BREAST CANCER

Other than skin cancer, breast cancer is the commonest cancer in women in Australia.

In 2006, it is estimated that about 13,200 women were diagnosed with breast cancer.

Symptoms

Breast cancer can present in a variety of symptoms including:

1. Breast lump

2. Nipple discharge

3. Skin changes around the nipple

4. Breast pain/Mastalgia

An increasing number of cases of breast cancer are being detected through the screening mammography program in the abscence of any symptoms.

Investigations

Triple assessment needs to be performed namely:

1. Clinical examination

2. Imaging - Mammogram / Ultrasound

3. Pathology diagnosis for any suspicious lump or spot - either fine needle aspiration for cytology (to look at the cells) or core biopsy (more accurate): this is best done under ultrasound guidance.

Treatment Options for Breast Cancer

Initial treatment involves removing the breast cancer and sampling the lymph glands nearest to the breast to look for spread. The later is important to guide further treatmemt.

1. For the breast cancer itself:

(i) Wide local excision/Lumpectomy followed by radiotherapy. There is a risk that a further operation may be neccessary (Reoperation rate is about 20%) .

(ii) Mastectomy - this involves removing the whole breast. More risks of complications including wound healing, seroma, pain, scar etc.

2. For the lymph glands:

(i) Sentinel lymph node biopsy - this involves identifying the lymph gland the breast cancer first drains to(Identification is done by injection of a blue dye or injection of radionucleotide or both). Further operation at a later stage (axillary clearance) may be neccessary if lymph glands are involved. Also, there is a small risk of allergic reaction with the blue dye and the cancer cells skipping past to other glands.

(ii) Axillary clearance - this involves removing the glands in the axilla (under the armpit). Much more risks of complications including lymphoedema, seroma, pain/numbness in upper arm

Further Treatment

Other treatment following surgery will be guided by the patholgical findings.

1. Radiotherapy - once the wound is fully healed, this involves daily treatment for 4-6 weeks.

2. Chemotherapy - Herceptin, CMF/AC etc

3. Hormonal treatment - eg Tamoxifen, Aromatase inhibitors

Prognosis

For women with breast cancer diagnosed and treated between 1998-2002, nearly 9 out of 10 are still alive 5 years later here in Australia. The prognosis is getting better with advances in medical science and technology.

Useful link: www.nbcc.org.au (more detailed information can be found here)

Breast - Melbourne Surgery