Following are the treatment options for breast cancer surgery in India:
Breast cancer surgery
Surgical intervention may be done for the following reasons:
- Remove as many cancer cells as possible – breast-conserving surgery or mastectomy
- Determine whether cancer has spread to the nearby lymph nodes under the arm – sentinel lymph node biopsy or axillary lymph node dissection
- Restore the shape and appearance of the breast after the removal of cancer – breast reconstruction surgery
- To relieve the symptoms of advanced-stage breast cancer
Breast cancer surgery in India has the following options:
- Lumpectomy or breast-conserving surgery: This procedure involves the removal of the part of the breast with a tumor only, along with a small amount of surrounding healthy breast tissue. It is also referred to as partial mastectomy or segmental mastectomy. The goal is to remove the cancer cells as much as possible, while still conserving healthy parts of the breast. The amount of breast tissue that will be removed majorly depends on the location and size of the tumor.
A far less common breast cancer removal surgery is a quadrantectomy. In this, almost a quarter of the breast is removed. After this surgery, the operated breast will appear smaller depending on the amount of tissue removed. It is sometimes referred to as a segmental excision.
- Mastectomy: It involves the complete removal of all the breast tissue. With advanced surgical techniques, this surgery has become more refined and less intrusive than it used to be earlier. Now, the muscles under the breast are no longer removed (radical mastectomy) in most cases.
There are different types of mastectomy procedures available, such as skin-sparing mastectomy (skin can be preserved), or a nipple-sparing mastectomy (the nipple can be preserved).
Some women may need the removal of both of the breasts, which is known as a double mastectomy.
Radiotherapy is also administered as adjuvant therapy after the surgery if there is a risk of relapse or recurrence.
Lymph node removal: It can be performed during a lumpectomy and mastectomy if the biopsy results indicate that breast cancer has spread to the lymph nodes.
- Sentinel lymph node dissection or biopsy: In this, the surgeon locates and removes one or a few lymph nodes from under the arm. These lymph nodes receive drainage from the breast area and the first nodes to which cancer can spread. This is a less-invasive which helps in avoiding the removal of multiple lymph nodes with an axillary lymph node dissection. Removing the lesser number of the lymph nodes in this procedure helps lower the risk of several side effects of the surgery, including lymphoedema (arm swelling).
- Axillary lymph node dissection: This procedure involves the removal of several lymph nodes from under the arm. The number of lymph nodes removed in an axillary lymph node dissection varies for different patients. It may not be required for all women with early-stage breast cancer who have small amounts of cancer in their sentinel lymph nodes. A full axillary lymph node dissection is generally avoided in women having a lumpectomy and radiation therapy, and those who have a smaller tumor and not more than 2 sentinel lymph nodes have cancer. It is to reduce the risk of side effects of the procedure without affecting survival.
- Breast reconstruction: This is a procedure to rebuild the breast after a surgery – mastectomy and sometimes lumpectomy. Breast reconstruction can be performed at the same time as cancer-removing surgery, this is known as immediate reconstruction, or months to years later, called as delayed reconstruction. There are different options for reconstruction, including a prosthesis or tissue flap procedure. Many women having mastectomy surgery for breast cancer will have the option of breast reconstruction. The aim is to restore the natural appearance of the breast after surgery. For some patients undergoing breast-conserving surgeries, the doctor may suggest grafting fat into the affected breast to cover any dimples left after the surgery. There are several types of reconstructive surgery, and a woman may choose a certain reconstruction option depending on the individual preference and medical condition.
Breast implant: These are prosthetic devices that are placed under the skin to give a natural appearance of the breast. The two most common types of implants are saline-filled or silicone gel-filled. The saline-filled implants have an outer shell made up of silicone and filled with sterile saline or salt water inside. A silicone gel-filled implant is filled with silicone gel instead of saltwater. There are several other types of implants with different shapes and textures. Each implant has its own benefits and risks. The choice of the implant varies from person to person.
Tissue flap procedure: In this method, the surgeon uses muscle and tissue taken from other parts of the body to reshape the breast. A tissue flap surgery can be done using the tissue from the back or belly, called a pedicle flap. This flap is transferred to the chest without cutting any blood vessels. A free flap procedure means the surgeon cuts the blood vessels and the moved tissue is attached to the new blood vessels in the chest.
The oncologist may also suggest prophylactic procedures to reduce the risk of cancer –
- Prophylactic mastectomy: It is a preventive procedure in which the breast is removed to lower the risk of breast cancer in people who are at high risk.
- Prophylactic ovary removal: This is a preventive procedure to reduce the amount of estrogen in the body. It aims to make it less likely for estrogen to stimulate or aid in the development of breast cancer.
It administered either before or after breast cancer surgery. It involves the use of specific drugs to kill off cancer cells. The use of chemotherapy may depend on the stage and the location of the cancer. Different doses of chemotherapy drugs are administered through injections directly into the veins or with the help of an IV solution or pills. The motive is to kill the cancerous cells and impede further relapse.
Radiation therapy –
It is often done post-surgery to kill the cancerous cells that are still left. Radiation therapy is done in combination with chemotherapy for the treatment of invasive breast cancer.
Types of Radiotherapy for breast cancer treatment:
External beam radiation: It is the most common type of radiation therapy used for breast cancer patients. In this, radiation is delivered by a machine outside the body which focuses the radiation beams on the targeted area having cancer.
Women who had lumpectomy will most likely have radiation to the entire breast, referred to as whole breast radiation.
The standard radiotherapy schedule for whole breast radiation is about 5 days a week for about 6 to 7 weeks. Another option for this therapy is hypofractionated radiation therapy in which the radiation is given to the whole breast, but in larger daily doses and with fewer cycles, typically for only 3 to 4 weeks.
Partial breast irradiation is also an option for some women, in which larger doses of radiation are given over a shorter time to only a selected part of the breast, instead of the entire breast.
Other types of radiation therapy for breast cancer:
- Intraoperative radiation therapy (IORT): This treatment involves administering a single large dose of radiation to only the area from where the tumor was removed in the operating room. It is performed right after a Breast-Conserving Surgery, just before the incision on the breast are closed.
- 3D-conformal radiotherapy (3D-CRT): It is an advanced radiation technique, in which special machines are used to accurately aim the radiation at the area from where the tumor was removed. This helps to prevent damage to the healthy breast tissues.
- Intensity-modulated radiotherapy (IMRT): This is also an effective radiation delivery method, like 3D-CRT. It involves changing the strength of the radiation beams in certain areas, to allow stronger doses to certain parts of the breast. This helps lessen the damage to surrounding healthy body tissues.
- Brachytherapy: This is an internal radiation technique. In this treatment, radiation beams are not aimed from outside the body, but a device containing the radioactive seeds or pellets is directly placed into the area of the breast where cancer had been removed, for a short period of time. Brachytherapy is an option for selected cases depending on factors such as tumor size and location.
Hormonal therapy –
It is administered on PR-positive and ER-positive types of patients with breast cancer. The idea is to give hormonal therapy medicines so as to obstruct the action of hormones on the cancer cells and stop their further proliferation.
Targeted drug therapy –
It is the most advanced type of treatment for breast cancer. It is expensive but result-oriented. Targeted drug therapy is different from chemotherapy wherein certain characteristics of the cancer cells are targeted. For example, the presence of HER-2 receptors on the surface of the cancer cells in the case of breast cancer. These cells tend to grow abnormally and so are specifically killed by targeted drug therapy. Unlike chemotherapy, targeted drug therapy does not kill healthy cells in the body.