Pune Breast Care

How do I know if I have breast cancer?

In the early stages, a woman with a painless breast lump, may not have any changes to appetite, weight or wellbeing. Symptoms of breast cancer include but are not limited to 1) A lump in the breast or armpit 2) Change in shape size or feel of the breast 3) Nipple discharge 4) Retraction (pulling in) of the nipple 5) Dimpling of the skin of the breast 6) Thickening or redness of the skin of the breast 7) Rash around the nipple or areola A lot of these signs can overlap with those of benign (non cancerous) breast condition. It is hence important to get yourself examined by a specialist and not try to diagnose yourself at home. Eary breast cancer can exisit even in the absence of any of the symptoms above in which case it is usualy picked up by mammography or other imaging.

For Breast Cancer Surgery is a mastectomy better than lumpectomy?

Patients often believe that the cancer can come back in the remaining breast after lumpectomy, but cannot recur after mastectomy. Truth is although most patients will never develop a recurrence, a cancer can recur in the chest wall or skin flap after a mastectomy or in the remaining breast after a lumpectomy. Regardless of which surgical approach is taken, routine follow-up with your breast surgeon or oncologist is a must. After a breast surgeon has evaluated you for breast cancer, you may be a offered a the choice between lumpectomy+ radiation and a mastectomy. The choice is only offered if the cancer lends itself safely to be treated by either options. This means that you will not be offered a lumpectomy if the tumor were not suitable for that treatment eg. if the tumor involved multiple areas of the breast. However when the choice is offered to you, your survival will not be affected by the surgical treatment you choose, as long as you complete all treatments advised. Not completing radiation after lumpectomy has high risk of recurrence. When making the decision between lumpectomy and mastectomy discuss the following with your breast surgeon. 1) Need for radiation: Radiation is almost always given after a lumpectomy, whereas it can be av oided in certain cases after a mastectomy. 2) Options for reconstruction after mastectomy: A mastectomy may not be a mutilating surgery, often the skin and nipple areolar complex can be preserved at the time of surgery and the breast is removed and replaced with an implant or a flap. 3) Plan for surveillance / follow-up after surgery: Routine mammography for the treated side is necessary after a lumpectomy. If you undergo a mastectomy, mammography is needed for the opposite side. The side of the cancer is followed with clinical exam alone 4) Possibility of genetic/ hereditary breast cancer: In cases of known BRCA mutations, a bilateral mastectomy may be offered over the choice of lumpectomy and radiation. If you opt for a lumpectomy in this situation, annual MRI is also advised for surveillance given the higher risk of recurrence. 5) Expected cosmetic outcomes of either approach: Aesthetic outcomes of both approaches may be satisfactory. Sometimes patients opt for a bilateral mastectomy with reconstruction for symmetry. In cases of a lumpectomy, a symmetrization procedure may be offered for the opposite side. Radiation also affects long-term appearance of the breast. It is important for the woman to be comfortable with the decision she makes. It is also important for family members to help the patient make her own decision and notjudge them for the choices they make.

If the lump seen on mammography is not felt by hand, how does the surgeon know what to remove?

Mammography screening (Fig. A) often detects tumors that neither you nor the surgeon can feel by hand. It is imperative that image guidance is used in planning surgery for removal of such tumors. Use of ultrasound (Fig. B & C) in the operating room or wire-localisation technique enables surgeons to remove the exact area that bears the tumor

I have cysts in the breast, what should I do?

There are different types of breast cysts. "Simple cysts" can often be safely observed. They do not convert to cancer nor do they increase risk of breast cancer . "Complex cysts" may need a needle aspiration and occasionaly a biopsy of the wall. A cyst may occasionally grow to a large size, be felt by hand and cause discomfort. A needle aspiration can be performed to remove fluid and alleviate the discomfort. Much like a water balloon, a cyst collapses after removal of fluid. Cyst fluid may be sent for testing if needed. A breast specialist can help decide what if anything needs to be done about these cysts. Rarely does a cyst need surgery.

What causes repeated breast abscesses?

Puerperal breast abscesses are common in women during lactation. Bacteria from the baby's mouth travel into collections of milk causing infections and abscesses. These can often be treated with a combination of needle aspiration (removal of the pus collection with a needle) and antibioitics. Sometimes they need open incision and drainage with surgery. When an abscess occurs outside of the context of breast feeding and pregnancy and especially if they occur repeatedly, a specialist consultation is advisabe. Causes can include Diabetes: Poorly controlled blood glucose makes diabetics prone to infections Smoking/ tobacco: Smoking can cause ongoing inflammation and recurring infections around the nipple and areolar region. Tuberculosis: TB does not respond to standard antibiotics and can cause long standing breast infections, abscesses, sinuses and fistule.It responds well to anti-TB treatments. Idiopathic Granulomatous Mastitis: This condition causes recurring inflammation, abscess formation, sinuses and fistulae in the breast. It is a difficult to treat, autoimmune, chronic condition but responds to medical therapies that may include steroids and immunosuppression. As treatments for each of these conditions differ, a correct diagnosis and treatment is critical to avoid repeated surgery and defomitiy of the breast.

Does a fibroadenoma convert to cancer?

A fibroadenoma is a benign non-cancerous condition and does not convert to cancer. It is important to ascertain that a breast lump is a benign fibroadenoma with a combination of imaging and needle biopsy as needed.

Can I take medicines to shrink a fibroadenoma?

Fibroadenomas that are small and not causing discomfort do not need treatment. Some fibroadenomas continue to grow while others regress or shrink on their own. If a fibroadenoma is growing, causing pain or other symptoms it can be surgically removed.

If I have a breast problem, should I undergo a mammogram or an ultrasound?

Mammography and breast ultrasound are complementary tests. One is not necessarily better than the other, as they provide different types of information. In young women < 40 years of age, we usually start with a breast ultrasound. If needed digital mammography or breast MRI may be used to investigate a problem further. In women over the age of 40 years we start with a diagnostic mammogram. An ultrasound or needle biopsy may be needed to complete the diagnosis. It is best to discuss the problem with a breast specialist or breast surgeon who can guide you about appropriate investigations. If you have a concern and the mammogram is normal, do not let it stop you from seeing a specialist. Mammography is not perfect and can miss 10-20% of cancers.

How should I prepare for a mammogram?

On the morning of your mammogram, take a shower but do not apply talc or anti-perspirants as they can show up on a mammogram. Carry all old mammography or breast ultrasound reports, films or CDs you may have. You do not need to fast before the exam and you should be able to drive yourself back and forth from the test. If you're anxious, you may have a friend accompany you.

I have been advised a breast biopsy. Which type of biopsy should I choose?

I will often prefer an ultrasound guided core needle biopsy over conventional FNAC or excision of the breast mass or lesion. The core biopsy is done under local anesthesia in the ultrasound room with minimal discomfort and takes 10 - 15 minutes. You do not have to be fasting for it. Ultrasound guidance allows accurate sampling of the tissue and less chance of missed diagnosis. Histopathological diagnosis obtained with core biopsy has lower error rate than FNAC and avoids unnecessary surgery for diagnosis. If the condition is benign or amenable to medical management, surgery can be avoided. If the condition is cancerous, information about the exact type of tumor can be obtained from this biopsy and the right surgery can be planned for treatment, avoided need for re-operations. Know more about breast biopsy here

Is Breast Cancer Hereditary?

Most breast cancers are sporadic ie, most patients with breast cancers occur in women who have no significant family history. 5-10% of breast cancers are clearly linked to genetic mutations that can be inherited from parents and passed down to children. BRCA 1 and BRCA 2 mutations are the commonest genetic defects found in families with breast and ovarian cancers, however other genes may be responsible. If you have a family history of breast cancers or multiple other cancers, genetic counselling prior to genetic testing is advised.

Can breast cancer be inherited from the father's side?

Yes, genes responsible for breast cancer can be inherited from maternal or paternal side of the family. Men with BRCA mutations are prone to breast cancer and prostate cancer. A father may carry the breast cancer gene and pass them down to his children without facing cancer himself. If you father's mother, sisters, aunts have a history of breast cancer, you need to discuss this history with your genetic counsellor of breast specialist.

What sample is needed for genetic testing?

The gene defect responsible for hereditary cancer syndromes, if present is found in all cells of the body. A patient can hence provide blood , saliva or a cheek swab for testing.

I have a lump in the breast. How do I know if its serious?

Never try to diagnose yourself at home. Consult a breast specialist for a physical breast exam and get a mammography and /or ultrasound as advised. If needed, you may be advised to undergo a needle biopsy for complete diagnosis. Always seek attention prompty and undergo athorough diagnostic evaluation for a breast mass.

Why do I need so many tests for a breast lump?

Diagnosis of a Breast lump usualy needs a complete triple test. This includes 1) Clinical breast exam ie. Physical exam by a doctor 2) Age appropriate imaging: Mammography and or ultrasound 3) Needle biopsy for a definite pathological diagnosis

The breast swelling I have is not painful- can it still be cancer?

Breast cancer is often a painless lump. That being said, benign lumps like fibroadenomas and cysts can also be painless. Pain or lack therof is not a reason to ignore a breast lump. Any lump in the breast should be thoroughly investigated.

Do all breast cancers need chemotherapy?

No. Certain subtypes of breast cancer may do very well with hormone therapy alone. The decision about chemotherapy should be made in consultation with an oncologist that has expertise in breast cancer

What are the advantages of getting a port for chemotherapy?

A chemo port helps a patient avoid repeated needle sticks for blood draws and intravenous (IV) cannula placements. Chemotherapy drugs are often irritant and cause the veins of the forearms to get clotted off and scarred. Finding veins for IVs becomes difficult with successive chemo cycles. In breast cancer patients, we protect the arm on the side of the cancer if the lymph nodes have been removed. This limits IV placement options to the opposite side. In this scenario, a port is helpful as it allows blood draws and drug adminstration without repeated IV placements. Before choosing to undergo a port placement, discuss risks and benefits risks of port placement with your cancer surgeon.

What can I eat and what foods do I avoid during chemotherapy?

On the day of planned chemotherapy, eat a light meal before coming to the hospital/ chemo center. Lower Infection risk during chemotherapy by following safe food –practices as below

• Water should be filtered or boiled.
• Milk should be pasteurized.
• Leaves of vegetables be washed thoroughly
• Fruits should be cleaned and peeled & eaten.
• Avoid raw meat, raw eggs.

• Sprouts should be well cooked
• Home food is general y safer than eating out.
• Avoid thawing food: Perishables should be cooked or consumed immediately after removing from the fridge
• Clean surfaces, knives and utensils should be used to prepare food.

What do I do for eating problems during chemotherapy?

If you experience nausea/ vomiting: Do not force-feed yourself. Try to eat small portions of light food several times a day. Ginger may help with nausea. Avoid hot, fatty, spicy food. Try cold liquids, cleaned and peeled fruits. Light exercise may help improve appetite. If you cannot maintain enought intake, you may need to be admitted to the hospital for hydration. If you have diarrhea/loose stools: Keep sipping water and clear fluids. Try soups, juices, bananas to maintain hydration and electrolytes. If diarrhea persists, you may need to be admitted to the hospital for hydration. FLUIDS: Water, Fruit juice, lime juice, coconut water, broth, buttermilk, lassi. ELECTROLYTES: Bananas, fresh fruits If you get Mouth Sores during chemotherapy: Try soft cold foods. Avoid nuts, seeds and others foods that have sharp edges. Ask your oncologist about medicated mouthwashes.

What Diet Plan Should a breast Cancer Patient follow?

* There is no Magic Diet Plan that is proven to cure cancer or stop its growth. *A Healthy Balanced Diet rich in protein & vitamins will help meet additional demands of treatments. *Avoid Fad Diets that make sudden large changes, as they may be harmful. *Do not attempt rapid weight loss if you are overweight.

What should I eat after breast cancer surgery?

• After general anesthesia, your appetite may be low for a day or two, and you may experience some nausea. Do not force- feed yourself. In the hospital, you will be started on liquids and slowly given solid food.

What diet should I follow during radiation?

*Radiation for breast cancer should not affect your ability to eat. You can take a normal balanced diet. *Eat a light diet before going to the radiation center. Keep a snack with you if you anticipate a wait. *If you have gained weight during other treatments, restrict high calorie, fatty food. *Do not take antioxidants/ vitamin supplements without consulting your oncologist.