- Following are the most often performed surgical interventions to treat Breast cancer:
- Breast Conserving Surgery (BCS) Type of surgery where the cancerous lump is removed with a rim of surrounding normal breast tissue, and the remaining breast tissue is preserved.
With recent advances in Plastic surgical techniques, the remaining breast tissue is refashioned to ensure better cosmesis, which is called Oncoplasty. Occasionally, a pedicled flap may be required to fill in the defect caused by the removal of the cancerous lump.
- MastectomyIt is the removal of the entire breast, its internal anatomical structures like lobules, ducts, fatty tissue and the overlying skin, including the nipple and areola.
- Modified Radical Mastectomy Removal of the entire breast with nipple and areola complex and the regional axillary lymph nodes.
Many women who have surgery to remove an entire breast have the option of having the shape of the removed breast rebuilt – Reconstructive surgery
Surgery to reconstruct the breasts can be done at the time of the mastectomy or after breast cancer treatment has been completed. This can be done months or even years after the mastectomy.
Women who choose to have breast reconstructive surgery have several options :
- Breasts can be rebuilt using implants (saline or silicone).
- They can also be rebuilt using autologous tissue (that is, tissue from elsewhere in the body).
- Sometimes both implants and autologous tissue are used to rebuild the breast.
- Sentinel Node Biopsy Surgical procedure used to determine whether cancer has spread beyond a primary tumor into the lymphatic system. A single-dye or a dual-dye technique may be used to perform the above procedure. Post identification, the nodes are removed and analyzed for the spread of cancer by frozen section or routine histopathology.
- Axillary lymph node dissection Removal of lymph nodes in the armpit (axilla). This procedure is usually performed once the spread of cancer has been confirmed through the Sentinel Node Biopsy procedure.
- Majority of breast cancer patients can conserve their breasts today because of the use of adjuvant radiotherapy after undergoing a breast conserving surgery instead of a mastectomy.
Radiation therapy is typically done using a Linear Accelerator that aims the high energy X-rays, electrons or Protons to the desired tumor site. (external beam radiation). This can be completed in three weeks.
During external beam radiation therapy, you lie on a table while a machine moves around your body, directing high-powered energy beams, such as X-rays or protons, to the breast cancer with various techniques such as IMRT, IGRT, V- MAT, Tomotherapy and particulate therapy like Proton Beam Therapy.
- HDR Brachytherapy: Radiation can also be delivered by placing radioactive material inside your body (brachytherapy). In this technique, the radiation is given by placing needles in the breast, and a source of radiation is then passed through these needles. The radioactive source delivers a high dose of radiation over a shorter period.
- Hypo-fractionated Radiotherapy using EBRT or Brachytherapy can be given in Breast Cancer. This reduces the total duration of therapy.
- Intraoperative Radiotherapy - Radiation can be delivered immediately after surgery in the operation theater after the removal of the tumor.
- Chemotherapy Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. In Breast Cancer, Chemotherapy is used before surgery or after surgery, depending upon the stage and risk factors. Chemotherapy given before surgery helps to shrink the tumor. Sometimes it is recommended after surgery to decrease the chance of recurrence. Chemotherapy is also indicated in advanced and metastatic disease.
- Hormonal therapy Hormonal therapy works by acting on the hormonal receptors and modulating their functions, thereby blocking cancer cell proliferation. Hormonal therapy is indicated in patients who express estrogen and progesterone receptors in the tumor. It is generally used after surgery. Also, it is used in advanced and recurrent diseases.
- Targeted drug therapy Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Targeted therapy in combination with chemotherapy is generally used in advanced disease and in disease recurrence based on immunohistochemical tests and molecular tests. It is also used along with chemotherapy before or after surgery in certain patients based on immunohistochemical tests.
- Immunotherapy Immunotherapy is a drug treatment that uses the immune system to fight cancer. Immunotherapy might be an option if you have triple-negative breast cancer, which means that the cancer cells don't have receptors for estrogen, progesterone or HER2. The indication for immunotherapy is based on immunohistochemical tests and molecular tests in advanced disease and recurrence. Immunotherapy is generally used in combination with chemotherapy in advanced diseases.