BREAST CANCER :
In India, Breast cancer is the second most commonly found cancer disease in females , although it is spreading very fast, like a wild fire. Cancer of uterine cervix is the commonest cancer seen in Indian females but in metropolitan cities like New Delhi, Mumbai, Chennai, Bangalore , breast cancer has over taken the incidence of cancer of cervix.
Breast cancer has fairly good prognosis but only if detected at an early stage ( Stage I ) but unfortunately, in India majority of cases are seen in stage III only when outcome is not very good.
The modern management of breast cancer consists of multimodality treatment – surgery, chemotherapy, radiotherapy, hormone therapy etc, the sequence of application and number of therapies used depend upon the stage of the disease, general condition of the patient and choice of the treating specialist.
Breast cancer can be seen in males also ( 1 out of 100 breast cancer patients) and they have to be treated in the same manner as in females.
Early Breast Cancer :
In this the first line of treatment is surgery followed by other therapies.
In early breast cancer surgery:
- One can remove the entire breast known as Total mastectomy and this is combined with Clearance of axilla on the same side to remove all the lymph nodes ; and the combined procedure is known as MRM ( Modified Radical Mastectomy).
- One can undertake only removal of the tumour along with rim of normal breast tissue all around the tumour usually combined with axillary clearance. – known as segmental mastectomy ; and the total procedure is known as BCS (Breast Conservation surgery).
It has been established that both BCS and MRM give equally good results , the only significant difference being that there is 5% increased risk of local recurrence after BCS .
In India, BCS is done only by a very few surgeons. I have been undertaking BCS for the last thirty years and I am quite happy with the results. It gives good cosmetic looks and therefore patients are also very satisfied.
BENIGN BREAST DISEASE :
Following diseases are included in this category :
Fibroadenoma of breast : mobile swelling in the breast, usually seen in young females, it may be a single or multiple in number, it may be small in size or may attin a very big size. Most of these require surgical removal or some of the small ones may respond to medicines.
As fibroadenomas are mostly seen in young females, cosmetic results are very important.
I undertake the operation in such a way that the cosmetic results are very good, the scar is hardly seen and the shape and size of the involved breast remains the same.
Tuberculosis of breast : Tuberculosis is a very common problem in India, mostly seen in Lungs, Lymph nodes, Intestines, female genitalia etc but rarely seen in breasts also. It becomes very difficult to diagnose this condition as there are not very many leading symptoms and signs.
I have seen a few young ladies from well to do families who had this problem, could not be diagnosed for a long time, luckily I could detect it , treated them and were cured of the problem.
NON TUBERCULOUS GRANULOMATOUS PROBLEMS OF BREAST :
These are infrequent problems seen in breast , present with progressively increasing swellings or ulcers ( wounds ) in the breast, does not heal with usual treatment with antibiotics,dressings etc. I have seen a few of these cases, managed them with medicines, dressings and subsequently operated upon them and they have been cured of the problem. ( photographs )
Breast abscess is commonly seen in young mothers during their early feeding activities , particularly amongst first time mothers , who are not experienced in breast feeding their kids.
Breast cancer cases are usually surgically treated with incision and drainage, leaving behind an open purulent cavity , which has to be dressed frequently and requires a long time for complete healing and lot of pain for the patient.
I have been treating these breast cancer patients with drainage by undertaking aspiration, which may be required on a number of occasions.
I have been undertaking this form of treatment for the last fifteen years and have been successful almost in all the patients, even treating patients with 400 to 500 ml of pus on the first aspiration. In three patients , who required repeated aspirations for more than five times, I placed a drainage in the dependent part and all the three patients recovered in due course of time.