Breast cancer is spreading at a phenomenal speed.
Every 6.5 minutes, a fresh case is reported somewhere in this country. As the population continues to age and increase and more Indians adopt western lifestyles, numbers are expected to climb sharply.
There are certain options to fight with Breast Cancer
When the tumour alone is excised, the procedure is called lumpectomy. In other cases, the whole breast can be removed (mastectomy). Surgical removal of at least some of the lymph nodes from the underarm is also done to determine whether the cancer has spread to the nodes. In addition, some women choose to have reconstructive surgery to create a new breast form after mastectomy.
The standard method, known as external beam, delivers high-energy X-rays, gamma rays or particle beams to the site of the cancer. This painless procedure is generally given daily for five to seven weeks. The type of beam used depends on how large an area has to be radiated and how deep the treatment must penetrate.
Radiation therapy can produce side effects that build up over time. They include fatigue, skin irritation and darkening or shrinking of the breast. Less common side effects: rib fractures, lung inflammation and damage to the nerves and heart. Very rarely, radiation may foster an additional tumour.
Often used after surgery to kill cancer cells that may have spread outside the breast. The drug may be administered intravenously, in pill form, or using both. May also be recommended before surgery if the breast tumour is large (diameter greater than 5 cm), if the tumour is attached to the chest wall muscles, or if the patient has rapidly spreading inflammatory breast cancer. If the cancer responds well to chemotherapy before surgery, more of the breast may be conserved.
The patient receives chemicals that move through the bloodstream to all parts of the body, where they can destroy cells that have spread from the primary tumour. The course of this periodic treatment usually takes several months.
There are a large number of different chemotherapy drugs, and newer ones are under development. Sometimes, oncologists choose to give chemotherapy through a combination of drugs or ‘cocktails’ to subject cancer cells to a battery of attacks.
Though chemotherapy drugs target cancer cells, they can be toxic to normal cells. They harm cells that are rapidly dividing, damaging the cells of hair follicles, blood, the immune system, and the lining of the digestive tract, among others. Side effects vary in kind and severity. Depending on the drugs used, they can cause hair loss, nausea, vomiting, diarrhoea, mouth sores, fatigue and a suppressed immune system.
The female hormones estrogen and progesterone play a role in the growth of breast cells. To make use of these hormones, breast cells normally have special receptors that permit the hormones to connect to the cells. Breast cancer cells that also have such receptors are known as hormone-receptor positive. This therapy is aimed at reducing the hormones available to the cancer cells and may cause them to cease growing or die.
Tamoxifen is the most widely used hormonal treatment for breast cancer in both pre-menopausal and postmenopausal women. It blocks the ability of the hormones to attach to cancer cell receptors. Patients take a pill once a day for at least 5 years after their surgery. Side effects include night sweats and hot flashes, nausea, menstrual irregularity (when taken before menopause), vaginal discharge, and a dry, itchy vagina. It can also increase the risk of strokes, pulmonary embolism or a blood clot in the lung, and cancers of the uterus.
Living with cancer
The patient may need to adjust to effects which can be temporary— hair loss during chemotherapy—or permanent, such as the loss of a breast. This adjustment may include using a prosthesis to replace a missing breast; taking medication (hormonal treatments that have side effects); dealing with fears of a recurrence as well as changes in the emotional landscape surrounding physical intimacy and sexuality. Patients should opt for a lifestyle that cuts down risks of recurrence.
Most critical. The exact schedule will depend on individual circumstances. Routine care should involve visiting the doctor every 3 to 6 months for a physical examination and clinical breast exam, if the patient had a lumpectomy plus radiation, or an evaluation of the chest wall and unaffected breast (in case of mastectomy).
Regardless of the type of treatment, this schedule should continue for at least 5 years and yearly thereafter. Monthly breast self-examination is often suggested. Any change in breast tissue or nearby sites, as well as signs or symptoms that may suggest a recurrence should be reported immediately. Signs include new, persistent pain in the bones, chest, or abdomen; weight loss, and shortness of breath. If the patient is taking tamoxifen and have not had a hysterectomy, she will need a yearly pap test and pelvic examination because of the small risk of uterine cancer associated with this drug. If she has new symptoms, her doctor will recommend the necessary tests to determine whether they are associated with a metastatic recurrence.
Sexual intimacy after treatment
Many women fear that the physical changes caused by breast surgery, not to mention the toll taken by chemotherapy and radiation, will have an impact on their intimate relationship with their partner. It’s best for both partners to communicate their needs and their fears. During the months of chemotherapy, intimacy is possible, but at times a patient may be too physically exhausted to think about sex.
Tamoxifen is usually prescribed for 5 years following cancer treatment. This drug blocks the ability of estrogen to attach to cells and promote their growth. It reduces the risk that women who have had a ‘receptor positive’ breast cancer—meaning their cancer cells have hormone receptors—will experience a recurrence of the original cancer or a new cancer.
Women who triumphed
The next time you reach out for that Fabindia kurta, think of Bim Bissell, the woman who joined her husband to make what Fabindia is today. Renu Prasad turned adversity on its head and brings hope to others diagnosed with cancer as secretary, Indian Cancer Society. These and many more women have gone out to prove that cancer is just a word. Not a sentence
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