Description

Breast Cancer Surgery

Overview

Breast is an organ that is formed by three types of
tissues, namely adipose tissues, connective tissue and secretory glands;
breasts produce milk and enable breastfeeding in women, but, they are rather
premature and dysfunctional in men. There is a major milk duct that runs to the
nipple at the middle zone of each breast. Smaller ducts of mammary lobes drain
to the major duct, usually just before the nipple. A breast lobe is formed by
lobules that contain milk-producing glands.

In addition to above mentioned tissues, breasts also
have lymphatic ducts that are connected to lymph nodes of the armpit through
lymphatic vessels.

Breast cancer is the uncontrolled growth of breast
cells. Although breast cancer can also occur in men, the incidence of the
condition in women is beyond comparison.

Recently, campaigns to raise awareness of breast
cancer, screening methods that allow early diagnosis and advancements in
treatment methods have both increased chance of cure and decreased deaths
caused by this disease.

Risk Factors:

It is not clearly known what causes the breast cancer.
The underlying mechanism is that some cells grow and divide faster than usual
and they form a mass or a lump in the breast, as they continue living when
healthy cells die. Moreover, these cells may spread to other organs and tissues
through lymphatic circulation, blood circulation and the anatomic proximity.

It is estimated that inherited genes account for
approximately 10% of all breast cancer cases. A family history of breast cancer
is a potent risk factor.

Breast cancer usually starts in milk ducts. Studies
show that incidence of breast cancer is increased by a number of factors, such
as hormones, environmental conditions and lifestyle.

The risk factors of breast cancer are listed below;

• Female gender
• Age
• Exposure to radiation
• Health history of breast cancer (presence of
  cancer in one breast increases the risk of cancer in the other breast)
• Family history of breast cancer
• Genetic predisposition
• Exposure to high-dose radiation
• Early onset of menstrual cycles
• Late menopause
• Having first child at an older age
• Obesity, alcohol
• Having never been pregnant

Types:

There are two common classifications in the breast
cancer; non invasive or not spreading (in situ) cancers and invasive or
spreading cancers.

Invasive breast cancers

• Invasive ductal carcinoma
• Paget’s disease
• Inflammatory breast cancer
• Invasive lobular carcinoma.
• Others (rare types)

Non-invasive breast cancers

• Ductal carcinoma in-situ
• Lobular carcinoma in-situ

*Invasive ductal carcinoma is responsible for
approximately 90% of all breast cancer cases.

Symptoms

Breast cancer has many symptoms.  In some
patients with no symptom, breast cancer is discovered in mammography that is
ordered upon a suspicious finding or that is part of routine screening.

Signs and symptoms of the breast cancer are as follow;

• Palpable mass, solid lump or space occupying
  lesion in breast and/or armpit
• Discharge from nipple
• Changes in the nipple (size, shape or appearance)
• Changes in the skin of nipple
• Peeling and scaling in the skin of the breast or
  the darker skin that surrounds the nipple
• Edema, swelling and dimpling in the skin of breast,
• Redness and texture of orange peel in the skin of
  breast

Prevention

As is the case for all other cancers, prevention of
breast cancer is also to eliminate or minimize manageable risks. The first step
of treatment should be to alleviate risk factors that help onset of the
disease. Weight control, healthy eating habits and regular exercise are
preventive measures that should be applied by everybody.

The texture and hardness of breast tissue varies from
one person to the other. On the other hand, breast tissue of the same person
shows some variations due to aging, pregnancy and lactation. Therefore,
self-examination of breast at regular intervals is a very important screening
method.

Diagnosis:

As is the case for all cancers, detection of breast
cancer in early stage not only increase the chance of treatment, but also
number of treatment options.

Clinical breast examination: Your doctor will examine both
breasts and your armpit to check if there is a mass or lump.

Mammogram: It is a frequently used to diagnose and screen
breast cancer.

Breast Ultrasound

Imaging-guided biopsy: The biopsy specimen that is
taken with ultrasound guidance is the principal method to make the definitive
diagnosis of breast cancer. A small metal marker may also be inserted into the
suspicious areas for the future use in surgery or imaging studies.

Magnetic Resonance Imaging

Treatment

There are various options for treatment of breast
cancer, depending on stage of the disease and the patient-related factors.
These are hormone therapy, chemotherapy, radiotherapy and surgery. Your doctor
will determine the optimum option for you in the light of these findings.

Among the treatment options of the breast cancer are
chemotherapy, targeted therapy, hormone therapy, radiotherapy and surgery.
These treatments can directly be used to treat the tumor or they are instituted
to increase quality of life and relieve symptoms in advanced stage cancers.
Moreover, treatment options can be used alone or in combination.

Chemotherapy

Chemotherapy uses drugs to treat the cancer. The
active substances of drugs kill the cancerous cells. Chemotherapeutic agents
can be given into a vein or be taken by mouth. In case of intravenous
administration, a thin tube, called catheter, is inserted into a great vein and
the chemotherapeutic agent is administered through this catheter throughout the
treatment period.

One or more than one chemotherapeutic agent can be
administered depending on the type of cancer and response to treatment. Active
chemotherapy maintained for a particular time is followed by an “off” period.
After the “off” period expires, the treatment resumes. Each of these sequential
active and “off” periods is called a cycle.

In the early stage breast cancers, chemotherapy may be
instituted before or after the surgery.

Side effects of the chemotherapy are a function of the
chemotherapeutic agent and the dose. Most common side effects of
chemotherapeutics include; fatigue, nausea, vomiting, mouth sores, hair loss
and inflammation of the digestive system. Side effects caused by chemotherapy
will also be treated by your doctor. If these side effects are severe enough to
threaten your health, your doctor may advise to suspend the treatment or to
switch you to another chemotherapeutic agent.

Targeted Therapy

Targeted therapies are newer anti-cancer treatments
compared to chemotherapy. These medicines target specific abnormalities that
are present in cancerous cells. Before these medicines are started, cancer
cells are first analyzed in laboratories to determine whether they have particular
mutations or not. In breast cancer, some cancer cells overproduce a substance
called epidermal growth factor receptor 2 (HER2) in comparison to healthy
cells. When drugs that specifically target these cells are used, cancer cells
can be killed, while healthy cells are spared.

Radiotherapy

Radiation therapy aims to kill cancer cells by using
high-powered energy beams.  

If the radiation source is out of the body and the
beams are directed to cancer, this treatment is called external radiotherapy.
 On the other hand, if the radioactive agent is placed at the locus of the
tumor through a needle or a catheter, method is called internal radiotherapy
(brachytheraphy).

Radiotherapy is mostly combined with chemotherapy and
this modality is also called chemoradiotherapy.  In breast cancer, the
adverse effects of radiation therapy include fatigue, skin rash and swelling of
the breast treated with radiation therapy.

Hormone therapy

It is often used in the treatment of hormone-sensitive
breast cancers. It is instituted before and after the surgery to prevent
recurrence or to reduce size of masses that have spread to the body.

Side effects of hormone therapy include hot flashes,
night sweats, vaginal dryness and blood clotting, though not an exhaustive
list. Your doctor will plan not only management of the side effects, he will
also follow up said side effects throughout the treatment.

Surgery

Surgery is the most common treatment method for breast
cancer. If the patient is operated on by experienced surgeons, the success rate
of surgery is higher in breast cancer than the other cancers.

Modified radical mastectomy is the most common
surgical technique in the breast cancer. The surgery is usually carried out
under general anesthesia. The entire breast is removed along with the lymph
nodes located at unilateral armpit. This increases the success of treatment,
but aesthetic results are not so promising. Therefore, breast-conserving
mastectomy is performed, where skin of breast and the nipple are untouched, as
long as tumor- and patient-related factors allow.

If the tumor is benign, your surgeon may remove the
tumor and some surrounding healthy tissue (lumpectomy).

Sentinel lymph node biopsy: Your surgeon removes some
lymph nodes located nearby your breast in order to determine the extent your
tumor spread. If it is determined that the cancer spreads to nearby tissues,
after lymph nodes are examined, it can be decided to remove all surrounding
lymph nodes (axillary lymph node dissection).

Possible postoperative complications of breast cancer
surgery are pain, bleeding, infection and abnormal swelling of arm
(lymphedema). After you undergo a breast surgery, it is necessary to protect
hand, forearm and arms against impacts and external conditions and to work out
in line with the exercise program instructed by your doctor.

Asking your questions about the treatment of breast
cancer, your life after treatment, rehabilitation, pain management, clinical
studies and all the questions in your mind about the breast cancer to your
doctor will help you for an informed participation to your treatment and
alleviating your concerns.