Content

Cancer scenario 2015, Guwahati.

Saturday, 13th June 2015, 7:00 pm at Hotel Radisson Blu, Guwahati

Breast Cancer

breast cancer treatment by cancer specialist doctor sameer kaul delhi

Our mission at Onkaulogy Kombine is to give you comprehensive, state-of-the-art care in the most supportive and patient-centred environments possible.

We have a special department which focuses exclusively on breast cancer. Our surgeons are experienced with some of the most complex breast cancer cases, surgeries, minimally invasive procedures, and innovative oncoplastic techniques.

Team

Headed by Dr. Sameer Kaul, our multidisciplinary team is renowned for providing the most sophisticated diagnostic and medical technologies. Our team’s expertise lies in surgical removal of benign and malignant tumors, customized systemic and radiation treatments, breast reconstruction, and supportive and palliative care for even the most complex cases.

The team of specialists at Onkaulogy Kombine is comprised of some of the best doctors in the country. We have radiologists specializing in breast imaging, breast surgeons, plastic surgeons, medical oncologists, radiation oncologists, pathologists, psychologists, palliative care specialists, physical therapists, genetic counselors, and nurses working together to help our patients get back to the a better and easier life.

Our surgeons specialize exclusively in breast surgery. They are highly experienced with the latest techniques of oncoplastic surgery, also skin-sparing and nipple-sparing mastectomy so that patients can have a more natural reconstructive surgery to recreate, as closely as possible, their natural breasts.

About Breast Cancer

Breast cancer arises when cells within the breast grow and multiply abnormally. This can lead to the formation of a lump or mass of extra cells, called a tumor. In case of malignant (harmful) tumors, the cells continue dividing uncontrollably and have the capacity to invade nearby tissues and potentially spread (metastasize) to distant sites. There is also a form of “noninvasive” breast cancer called ductal carcinoma in situ (DCIS); some DCIS tumors may become invasive.

Fortunately, the advent and widespread use of mammography has led to a larger proportion of breast cancers being diagnosed in their earlier, more curable stages.

Types of Breast Cancer

A delicate area like the breast can have cancers of various kinds. Listed below are the different cancers.

Lobular Carcinoma in Situ (LCIS)

Lobular carcinoma in situ (LCIS) occurs when abnormal cells develop in the lobules. LCIS is not a cancer, but rather a marker of an increased risk of developing breast cancer in either breast.

Ductal Carcinoma in Situ (DCIS)

Ductal carcinoma in situ (DCIS) is a pre-invasive form of breast cancer in which cancer cells arise in the milk ducts, but have not yet spread. DCIS can progress over time and break out of the milk ducts to become invasive (infiltrating) breast cancer in some women. Treatment for DCIS may consist of surgery and radiation therapy.

Invasive Cancer (also called Infiltrating Cancer)

Invasive cancer cells spread outside of the structures in which they first arise, moving to surrounding tissues and sometimes into the lymph nodes. The majority of breast cancers begin in the ducts. Some develop in the lobules.

Inflammatory Breast Cancer

Rarely, breast cancers appear as inflammatory changes in the breast that mimic other conditions such as a skin infection. The skin may appear red or discolored, or may take on a “peaud'orange” appearance (skin thickening with tiny dimples like an orange peel). Women who observe these breast changes should see a healthcare provider immediately.

Detection & Diagnosis

  1. Screening Methods

    Screening for breast cancer includes breast self-examination, clinical examination by a physician, and mammography. Ultrasound and MRI are also performed in selected women.

  2. Breast Biopsy Techniques

    During a breast biopsy, a tissue sample is taken from the breast and examined under a microscope to determine whether or not it contains cancerous cells.

    Types of Biopsy

    Fine Needle Aspiration (FNA)

    During this procedure, the doctor inserts a very thin needle into the suspicious area of the breast. Fluids or cells are withdrawn (aspirated) from the lump and examined under a microscope by a pathologist.

    Core Needle Biopsy

    A core needle biopsy may be used if a tissue sample that is larger than can be obtained by a fine needle aspiration biopsy is needed, or if the tissue removed during a needle aspiration biopsy does not lead to a definitive diagnosis. This type of biopsy requires a local anesthetic, and uses a large, hollow needle to remove a thin cylinder of tissue, which is then analyzed by a pathologist.

    Image-Guided Biopsy

    If the suspicious area cannot be felt, then a radiologist can use imaging techniques to examine the area. Ultrasound, stereotactic mammographic imaging, or MRI can be used, depending on what the abnormality looks like and which technique is most appropriate for visualizing it.

    Surgical Biopsy

    A surgical biopsy may be done if other biopsy procedures do not provide a definitive diagnosis. A surgical biopsy is also performed if the suspicious area is too deep or too superficial for a fine needle or core biopsy.

  3. Advanced Imaging Technology for Breast Cancer

    Digital mammography, a technique that enables radiologists to produce an image of the breast more quickly and to see lesions more clearly.

Treatment

  • Characterizing the Tumor
    If breast cancer is found, several other tests can help to fully characterize the type of tumor and how advanced it is. This helps us personalize your care to the specific characteristics of your disease.
  • Surgery
    • Lumpectomy
      Lumpectomy is a breast conserving treatment. Only the cancerous breast tissue, with a rim of normal tissue around it, is removed. Lumpectomy is performed as a short stay surgical procedure, and is often combined with sentinel node biopsy. Most women do not require the use of drains after the operation. Lumpectomy also preserves sensation in the breast, an important consideration for many women.
    • Mastectomy
      With mastectomy, the entire breast (usually including the nipple) is removed. The muscle on the chest wall (pectoral muscle) is not removed, although if cancer is very close to the muscle, a small piece of muscle underneath the cancer may be taken. Depending on the stage of the breast cancer, some women are advised to undergo radiation therapy after mastectomy.
    • At OnkaulogyKombine, we offer innovative reconstructive techniques for women who have undergone a mastectomy. A major advance in breast reconstruction, called skin-sparing mastectomy, may be appropriate for some patients. In this procedure, the surgeon removes the inner breast tissue and nipple, leaving a shell of skin in place. He or she then fills in the shell with tissue from the woman's abdomen or places a tissue expander underneath the chest (pectoral) muscle and, later, reconstructs the nipple. This approach results in a more natural-looking breast.
    • Lymph Node Biopsy
      Planning drug treatment for breast cancer requires a specialist to determine if it has spread to the lymph nodes. In the past, they had no choice but to remove most of the underarm lymph nodes — an operation called axillary dissection.

      We now offer a conservative surgical procedure for many women that is easier to tolerate, speeds recovery time, and enables them to return sooner to their normal day-to-day activities.

  • Reconstruction and Prosthesis
    • Implant Surgery
      Implants are best for women with small- to medium-size breasts and those who have not had any radiation therapy to the breast area.
    • Tissue Transfer
      Another method for reconstructing the breast is to use tissue transferred from somewhere else in the body. The new breast mound is built using muscle from one of three locations:
    • TRAM (transverse rectus abdominusmyocutaneous) Flap
      An oval-shaped section of fat and skin is removed from the abdomen and shaped into a breast on the chest wall.
      • Gluteal Free Flap
        Tissue is taken from the upper or lower buttocks and shaped into a breast on the chest wall.
      • Latissimus Dorsi Flap
        Skin and muscle are moved from the upper back to the chest area and shaped into a breast.
    • Prosthesis
      Women who decline or cannot undergo breast reconstruction can use a silicone breast prosthesis for symmetry. Breast prostheses come in firm, medium, and soft silicone textures, as well as a variety of sizes, shapes, and skin tones to match the other breast.
  • Systemic Therapy
    We are a leading centre for the development of innovative systemic therapies for breast cancer, including chemotherapy, hormone therapy, targeted therapies, and vaccines.
  • Radiation Therapy
    It is a technology that delivers radiation with high precision and minimize side effects. We offer an integrated radiation program following breast reconstruction and an intraoperative program for older women with very early breast cancer.
  • Preventive Treatments
    Women at high risk of breast cancer can now consider taking medications to reduce risk, or undergoing prophylactic surgery to remove the breasts and/or ovaries.

Follow-up Care

OnkaulogyKombine’s Breast Cancer Department provides services that specifically address the care required by patients who have been recently treated and the unique needs of breast cancer survivors in the years following treatment.

About Breast Cancer

Breast cancer arises when cells within the breast grow and multiply abnormally. This can lead to the formation of a lump or mass of extra cells, called a tumor. In case of malignant (harmful) tumors, the cells continue dividing uncontrollably and have the capacity to invade nearby tissues and potentially spread (metastasize) to distant sites. There is also a form of “noninvasive” breast cancer called ductal carcinoma in situ (DCIS); some DCIS tumors may become invasive.

Fortunately, the advent and widespread use of mammography has led to a larger proportion of breast cancers being diagnosed in their earlier, more curable stages.

Types of Breast Cancer

A delicate area like the breast can have cancers of various kinds. Listed below are the different cancers.

Lobular Carcinoma in Situ (LCIS)

Lobular carcinoma in situ (LCIS) occurs when abnormal cells develop in the lobules. LCIS is not a cancer, but rather a marker of an increased risk of developing breast cancer in either breast.

Ductal Carcinoma in Situ (DCIS)

Ductal carcinoma in situ (DCIS) is a pre-invasive form of breast cancer in which cancer cells arise in the milk ducts, but have not yet spread. DCIS can progress over time and break out of the milk ducts to become invasive (infiltrating) breast cancer in some women. Treatment for DCIS may consist of surgery and radiation therapy.

Invasive Cancer (also called Infiltrating Cancer)

Invasive cancer cells spread outside of the structures in which they first arise, moving to surrounding tissues and sometimes into the lymph nodes. The majority of breast cancers begin in the ducts. Some develop in the lobules.

Inflammatory Breast Cancer

Rarely, breast cancers appear as inflammatory changes in the breast that mimic other conditions such as a skin infection. The skin may appear red or discolored, or may take on a “peaud'orange” appearance (skin thickening with tiny dimples like an orange peel). Women who observe these breast changes should see a healthcare provider immediately.

Detection & Diagnosis

  1. Screening Methods

    Screening for breast cancer includes breast self-examination, clinical examination by a physician, and mammography. Ultrasound and MRI are also performed in selected women.

  2. Breast Biopsy Techniques

    During a breast biopsy, a tissue sample is taken from the breast and examined under a microscope to determine whether or not it contains cancerous cells.

    Types of Biopsy

    Fine Needle Aspiration (FNA)

    During this procedure, the doctor inserts a very thin needle into the suspicious area of the breast. Fluids or cells are withdrawn (aspirated) from the lump and examined under a microscope by a pathologist.

    Core Needle Biopsy

    A core needle biopsy may be used if a tissue sample that is larger than can be obtained by a fine needle aspiration biopsy is needed, or if the tissue removed during a needle aspiration biopsy does not lead to a definitive diagnosis. This type of biopsy requires a local anesthetic, and uses a large, hollow needle to remove a thin cylinder of tissue, which is then analyzed by a pathologist.

    Image-Guided Biopsy

    If the suspicious area cannot be felt, then a radiologist can use imaging techniques to examine the area. Ultrasound, stereotactic mammographic imaging, or MRI can be used, depending on what the abnormality looks like and which technique is most appropriate for visualizing it.

    Surgical Biopsy

    A surgical biopsy may be done if other biopsy procedures do not provide a definitive diagnosis. A surgical biopsy is also performed if the suspicious area is too deep or too superficial for a fine needle or core biopsy.

  3. Advanced Imaging Technology for Breast Cancer

    Digital mammography, a technique that enables radiologists to produce an image of the breast more quickly and to see lesions more clearly.

Treatment

  • Characterizing the Tumor
    If breast cancer is found, several other tests can help to fully characterize the type of tumor and how advanced it is. This helps us personalize your care to the specific characteristics of your disease.
  • Surgery
    • Lumpectomy
      Lumpectomy is a breast conserving treatment. Only the cancerous breast tissue, with a rim of normal tissue around it, is removed. Lumpectomy is performed as a short stay surgical procedure, and is often combined with sentinel node biopsy. Most women do not require the use of drains after the operation. Lumpectomy also preserves sensation in the breast, an important consideration for many women.
    • Mastectomy
      With mastectomy, the entire breast (usually including the nipple) is removed. The muscle on the chest wall (pectoral muscle) is not removed, although if cancer is very close to the muscle, a small piece of muscle underneath the cancer may be taken. Depending on the stage of the breast cancer, some women are advised to undergo radiation therapy after mastectomy.
    • At OnkaulogyKombine, we offer innovative reconstructive techniques for women who have undergone a mastectomy. A major advance in breast reconstruction, called skin-sparing mastectomy, may be appropriate for some patients. In this procedure, the surgeon removes the inner breast tissue and nipple, leaving a shell of skin in place. He or she then fills in the shell with tissue from the woman's abdomen or places a tissue expander underneath the chest (pectoral) muscle and, later, reconstructs the nipple. This approach results in a more natural-looking breast.
    • Lymph Node Biopsy
      Planning drug treatment for breast cancer requires a specialist to determine if it has spread to the lymph nodes. In the past, they had no choice but to remove most of the underarm lymph nodes — an operation called axillary dissection.

      We now offer a conservative surgical procedure for many women that is easier to tolerate, speeds recovery time, and enables them to return sooner to their normal day-to-day activities.

  • Reconstruction and Prosthesis
    • Implant Surgery
      Implants are best for women with small- to medium-size breasts and those who have not had any radiation therapy to the breast area.
    • Tissue Transfer
      Another method for reconstructing the breast is to use tissue transferred from somewhere else in the body. The new breast mound is built using muscle from one of three locations:
    • TRAM (transverse rectus abdominusmyocutaneous) Flap
      An oval-shaped section of fat and skin is removed from the abdomen and shaped into a breast on the chest wall.
      • Gluteal Free Flap
        Tissue is taken from the upper or lower buttocks and shaped into a breast on the chest wall.
      • Latissimus Dorsi Flap
        Skin and muscle are moved from the upper back to the chest area and shaped into a breast.
    • Prosthesis
      Women who decline or cannot undergo breast reconstruction can use a silicone breast prosthesis for symmetry. Breast prostheses come in firm, medium, and soft silicone textures, as well as a variety of sizes, shapes, and skin tones to match the other breast.
  • Systemic Therapy
    We are a leading centre for the development of innovative systemic therapies for breast cancer, including chemotherapy, hormone therapy, targeted therapies, and vaccines.
  • Radiation Therapy
    It is a technology that delivers radiation with high precision and minimize side effects. We offer an integrated radiation program following breast reconstruction and an intraoperative program for older women with very early breast cancer.
  • Preventive Treatments
    Women at high risk of breast cancer can now consider taking medications to reduce risk, or undergoing prophylactic surgery to remove the breasts and/or ovaries.

Follow-up Care

OnkaulogyKombine’s Breast Cancer Department provides services that specifically address the care required by patients who have been recently treated and the unique needs of breast cancer survivors in the years following treatment.