Breast Cancer Program at Nanavati Max Hospital

The Breast Cancer Program at the Nanavati Max Institute of Cancer Centre is a dedicated program offering the most comprehensive treatment options for breast cancer, irrespective of the complexity of the type of cancer. Our team of highly qualified, compassionate, world-renowned oncologists and reconstructive surgeons hold specialized expertise in treating all types of breast cancer from early to advanced stages and is ascertaining new ways to bring the best care for managing breast cancer.

We offer a full spectrum of services such as state-of-the-art infrastructure, cutting-edge technology, on-site multidisciplinary experts, second opinion, and innovative treatment methodologies. We follow a team-based approach for diagnosis and advanced treatment options in breast cancer surgery, radiation, and chemotherapy and targeted therapy, thereby offering seamless, coordinated breast cancer care under one roof.

About Breast Cancer

Breast cancer is one of the most common cancers in women that develop when cells in the breast begin to grow out of control. This uncontrolled growth of the cells usually forms a tumour that can be felt as a lump.

Types of Breast Cancer

Ductal Carcinoma in Situ: these are premalignant cells confined within the duct.

Lobular Carcinoma in Situ: It affects the breast’s milk-producing glands, but does not invade the surrounding tissue.

Invasive Ductal Carcinoma: This is the most common type of breast cancer that commences in the ducts.When cancer cells spreads beyond the ducts into the surrounding tissue.

Invasive Lobular Carcinoma: When cancer cells spreads beyond the lobules into the surrounding tissue.

The lesser-known breast cancer/tumour types include Paget’s Disease of the Nipple, Phyllodes Tumor, Inflammatory Breast Cancer, Male Breast Cancer, Metastatic Breast Cancer, Pregnancy associated breast cancer , and Angiosarcoma.

Stages of Breast Cancer

The TNM staging is used to determine the stages of breast cancer.

Tumor (T):

The tumor is classified from TX to T4 where the former one cannot be evaluated to T4 which involves spread of the cancer to the rest of the breast involving skin or chest wall or both.

Node (N):

The nodes are classified into NX to N3. NX cannot be evaluated. The node progresses to next stages and reaches the N3 stage where the cancer involves 10 or more axillary lymph nodes or it involves the nodes above the collar bone or nodes along the internal mammary vessels ( vessels that supply the breast but are inside the rib cage)

Metastasis (M):

The spread of the cancer to other parts of the body is classified into stages such as MX to M1..Oligometastatic breast cancer is a special group of metastatic breast cancer patients with low burden of metastatic deposits that is amenable to curative treatment.

Natural Progression

The natural progress of breast cancer can be understood well with the help of the TNM stages as specified above. Most commonly the breast cancer originates from the cell in the breast and progresses to involve other sites and hence it becomes extremely important to detect it when it is still in the breast or is spread only to the regional lymphnodes.

Signs and Symptoms of Breast Cancer

Different people have different signs and symptoms of breast cancer. Some of the very common ones include:

  • A lump in the breast or under the armpit. Lump is the most common symptom of breast cancer and is most commonly painless.
  • Change in the consistency or feel of the breast, this change in feel may be localised to one area or may be in the whole breast
  • A change in the texture of the skin such as puckering or dimpling (like the skin of an orange)
  • Redness or ulcer around the nipple or on the skin of the breast
  • A change in shape, position or the look of the nipple (nipple might become pulled or changes its position or its shape)
  • Discharge from the nipple. Any discharge from the nipple should be reported to a breast cancer specialist especially when the discharge is blood stained.
  • A change in size or shape of the breasts

In some cases, a patient does not experience any signs or symptoms; therefore, a regular screening for breast cancer is necessary. The screening for breast cancer need not always be with mammograms as they fraught with problems like over diagnosis and over treatment. The best way to screen for breast cancer would be to do a proper monthly self breast examination combined with an annual clinical breast examination by a breast surgeon. The doctor will be able to give you a fair estimate on your risk of developing breast cancer in your life time. This risk is not the same for everybody and changes based on your age, menopausal status, reproductive history and many environmental and genetic factors.

Causes/Risks of Breast Cancer

Ageing: As you age the risk for breast cancer increases, most common age for incidence of breast cancer is between 40 and 50 years of age.

Obesity: One of the most understated risk factors for development of breast cancer and risk factor for development of recurrence after completing treatment for breast cancer is obesity.

Genetic Mutations: Women who inherit certain genes like BRCA1 and BRCA2 are at higher risk of breast and ovarian cancer. Other than BRCA genes there are other deleterious mutations which increase the chances of development of breast cancer in a life time. Having a genetic mutation only means that the risk is higher as compared to rest of the population. Each mutation is associated with a different risk.

The Family History of Breast Cancer: Having a first-degree or second degree relative either from maternal or paternal side of the family, who have had breast  or ovarian cancer increases a woman’s risk of developing breast cancer.

Reproductive History: Women who experience early menstruation that starts before 12 years of age or have menopause after 55 years of age are at risk of developing breast cancer. Having ones first pregnancy after the age of 30 years also increases the risk of development of breast cancer.

Hormone Pills: Use of hormone replacement therapy after menopause or use of oral contraceptives for more than 10 years

Personal History: Having a personal history of breast cancer or history of benign breast lesions

Previous exposure to radiation (childhood cancers)

Having Dense Breasts: Women having radiologically dense breasts are at high risk of developing breast cancer. This is because dense breasts have more connective tissues than fatty tissues, which makes it harder to detect cancer

Treatment for Breast Cancer

Our multidisciplinary team of national and international oncologists offers a personalised treatment plan to patients diagnosed with breast cancer. Some of the advanced treatment options we offer include:

Surgery:

Surgery is performed by the experts to remove the tumour from the breast and there are two types of  surgeries for the primary tumour performed:

Mastectomy:

Removal of the entire breast along with either removal of axillary lymph nodes or with sentinel node biopsy of axillary nodes.  

Breast Conservation Surgery:

Removal of the tumour alone with a safe rim of surrounding healthy breast tissues along with axillary surgery while conserving the breast.

Axillary Surgery :

Sentinel Node Biopsy:

Removal of a few lymph nodes in the armpits to confirm the presence of cancer. Prior to the procedure a radio isotope is injected in the vicinity of the tumour to locate the sentinel lymph-node a blue dye is also injected at the time of surgery to identify the first node to which the tumour drains.This procedure is oncologically safe and also decreases the chances of lymphedema after breast cancer surgery. It is performed in selected cases, where clinically and radiologically axillary lymph nodes (located in armpits) are not involved.

Axillary Clearance:

Complete removal of all axillary lymph nodes suspected of harbouring cancer cells.

Oncoplastic Surgeries:

These array of procedures are done keeping in mind that breast conservation is now possible in suitable cases even if the tumours are big. The surgeons reconstruct the part of the breast using perforators flap harvested from the fat around the breast or from the patients back. These procedures are oncologically safe while offering patients cosmetically acceptable breasts after cancer surgeries. They can be combined with symmetrisation procedure of the opposite breast.

 Microsurgical Breast Reconstruction:

It is an advanced surgical procedure after removal of the whole of a breast for cancer, it involves transferring of tissue (skin and fat) from the normal part of the patient’s body to the chest for reconstruction. For those women who are unhappy with the idea of losing their breast this immediate breast reconstruction can help them wake up with ta breast after surgery. A plastic surgeon is involved in this case and utilises the patient’s own tissue to create a breast from form which closely matches the opposite breast and if required with an artificial implant is also used . If the patient does not wish to get the breast reconstructed in the same sitting then she can delay reconstruction for about 1 to 2 years after completion of treatment.

Radiation Therapy:

Radiation therapy is given post-operatively and after completion of all chemotherapy for local control and reduce the chances  of distant metastases. Radiation therapy is also given in metastatic breast cancer at the site of bony mets and it provides pain control therapy is a safe & effective procedure where radioactive isotopes or high-energy photons, electrons or other particles are used to destroy the cancer cells. There are two types of radiation.

  • External Beam Radiotherapy (EBRT)
  • Brachytherapy or interstitial (HDR)

A Radiation Oncologist is the specialised doctor for this treatment. Radiotherapy regimens or schedules and protocols are specific for different tumours and hence the time for treatment differs from case to case.

For  early breast cancer it is now possible to offer radiation therapy only to the part of the breast that had the tumour. This can be done intraoperatively as well as post operatively. The amount of radiation given and the time required to complete the treatment  in these cases is less. This is called as Accelerated Partial Breast Irradiation ( APBI).

Hormone Therapy:

Hormone therapy is a treatment that uses anti hormone medication to slow down or stop the growth of hormone-positive (tumours that depend on oestrogen to grow) cancer, and give the quality of life with minimal side-effects. Hormone therapy is often offered after surgery to reduce the risk of cancer recurrence. It is can also be used before surgery in certain large cancers to downsize the tumour burden. Hormone therapy can also be used to treat cancer that has come back or has spread to other parts of the body. This treatment is available in tablet form to be taken once daily. In premenopausal women the drug used is Tamoxifen and in postmenopausal women the drug bro used is an aromatase inhibitor(Anestrazole, letrozole,exemestane)

Chemotherapy:

Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It is given to lower the risk of cancer returning.Chemotherapy is usually given to a patient through injection, or infusion, and rarely by mouth depending on the type and stage of the cancer being treated. We offer tailored protocols of chemotherapy as per patient needs, tolerability and type of cancer. Along with chemotherapy we also give medications to keep the side effects of the chemotherapeutic agents to the minimum. We also try to maximise day-care chemotherapy to allow our patients to carry out their daily lifestyle activities with ease. Sometimes chemotherapy can be given prior to surgery to shrink the size of the tumour in order to offer them The possibility of Breast conservation

Targeted Therapy:

Targeted therapy works by targeting the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. These genes and proteins are found in cancer cells or cells related to cancer growth, hence it does not affect other tissues. Targeted therapy is given to block the effect of these genes and proteins. Targeted therapy is used by itself or along with chemotherapy and immunotherapy. These agents have shown to give results as good as and sometimes better than chemotherapy with minimal side effects.

Immunotherapy:

Cancer immunotherapy is the artificial stimulation of the immune system to treat cancer, improving the immune system's natural ability to fight cancer. It is considered as a fundamental application of the research of cancer immunology and is a growing subspeciality of oncology. The current use of immunotherapy is restricted to certain breast cancers that do not have any receptor positivity.

Physiotherapy for Lymphoedema of the Affected Arm:

Dynamic compression therapy an advanced form of inflatable compression therapy is being provided at Nanavati Max Super Speciality Hospital which reduced the lymph oedema significantly in most cases.

Precautions for Breast Cancer

Some of the Major Precautions And Lifestyle Changes one Must Adopt Include:

  • Watch Your Weight: Obesity or being overweight increases your risk of breast cancer.
  • Breastfeed Your Baby: Women who breastfeed their baby are at very low risk of breast cancer than women who do not breastfeed at all.
  • Reduce Your Hormone Intake: women who take hormone replacement therapy for prolonged periods are at risk of developing breast cancer. Discuss with your doctor before taking hormones to relieve menopausal symptoms.
  • Avoid prolonged Use Of Birth Control Pills: Certain kinds of Birth control pills can alter your hormones and increase your chances of breast cancer if used for prolonged periods, particularly if you smoke or above 35 years of Age.
  • Opt For Regular Screening: It is must opt for regular screening for breast cancer every year, Do a monthly Self breast examination and visit your breast cancer specialist at-least once a year for a breast examination. Mammography screening between the ages of 40 and 75 have been recommended by various international guidelines. Discuss with your doctor to find out what your risk of getting breast cancer is and how often should you get screened.
  • Limit Your Alcohol Intake: Excessive intake of alcohol can increase your risk of breast cancer
  • No Tobacco / Smoking
  • Exercise: Women who work out every day for about 40 minutes, have a lower risk of developing breast cancer.

Survival Rates for Breast Cancer:

The 5-year relative survival rates related to localized and regional types falls between 85%-99% whereas it falls between 20%-30% for breast cancer that has spread to other parts of the body.

Diagnosis

At Nanavati Max Institute of Cancer Care, we offer you the most advanced diagnosis and treatment techniques for breast cancer, irrespective of its complexity. Our doctors conduct several tests to diagnose cancer, these tests include:

  • A thorough clinical examination
  • Sonograms (Breast ultrasound)
  • Mammography
  • Magnetic resonance imaging (MRI)
  • Core Biopsy (ultrasound-guided)/ FNAC
  • Core Biopsy (ultrasound-guided)/ FNAC
  • Image guided biopsy for small tumours with the advanced techniques of vaccum assisted stereotactic biopsy or wire-guided biopsies.

Pathophysiology

This malignant tumor commences in breast cells of the patient. DNA damage and genetic mutations are often responsible for breast cancer.

Typical Test

The most common type of test to detect breast cancer is called a Triple test and it includes Clinical examination, a diagnostic mammogram and a biopsy of the breast lump.

Our Breast Cancer Specialist

If you are facing any similar signs or symptoms please contact the Nanavati Max team to schedule an appointment at : +91 22 6836 0000

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