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Breast Cancer : An Awareness Drive Against Cancer , "The Emperor of all Maladies"

Thursday - October 1, 2020 5:03 pm , Category : WTN SPECIAL

By - Dr Dodul Mondal
Consultant Radiation and Clinical Oncologist, Indraprastha Apollo Hospitals, Delhi, India

I hope most of the people by this time are familiar with the word “Cancer”. With an estimated number of new cancer patients of 14million per year worldwide, the number is expected to increase by 70% in another two decades time. You can expect that a time in future will come when one member of every family will suffer from cancer.
 
What is Cancer?
By this time many of you reading this page, know what cancer is. Yes, it is nothing but an uncontrolled growth of cells of our body which can occur anywhere starting from skin of our head to toe. Normally every cell and tissue of our body is finely tuned to grow and die in an orderly manner. Problem starts when some of these cells do not die and the affected organ or tissue grows in uncontrolled fashion. That means, no death and only growth gives rise to cancer.
 
Does that mean tumor and cancer is same?
The answer is “NO”. For understanding, let us say, tumors can be good or bad. The good tumors can be called as BENIGN TUMORS. The bad tumors, which we call cancer, are rather aggressive in nature. They can start from a small swelling and with time, grow to become larger and larger. If they are not treated properly, they spread to other organsand can kill a person. That means, CANCER=BAD TUMORS, and NOT ALL TUMORS ARE CANCERS.
 
Does that mean I can wait if I notice a swelling or tumor in my body?
“NO”. You should not wait to see the tumor growing big. Whenever you notice a swelling or lump, visit a doctor. Make sure, the doctor is not a quack or alternative medicine practitioner. Please visit cancer/oncology department of a hospital or a cancer specialist.
 
What are the common symptoms of a cancer?
There is a small list of common symptoms. Just remember seven early warning signs of cancer and think of the word
CAUTION:
Change in bowel or bladder habits.
A sore that does not heal.
Unusual bleeding or discharge.
Thickening or lump
Indigestion or difficulty swallowing.
Obvious change in the size, color, shape, or
thickness of a wart, mole, or mouth sore.
Nagging cough or hoarseness.                                   
 
What are the common symptoms of Breast cancer?
This diagram shows common symptoms of breast cancer. Apart from these, you can also feel enlarged glands at your armpit. There can be many more symptoms depending on the stage of the tumor and organ(s) involved.
 
How to diagnose?
Different tests are done to determine whether your tumor is cancer or not. The most important and mandatory one is a BIOPSY.
 
What is Biopsy?
A biopsy is a procedure by which a small chunk of the tumor is cut or obtained by a thick needle and examined under microscope or by other techniques. This is the most confirmatory method. However, no quack should attempt this.
Is FNAC and Biopsy same?
NO. They are different. FNAC means Fine Needle Aspiration Cytology. Cytology means assessment of cell structure and function. That means, some cells from the tumor are obtained via fine needle (like, a common syringe used to give injections) and tested to know whether the cells contain any cancerous change or not. For breast lumps, a thick needle biopsy (Tru cut or core needle biopsy)  is usually performed in the beginning.
 
What other tests are done?
Many tests are donewith different purpose. Few blood tests are done to assess your body and organ function. We do CT scan, MRI, Bone scan, PET scan or PET-CT scan, different cancer marker study, genetic and mutation analysis as we feel appropriate and necessary. Some of these tests helps us to know where and how far the cancer has spread and some of these helps to decide treatment for you. It depends on what kind of cancer you have. Some new tests like Liquid biopsy, Oncotype-DXTM or MammaprintTM are increasingly being utilized for different purpose.
It is always necessary to have all these required tests to be done before your treatment starts. Jumping to treatment without properly knowing your disease and stage can be harmful.
 
What is Mammography?
Mammography is a specially designed soft X-ray for detecting and screening breast cancer. It can detect breast cancer at a very early stage. However, it may not detect the tumor always, particularly in very young patients. Please remember, no method is absolute, and everything has its own drawback.
 
Can I start screening for breast cancer?
Yes, certainly. Different cancer organizations have recommendations regarding breast cancer screening. You can read summary of these guidelines online or from nccn.org website. If you are over 25 years of age, you can start breast cancer screening after giving due importance to risks, benefits, side effects etc. It is a common perception that Indian women develop breast cancer one decade earlier compared to western women.
What are the methods of breast cancer screening
Usually a good history taking, clinical breast examination, mammography for both breasts or remaining breast and ultrasound of breasts are done. Depending on your need based on your background, I shall advise you what to do.
 
Can I go for genetic testing to check my risk?
Yes, if you have high risk of developing breast cancer because of genetic factors. This is not routinely recommended for all. Only few selective women may have benefit of genetic screening. However, please remember, you should have detailed genetic counselling before considering genetic screening.
 
What is cancer stage?
It indicates how far the cancer has spread in your body. In simple terms, most of the cancers including breast cancer have four stages.
Stage I-Very early stage where the tumor is confined to the breast only
Stage II and III- Tumor is not as small as in stage I butremains confined to breast and or armpit glands.
Stage IV- Signifies that the tumor has spread to other organs of the body or to a remote place of the body, like tumor spreading to bones or lungs or brains etc.
People commonly mistake stage IV as last stage of the patient. They are not the same. Stage IV means that the tumor has spread widely in the body. However, many patients with breast cancer live long even with stage IV cancer when treated properly.
 
What are different treatment options?
Depending on type and stage of your cancer, different treatments can be offered. It can be a surgical removal of the tumor or entire breast along with removal of glands form armpit, radiation therapy, chemotherapy, hormone therapy,targeted therapy, immunotherapy or a combination of them depending on stage and condition of the patient. Usually a team of cancer specialists decides the treatment course. Don’t forget to take a cancer specialist’s opinion before you start your treatment.

What do you need to keep in mind?
The above discussion is partial and for awareness drive only. It should not be used for actual treatment of a patient. You can contact me or any other cancer specialist for your needs which will be customized.
One treatment does not fit all. So, do not compare your disease or outcome to others.
Cancer screening, detection, diagnosis, treatment, managing complication and its prevention is a highly specialized and difficult field. Any error or mistake in decision can change your outcome.
Always consult an oncologist with adequate experience and expertise. Usually decisions are made in a joint clinic or tumor board.
Do not ignore your lump/symptom. Seek medical help.
My intention is to make you aware and not afraid. You can contact me in my clinic or via email if you need more clarification.

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