Patient education and resources

(All information you need to know about breast cancer treatment, diagnosis, chemotherapy, surgery.)

A, Breast cancer surgery

Breast cancer surgery is the key component of breast cancer treatment that includes removing the tumor itself with a border of normal breast tissue while conserving the maximum portion of the breast as possible, because Breast is the most important external identification of feminism.

Breast cancer surgery can be used alone or in combination with other types of treatments to remove breast cancer tissues, such as chemotherapy, radiation therapy, targeted therapy and hormone therapy.

These are the following questions which will help you to understand breast cancer surgery briefly.

Why there is no need to remove the whole breast section, you can understand that this surgery only removes the tumor, not the whole breast.

What is breast conservation therapy (Lumpectomy)? I

t refers to a breast surgery that only aims to remove breast cancer without removing the whole breast, a loss of a breast can have shocking psychological effects on a woman. therefore breast conservation therapy plays a key role in the treatment of breast cancer.

Breast conservation surgery is also called lumpectomy, quadrantectomy, segmental mastectomy and partial mastectomy which depends on how much tissue is affected.

How much breast is to be removed?

Depends upon the size of the tumor and the affected part of the breast surroundings.

What type of breast cancer is required for Mastectomy?

It is a type of breast cancer surgery in which the whole breast is removed, involving all the affected breast tissue and sometimes nearby surrounding tissues. There are many different types of Mastectomy and in some patients both breasts are removed.

Is breast reconstruction possible after mastectomy?

Yes it can be done during or after months or years after mastectomy or Lumpectomy It is  a surgical procedure of recreating the look and shape of the breast by the surgeon with the help of artificial implant or a flap of tissue from the other part of the body or both with the goal of reconstruction of natural looking breast. There are many types of reconstructive breast surgery but options depend upon your medical condition and personal choices.

Is BCS ( breast conserving surgery or Lumpectomy) inferior to MRM (modified radical mastectomy)? 

Women with early stage breast cancer can choose between breast conserving surgery (BCS) and modified radical mastectomy (MRM).

  • The main advantage of BCS is that a woman can keep most of her breast with the removal of tumor and less of a change to the body than a mastectomy. Radiation therapy is also required for some cases of breast cancer. While in mastectomy, early stage cancers are less likely to need radiation during the treatment. Some women may have more surgeries if the margins are not clear.

It has a recovery time of a few weeks.

  • In Mastectomy, the woman might feel more confident that cancer will not come back, and radiation therapy will only be used if the cancer comes back in the future. After mastectomy women have permanent removal of the breast.

How to remove Lymph nodes from the breast?  Cancer cells can be found in the axillary lymph nodes in breast cancer. It might have spread into the lymph nodes near the breast and it’s surrounding. It is important to rule out whether any of the lymph nodes near the breast cause cancer. So early detection is very important to find out the stage, treatment and prognosis of breast cancer.

To find out if the cancer has spread outside the breast, one or more lymph nodes can be removed.

Lymph node surgery is a surgery to remove all the lymph nodes under the arm and to protect the breast and it’s surrounding from cancer.

The surgeon makes a small cut in the armpit to remove lymph nodes and send them to the lab to check them for cancer cells.

Sentinel lymph node biopsy- It is a technique where surgeons remove 2 to 3 lymph nodes only and if lymph nodes are positive then only they do remove rest of lymph nodes. Because they  want to prevent the lympedem.a Lymph edema is the swelling in arm because after removal of lymph nodes lymph has nowhere to flow so it gets accumulated in arm.

How dangerous is breast cancer removal surgery? Breast cancer surgery has the same risks as any other type of major surgery like infection, bleeding and other adverse reactions to the anesthesia.

There are some other possible risks which includes;

  • Bruising, which can be temporary
  • Scarring, can be permanent
  • Bleeding
  • Infection
  • Pain
  • Loss of sensation on the breast and nipple.
  • Fluid collection at operative site.
  • Swelling on the arm
  • Risks related to anesthesia.

Is early detection of breast cancer helpful? Yes it is very important to detect breast cancer in the early stage as it is associated with an increased number of treatment options, increased survival rates and also improved quality of life. Breast cancer is sometimes found after some symptoms appear, but there are many women who are diagnosed with breast cancer with no symptoms. That’s why early detection of breast cancer and regular screening is so important.

B, Breast cancer types

What are the types of breast cancer?

There are various types of breast cancer and various different ways to describe them. Breast cancer type is usually determined by the specific cells in the breast that are affected.

When carcinomas are tumors in the breast, they are usually a more specific type of breast cancer called Adenocarcinoma.

Which grows in the cells of the milk duct or the milk producing glands (Lobules) .

Difference between In situ or invasive breast cancer

Breast cancer type can also refer to whether the cancer has spread or not in the breast and it’s surrounding.

  • In situ or ductal carcinoma in situ (DCIS) cancer grows in a milk duct and has not grown into the rest of the breast tissue and the surroundings.

This type of cancer is not life threatening but can increase the risk of developing an invasive breast cancer later in future.
In situ breast cancer is also referred to as pre-cancer.
This type of breast cancer is usually detected during a mammography, or breast examination to check any kind of lump.

DCIS treatment may include breast conserving surgery that can combine with the surgery or radiation to remove all the tumors from the breast.

  • Whereas in invasive breast cancer, the cancer has spread into the surrounding breast tissue. About 70%-80% of women are affected by invasive breast cancer.

Invasive breast cancer is the most common type of breast cancer. In which the cancer cells have broken out of the lobule and began to spread to the lymph nodes and other parts of the body.

In this breast cancer, staging can be done with the help of a physical examination and a brief medical history to identify the best treatment options.

In overtime, the invasive breast cancer can spread to the lymph nodes and potentially to the other parts of the body.

Some other types of invasive breast cancer

  • Triple negative breast cancer, it is an aggressive type of invasive breast cancer that accounts for about 15%of all breast cancer.

This type of cancer may respond even better to chemotherapy in the earlier stage than many other types of cancer.

Inflammatory breast cancer is an aggressive and fast growing breast cancer, in which cancer cells infiltrate the breast skin and lymph vessels.

It is an uncommon type of invasive breast cancer that accounts for about 1% to 5% of all breast cancer.

This type of breast cancer grows rapidly, and the cancer cells block the lymph vessels in skin covering the breast,  causing the characteristics of swollen, red, and tender breast appearance.

Some less common types of breast cancer

There are some types of breast cancer that are much less common and sometimes need different types of treatment.

  • Paget disease of the breast, in this type of breast cancer the cancer grows in the breast duct and spreads to the skin of the nipples and to the areola

  ( dark circle around the nipple).

It is the rare type of breast cancer,   accounting for only about 1-3% of all the cases of breast cancer.

This type of breast cancer mostly occurs after the age of 50 years.

  • Phyllodes tumors are a rare type of breast tumor. This type of tumors are developed in the connective tissues of the breast.

These tumors are mostly benign but there are some other tumors which are malignant cancer.

  • Angiocarcinoma, is a type of breast cancer that is rare for making up less than 1% of all the cases of breast cancer.

It grows in the cells of the breast that line blood vessels or lymph vessels, and can involve the breast tissue or the skin of the breast.

Lymph vessels, which are a part of our immune system, collect bacteria, viruses and waste products from the body and dispose of them.

It can occur anywhere in the body, but most often occurs in the skin on the breast, head and neck.

Angiocarcinoma can also occur in areas previously treated with radiation therapy.

The treatment of angiosarcoma depends on where cancer is located and may include radiation therapy, chemotherapy and surgery.

Some other types of Breast cancer

  • Hormone receptor – positive breast cancer

About 80% of all breast cancers are ER- positive, that means the cancer cells grow in response to the estrogen hormone, and about 65% of breast cancers are PR- positive, that means the cancer cells grow in response to another hormone progesterone.

If a woman with breast cancer has a significant number of receptors for either progesterone or estrogen, then it is considered as hormone receptor positive breast cancer.

Breast tumors that are PR/ER positive are more likely to respond to hormone therapy than the tumors that are PR/ER negative.

Patients may have hormone therapy after surgery, when chemotherapy and radiation therapy are finished.

This treatment can help and prevent the return of the disease by blocking the effects of estrogen.

They do this in one of the several ways

  • Tamoxifen or nolvadex is a type of drug that helps to stop cancer from coming back by blocking hormone receptors, preventing hormones from binding to them. This medicine is sometimes taken for up to 5years after the breast cancer initial treatment.
  • Aromatase inhibitors is a class of drugs that actually stops estrogen production. These include letrozole (femara), exemestane (aromasin) and anastrozole (arimidex). They are only used in women who have already gone through menopause.

HER2 – Positive breast cancer

About 20% of breast cancers, the cells make too much of a protein called HER2. These cancers tend to be more aggressive and fast growing than other types of breast cancer.

Women with HER2-positive breast cancer, the targeted medicine trastuzumab or herceptin has been shown to dramatically reduce the risk of the cancer coming back.

These medications can be used along with chemotherapy after surgery to women with breast cancer that is spread to other areas of the body.

It can also be used in the early – stage of breast cancer, but there is a risk of heart damage and possible lung damage.

There are some targeted therapies used in the treatment of HER2 – positive breast cancer.

It include:

  • Tucatinib (tukyasa)
  • Pertuzumab (perjeta)
  • Margetuximab (margenza)
  • Neratinib (nerlynx)
  • Margetuximab (margenza)
  • Lapatinib (tykerb)
  • Ado trastuzumab emtansine (kadcyla)

Triple negative breast cancer

About 10% – 20% of breast cancers are known as triple negative breast cancer because they do not have estrogen and progesterone receptors and do not overexpress the HER2 protein.

There are many breast cancers which are associated with the gene BRCA1 that are triple negative. They are mostly treated with chemotherapy, surgery and radiation therapy.

  • Atezolizumab or tecentriq is a type of immunotherapy drug used in combination with the chemotherapy abraxane to block a protein known as PDL-L1 in triple negative breast cancers.
  • Talazoparib or olaparib are targeted therapy drugs used in the treatment of women with a BRCA mutation and have metastatic HER2 negative breast cancer.

C, Chemotherapy and breast cancer treatment

What type of chemotherapy is used for breast cancer?

  • Chemotherapy is a type of drug therapy used to destroy cancer cells, or meant to destroy rapidly growing cells in the body.
  • For breast cancer chemotherapy uses drugs to target and destroy the breast cancer cells. These chemo medicines are usually injected intravenously (given directly into the vein) or taken by mouth orally.
  • Chemotherapy for breast cancer regularly is used in addition to other treatments, such as surgery, radiation therapy or hormone therapy.
  • It can be used to increase the chance of a cure, decrease the risk of the cancer returning, and reduce symptoms from the cancer.
  • It also helps individuals with cancer live longer with a better quality of life.
  • In breast cancer, if the cancer has recurred or spread, chemotherapy may control the breast cancer to help women to live longer.

Why is it given?

Chemotherapy for breast cancer can be given in the following situations;

  • After breast cancer surgery

a woman after breast cancer surgery to remove the breast cancer, may undergo chemotherapy to destroy any undetected cancer cells and also reduce risk of the cancer recurring. This is referred to as adjuvant chemotherapy.

Adjuvant chemotherapy is only recommended to a woman who has a high risk of the cancer recurring or spreading to another part of the body also known as metastasizing, even if there is no evidence of cancer after breast cancer surgery.

  • Before breast cancer surgery

In some cases, chemotherapy is given before surgery to shrink large tumors in the breast, also known as neoadjuvant chemotherapy or pre-operative chemotherapy. It may also helps

  1. To give the best chance of removing the cancer completely.
  1. To remove only the cancer rather than the entire breast.
  1. To decrease the size of the tumor in lymph nodes, for allowing less invasive lymph node surgery.

Neoadjuvant chemotherapy is mostly used for;

  • Inflammatory breast cancer
  • HER2-positive breast cancer
  • Triple-negative breast cancer
  • High-grade breast cancer
  • Large breast cancer
  • Cancer that have spread to the lymph nodes

What is the role of chemotherapy in the treatment of advanced breast cancer?

Chemotherapy can be used as the primary treatment, if the breast cancer has spread to other parts of the body and surgery is not an option because of metastasis.

It may be used in combination with targeted therapy in the treatment of breast cancer.

The key role of chemotherapy for advanced breast cancer is mainly to improve quality and length of life rather than to cure the cancer.

What are the side effects of chemotherapy in breast cancer treatment?

Chemotherapy side effects depend on the drugs patients receive and their reaction towards the drugs. Side effects may get worse during the course of treatment, that may be temporary and subside once treatment is finished.

But sometimes chemotherapy can have long-term or permanent side effects.

Common short-term side effects of chemotherapy

Chemotherapy drugs can also damage other fast-growing healthy cells, in the process of damaging fast growing cancer cells, such as in the digestive tract, hair follicles and bone marrow.

These side effects mostly disappear after treatment is finished or within a period after completing chemotherapy, and some cases they may be long lasting and take time to go away.

It may include:

  • Fatigue
  • Loss of appetite
  • Hair loss or alopecia
  • Nausea and vomiting
  • Mouth sores
  • Constipation or diarrhea
  • Skin and nail changing ( colour change, peeling, dryness, etc)
  • Increased risk of developing infections ( decrease in WBCs)
  • Neuropathy

Long term side effects of chemotherapy

Chemotherapy for breast cancer can cause long- term side effects, it includes:

  • Leukemia – chemotherapy for breast cancer can trigger a secondary cancer, such as cancer of the blood cells, known as leukemia, several years after the chemotherapy is completed.
  • Heart damage – in chemotherapy there are some drugs with a small risk of weakening the heart muscle and causing other heart related problems. Some chemo medicines are associated with a higher risk of future cardiac problems.

There are some drugs like doxorubicin, epirubicin and some others can cause prema heart damage, known as cardiomyopathy.

  • Bone thinning – women who experience menopause earlier than their age, due to chemotherapy may have a higher risk of the bone thinning conditions like osteoporosis and osteopenia. After chemotherapy, it is generally recommended that these women have periodic bone density tests and, possibly treatments to prevent further bone related issues.
  • Menstrual cycle changes and Infertility – it is a possible side effect of chemotherapy that may not go away in a woman who is suffering from cancer. There are some chemo drugs that damage the ovaries, which may cause menopause symptoms (hot flashes, vaginal dryness).

Menstrual cycle may become irregular or may stop (Amenorrhea), and if ovulation ceases pregnancy becomes impossible.

Even if a woman’s periods have stopped while she is on chemotherapy, she may still be able to get pregnant.

If a woman gets pregnant during the chemotherapy, that could lead to birth defects and interfere with treatment.

  • Neuropathy

Certain chemo drugs such as taxanes (paclitaxel, docetaxel and protein – bound paclitaxel)  platinum agents (cisplatin, carboplatin) can damage nerves in the arms, hands, feets and legs.

This kind of nerve damage can lead to

Symptoms on those areas like pain, burning sensation, numbness, sensitivity to heat or cold, tingling sensations or weakness.

In some cases these symptoms go away once the treatment is stopped or completed, but in some women it might last a long time or become permanent.

How is chemotherapy given to the women with breast cancer?

Once the chemo drugs enter the bloodstream, they are delivered to all parts of the body to destroy cancer cells that may have spread beyond the breast.

As a result, chemotherapy is considered as an effective systemic form of breast cancer treatment.

Breast cancer chemotherapy can be given in a variety of ways, including

  • Intravenously ( directly injected into the veins)
  • By mouth as pills or tablets (orally)

Chemotherapy intravenously

It can be given in various ways mainly depending upon the factors such as how easy it is to find a vein and patient preferences. It includes:

  • Iv cannula, is the most common way of giving chemotherapy that involves inserting a small needle and plastic tube called a cannula into a vein.

Chemotherapy is usually given into a vein in the arm on the opposite side to where a woman had breast cancer surgery, as this may help reduce the risk of developing lymphoedema (swelling of the arm, or breast area caused by build up of lymph fluid).

  • Other iv devices

However, an iv cannula is the most common way of giving chemotherapy, but sometimes a central venous access is used instead of that.

This plays in place throughout the treatment and the chemotherapy is given through the line.

  • Some other central venous access

Skin – tunnelled catheter or Hickman line is a fine silicon tube that is interested into a vein, through a small cut in the chest.

This tube can stay in place for several months, for chemotherapy and blood samples can also be taken from the catheter.

  • Peripherally inserted central catheter (PICC)

It is inserted into a vein in the arm, at or above the bend in elbow, and extends into the large vein leading to heart.

It can stays in place until the whole course of chemotherapy, blood samples can also be taken from this device.

  • Implanted chemotherapy pots

It is a small device connected to a thin catheter. It is put under the skin, usually in the chest or arm. The other end of the tube goes into a large vein just above the heart.

This chemo port is hidden but can be felt under the skin.

Chemotherapy drugs are given directly into the port, and also be used to take blood samples

What type of chemotherapy is used for breast cancer?

  • Chemotherapy is a type of drug therapy used to destroy cancer cells, or meant to destroy rapidly growing cells in the body.
  • For breast cancer chemotherapy uses drugs to target and destroy the breast cancer cells. These chemo medicines are usually injected intravenously (given directly into the vein) or taken by mouth orally.
  • Chemotherapy for breast cancer regularly is used in addition to other treatments, such as surgery, radiation therapy or hormone therapy.
  • It can be used to increase the chance of a cure, decrease the risk of the cancer returning, and reduce symptoms from the cancer.
  • It also helps individuals with cancer live longer with a better quality of life.
  • In breast cancer, if the cancer has recurred or spread, chemotherapy may control the breast cancer to help women to live longer.

Why is it given?

Chemotherapy for breast cancer can be given in the following situations;

  • After breast cancer surgery

a woman after breast cancer surgery to remove the breast cancer, may undergo chemotherapy to destroy any undetected cancer cells and also reduce risk of the cancer recurring. This is referred to as adjuvant chemotherapy.

Adjuvant chemotherapy is only recommended to a woman who has a high risk of the cancer recurring or spreading to another part of the body also known as metastasizing, even if there is no evidence of cancer after breast cancer surgery.

  • Before breast cancer surgery

In some cases, chemotherapy is given before surgery to shrink large tumors in the breast, also known as neoadjuvant chemotherapy or pre-operative chemotherapy. It may also helps

  1. To give the best chance of removing the cancer completely.
  1. To remove only the cancer rather than the entire breast.
  1. To decrease the size of the tumor in lymph nodes, for allowing less invasive lymph node surgery.

Neoadjuvant chemotherapy is mostly used for;

  • Inflammatory breast cancer
  • HER2-positive breast cancer
  • Triple-negative breast cancer
  • High-grade breast cancer
  • Large breast cancer
  • Cancer that have spread to the lymph nodes

What is the role of chemotherapy in the treatment of advanced breast cancer?

Chemotherapy can be used as the primary treatment, if the breast cancer has spread to other parts of the body and surgery is not an option because of metastasis.

It may be used in combination with targeted therapy in the treatment of breast cancer.

The key role of chemotherapy for advanced breast cancer is mainly to improve quality and length of life rather than to cure the cancer.

What are the side effects of chemotherapy in breast cancer treatment?

Chemotherapy side effects depend on the drugs patients receive and their reaction towards the drugs. Side effects may get worse during the course of treatment, that may be temporary and subside once treatment is finished.

But sometimes chemotherapy can have long-term or permanent side effects.

Common short-term side effects of chemotherapy

Chemotherapy drugs can also damage other fast-growing healthy cells, in the process of damaging fast growing cancer cells, such as in the digestive tract, hair follicles and bone marrow.

These side effects mostly disappear after treatment is finished or within a period after completing chemotherapy, and some cases they may be long lasting and take time to go away.

It may include:

  • Fatigue
  • Loss of appetite
  • Hair loss or alopecia
  • Nausea and vomiting
  • Mouth sores
  • Constipation or diarrhea
  • Skin and nail changing ( colour change, peeling, dryness, etc)
  • Increased risk of developing infections ( decrease in WBCs)
  • Neuropathy

 

 

Long term side effects of chemotherapy

Chemotherapy for breast cancer can cause long- term side effects, it includes:

  • Leukemia – chemotherapy for breast cancer can trigger a secondary cancer, such as cancer of the blood cells, known as leukemia, several years after the chemotherapy is completed.
  • Heart damage – in chemotherapy there are some drugs with a small risk of weakening the heart muscle and causing other heart related problems. Some chemo medicines are associated with a higher risk of future cardiac problems.

There are some drugs like doxorubicin, epirubicin and some others can cause prema heart damage, known as cardiomyopathy.

  • Bone thinning – women who experience menopause earlier than their age, due to chemotherapy may have a higher risk of the bone thinning conditions like osteoporosis and osteopenia. After chemotherapy, it is generally recommended that these women have periodic bone density tests and, possibly treatments to prevent further bone related issues.
  • Menstrual cycle changes and Infertility – it is a possible side effect of chemotherapy that may not go away in a woman who is suffering from cancer. There are some chemo drugs that damage the ovaries, which may cause menopause symptoms (hot flashes, vaginal dryness).

Menstrual cycle may become irregular or may stop (Amenorrhea), and if ovulation ceases pregnancy becomes impossible.

Even if a woman’s periods have stopped while she is on chemotherapy, she may still be able to get pregnant.

If a woman gets pregnant during the chemotherapy, that could lead to birth defects and interfere with treatment.

  • Neuropathy

Certain chemo drugs such as taxanes (paclitaxel, docetaxel and protein – bound paclitaxel)  platinum agents (cisplatin, carboplatin) can damage nerves in the arms, hands, feets and legs.

This kind of nerve damage can lead to

Symptoms on those areas like pain, burning sensation, numbness, sensitivity to heat or cold, tingling sensations or weakness.

In some cases these symptoms go away once the treatment is stopped or completed, but in some women it might last a long time or become permanent.

How is chemotherapy given to the women with breast cancer?

Once the chemo drugs enter the bloodstream, they are delivered to all parts of the body to destroy cancer cells that may have spread beyond the breast.

As a result, chemotherapy is considered as an effective systemic form of breast cancer treatment.

Breast cancer chemotherapy can be given in a variety of ways, including

  • Intravenously ( directly injected into the veins)
  • By mouth as pills or tablets (orally)

Chemotherapy intravenously

It can be given in various ways mainly depending upon the factors such as how easy it is to find a vein and patient preferences. It includes:

  • Iv cannula, is the most common way of giving chemotherapy that involves inserting a small needle and plastic tube called a cannula into a vein.

Chemotherapy is usually given into a vein in the arm on the opposite side to where a woman had breast cancer surgery, as this may help reduce the risk of developing lymphoedema (swelling of the arm, or breast area caused by build up of lymph fluid).

  • Other iv devices

However, an iv cannula is the most common way of giving chemotherapy, but sometimes a central venous access is used instead of that.

This plays in place throughout the treatment and the chemotherapy is given through the line.

  • Some other central venous access

Skin – tunnelled catheter or Hickman line is a fine silicon tube that is interested into a vein, through a small cut in the chest.

This tube can stay in place for several months, for chemotherapy and blood samples can also be taken from the catheter.

  • Peripherally inserted central catheter (PICC)

It is inserted into a vein in the arm, at or above the bend in elbow, and extends into the large vein leading to heart.

It can stays in place until the whole course of chemotherapy, blood samples can also be taken from this device.

  • Implanted chemotherapy pots

It is a small device connected to a thin catheter. It is put under the skin, usually in the chest or arm. The other end of the tube goes into a large vein just above the heart.

This chemo port is hidden but can be felt under the skin.

Chemotherapy drugs are given directly into the port, and also be used to take blood samples.

D, Myths about chemotherapy

Advanced researches have important cancer treatments to make it more effective and to reduce side effects during the treatment.

But some misleading ideas about chemotherapy still persist.

There are some myths or misconceptions about chemotherapy and explanations to help you understand the truth. It includes:

  • Chemotherapy will make me sick

 Patients can now take medicines before chemotherapy to prevent side effects like nausea and vomiting.

In the past days, chemotherapy used to cause very serious or sometimes life-threatening conditions or infections in patients during the treatment because of the suppression of the immune system. Therefore, the body is not able to fight against infection resulting in sickness.

Today, cancer patients are not subjected to these life-threatening illnesses and so do not have to worry about the immune system and fear of sickness during chemotherapy.

  • Chemotherapy will make me bald

With a strong belief some people think that they will lose all of their hair in the chemotherapy treatment. Not all chemo drugs causes hair loss, and some only cause hair thinning, mainly depending upon the type of chemo drugs.

Most chemo drugs affect instantly by dividing the cells in the body like in the hair follicles, but nowadays there are some targeted medicines that influence specific cells, which rarely affect the hair.

Scalp cooling may help the patients at the risk of losing hair. In this scalp cooling procedure, the patient is fitted with a special cold cap that reduces the blood flow to the scalp, which helps to diminish the amount of chemo that comes in contact with hair follicles.

  • Chemotherapy will cause infertility

A myth is grounded that, many women menstruation stops during the treatment of chemotherapy. But women in their 20s, 30s and even in their 40s will likely menstruate again after the end of the treatment.

Nowadays, pregnant women who are diagnosed with cancer may be prescribed certain chemotherapy medicine that does not affect the baby, so pregnancy should not restrain the chemotherapy treatment either.

Chemotherapy has changed so much over the years, and therefore it is very essential to many cancer patient’s to understand their treatment plans, and education is vital.

  • Chemotherapy is outdated, immunotherapy is effective

Fact is that immunotherapy is a treatment that patients look forward to instead of chemotherapy for the cancer treatment.

But, the mechanisms of action of both the treatments are totally different.

Immunotherapy is not so popular as it totally depends on the immune system of the individual, to target cancer cells.

Even research studies have not yet confirmed the effectiveness of immunotherapy for the treatment of all types of cancer.

Chemotherapy has been used for decades, so it is highly recommended and successful in the treatment of cancer and can not be undermined by any other alternative treatment option.

  • Chemotherapy is a painful treatment

Many people think that but this is not an entirely true treatment, because chemotherapy is a treatment to target cancer and the pain occurring during chemotherapy is of cancer itself.

Intensity of pain may depend upon the condition, stage and type of cancer.

Like, if cancer has spread to other parts of the body like bones, liver, stomach etc, then it is a condition that may have been causing pain.

Therefore, it is always suggested to go for cancer treatment as early as possible, or else it will add more risk and complications and also associated pain.

Rather, chemotherapy is a treatment to provide pain free life to the individual.

  • Chemotherapy drugs are administered intravenously only and requires hospital stay

Intravenous infusion is just one of the modes through which the chemotherapy drugs are administered.

Not all chemo drugs are given intravenously, and require the patient to stay in hospital for the treatment.

There are a majority of chemo drugs which are either taken orally (by mouth) at the hospital or home. Some of the chemo drugs are administered intramuscularly in an injection form or applied topically.

Therefore, there is no need for the patient to stay in hospital, even nowadays in case of intravenous infusions, patients are released on the same day once the chemotherapy drugs are successfully administered.

  • There is only one type of chemotherapy is used during the treatment.

Chemotherapy is a standardized treatment and it is becoming more customized. There are variety of drug therapies are used for different reasons sometimes a doublet or in combination with other drugs.

Chemotherapy is more often used before surgery that is called neoadjuvent chemotherapy, to reduce the size and spread of the tumor. After surgery adjuvant chemotherapy is used to reduce the spread of any cancer cells that the procedure may have missed, or along with radiation therapy.

Each patient is treated as a different and separate case, is given the treatment option best suited for them.

  • Chemotherapy will make me toxic

Chemotherapy drugs are the powerful medications, and may have many toxic properties that can be harmful if not administered carefully with great care.

But these toxic properties do not make patients untouchable.

Even some patients think that they need to sleep in different beds from others and use different washrooms.

Patient during chemotherapy treatment cannot their family or friends with toxic excretions, so their is no issue with maintaining a regular healthy lifestyle.

  • Chemotherapy treatment is worse than the cancer disease

Many people have the perception that chemotherapy will significantly reduce their quality of life for an extended period of time.

But the fact is, that the transient negative effects are worth the goal, and the side effects are usually disappears shortly after chemotherapy treatment.

Chemotherapy can take an emotional, physical and mental damage or toll, but it is not destructive as many people assume.

This type of treatment can be a tough slog for those people who must go through it, but the myths about the chemotherapy cause a fear that has little basis in reality.

However, most of the people seems to think of chemotherapy much as it was in the ’50s or 60s and are not aware of the massive changes that the treatment has undergone.

  • Chemotherapy kills cancer cells only

Chemotherapy drugs are defined as anti-cancer drugs or cancer killers, these chemo drugs are designed to inhibit rapid cellular growth by targeting cells at their core, their DNA or the enzymes that promote their growth.

Cancer cells grows in a different and irregular manner that property is a key difference between cancer cells and healthy cells.

Chemo drugs are invented to kill cells that grow in a specific manner, but they cannot always attack cancer cells only.

Therefore, common side effects such as hair loss, which is an indication of the drugs targeting the rapidly growing cells in the hair follicles.

It is important to understand that chemotherapy doest not affect cancer cells alone and may also harm healthy cells in the body.

E,Hereditary breast cancer

Is breast cancer and ovarian cancer hereditary?

Most cases of ovarian cancer and hereditary breast cancer are caused by certain changes in the in the BRCA1 or the BRCA2 gene.

Hereditary breast cancer and ovarian cancer,  diagnosis is considered when there are multiple cases of ovarian cancer and or breast cancer on the same side of the family.

Women with ovarian cancer and hereditary breast cancer may also have an increased risk of some other type of cancer, like melanoma, pancreatic cancer, also known as

Hereditary breast ovarian cancer syndrome  (HBOC).

It is an inherited cancer-predisposition syndrome, affected human have a significantly greater risk of developing certain cancers, mainly breast cancer in both females and males and ovarian cancer in females.

There are the following situations where a family has a increase chances of having HBOC syndrome:

  • More than one type of cancer in a woman with breast cancer and ovarian cancer.
  • Mostly cases of a rare or uncommon type of cancer.
  • Occurrence of cancer in the gender usually affected, like breast cancer in a man.
  • Occurrence of cancer at younger ages, like colon cancer in 20 years old.
  • More than one cancer (childhood) in siblings like sarcoma in both brother and sister.
  • Occurance of cancer in many generations like in grandfather, father and son.

What are the causes of HBOC?

It is an inherited genetic condition, which means that the cancer risk is passed from generation to generation in a family.

  • It is caused by harmful mutations in the BRCA1 and BRCA2 genes.
  • These genes BRCA1 and BRCA2 can produce very high rates of ovarian and breast cancer as well as other types of cancer.
  • Gene mutations in BRCA1 are associated with a 39-46% risk of ovarian cancers and the mutations in BRCA2 are associated with a 10-27% risk of ovarian cancer.
  • There are some other identified gene include MLH1, MSH2, MSH6 and PMS2, mutations in these genes lead to Lynch Syndrome, which put women at risk of ovarian cancer.
  • When an individual has inherited a mutation in their BRCA1 and BRCA2 genes, it means that their body is not able to properly repair
  • There is a mistake in gene that normally helps and prevent cancer, that is why mutations in these genes are associated with a higher risk of some cancers.

Chances of inheriting HBOC Syndrome

  • About 50% of chance that that an individual with HBOC will pass their mutation on their children or generation.
  • This syndrome does not skip generational, and male or female have the equal chance of inheriting the mutations in genes, this is called autosomal dominant inheritance.

How the Inheriting HBOC works?

  • Every individual has two copies of the HBOC syndrome genes, where one copy inherited from the mother and other copy inherited from the father.
  • Individual, who has one normal gene and one mutated gene will have definitely the chances of HBOC syndrome.

How to avoid HBOC syndrome?

Individual with HBOC syndrome, who are interested in having a child, and wanted to reducing the risk of this hereditary syndrome in the child can go for PGD ( preimplantatiom genetic diagnosis).

  • PGD is a medical procedure which can be done along with IVF ( In vitro fertilization), which allows the individual who carry a specific known mutations in the gene to reduce the risk that their generation will inherite the syndrome.
  • PGD procedure has been used for over 2 decades for many kinds of hereditary cancer syndrome, but it is a complex procedure with physical, emotional and financial factors should be consider.
  • Cancer screening- it will not actually reduce the risk of cancer but will help to find out the cancer as early as possible, when treatment is likely to be most effective.
  • Early gene testing or screening for woman risky gene carriers usually begins at the age of 25 and for the man at the age of 40. It may include the following ways
    • Breast cancer screening, ( mammography, MRI)
    • Abdominal examination
    • Self awareness practice like breast self examination
    • Ovarian screening, (internal ultrasound, CA125)
    • Cervical screening
    • Prostate examination (serum PSA)
    • Other types of cancer screening.

How to reduce the risk of HBOC syndrome?

  • Chemoprevention

Chemoprevention or preventive medicines can reduce the risk of developing of cancer and also reduce the chance in women at high risk of HBOC syndrome.

If a woman is at high risk of breast cancer, she may be able to improve her odds of staying cancer- free by taking centain drugs, an approch refer as chemoprevention or preventive medicines.

Breast cancer chemopreventive medications are the subject of much ongoing research, including how they may work to prevent breast cancer and the possible health risks and side effects, it includes

Tamoxifen – it belongs to the class of drugs know as selective estrogen receptorreceptor modulators ( SERMs).

It blocks and reduces the effects of estrogens, a reproductive hormone that influences the growth and development of many tumors in the breast.

Reloxifene – it also belongs to the class of drugs SERMs, used to reduce the risks of invasive breast cancer at high risk women, who are post menopausal.

This medicine is also used for the prevention and treatment of the bone- thinning disease known as osteoporosis.

OCP ( Oral contraceptive pills) or birth control pill has been proven to reduce the risk of ovarian cancer, for BRCA mutationmutation carriers .

It may be recommended as a preventive measure.

As the research supports the birth control as a risk factor for breast cancer, so be cautious if a woman experience any kind of abnormality in the breast.

  • Preventive surgery also known as prophylactic surgery, it is the most effective risk- reducing procedure has been proven to be in the form of preventive surgery.

These surgeries are performed to remove at the risk organs prior to the development of cancer.

Bilateral salpingo -oorophactomy(BSO) is the standard surgical prevention for patients with HBOC syndrome.

BSO has been linked to significantly improved cancer specific mortality for fallopian tube, ovarian, peritoneal and breast cancers and also improved mortality in BRCA mutation carriers in genes.

This surgery can lower the risk of ovarian cancer by approximately 90% with removal of ovaries and fallopian tubes.

Removal of one ovary and fallopian tube is known as unilateral salpingo- oorophactomy, when both ovaries are removed with fallopian tube is called bilateral salpingo- oorophactomy.

Sometimes healthy fallopian tubes and ovaries are removed that help to prevent ovarian cancer in women, who are at high risk, this is known as risk reducing salpingo-oorophactomy.

Bilateral mastectomy

In this preventive surgery a woman could mean removal of both breasts known as double mastectomy, can lower the risk of breast cancer by more than 90% and upto 100% if  there is a strong family history of breast cancer or BRCA mutation in genes, followed by breast reconstruction if desires .

Bilateral mastectomy is an invasive and irreversible procedure, so women with BRCA mutation could undergo for surgery after 30 year of age, because 3% of breast cancer associated with mutations in BRCA are diagnosed before age 30.

About 10% of women will develop breast cancer, even though their breast tissue has been removed, but in most studies patient didn’t develop cancer after prophylactic mastectomy.

Breast reconstruction can be take place after mastectomy to reduce the psychological impact of the breast removal to a woman. It can help a woman to find her self-confidence again and feel better in life.

There are some suitable types of breast reconstruction surgery;

  • Implants or prosthetics, type of surgery uses silicon or saline implant that give look and shape of breast.
  • Autologous or skin flap surgery, this method uses tissue from another part of body like abdomen tissue, thighs, and buttocks.

Preventive or prophylactic surgery may also include a hysterectomy and removal of top of the cervix depending upon the risk factors and doctor recommendations.

Many women opt to to undergo risk-reducing surgery in order to prevent breast and/or ovarian cancer, like

Angelina Jolie, a hollywood film star also elected to proceed with preventive surgery, double mastectomy after undergoing genetic screening and learning that she had a significantly raised risk of developing breast cancer because of mutation of the BRCA gene.

  • Lifestyle changes , it have been proven to be a very effective in reducing the risk of HBOC syndrome.

Eating a well balanced diet, regular exercising and maintaining a healthy body weight, have been linked to better over health and better outcome related to cancer.

A recent health services study suggests that the half of all cancer is preventival by the lifestyle choices.

Obesity or having a higher body mass index BMI, while carrying BRCA mutation is positively linked with higher levels of damage in the DNA in the glands of the breast.

Breast cancer has been shown to occur more frequently in BRCA mutation who are overweight.

Estimated cancer risks associated with HBOC syndrome

HBOC syndrome is characterized with a increased risk of other cancers such as prostate cancer, pancreatic cancer, male breast cancer and melanoma.

 

Cancer       BRCA1        BRCA2       General

Type                                                 population

 

Breast           >60%            >60%           12.3%

Cancer

 

 

Male breast   1.2%              7-8%            0.1%
Cancer

Ovarian       39-58%          13-19%          1.6%
Cancer

Pancreatic    <=5%             5-10%           1.6%
Cancer

Prostate      increased*      15-20%           12%
Cancer

(Prostate cancer risks for BRCA1 and BRCA2 carried by age 65.)

Melanoma   no increase    increased        2.3%

Research

https://www.cureus.com/articles/17222-harnessing-the-immunomodulatory-effects-of-radiation-in-urinary-bladder-cancer#:~:text=Extensive%20preclinical%20data%20supports%20the,the%20systemic%20anti%2Dtumor%20effect.

https://www.ojionline.org/article.asp?issn=2589-1871;year=2020;volume=4;issue=3;spage=110;epage=114;aulast=Patil

https://ijmio.com/cardiotoxicity-in-patients-on-trastuzumab-in-her2-positive-breast-cancer-a-retrospective-analysis-from-a-center-in-north-india/

https://www.crstonline.com/article.asp?issn=2590-3233;year=2020;volume=3;issue=1;spage=146;epage=147;aulast=Abbas

https://www.researchgate.net/publication/343512692_Predictors_of_Occult_Neck_Metastasis_and_Extra_Capsular_Spread_in_Early_Oral_Cancers

https://pubmed.ncbi.nlm.nih.gov/30050778/

https://pubmed.ncbi.nlm.nih.gov/31607695/

https://pubmed.ncbi.nlm.nih.gov/31807489/

https://www.proquest.com/openview/d26bb79fb4948a5db6724295f88156a5/1.pdf?pq-origsite=gscholar&cbl=226512

https://pubmed.ncbi.nlm.nih.gov/31489291/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498714/

https://www.journalofcurrentoncology.org/article.asp?issn=2589-8892;year=2018;volume=1;issue=2;spage=97;epage=100;aulast=Patil

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348784/

https://www.researchgate.net/publication/334632035_Cancer_Awareness_amongst_Nurses_in_a_Tertiary_Care_Hospital_in_North_Delhi_India

https://www.crstonline.com/article.asp?issn=2590-3233;year=2021;volume=4;issue=1;spage=55;epage=60;aulast=Abbas

https://www.crstonline.com/article.asp?issn=2590-3233;year=2020;volume=3;issue=1;spage=146;epage=147;aulast=Abbas

 

Dr. Waseem Abbas

Director research @MAX institute of cancer care.

Senior consultant medical and Hemato-oncology @MAX cance centre shalimarbagh.

Clinical lead in Medical oncology from MAX cancer centre shalimarbagh.

Dr. Abbas is the Director of research at MAX Institute of cancer care and is one of the best breast cancer specialists in Delhi/India. He has treated more than 1000 breast cancer cases successfully till date. He also has done some breakthrough research in this field and is dedicated to research in the field of breast cancer. He is expert in treating aggressive breast cancers. Has received multiple national and international awards for his research.