Breast Cancer Treatment Options: Throughout the world (India, Turkey, Singapore and U.A.E)

The human body is made up of cells. Every cell follows a pattern of growth and death. That is, every cell grows and dies after a certain period of time. But cancer occurs when normal cells of our body become abnormal and their growth becomes out of control. Similarly, breast cancer occurs when healthy cells of the breast divide uncontrollably and form a mass called a tumor. This tumor can be benign or malignant. Benign tumors are not dangerous and cannot spread but malignant tumors can grow and spread to other parts of the body.

What are the Symptoms Of Breast Cancer?

The symptoms of breast cancer vary widely, and so anything that is unusual must be checked by a doctor. Every woman should keep an eye on any kind of abnormality that may include the following:

• A painless and hard lump with uneven edges in any breast (But even a tender, soft, and rounded lump should not be ignored)
• A lump in the underarm
• Breast pain
• Nipple pain
• Swelling of one or all the parts of the breast
• Change in the size or shape of the breast
• Irritation or dimpling of the skin
• The inward turning of the nipple
• Discharge from nipple other than milk
• Redness, thickening, or scaling of breast skin or nipple

Sometimes breast cancer may not show any of the obvious symptoms at all. Or in some cases, the lump can be so small that you may not feel it. So screening for breast cancer is most important as any abnormality can turn up in the mammogram (breast X-ray) that can lead to further testing and early diagnosis.

Breast Cancer Stages

There are five stages of breast cancer, starting from 0 to IV. While stage 0 is the non-invasive stage such as DCIS (ductal carcinoma in situ) breast cancer in which the cancer is still within its original place, stage IV is the most invasive stage in which cancer has spread out of the breast and reached other parts of the body. It is also called metastatic breast cancer. Ductal carcinoma or lobular carcinoma are the two most common forms of breast cancer. Some other forms of less commonly found breast cancer include medullary, mucinous, tubular, metaplastic, papillary, Paget’s, and inflammatory breast cancer. Inflammatory breast cancer prognosis can be anywhere between 20 months to 30 months.

Diagnosis of Breast Cancer

Diagnosis of breast cancer is an intense process that may take weeks or more. It involves different tests like breast ultrasound, breast MRI scans, breast biopsy, sentinel node biopsy, and other imaging or blood tests to conclude the diagnosis and staging of breast cancer.

Breast Cancer Treatment

Treatment of breast cancer majorly depends upon the stage and characteristics of cancer. Though there were very limited treatment options a few years back, now a variety of new life-saving treatments are available for breast cancer. For most, DCIS and early-stage invasive breast cancer, surgery is the most recommended treatment. But in cases of large or advanced-stage breast cancers, systemic treatment with chemotherapy or hormonal therapy is done to shrink the tumor size before surgery.

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What Are the Treatment Options for Breast Cancer?

The most commonly available breast cancer treatment options include the following:

• Surgery: Surgery is performed to remove the tumor along with some of the healthy surrounding tissue. In addition, lymph nodes under the arm are also examined for cancer cells. Most commonly, two types of surgeries are performed --  lumpectomy and mastectomy. Lumpectomy is the surgical removal of the tumor along with some healthy tissue while keeping the breast intact. A lumpectomy may also be called breast-conserving surgery, quadrantectomy, partial mastectomy, or segmental mastectomy. On the other side, mastectomy is the complete removal of the breast and can be of many types depending upon the stage and characteristic of cancer. Most of the women who undergo mastectomy consider breast reconstruction. Breast reconstruction is a procedure in which the breast is re-created using the tissue taken from some other part of the body or using synthetic implants.
• Radiation Therapy: Radiation therapy or radiotherapy uses high-energy radiation (x-rays) to destroy cancer cells. External-beam radiation therapy is the commonest type of radiotherapy in which radiation is given to the patient by a machine outside the body. It may be given as partial breast irradiation (PBI) in which radiation is given directly to the tumor area and not the entire breast. It can also be given as intensity-modulated radiation therapy (IMRT) in which radiation at the breast is highly intense. This is done to better target the tumor while evenly spreading the radiation throughout the breast. Proton therapy is another form of external-beam radiation therapy in which protons are used to kill cancer cells rather than x-rays.

In addition to external-beam radiotherapy, there are other forms of radiotherapy. When radiation is given in the operating room by using a probe, it is called intra-operative radiation therapy. Brachytherapy is another type of radiotherapy in which radiation is given by placing radioactive substances in-between the tumor. Hypo-fractionated radiation therapy is radiotherapy in which a higher daily dose of radiation is given to the whole breast so as to shorten the overall length of treatment. Radiation therapy can be given before or after surgery depending upon the cancer stage. It is called neoadjuvant radiation therapy if radiation is given before surgery and adjuvant radiation therapy if it is given after surgery. It is given as a specific number of treatments over a decided period of time, for example, 5 days a week for 5 to 6 weeks

• Systemic Therapy: Systemic therapy is the type of cancer treatment that is given either by mouth or through a vein. In this form of treatment, drugs enter the bloodstream and reach cancer cells to kill them. It is mainly of three types:
• Chemotherapy: Most common form of cancer treatment, involves the use of drugs to destroy cancer cells and their ability to grow and divide. It passes through the bloodstream and reaches cancer cells anywhere in the body. It can be given through an intravenous (IV) tube or subcutaneously through an injection under the skin or intramuscularly into a muscle, or orally via a pill or capsule that is swallowed. Similar to radiation therapy, chemotherapy can be given before surgery to shrink a large tumor and is called neoadjuvant chemotherapy. But if it is given after surgery to reduce recurrence risk, it is called adjuvant chemotherapy. A chemotherapy regimen is given as a specific number of cycles over a decided period of time, for example, once a week, once every 2 weeks, etc. Also, it may include a single drug or a combination of drugs.
• Hormonal Therapy: Also called endocrine therapy, hormone therapy is emerging as an effective treatment for ER (estrogen)-positive or PR (progesterone)-positive breast cancer. These tumors are driven by hormones for their growth. So if the hormones are blocked with hormonal therapy, recurrence or death due to breast cancer can be prevented. Like radiation or chemotherapy, hormonal therapy can be given before surgery to shrink a large tumor and is called neoadjuvant hormonal therapy. But if it is given after surgery to reduce recurrence risk, it is called adjuvant hormonal therapy.
• Targeted Therapy: Targeted therapy is a focused treatment that specifically targets and blocks the tissue, genes, or proteins that contribute to the growth and survival of cancer. It requires additional testing to identify targets like genes or proteins in the tumor. Hormonal therapy is the first approved targeted treatment for breast cancer, while recently HER2-targeted therapies have been approved for the treatment of HER2-positive breast cancer.
• Biological Therapy: Also called immunotherapy, it strengthens the immunity of the body to fight against cancer cells and also controls the side effects of cancer treatments.

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Cost of Breast Cancer Treatment

Breast cancer treatment cost depends upon factors such as the stage of cancer, the treatment required, the country's currency, etc. The cost of breast cancer treatment by stage increases with increasing stage due to the rise in intensity of treatment required.