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Breast Cancer Overview – Yara Elshebiny

Three main reasons why detection of breast cancer is delayed:

  • Financial issues.
  • Illusions; the female is too afraid to seek medical advice so as not to discover any serious disease.
  • Level of medical awareness. The patient must know that any abnormality detected should be followed by visiting the doctor.

Assessment of Breast Cancer

The first step is applying radiological imaging on the patients’ breast either mammography -in older age over 35 years- or ultrasound in younger ages. This step detects the presence of a breast mass. In this case, we have to take a needle biopsy from it, this biopsy could be taken either by:

  • Fine needle aspiration cytology which detects cancer cells. if it’s negative we proceed to next step which is:
  • True cut biopsy for examination of tissues. In some case, there may be a mass detected by mammography or Ultrasound but still gives negative results in the biopsies.These cases should undergo an open biopsy in which the whole mass is surgically removed with a safety margin and examined for malignancies. If it proved to be a malignancy, the case should continue her investigations and treatment.

Workup

There are some routine investigations that should be done before starting treatment:

  • PET scan of bone — to eliminate the presence of any cancer cells in the bone.
  • CT scan of chest, abdomen, and pelvis.
  • CT scan of the brain.

Lines Of Treatment

Choosing the treatment plan defers from one case to another. There are three main lines of treatment that are closely related to each other:

  • Surgical removal of the mass alone or the whole breast.
  • Radiotherapy.
  • Chemotherapy.

Early cases with surgically removable L.N and no secondaries detected are mostly treated by surgical removal of the mass or whole breast. Depending on the size of the mass, size of the breast and the ratio between the two sizes.

Cure rates may reach 100% in early cases after surgery and radiotherapy and/or chemotherapy.

If the mass is removed alone, the patient should receive radiotherapy within six months of surgery after finishing chemotherapy, this helps eradication of any cancer cells invisible by naked eye left in the remaining breast tissue.

Chemotherapy treatment depends on the presence or absence of secondaries in axillary L.N, this is detected by injecting methylene blue dye; that gives blue color in the affected L.N. (The presence of only one affected L.N is an indication for starting chemotherapy.), the patient should receive 6 cycles of treatment separated by 3 weeks.

There’s another additional treatment which is the hormonal treatment. Only effective if there are positive hormonal receptors on cancer cells, the detection of these receptors occurs during the examination of cancer biopsy. The hormonal treatment continues for 5 years after chemotherapy.

In delayed advanced cases with secondaries in other parts of the body, the rule of surgery is limited to improving quality of life if there is a pain in the breast or bleeding but the main treatment is chemotherapy and/or radiotherapy depending on the condition of each case.


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