Breast Cancer Management

written by Dr Harjit Kaur on 1 November 2011

Where are we heading?

THE MANAGEMENT OF BREAST CANCER HAS UNDERGONE GREAT TRANSITIONS AND OVER THE YEARS
THERE HAS BEEN A PARADIGM SHIFT FROM EXTENSIVE AND RADICAL SURGERIES TO MORE MINIMALLY INVASIVE PROCEDURES.
 
The increasing incidence of the disease, its dreaded complications and outcome, has spurred worldwide awareness campaigns. Most of these campaigns aim at screening and promoting increased awareness of the disease and its management. The positive outcome of these campaigns is the increase in the pick- up rate of breast cancer at its early stage where a potential cure is possible.
 
Dr Harjit says - “When breast cancer is detected early, it opens a whole range of possibilities in its management. The options of surgical treatment are often minimally invasive, leaving small and acceptable scars. The breast conserving surgeries are easily and effectively performed.” 
 
She continues saying that the most important aspect of breast cancer surgery is the surgery of the lymph nodes.
 
“In early breast cancers where the tumor size is less than 3cm, the sentinel node biopsy procedure is practiced,” she said.
 
Sentinel Lymph Node Biopsy (SLNB) is a minimally invasive technique used in the management of cancers especially Breast Cancer & Melanomas. It is a specialised technique involving a multidisciplinary team of trained Breast Surgeons, Breast Radiologists, Nuclear Medicine and Pathologists. It is the gold standard of care in the management of lymph nodes in these cancers.
 
This procedure is currently available and routinely performed at the Breast Centre in Prince Court Medical Centre, Kuala Lumpur. 
 
This technique involves the injection of a radioisotope (technetium) either peritumorally or periareolarly. After a delay, lymphocintigrams are done with the assistance of a hand-held gamma probe by which the sentinel node(s) are identified and marked. The patient then undergoes surgery.
 
Dr.Harjit explains, “Intraoperatively, the sentinel node is identified using the gamma probe and with the assistance of patent blue dye. The “hot” (radioactive) and “blue” node(s) are identifed. The lymph nodes are sent immediately to the pathologist for frozen section. A full axillary surgery of the lymph nodes is only done if the sentinel node is positive for cancer cells. This technique therefore avoids unnecessary radical dissection of the
axilla especially in node negative, small / screen detected cancers which may potentially result in long term complications like lymphedema, shoulder stiffness and pain.
 
This procedure can be done with a lumpectomy, mastectomy or mastectomy with immediate reconstruction.”
 
She notes that in the current era of minimally invasive surgical techniques, SLNB is the accepted standard of care in all Breast Centers around the world. It may be done as day case to reduce hospitalization cost. It is cosmetically superior and allows early recovery and quality of life issues associated with axillary dissection which is markedly reduced with the sentinel node biopsy.
 
Dr.Harjit is of the opinion that women with breast cancer have many options where breast surgery is concerned. Unfortunately, many still believe that mastectomy is the only option and hence they delay seeking treatment for fear of losing the breast. This problem is still very much rampant in Malaysia and many other Asian countries as well. More alarming is the fact that breast cancers are seen in younger and younger women. These young mothers and professionals suffer a major upheaval in their lives when faced with this situation. Major decisions and changes take place in their lives affecting many not only physically but emotionally and psychologically as well.
 
“In Malaysia, the number of women presenting with late disease is unfortunately still very high. Lack of awareness, religious beliefs and taboos are the main reasons often cited .The repeated trials of alternative methods by patients before seeking conventional treatment and advice often led to advanced disease and death,” she warns.
 
She says education and awareness campaigns should highlight these issues so that patients are aware of the need to seek early treatment to win the battle against the disease.
 
“Education and awareness of treatment modalities available are the keys in changing the negative perception of breast cancer management. It is her hope that more women come forward and practice their regular clinical breast assessment and annual screening. This will ensure that the disease is picked up early, making minimally invasive procedures possible and affording a good survival outcome,” she concludes.