Dr. Deepak Chhabra
MS. (Bom), DNB, M.R.C.S. (Edin. UK)
- What is cancer
- Cancer Risk factors
- Stages of Cancer
- Early signs of Cancer
- Early detection of Cancer
The world knows this man as a consultant oncosurgeon with vast experience in Gastrointestinal and Hepatobiliary-Pancreatic cancers,who specializes in stapled anastomosis for bowel cancers and sphincter saving resections for rectal cancers. In short, he is the person to be contacted for all kinds of cancer related cases.Richa AgrawalPancreatic Cancer
Thank you Dr Deepak for all you have done for mum, for putting the smile back of her face. I wish you success in all your future endeavors and know that you will continue to touch peoples lives and help them be healthy - the way you have done for my mum….. and me.Nicola MathiasStomach Cancer
For 67years I've led a very healthy life and thank the "Almighty" for it. However as I said all good things come to an end some time and so be it. Out of the blues was detected the dreadful illness "C" which had shown no signs or symptoms whatsoever..... Time had now come for me to choose a very efficient Oncologist for my treatment.Patient
My mother was diagnosed of colon cancer, and I was recommended to see Dr Deepak Chhabra for consultation.Neelu GroverColon Cancer
The first impression of Dr Chhabra was… he is so young! But after consulting him we realized his level of experience and there was a sense of confidence he spilt over us.We knew we could trust him.....
Some Facts about Breast Cancer
Breast cancer is the most common form of cancer today among Indian women. More than 100,000 women are diagnosed with breast cancer each year and almost everyone knows at least one person who has been treated for it. Current data shows that 1 in every 28 women are detected with breast cancer. Three-fourths of the cases of breast cancer occur in women ages 50 and older, but it also affects younger women.
More women are getting breast cancer, but no one yet knows all the reasons why. Some of the increase can be traced to better ways of recognizing and detecting cancer in an early stage. The increase also may be the result of changes in the way we live – postponing childbirth, taking replacement hormones and oral contraceptives, eating high-fat foods, or drinking more alcohol. However, even though the incidence of breast cancer is increasing, the death rate is decreasing due to medical and surgical intervention.
The encouraging news is that breast cancer is being detected earlier while the tumor is very small and limited to the breast.Currently, two-thirds of newly diagnosed breast cancers show no signs that the cancer has spread beyond the breast.
The Breast structure
Each breast also contains blood vessels and lymph vessels. The lymph vessels carry colourless fluid, called lymph, and lead to small bean-shaped organs called lymph nodes.
Clusters of lymph nodes are found near the breast under the arm (in the axilla), above the collarbone, and in the chest. Lymph nodes are also found in many other parts of the body.
Over her lifetime, a woman can encounter a broad variety of breast conditions. These include normal changes that occur during the menstrual cycle as well as several types of benign (noncancerous) lumps. What they have in common is that they are not cancer. Even for breast lumps that require a biopsy, some 80 percent prove to be benign.
What are the risks for developing breast cancer?
Simply being female and getting older puts a woman at average risk for developing breast cancer. The older she is, the greater her chance of getting breast cancer. This disease is uncommon in women under the age of 35 and most breast cancers occur in women over the age of 50.The risk is especially high for women over the age of 60. No woman should consider herself too old to need regular screening mammograms. Research has also shown that the following conditions increase a woman’s chance of getting breast cancer:
- Personal history of breast cancer: Women who have had breast cancer face an increased risk of getting breast cancer in their other breast.
- Family history of breast cancer: A woman’s risk for developing breast cancer increases if her mother, sister, or daughter had breast cancer, especially at a young age.
- Certain breast changes: Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ (LCIS) may increase a woman’s risk for developing cancer.
- Estrogen: Evidence suggests that the longer a woman is exposed to estrogen (estrogen made by the body, taken as a drug, or delivered by a patch), the more likely she is to develop breast cancer. For example, the risk is somewhat increased among women who begin menstruation before age 12, experience menopause after age 50, never have children, or take hormone replacement therapy for long periods of time. Each of these factors increases the amount of time a woman’s body is exposed to estrogens. DES (diethylstilbestrol), a synthetic form of estrogen, was used between the early 1940s and 1971.Women who took DES during pregnancy to prevent certain complications are at a slightly higher risk for breast cancer.
- Late childbearing: Women who have their first child after about 30 have a greater chance of developing breast cancer than women who have their children at a younger age.
- Radiation therapy: Women whose breasts were exposed to radiation during radiation therapy before age 30, especially those who were treated with radiation for Hodgkin’s disease, are at an increased risk for developing breast cancer. Studies show that the younger a woman was when she received treatment, the higher her risk for developing breast cancer later in life.
- Alcohol: Some studies suggest a slightly higher risk of breast cancer among women who drink alcohol.
- Diet and dietary factors: Some evidence exists that a diet high in animal fat may increase the risk of breast cancer and a diet high in fruits and vegetables may decrease the risk. Most of the women who develop breast cancer may have none of the risk factors listed above, other than the risk that comes with growing older. Scientists are conducting research into the causes of breast cancer to learn more about risk factors and ways of preventing this disease.
- Genetic alterations: Changes in certain genes (BRCA1, BRCA2 and others) increase the risk of breast cancer. In families in which many women have had the disease, genetic testing can sometimes show the presence of specific genetic changes that increase the risk of breast cancer. Your doctor can give you more information about this.
What are the symptoms of breast cancer?
Early breast cancer usually does not cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for:
- A lump or thickening in or near the breast or in the underarm area.
- A change in the size or shape of a breast.
- Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast.
- Ridges or pitting of the breast (the skin looks like the skin of an orange).
- A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red or scaly).
A woman should see her doctor about any symptoms like these. Most often, they are not cancer, but it’s important to check with the doctor so that any problems can be diagnosed and treated as early as possible.
How is breast cancer detected?
- Breast Self Examination (BSE): From age 20 on, monthly Breast Self-Examination (BSE) is recommended seven to 10 days after a woman’s period begins. After menopause, BSE should be performed on the first day of the month. BSE only takes a few minutes, costs nothing, and helps find tumors at a smaller size. Nine out of every 10 breast lumps are found by women themselves. Although eight out of every ten lumps are NOT cancerous, it is important to seek medical help immediately when a change or lump is detected. Early detection is the best defence against breast cancer.
- Clinical breast exam: The doctor can tell a lot about a lump by carefully feeling it and the tissue around it. Benign lumps often feel different from cancerous ones. The doctor can examine the size and texture of the lump and determine whether the lump moves easily. Your doctor will also check the armpits for any abnormal lumps (lymph nodes).
- Mammography: A mammogram is a safe low dose X-ray picture of the breast. A screening mammogram is a quick, easy way to detect breast cancer early when treatment is more effective and survival rates high. Usually two X-ray pictures are taken of each breast. If you have sensitive breasts, try having your mammogram at a time of the month when your breasts will be least tender. Try to avoid the week right before your period to help lessen any discomfort. A screening mammogram should begin by age 50 and should be performed annually. A lump should never be ignored just because it is not visible on a mammogram. Breasts of younger women contain many glands and ligaments. Because their breasts appear dense on mammograms, it is difficult to see tumors or to distinguish between normal and abnormal breast conditions. As a woman grows older, the glandular and fibrous tissues of her breasts gradually give way to less dense fatty tissues.Mammograms can then see into the breast tissue more easily to detect abnormal changes.
Using high-frequency sound waves, ultrasonography can often show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer).This exam may be used along with mammography and is called Sonomammography. Based on these exams, the doctor may decide that no further tests are needed and no treatment is necessary. In such cases the doctor may need to check your breasts more regularly to watch for any changes.
Your doctor will suggest a biopsy if an abnormal or unusual area of tissue is found in your breast. You may need one or more biopsies. A biopsy removes a small amount of breast tissue. There are a few ways of doing this. After a biopsy a pathologist examines the removed tissue.
Fine needle aspiration
A thin needle is used to take some cells from the breast lump or abnormal area. Sometimes an ultrasound is used to help guide the needle. The test is a similar to having blood taken for a blood test.It is usually done in a specialist’s rooms, a hospital outpatient department or at a radiology practice.
A wider needle is used to remove a small piece of tissue, called a core, from the lump or abnormal area. It is usually done under local anaesthetic.A mammogram or ultrasound is used to help guide the needle.
If the lump is too small to be biopsied using the method above, a surgical biopsy is needed.
Sometimes mammography may detect abnormalities in the breast (micro calcifications) without any lump in the breast. This may need to be tested. To help the surgeon find the abnormal tissue, a needle and wire may be put into the breast with the help of sonography guidance just before the biopsy. The biopsy is then done in a separate operation using a general anaesthetic. The lump and a small area of normal breast tissue around the lump are removed, along with the wire. This operation is usually done as day surgery but may mean an overnight stay in hospital. If the surgical biopsy removes all the cancer, further surgery may not be needed.
What is the treatment for breast cancer?
Treatment for early breast cancer aims to remove the cancer and to reduce the risk of the cancer spreading or coming back. Treatment may include surgery, radiation, chemotherapy and hormone therapy. Usually more than one treatment is used.
Your doctor will advise you on the best treatment for your breast cancer. The choice of treatment will depend on your test results; where the cancer is and if it has spread; your age and general health; and what you choose.
You may know other people with breast cancer but remember there are different types of breast cancer and the best treatment for one person may not be best for another.
If your cancer hasn’t spread, you will almost certainly be offered surgery.
Surgery For Breast Cancer
If your cancer hasn’t spread, you will almost certainly be offered surgery to remove the colon. Unlike other cancers of gastrointestinal system, cases where in colon cancer has spread to other areas, surgery is performed and is of proven benefit. This is very unique to colon cancers treatment.
If you are found suitable for the surgery, you will be usually admitted one day prior to the proposed date of surgery. There are no dietary restrictions for a breast surgery. You will have your armpits shaved for the surgery. You will be given a consent form for your signature.
The form would have details of the procedure to be performed on you by your treating surgeon. In case you have any doubts you should feel free to ask them to the surgical team.
The size and position of the tumour in the breast and lumps (nodes) at the armpit will determine the extent of breast surgery.
Some women want to keep their breast at all costs. Others want a mastectomy, because they want to feel the cancer has gone or they prefer not to have radiotherapy. Both treatment approaches work equally well for early breast cancer.
Surgery for breast cancer will involve one of the following: Breast Conserving Surgery (removal of part of the breast) orMastectomy (removal of whole breast). In most cases, breast surgery also involves removal of lymph nodes from the armpit.
BREST CONSERVATION SURGERY:
As the name suggests, the breast is not removed but conserved while only the abnormal lump is removed. Breast conserving surgery is offered if the cancer is small compared to the size of your breast. The surgeon removes the entire abnormal lump along with a sufficient margin of surrounding normal breast tissue (Wide local excision). This is then sent for testing immediately (Frozen section studies) to determine if all the abnormal tissue from the breast has been removed. The doctor gets the result within 10 minutes.
The pathologist examines the removed breast tissue to see if there is an area of healthy cells all around the cancer – this is known as a clear margin. If cancer cells are found at the edge of the removed tissue, this increases the chance of cancer returning. You may need more tissue removed (re-excision) or your doctor may recommend a mastectomy (removal of entire breast)
It is then followed by removal of the lymph nodes from under the armpit on the same side as the lump.
A small tube is then kept at the site of the surgery.
Radiotherapy (radiation treatment) is a must to the breast after a breast conserving surgery and is a part of Breast Conservation treatment
Surgery to remove the whole breast is called mastectomy. The nipple and the surrounding dark area (areola) is also removed. The chest muscles are not removed. Some or all of the lymph nodes in the armpit closest to your affected breast may also be removed. You may be offered a mastectomy if the cancer is large compared to the size of the breast or the cancer is in more than one area of the breast.
Thin tubes are usually kept to drain out all the fluid that forms over the chest area after a breast surgery.
Following a complete removal of the breast, the breast can be reconstructed. During a breast reconstruction, the breast shape is recreated using either an implant or tissue from another part of your body. Some surgeons do the reconstruction at the same time as the mastectomy. Others prefer to wait for several months or longer. Talk to your surgeon about what is best for you.
You will be transferred to the room after the surgery and the overall hospital stay is usually between 3-4 days. Your pain and discomfort will be taken care of by the anaesthetic team. You will be given pain-killers and an intravenous infusion (drip) to replace your body’s fluids until you are able to drink and eat again after a few hours.
After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.
The fluid coming out of the tubes will be measured on a daily basis.
Drinking and eating after surgery
You will probably be ready to start taking small sips of water within 6 hours of your surgery; however your doctors will tell you when it is appropriate for you to start drinking some fluids. You should be able to eat a regular light diet on the next day of your operation.
After a mastectomy or if you have surgery to your armpit, your surgeon and nurse will ask you to do regular exercises to help you recover. Your arm may feel stiff on the side where your breast was removed. Simple arm exercises can help to give you back your full range of movement, relive pain and stiffness and reduce swelling
After surgery, do the exercises until you have full movement back in your arm and shoulder. Ideally, you should do these twice a day.
To start with, the exercises are quite gentle. The aim is to get your arm and shoulder moving as it was before the surgery. You can begin each session by circling your shoulders, to get the muscles moving. Other early exercises are brushing or combing your hair, putting your arms behind your back and touching your shoulder with your hand. As you get stronger and more confident, you can do more of the exercises and gradually increase the range of movements.
You will probably be ready to go home in about two days after your operation. You will be discharged with the tubes and asked to keep a check on the quantity of fluid coming out daily from the tubes. By and large you should be able to do all your routine household work after your discharge from the hospital. The tubes may be removed from anywhere between 7-10 days from your surgery date.
Before you leave hospital you will be given an appointment for a post-operative check-up at the outpatient clinic. You should have the detailed report of the tumor by a week’s time and your doctor will be in a better position to explain what is the next best step to be taken for your treatment.