Breast cancerBreast cancer is a difficult adversary but it can be beaten
It is currently estimated that 1 in 8 women will develop breast cancer at some time in their lives. According to World Health Organisation data, breast cancer is the most common type of cancer affecting women throughout the world, representing 16% of all female cancers. Despite these data, breast cancer mortality rates are falling each year thanks to the advances in early diagnosis and treatment. In fact, when it is detected early, chances of survival are virtually 100%.
After being diagnosed with breast cancer, it is important to remain calm and find out the best treatment options. At the Instituto Oncológico Teknon Breast Cancer Unit you will receive integrated, personalised care from a multidisciplinary team of specialists backed up by the latest technology. They will provide the minimally-invasive treatment option requiring the shortest recovery time that best suits your particular case.
Treatment of breast cancer
There are different treatments available for breast cancer which can be combined where necessary. Depending on the size and location of the tumour and the degree to which it has spread, it may be treated with:
The usual treatment consists firstly of surgery, followed by chemotherapy and, if necessary, radiotherapy. Chemotherapy may be given before the operation to reduce the size of the tumour so the surgery does not need to be so aggressive.
After the operation, by analysing the tumour through a biopsy, the specialist team will decide what postsurgical treatment you need.
Why at Instituto Oncológico Teknon?
- Multidisciplinary Committee. The Unit has a Multidisciplinary Committee made up of specialists in Oncology, Surgery, Gynaecology, Radio-Oncology and Plastic Surgery, Radiology, Pathology and Nuclear Medicine. This Committee provides personalised care and treatment based on the well-being of the patient.
- Fast and reliable diagnosis. In a warm, friendly and intimate environment, patients in the Breast Cancer Unit are able to obtain a fast, reliable diagnosis and integrated treatment from internationally renowned specialists.
- Oncology Nursing Team. The Instituto Oncológico Teknon nurses, with specific training in oncology, are a fundamental part of the care team before, during and after treatment. Each patient will have an assigned nurse, who will provide advice and guidance concerning all the needs and/or worries that the patient and their family may have.
- Cutting-edge technology in the various departments involved in the diagnosis and treatment of breast cancer: blood testing; pathology; diagnostic imaging; nuclear medicine; radio-oncology, etc.
Early detection improves patient prognosis
The time at which breast cancer is diagnosed (whether early or late), and the size of the tumour and the areas affected, all determine how aggressive the cancer is and what the prognosis will be. The earlier the tumour is detected, the better the prognosis for the patient and the greater the chances that it can be cured.
What is the most common type of breast cancer?
Cancer is a collection of abnormal cells that multiply out of control and can invade other tissues. In breast cancer, the most common type is of epithelial origin (80-90%), usually carcinomas (tumour that starts in the mammary gland) and, less commonly, breast lymphoma or sarcoma, which are different kinds of cancer.
Other possible forms are:
- Benign tumour - a mass that grows without affecting the surrounding tissues or spreading and causing metastasis.
- Disseminated breast cancer - which grows locally when it progresses and can send cells through the blood vessels to the lymph nodes and affect other organs.
What are the risk factors?
Although not all risk factors are known, the most common ones are:
- Age. Although it can appear at any age, the risk increases in women over 50.
- Lifestyle. Not getting any exercise and not leading a healthy lifestyle can affect the risk of developing breast cancer.
- Hormonal factors. Women who start menstruating early (before the age of 12) or who have a late menopause (after the age of 55) and women who have never been pregnant are at higher risk of developing breast cancer.
- Family history. Women whose mother, sister or daughter has had breast cancer are at higher risk, especially in cases where the cancer has occurred before the menopause or has affected both breasts. In 10% of women with breast cancer, it is hereditary, and they tend to develop the disease at an early age. Genetic counselling is available at Instituto Oncológico Teknon.
What are the symptoms of breast cancer?
Breast cancer does not usually have symptoms, but it can cause changes that are possible to detect:
- A lump or a lumpier-feeling area in the breast or underarm
- Changes in the shape or size of the breast
- Nipple discharge
- Changes in the colour or the feel of the skin on the breast, the areola or the nipple itself
What diagnostic tests can be done?
- Diagnostic tests for early detection of the cancer:
- Mammogram. This is the standard test for monitoring and the early detection of breast cancer and it makes it possible to detect tumours before they can be felt, small deposits of calcium, etc. Depending on the results, it will be determined how regularly you should have the subsequent mammograms.
- Breast self-examination. Should be done by the patient once a month. The specialist will show you how to do it.
- Diagnostic tests to determine whether or not a person has breast cancer:
- Medical history
- Physical examination and blood tests
- Magnetic resonance imaging of the breast
- Biopsy with:
- Fine-needle aspiration biopsy (FNAB), where fluid or tumour cells are extracted.
- Cylinder biopsy, where cylinders of tissue are extracted.
- Surgical biopsy, where the surgeon extracts a part of the tumour in the operating theatre.
- Investigations (CT scan, bone scan, PET-CT)
- Diagnostic tests for early detection of the cancer:
Conserving the breast is our primary objective
Surgery is a fundamental part of breast cancer treatment, since the primary objective is to conserve the breast, and it is therefore used in the majority of cases.
- Conservative breast surgery which, in 80% of cancer cases, allows the tumour and the affected area to be removed while still conserving the breast. Depending on the area, a lumpectomy can be performed (removing only the tumour area) or a partial mastectomy (removal of a quadrant of breast tissue because the tumour does not have visible borders).
- Mastectomy, which consists of complete removal of the breast. This may be a modified radical mastectomy (removal of the mammary gland, the nipple/areola, the axillary (armpit) lymph nodes and, depending on the case, the pectoral muscles) or radical mastectomy (removal of the whole breast, the nipple/areola, the pectoral muscles, and the axillary lymph nodes).
Depending on the type of surgery, to save the breast if a large tumour has to be removed, oncoplastic and reconstructive surgery techniques may be used. The specialist will assess the different treatment options with the patient.
The use of diagnostic techniques makes it possible to detect the tumours early and this means that it is not always necessary to remove the axillary lymph nodes. These nodes are responsible for fighting infection, destroying the bacteria and preventing them from passing into the bloodstream.
The technique used to identify the first nodes (sentinel nodes) to which the tumour is likely to spread (metastasize) is called asentinel lymph node biopsy (SLNB). There are a number of advantages with this technique compared to conventional axillary lymph node dissection, such as a reduced incidence of lymphoedema(swelling of the arm) and fewer surgical complications. With a sentinel lymph node biopsy (SLNB), the biopsy is examined later by pathology in order to allow a full study to be carried out and rule out possible micrometastases in cases where the conventional study has come back negative.
Teknon currently works with the OSNA method, a new generation technique which is more accurate and enables analysis of the whole sentinel lymph node during the operation. This avoids the situation of having to subject the patient to a second operation to dissect the axillary lymph nodes after the post-operative analysis comes back positive. It also makes it possible to determine more accurately and with greater precision which nodes may be affected by tumour cells.
In order to operate with precision, the surgeon is guided by intra-operative ultrasound (IU) images for extracting non-palpable lesions (in early stages) in the breast. Thanks to the ultrasound, the surgeon can see the lesion at all times, can tell how deep it is and make sure that the margins of the extracted area are adequate (less than a centimetre).
Depending on the surgical technique used, and whether or not breast reconstruction has been necessary, the specialist will make a series of recommendations for the patient to follow. It is also very important that after the operation, you take very good care of the wound and, in cases of axillary lymph node dissection, physiotherapy may be necessary to help regain movement, strength and flexibility.
After an operation, patients can suffer the following adverse effects:
- Impact on appearance, in patients who have lost their breast and in whom reconstruction has not been possible
- Secondary complications after surgery
- Lymphoedema (swelling of the arm in the area operated on)
- Superficial lymphatic thrombosis (inflammation that develops on the underside of the arm after removal of the axillary lymph nodes)
- Collection of fluid in the area of the surgical incision
A natural-looking breast with the best cosmetic results
Breast reconstruction may be carried out after a mastectomy (partial or total). Today's techniques mean that a natural-looking breast can be achieved (with nipple and areola) with the same shape, texture and size as the breast not operated on. Being able to have her breast back helps the patient with her recovery psychologically, oncologically and from a cosmetic point of view.
In the majority of cases, the techniques used at Centro Médico Teknon make it possible to save the skin of the breast, so cosmetically, the results are better. A multidisciplinary team analyses each case to determine whether or not they are able to undergo reconstruction and what the likely outcome would be, assessing the viability of reconstruction and the most appropriate technique.
Reconstruction may be:
- Immediate. Performed during the operation to remove the breast at the same time as the partial or total resection of the breast. This type of surgery means fewer surgical procedures and recovery time is reduced. In immediate reconstruction, the surgeon can preserve the skin of the breast, which gives better results cosmetically.
- Delayed. This is when the breast reconstruction is done at a later date and not during the operation for partial or total removal of the breast.
The following reconstruction techniques may be used:
- Implant. The reconstruction may be done with an implant placed beneath the pectoral chest muscle. If there is insufficient skin, a type of inflatable balloon is placed under the skin and the muscle where the breast will later be placed and is filled with saline solution. Although cosmetically, the result is not the same as when the patient's own tissue is used, it is a less complex operation and quicker to perform.
- Autologous tissue. This technique uses the patient's own tissues, achieving a more natural result. The skin used for the reconstruction is usually taken from the patient's abdomen, back or buttocks. It is a more complex technique than the others, which means it takes longer to recover, and it leaves a bigger scar, but cosmetically, it provides better results and has minimal complications.
- Mixed technique. This is the combination of the two techniques which provides optimal cosmetic results with the advantages of a less major operation.
Chemotherapy consists of the administration of a combination of drugs which specifically act on the cells forming the tumour to reduce its size or eliminate it completely to prevent it from coming back. Although it is usually given after surgery, in some cases, it is administered before the operation to reduce the size of the tumour and make it possible to perform conservative surgery.
It is given intravenously on an outpatient basis at the Instituto Oncológico Teknon Day Hospital. Depending on the patient, it may be given weekly, fortnightly, etc. For patients who require a long course of treatment or treatment in repeated cycles, a port-a-cath is inserted. This is a device placed under the skin which enables permanent access to the vascular system so the patient does not have to be jabbed at each session.
- Nausea, vomiting, diarrhoea and/or constipation. These effects occur when the chemotherapy affects the digestive system.
- Ulcers and sores. These effects occur when the mucosa is affected. Because of this, good oral hygiene, taking special care of the teeth and the mouth, is very important.
- Hair loss. This can affect the hair on your head and the hair on other parts of the body when the hair follicles are affected.
- Altered taste sensation. The taste buds on your tongue and palate may be affected, making food taste more bitter/metallic or even tasteless.
- Skin disorders. Itching, dryness or scaling may occur. It is very important to keep the skin moisturised.
Other drug treatments
- Hormone therapy. Consists of oral administration of hormones to prevent the malignant cells from reproducing by blocking the action of the oestrogens, thereby reducing size. It may be given in conjunction with chemotherapy.
- Biological therapy. Applied in specific cases and consists of a substance that stimulates the immune system to fight the cancer. It also allows the body to recover from the side effects of the treatment.
- New drugs. Research is currently underway into new drugs.
What is radiotherapy?
Radiotherapy is treatment that uses ionising radiation to eliminate the tumour cells. The technique is painless and non-invasive. During the treatment, the cells of healthy tissue are also affected, which means that it causes side effects. However, after the treatment is over, these healthy-tissue cells will recover.
For the treatment of breast cancer, 3D conformal external radiotherapy (3D CRT) is used. This requires a CT image to be obtained prior to the radiotherapy sessions so that the areas that need to receive high doses of radiation can be specifically identified.
Essentially, radiotherapy is used in all cases of conservative surgery in order to reduce the risk of local/regional recurrence. Occasionally, it is used before surgery and in radical surgery, depending on the size of the tumour.
Radiotherapy is given on an outpatient basis at Instituto Oncológico Teknon, usually daily, so the patient has to come to the centre every day for 5-6 weeks. The sessions last 15-20 minutes, although radiation is not being received all this time. Before starting the radiotherapy, the technicians mark the skin to make sure the same points are being targeted each time. During the session, the technicians operate in an adjoining room, monitoring the patient through a closed-circuit camera and intercom system.
- Inflammation of the skin. The skin can become reddened, pigmented, etc. This makes it important to keep the skin clean and well moisturised.
- Effects on the breast. The breast may appear pricked and feel heavy, etc.
- Tiredness. Some patients may find that the treatment makes them more tired, but most carry on with their usual activities.
The following are recommended:
- Avoid exposure to the sun
- Good hygiene is important, using neutral soaps
- Avoid using lotions, ointments and creams in the affected area
- Do not remove underarm hair with a razor
- Using deodorant is not recommended
Women of childbearing age who are diagnosed with cancer and have to undergo chemotherapy or radiotherapy may have fertility problems after treatment. Before starting treatment, therefore, they must be informed of the possibility of having fertility preservation treatment.
The type of preservation treatment depends on each individual case, according to the type of tumour and its size at the time of diagnosis, and may not be recommended in some specific cases. In the case of chemotherapy (which affects fertility when it damages the reproductive cells), the following are determining factors in terms of whether or not a treatment may affect the woman's fertility:
- Age of the patient
- Drug used as treatment
- Dose and time used in the chemotherapy
Measures used to preserve fertility
- Freezing / vitrification of eggs. This consists of extracting, freezing and storing the eggs; it is not always possible in all cancer treatments. In all cases, the patient has to take treatment to induce ovulation.
- Freezing of embryos. The extracted eggs are fertilised with donor semen or semen from the partner, and the embryos obtained are frozen and stored. The patient has to take treatment to induce ovulation.
- Freezing of ovarian tissue. Used when stimulation of the ovaries is not recommended or when there is insufficient time before the cancer treatment. This procedure is carried out laparoscopically and is currently in an investigational phase.
- Treatments with GH-RH analogues. They reduce the negative impact of the cancer treatment on the gonad (the organ where the gametes are formed, i.e. the ovaries).