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Breast cancer happens when the cell undergo mutation, which is abnormal changes in the genes that keeping us healthy. The cancer cells tend to grow, divide and repair themselves very quickly without control (13). Because of this problem, this cancer cells sometimes break away from the original site of tumour and spread to other parts of the body. Staging process is useful to know whether the cancer is invasive or non-invasive, the tumor sizes and treatment option. The first and second stages are the early stages and the third and fourth stages are the late stages.
Figure 1- stages of cancer
Breast cancer can often be cured if it is found at early stages. (9) At late stages, the cancers cells will spread not only to the breast, but all parts of body included liver, brain and bones. The stage four breast cancer is incurable, but with quick treatment, the patient can live about several years.(7) The researchers show that certain risk factor that cause breast cancer are associated with the disease, family history, and genes(14). However, the causes of most DNA mutation that lead to breast cancer are still unknown. What are the solution and treatment for this problem? In this report, I am going to discuss a possible solution to treat patient with breast cancer.
A POSSIBLE SOLUTION
Surgery is the mainstay of breast cancer treatment after the tumour is localised. The breast tumour need to be removed and usually the first line of attack against breast cancer. The patients are first divided into high risk and low risk cases based on the clinical criteria which are ages,type of cancer,size and metastasis. Each category will have different therapy include radiation therapy,hormone therapy,chemotherapy and immune therapy(17). Surgery is also used to check the lymph node under the arm for cancer spread and presence of cancer cells. The decision about surgery depend on many factors such as the stage of the cancer, the tumor's characteristics and the patient's feeling. Based on the staging and type of tumour, the tumour can be removed by lumpectomy or mastectomy.
Lumpectomy is referred to breast-conserving surgery,removes only the tumor and some surrounding tissue(20). Amount of removal is depend on the size,location of tumor and other factors. A second incision may be made to remove the lymph nodes and this treatment aims to maintain a normal breast appearance after the surgery. (17)
Usually,patient will receive radiation therapy after the surgery to remove any cancer cells that may be present in the remaining breast tissue. Majority of patient who have small,early-stage breast cancer which are stage I or II are excellent candidates for this treatment. In this case,when pathologist finds any positive margins(cancer cells)left after the surgery,the surgeon may need to go back and remove more tissues through re-excision operation. A mastectomy may be needed if the surgeon cannot remove enough breast tissue to get clear margins (no cancer cells).(13,18)
Surgical removal of the entire breast tissue is mastectomy. This treatment consists of total mastectomy, modified radical mastectomy and radical mastectomy(20).
It is preferred when the tumor is large relative to the size of breast,two or more tumor exist in different areas of breast,the breast has previously received radiotherapy and when the patient lives in area where radiotherapy is inaccessible(17) .
simple or total mastectomy is removal the entire breast tissue but sparing the lymph node. Simple mastectomy is frequently used to prevent any possibility of breast cancer occurence(27).
In modified radical mastectomy,all of the breast tissue with nipple and lymph nodes in the armpit is removed. The patient with invasive breast cancer will have this surgery so that the lymph nodes can be examined(9). Lymph nodes can be examined to identify whether the cancer cells has spread beyond the breast.(9,14)
The most extensive type of mastectomy is radical mastectomy. the surgeon will remove the entire breast,the underarm lymph and the chest wall muscles under breast. This surgical is only recommended when the cancer has spread to chest muscles under the breast.
Figure5- Radical mastectomy (http://www.breastcancer.org/treatment/surgery/)
for many cases,it is accompanied by either an immediate or delayed breast reconstruction. This is quite effectively using either breast implants or the patient's own tissue. This surgical option should be discussed with the physician to achieve the best outcomes.
For newly diagnosed breast cancer cases, up to 95 percent is still essential in surgery. Out of those, 30 percent require a full mastectomy or partial breast removal. About 70 percent of the patients are having lumpectomies because only small amount of breast is removed and less radiation is required (19)
Surgery is always the first step in cancer treatment because it can diagnose and treat cancer. Most of the patient who diagnosed with cancer will have some type of surgery at the same point. It can be used to remove tumour and reduce the size of large tumour. So that, the follow-up treatment after the surgery such as radiation therapy and chemotherapy will be more effective.
Sometimes,surgery alone can cures cancer,but sometimes the other treatment is also needed(13). Furthermore,there is no relationship between intensity of surgical treatment and duration of survival. This means that all of the factors are the same,there is no difference between breast conserving surgery and total mastectomy in either overall survival or disease-free.(4)
"There is definitely a proportion of women who are cured with just surgery alone, and I believe that we are definitely getting better at distinguishing which patients and which tumours need additional treatment and which don't,"-by BC Cancer Agency oncologist, Dr. Stephen Chia.
http://www.canada.com/health/Treatment+advances+bring+hope+breast+cancer+patients/2072511/story.html words: 122
SOCIAL AND ECONOMIC IMPLICATION
some of the people lose their confidence about themselves when they get to know that they are ill and have breast cancer. They refuse to met the others and think out of control. They may think that they will not survive and eventually die. The patients would be more like to be depressed, low self-esteem due to physical appearance,lost energy and cannot go bed at time(19). These problem could affect relationships,social support and cause a great burden to the families and friends. So,they must support and take a good care of the patient. In a novel 'The doctor's wife'(1) illustrates about the first doctor in the world who perform surgery for breast cancer under a general anesthetic. The surgical procedure was such a great success and he has a wife who always give support to him and the patients. The patients would feel happy and confidence to survive although they have changes in physical appearance after the surgery.(1).
Besides that,the patients require a great expenses and It is actually a great burden for the patient especially for the poor family. They need to pay for the surgery,expensive medications, medical check-up, transportation to and from treatment, home improvement to increase accessibility and follow-up treatment after surgery for instance,physical therapy and drugs therapy.(22) The patients can also have tax deduction for medical expenses,but the savings in the use of other health resources are very important to enhance the quality of life.
BENEFIT AND RISK
From my view, surgery is beneficial as most of the people who are suffered from breast cancer are survive after surgery. If a tumour is found in the breast at early diagnosis, it is most likely to be cured by surgery and furthermore can increase life expectancy and quality of life. People who do get better treatment can have a chance to lead rewarding and meaningful life in community again.So,it is very important for all of the woman do regular breast self-examination to prevent breast cancer.(21) There are always hope to survive and free from the cancer if the patient can follow the treatment that has been recommended for them.
Woman who suffered from breast cancer, at a greater risk of developing either premature menopause or menopausal symptoms. Besides that,people who get therapy after surgery may faced the risk of losing hairs,energy and some abilities to move and speak. the age of patient at the at the time of surgery had no impact on eventual risk of breast cancer. However,The risk of disease is lower if the amount of breast tissue removed in surgery is more.(24) Patients would feel sad and lonely especially when they have physically changes and scar in their body.people are encourages to talk with the doctors and patients who had done breast cancer surgery to know the risks that they will face including the reoccurrence of the cancer.(6)
Radiation therapy uses radiation to kill and shrink cancer cells. This radiation is very effective in killing cells that may remain after can reduce the chance the of the cancer to recur. This therapy can cure cancer either alone or with surgery and chemotherapy.(19)The radiation is strong,which is X-rays(gamma rays) can eliminate cancer cells and affects the normal cells as well. However,the healthy tissues are able to recover from the radiation but not the tumour.
This treatment enables the tissue to heal over the extended period, about 5-7 weeks and five times a week.(17)This therapy can improve symptoms such as pain, improve the quality of life of patient and extended their survival although the cure is not possible.(19)
This therapy can be used before, after surgery or when surgery is considered not suitable for the patient. (17)This treatment uses cytotoxic drug to weaken and kill cancer cell at original cancer site and any cancer cells that may have been spread to another parts of the body (5).
Figure.8 chemotherapy machines to treat the patients (http://www.radiology.ucsf.edu/breast_research/labs/mr)
Sometimes, the doctors give this therapy to decide the best course of action by monitoring the response of the patient because not everyone is suitable with this Therapy. (10, 11, 12)
Chemotherapy treatment is use to get rid of any cancer cells that may left behind after surgery and to reduce the risk of cancer coming back for early-stage breast cancer(6). For advanced-stage breast cancer, it is used to destroy the cancer cells as much as possible. The drugs will travel through the body and destroy the all the cancer cells.
The doctors have to develop and test the effective treatment plans using different medicines to the patients because each cancer is unique (16).
Drugs are used to slow and stop the growth of cancer cells and it is usually for the woman whose tumors are sensitive to the hormones estrogen and progesterone .Hormone therapy prevents the development of new cancer and the original cancer from returning. Not all breast cancer will respond to hormone-blocking treatment because not all breast cancers are hormone sensitive. (22)
Targeted drugs are modified strategically to kill specific cells in the body. The example is tamoxifen which given to premenopausal and menopausal woman to inhibit estrogen receptors. A daily dose of estrogen could stop the tumor and cause them to shrink. The Arimedex and Femara are drugs that fight tumor growth by stopping the conversion of androgens into estrogen. (22) Both of them are approved for the treatment and taken in pills form. Tamoxifon and raloxifene are only drugs approved for prevention of high-risk women.
figure.9 shows the percentage of treatment by stage after diagnosed
Based on the statistical data from 2006-2006,most of the patients at stage one got hormone therapy and the others are chemo+hormone therapy while some got no treatment at all. For stage two and three, about 70% of patients had chemo+hormone therapy while the remaining are hormone therapy. Just a very few of them got no treatment.
From this data, we can know that breast cancer's patient need side treatment after the surgery process. They must have continuous treatment and diagnosis to make sure that there are no cancer cells left and to prevent the reoccurence of the tumour.
Surgery is the main treatment to the patient after the location of the cancer cells has been identified. From the reference (20, http://www.webmd.com/breast-cancer/breast-cancer-surgery ) it explains about the amount of breast tissue that is removed with the tumor, depending on the tumor's characteristics and stages. This web contains a lot of information about the surgery with clear pictures based on the stages and risks of the cancer supported by the website (19,http://en.wikipedia.org/wiki/Breast_cancer_treatment#Surgery). Moreover, there are lists of medical experts, research news on breast cancer surgery and frequently asked question in this web.
The source (15, http://www.breastcancer.org/treatment/surgery/) is very trustable as the information on the website is factual and valid as reviewed by more than 60 practicing medical experts from all over the world who are very expertise in their fields. This website provides a lot of information about the chemotherapy including its medicine, how it works and the risks for the person who suffers from breast cancer. Besides, this web also contains some review articles and research news about the treatment.
The book 'what you should know about breast cancer 'is a reliable source as it contains a lot of information about breast cancer including the factor, treatment, procedure and risk of breast cancer. I think there are no biased facts by Dr. Robert Buckman, a medical expert and writer of medical books. Furthermore, the statement by BC Cancer Agency oncologist, Dr. Stephen from one article, (25,http://www.canada.com/health/Treatment+advances+bring+hope+breast+cancer+patients/2072511/story.html) can supports that surgery alone can cure some patients but some are not.