DIAGNOSTICS AND KIND OF THERAPHY FOR BREAST CANCER
21 Dec 2018
Breast cancer is an important health problem in women. In United State of America, 1 in 8 women (12.5%) in the course of their lives will suffer from breast cancer or 30% of all cancers in women. In Indonesia, breast cancer is the most common cancer case in women. (Glabocan 2008) recorded the incidence of breast cancer 36.2 / 100,000 / year, with a mortality rate of 18.6 / 100,000 / year: who was in an advanced stage> 50%. The incidence of breast cancer both in Indonesia and abroad (European-US) tends to increase.
There are several methods used to diagnose breast cancer. Until now, the gold standard for diagnosing breast cancer is histopathological examination. Histopathological examination can determine the type of breast cancer. The procedure for histopathology is that the patient must be do biopsy. Biopsy results can be used as a diagnosis of breast cancer and also monitoring the success of therapy. The histopathological picture in question is microscopic tissue morphology from anatomical pathology which is an important parameter and the diagnostic standard for breast cancer.
Mammography is a radiological examination. In some people this examination may cause discomfort, because the breast will be pressed from the top and bottom and then the breast is photographed with X-rays. For women under the age of 40, ultrasound should be done first and then strengthened by Mammography. As for women over 50 years, it is recommended to carry out mammography examination at least once every two years.
Ultrasound is a non-invasive examination that can be performed on young women. Just ultrasound without mammography is not recommended for breast cancer detection because of its small specificity and sensitivity. But if both are combined, the diagnostic value of breast cancer can be increased. Several other available examinations should be done as an additional examination of mammography, given the effectiveness and costs incurred for the purpose of early detection of breast cancer.
After the diagnosis is confirmed, one or several of the following treatment measures will be recommended to the patient:
There are two main types of surgical operations:
1) Breast conservation therapy
The surgeon only removes the breast tumor and surrounding tissue; the patient must undergo radiotherapy afterwards to reduce the risk of recurrence of the disease. This approach is best applied to small lumps located far from the nipples and there are only a few undesirable side effects.
2) Mastectomy (removal of the entire breast)
If the breast tumor is too large or is found in some parts of the breast, then the entire breast must be removed surgically. Lymph nodes in the armpit on the side of the affected breast must be sampled or removed for further microscopic examination. Today, patients who meet certain criteria will be asked to do a sentinel lymph node biopsy. If no tumor cells are detected in the sentinel lymph gland, the patient does not need to undergo axillary dissection surgery. This can reduce the possibility of postoperative lymphedema in the upper limb. For patients undergoing mastectomy, patients can choose to use a breast prosthesis or undergo breast reconstruction surgery. Reconstructive surgery generally uses fat from the abdomen or special saline implants made to restore breast contour and shape. You should ask for further advice from an experienced surgeon and nurse specialist before and after breast surgery.
For more aggressive tumors or residual tumor cells around surgical wounds (for example in breast conservation therapy), radiotherapy (treatment using high-energy X-rays) may also be needed as an adjuvant treatment to reduce the risk of disease recurrence. All treatment procedures with radiotherapy will usually take 5 to 6 weeks. Today, hypophraxation treatment for 3 to 4 weeks has been shown to be as effective as other conventional treatment measures.
Adjuvant chemotherapy is often given postoperatively to patients who have a moderate to high risk of recurrence. Anti-cancer cytotoxic drugs will be used to kill the remaining cancer cells, thus helping to reduce the risk of recurrence. The whole course of treatment with chemotherapy will usually take 3-6 months. For patients suffering from advanced breast cancer, chemotherapy can also be used in palliative conditions.
Estrogen will stimulate the growth of breast cancer cells. Therefore, doctors may prescribe drugs to block the effects of these female hormones to stop the growth of breast cancer cells. However, this approach is only effective in tumors with positive hormonal receptors. This treatment is usually done by taking medication tablets for up to 10 years.