an annual clinical breast exam (CBE) performed by a trained professional, and should perform monthly self-examination. The CBE should be conducted close to the scheduled mammogram.
Women ages 20-39 should have a clinical breast exam performed by a trained professional every three years and should perform monthly breast self-examination.
Uterus Cervix (mouth of the womb): All women above 30 years who have been sexually active should have an annual Pap test and pelvic examination. After three or more consecutive satisfactory examinations with normal findings, the Pap test may be performed less frequently.
Endometrium (lining of the womb): Women at high risk for cancer of the uterus (obese, infertile, diabetic, treated with oestrogens) should have a sample of endometrial tissue examined when menopause begins.
The Pap test is done by taking a small sample of cells from the cervix. A speculum (instrument) is placed in the vagina. The cervix is the lower part of the womb and is found at the top of the vagina. A spatula and a tiny brush are then used to remove a few cells from the cervix. These cells are then sent to the pathology laboratory for testing.
If the Pap test shows a significant abnormality, the cervix is examined and a small amount of cervical tissue is taken (biopsy) for examination by a colposcope (instrument which magnifies).
Diagnosis
The following tests are often done to diagnose cancer.
Imaging – X-rays – Images of areas inside the body can be made by x-rays. Special x-rays may be done with dye either swallowed or injected to have better image of the organs.
CT scan uses computer linked to an x-ray machine.
Radionuclide scanning – the patient swallows or is given an injection of a mildly radioactive substance and images are recorded by gamma camera.
Ultrasonography (High-frequency sound waves) can be seen on a monitor like a TV screen or can be printed on paper/x-ray film.
MRI – a powerful magnet linked to a computer is used to make detailed pictures of areas in the body. These pictures are viewed on a monitor and can also be printed.
Endoscopy allows the specialist to look into the body through a thin, fibreoptic, flexible, powerful lighted tube called an endoscope. The exam is named for the organ examined (for example, colonoscopy to look inside the colon). During the exam, tissue or cells are collected for cytological or histopathological examination.
Laboratory Tests – Although no single test can be used to diagnose cancer, laboratory tests such as blood and urine tests give important information. If cancer is present, certain substances in the blood (tumour marker), urine, other body fluids, or tumour tissue may reflect abnormal levels.
Biopsy – The physical exam, imaging, endoscopy, and lab tests can show that something abnormal is present, but a bopsy is the only sure way of finding out if a lump or abnormal tissue is cancerous. A pathologist examines the suspicious area contains cancer and you will need treatment.
Types of Biopsies
Fine needle aspiration (FNA) – This is an extremely simple, painless technique where a thin needle is inserted into a lump (tumour), and a few cells are drawn up (aspirated). These are examined under a microscope to confirm a diagnosis of cancer in few hours.
A bopsy is the only sure way of finding out if a lump or abnormal tissue is cancerous. A pathologist examines the suspicious area contains cancer and you will need treatment.
Excisional biopsy entails removal of a whole tumour or a lymph node by surgery.
Questions to ask your doctor after a biopsy
Please explain to me the pathology report.
What type of breast cancer do I have? What stage of breast cancer do I have?
Is a pathologist experienced in diagnosing breast cancer who has examined my biopsy slides?
Should my biopsy slides be reviewed by another pathologist.
What are the chances that the cancer has spread outside my breast?
Were estrogen and progesterone receptor tests done? What do the results mean for me?
What other tests do I need? (Chest x-ray, bone scan, etc)
What are my treatment choices?
What are the risks and possible side effects of treatment? Short-term? Long-term?
What are the risks if I do not get treatment?
What are my chances for recurrences?
How can I get another opinion?
Are all Breast Cancer cases alike
Breast cancer is a complex disease. All cases are not the same. Once breast cancer has been found, more tests will be done to find out the specific pattern (description) of your disease. This important step is called staging.
The size of the tumour and exactly where it is in your breast.
If the cancer has spread within your breast.
If cancer is present in your lymph nodes under your arm.
If cancer is present in other parts of your body.
Tumour Markers
Tumour markers are substances, which can be detected, in higher amounts in the blood, urine, or body tissues of some patients with certain types of cancers — useful in diagnosis of cancer. Besides helping in diagnosis, tumour markers are used to assess response to treatment and to check for recurrence.
CA 125 (ovary), Human chorionic gonadotropin (HCG) (choriocarcinoma, a rare cancer of the uterus) and CA 15-3 (breast) are elevated in the respective cancers mentioned in the brackets.
Treatment
Patients with cancer are often treated by a team of specialists which may include a surgical oncologist, a medical oncologist (specialist physician in cancer treatment), a radiation oncologist (specialist in radiation therapy), and others. The doctors may decide to use one treatment method or a combination of methods. The choice of treatment depends on the type and location of the cancer, the stage of the disease, the patient’s age and general health, and other factors such as training and experience of the individual who examines the patient first and makes a decision on treatment. Living with a serious disease is difficult. Cancer patients and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services. Cancer care continues even after the patient completes the planned course of treatment and they should continue to see the doctor for routine check-ups. Followup is necessary for: at the BSES MG Hospital, S. V. Road, Andheri (W), Mumbai 400 058 The Laboratories
Surgery – taking out the cancer in an operation
Surgery remains one of the most important treatment for breast, uterine and ovarian cancers and can be curative in localized disease. Many of these need combining surgery with other treatment modalities to achieve higher cure rates.
Most women with breast cancer can choose between breast-conserving surgery (lumpectomy with radiation therapy) or removal of the breast (mastectomy). Both options provide the same long-term survival rates for most types of early breast cancer. Neither option guarantees that cancer will not recur. Whichever choice you make, you will need close medical followup for the rest of your life.
Principles of Cancer Surgery
Slow growing cancers are the most amenable to surgical treatment.
A margin of normal tissue and adjacent lymph nodes are removed to assure an adequate resection.
Questions to ask your doctor before surgery for breast cancer
What kind of surgery do you recommend for me?
How much of my breast will be removed?
Will you remove any of my lymph nodes?
What side effects should I report to you?
How long will I stay in the hospital? Will I need followup care?
When can I get back to my normal activities? What activities should I avoid?
The surgeon removes the breast cancer and some normal tissue around it (in order to get clear margins). This procedure usually results in removing all the cancer, while leaving you with a breast that looks much the same as it did before surgery. Usually the surgeon also talks out some of the lymph nodes under the arm to find out if the cancer has spread. Women who have lumpectomies almost always have radiation therapy as well.
Cancer is found in more than one part of the breast
The breast is small or shaped so that a lumpectomy would leave little breast tissue or a very deformed breast.
A woman chooses not to have radiation therapy.
A woman prefers a mastectomy.
Possible Problems – There may be a collection of fluid under the skin; or tingling, numbness, stiffness, weakness, or swelling of the arm. Physical therapy and exercise can help to restore arm movement and strength.
After a mastectomy, a woman may choose to wear a breast form, called a prosthesis that fits in her bra.
Whether you have a lumpectomy or mastectomy, your surgeon will probably remove some of the lymph nodes under your arm. This procedure is usually done at the same time as the breast surgery to check if the cancer has spread outside the breast. Clear lymph nodes were reported as negative nodes. If cancer is found, you have positive nodes, your doctor will talk with you about any additional treatments needed to destroy and control cancer cells.
Breast reconstruction – surgery to rebuild a breast’s shape.
Lymphedema – The lymph nodes under your arm drain lymph fluid from your chest and arm. Both surgery and radiation therapy can change the normal drainage pattern. This can result in a swelling of the arm called lymphedema. The problem can develop right after surgery or months to years later. There is no cure for this condition, so you should do what you can to present it.
After underarm lymph nodes are removed, your arm will have to be protected for the rest of your life
To help prevent or control lymphedema and to protect your arm after treatment:
Carry packages or handbags on the other arm or shoulder.
Avoid sunburns and burns to your affected arm and hand
Have injections (including chemotherapy), blood collection and blood pressure tests done on the other arm.
Avoid cuts when shaving underarms; use an electric shaver
Wash cuts promptly, apply antibacterial medication, and cover with a bandage. Call your doctor if you think that you have an infection.
Avoid wearing tight jewelry on your affected arm; avoid elastic cuffs on blouses and nightgowns.
Have careful manicures; avoid cutting your cuticles.
Questions to ask your doctor after surgery for breast cancer
Please explain what is the pathology report?
How many lymph nodes were removed? Were they free of cancer? If not, how many showed signs of cancer?
Were hormone receptor tests done? What are the results?
Support for Cancer Patients
Cancer patients may worry about holding their job, caring for their family, or keeping up daily activities. Worries about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the team can answer questions about treatment. A social worker or counselor also can be helpful to patients who want to talk about their feelings or discuss their concerns about the future or about personal relationships.
Friends and relatives, especially those who have had personal experience with cancer, can be very supportive. It helps patients to meet others who are facing similar problems like theirs. Cancer patients often get together in support groups, where they share what they have learned about cancer and its treatment and about coping with the disease. Each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another– even if both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor.
Often, a social worker at the hospital or clinic can suggest groups that help with rehabilitation, emotional support, financial aid, transportation, or home care.
Follow-up
Management of any side effects from treatment.
Development of any late complications of treatments.
Early detection of cancer recurrence that may be amenable to treatment.
Increased risk of a second malignancy which can be identified at an early stage.
Detection of pre-malignant changes and the institution of treatment before cancer develops.
Management of medications that may decrease the risk of cancer recurrence and second malignancy (i.e. Tamoxifen in Breast Cancer patients).
Discussion of any new concerns that may arise.
Head and neck cancers
Facilities for Cancer Diagnosis & Treatment
Cancer Clinic
Chemotherapy
Specialised Operating Rooms
ICU/ICCU
Experienced Specialists
Surgical Oncology
Medical Oncology
Joint Consultation
Second Opinion
Cytology, Pap Test
Fine Needle Aspiration Cytology and Biopsy
Frozen Section
Pathology (Tumour)
Special tests – CA 15-3, CA 125, HCG, etc.
Imaging
Mammography
Ultra Sonography
CT Scan
Radiology
Rehabilitation, Physiotherapy
