Dear Doctor, I have breast cancer, recently diagnosed. I am trying to find out as much as possible so I can make informed choices about my treatment. I am overwhelmed by the information available on the internet. Can you recommend any reliable source of information? Barbara Dear Barbara, Breast cancer is the most common cancer in women worldwide. Having early beginning of menses, late menopause, not having children, not breastfeeding a child, use of hormonal contraceptive pills, hormone replacement therapy after menopause, are the major risk factors for its occurrence. These are situations where a woman is exposed to higher levels of the hormones oestrogen and progesterone and for a greater duration. Hence, these are implicated in occurrence of breast cancer. Advancing age, obesity, use of alcohol, a family member having breast cancer, are other risk factors. The cancer can occur in the breast tissue or the ducts or nipple. Feeling a hard painless lump in the breast, retraction or puckering of the nipple, discharge from the nipple, orange red skin over part of the breast, itchy skin with eruptions over breast or around nipple, swellings in the arm pit, are some of the common signs. If detected in the early stages, it is curable. Hence, the emphasis that women 40 years and above should regularly do self-examination of breasts. Any visible or palpable lump in the breast, any abnormality visible over the breast tissue, abnormality of the nipples, should alert one to the possibility of breast cancer. Imaging like mammography, magnetic resonance imaging (MRI) of the breast, PET scan, and etcetera, substantiate the findings of physical examination. Scans help to identify other sites where the cancer may have spread. Precise diagnosis of the type of cancer is made by a fine needle aspiration biopsy (FNAC). Indeed there is a lot of information available on the net regarding breast cancer and much of it would be highly technical as well. However, I shall explain it in a simple language. First stage is to confirm diagnosis of suspected breast cancer. By means of series of investigations, the histopathologic type of the tumour is determined, its hormone receptor type, whether it is spread to lymph nodes, under arms, chest wall, other breast and even different sites like lungs, backbone, etc. Based on the type of tumour, involvement of local or farther lymph nodes and metastasis to other parts (TNM), a stage of the cancer is decided. Treatment is based on this stage. Aim of treatment is to remove as many cancer cells as possible and prevent recurrence. In early stages, treatment involves surgery. Here, part of the affected breast or entire breast may be removed surgically. Lymph nodes on that side may also be removed. In later stages, if possible, palliative surgery is done. Hormone replacement therapy, radiotherapy and chemotherapy are other treatment modalities used. After surgery, regular screening is done for 10 years to check for any relapse. Information regarding treatment can be found on any authentic web site like, WebMD and American Cancer Society, among others. But it would be better to get investigated and then discuss treatment options with the treating physician. Dr. Rachna Pande is a specialist in internal medicine.
