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Breast Clinic
Breast cancer is the second most common cancer in Indian women. The
incidence is more in urban than rural women. It is more prevalent in the
higher socio-economic groups. The average incidence rate varies from 2228 per 100,000 women per year in urban settings to 6 per 100,000 women
per year in rural areas.
Typically, breast cancer arises from cells lining the milk ducts and slowly
grows into a lump. A malignant tumour has the ability to spread beyond the
breast to other parts of the body via the lymphatics or the blood stream.
Breast cancer is also one of the curable cancers if detected early.
Women with a higher than average risk of developing breast cancer may
be offered screening and genetic testing for the condition. Increased
awareness of breast cancer risk in the past decades has led to an increase
in the number of women undergoing mammography for screening, leading
to detection of cancers in earlier stages and an improvement in survival
rates.
The various abnormalities of the breast include nipple discharge,
inflammations, ANDI, benign disorders, phyllodes / sarcomas and
carcinoma. Most breast cancers are epithelial tumors that develop from
cells lining ducts or lobules. Cancers are divided into carcinoma in situ and
invasive cancer. Breast cancer invades locally and spreads initially through
the regional lymph nodes, bloodstream, or both. Advanced breast cancer
may affect almost any organ in the body—most commonly, lungs, liver,
bone, brain, and skin.
Most breast cancers may present as
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Painless lump in the breast
Dimpling of skin over breast
Change in contour over the breast
Rash or ulcer over the nipple
Indrawing/retraction of the nipple
Blood stained discharge through the nipple
Ulceration of the nipple
Lump or fullness in the armpit
Arm swelling
During a physical examination a lump is felt distinctly different from the
surrounding breast tissue. More advanced breast cancers are
characterized by fixation of the lump to the chest wall or to overlying skin,
by satellite nodules or ulcers in the skin. Matted or fixed axillary lymph
nodes suggest tumor spread.
The triple assessment of breast lump is helpful in the diagnosis of breast
carcinoma and includes: clinical examination, radiological investigation
(Mammography, Ultrasound of breast and or MRI of breast) and
pathological correlation. Confirmation of malignancy with cytology or
histology is the minimum requirement for “indeterminate” or “high-risk” solid
lesions. Fine-needle aspiration / Tru cut / core biopsy / surgical excision/
Incision biopsy / percutaneous breast biopsy for non-palpable disease are
the various methods used to obtain tissue for pathological confirmation.
The TNM staging is traditionally used to stage breast cancer. Patients are
clinically grouped into one of the following categories
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Operable Breast Cancer
Large Operable Breast Cancer
Locally Advanced Breast Cancer
Metastatic Breast Cancer
Breast cancer can be treated using a multimodality approach of surgery,
chemotherapy, radiotherapy and targeted therapy. The treatment options
vary as per the stage of the tumor. The doctor chooses the treatment
modality after many considerations like stage of disease, logistics of
treatment implementation and your choices. Hence two patients in the
same stage may receive different treatments. At present, we have four
established modes of treatment, aiming firstly to cure and secondly to
improve quality of life –
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Surgery
Chemotherapy
Radiotherapy
Hormonal therapy
Breast Clinic at Fortis Hospital Jaipur provides comprehensive breast
cancer management using evidence-based protocols, with emphasis on
early detection, breast conservation, sentinel lymph node biopsy,
oncoplastic procedures to reduce surgical morbidity; and high quality
adjuvant treatment.
I- The following services relating breast cancer management are
offered:
Screening: opportunistic screening with clinical breast examination,
mammography, breast ultrasonography.
Diagnosis: including fine needle aspiration cytology, core biopsy, etc.
Surgical Management: Includes a whole range of breast surgical
procedures with emphasis on breast conservation, sentinel lymph nodes
biopsy, onco-plastic and breast reconstructive procedures, and on
quality of breast and axillary surgery. Commonly performed procedures
include:
Modified radical mastectomy
Simple mastectomy with sentinel lymph node biopsy
Wide local excision with sentinel lymph node biopsy with/ without
axillary clearance
Oncoplastic procedures
Breast reconstructive procedures using pedicle flaps/ prosthesis
(Implant)
Chemotherapy ports implantation and removal
Neo-adjuvant chemotherapy/ other neo-adjuvant treatment for large/
locally operable breast cancers for facilitate safe and effective surgical
treatment, and to offer breast conservation to selected patients of this
group
Adjuvant treatment
Adjuvant chemotherapy
Adjuvant Hormone treatment
Adjuvant biological therapy: Trastazumab for HER 2 neu positive
cases and other targeted therapy
Specialized Supportive Care: Pain management, management of
post-mastectomy arm lymphedema, bone health management, well
trained nursing care etc.
Follow-up including tele-follow up
II- Benign Breast Disease (Nipple Discharge, Breast Lump like
Fibroadenoma, Fibrocystic Disease i.e. ANDI)
III- Aesthetic breast surgery
IV- Surgery for carcinoma in male breast and for gynecomastia