Breast cancer

The incidence of breast cancer is increasing. Breast cancer, which had been recorded in one in every twenty women in developed countries 50 years ago, is now being recorded in one in every 8 women. 

What is breast cancer?

Breast cancer occurs as a result of the modification and uncontrolled multiplication of a group of cells that makes up the breast tissue. Cancerous tissue first spreads to its immediate surrounding region, which is the lymph gland near the breast. Cancer which is not diagnosed and cured quickly, spreads to other organs and later entering an incurable phase. The real cause of this cancer is not yet precisely known. Two thirds of the women diagnosed with breast cancer are affected, although they do not have any of the recognized risk factors.

Most Frequently Used Methods of Imaging

Mammography: is an imaging method performed by the utilization of X rays in examination of breast diseases. Small bulks within the breast and changes which could not be recognized during clinical examination may be determined with mammography. Mammography is the main method of breast cancer diagnosis. The World Health Organization (WHO) recommends that every woman over the age of 40 should undergo mammography once a year. The level of radiation utilized by mammography is low and harmless. It is used for women with no complaints during the examination or during the diagnosis. Modern digital mammography equipment provides much higher quality vision and a higher rate of diagnosis. Mammography is not recommended for women under the age of 35, due to the danger of condensation of the breast tissue at such age and therefrom the low sensitivity of mammography as well as a high sensitivity of the breast tissue to radiation in this. Ultrasound: Ultrasound is a supporting examination technique to mammography. It is utilizes ultrasonic sound waves for imaging. It is mainly utilized to provide additional information concerning the interior structure of the bulks determined during a previous clinical examination or mammography. Ultrasound provides more information concerning younger patients in comparison to mammography.

Magnetic Resonance Imaging (MRI): Due to its ability to combine structural evidence with functional evidence, MRI is considered to be one of the most sensitive imaging methods in breast cancer detection. If applied in an accurate and timely manner, it can provide invaluable information, and its use is becoming increasingly widespread. Biopsy: This is a method of taking samples from bulks and lesions for pathological examination when breast cancer is suspected. It is the operation of taking a sample from a suspicious bulk with a thin needle, tru-cut or surgery technique. In surgery biopsy, the whole bulk is generally removed and subdued to pathology examination. Biopsy of suspicious lesions deeper in the breast tissue, which cannot be sensed by hand, is realized with radiologists guidance by utilizing mammography, ultrasound or MRI. Before the surgery, radiologists mark suspicious lesions (which cannot be detected by hand) with a wire. The surgeon follows this wire and completes the surgery without causing unnecessary damage to the breast.

The main aim of such marking is to enable the best cosmetic result while removing a minimum amount of tissue, but ensuring that the whole lesion is removed.

Biopsy: This is a method of taking samples from bulks and lesion sunder the suspicion of breast cancer for pathological examination. It isthe operation of taking a samplefrom a suspicious bulk with a thinneedle, tru-cut or surgery technique.In surgery biopsy, the whole bulk isgenerally removed and referred forpathological examination.Biopsy of suspicious lesions,which cannot be sensed by hand and reside in the deeper parts of breast tissue, is realized in the guidance of radiologists utilizing mammography, ultrasound or MRI.The radiologist marks suspicious lesions which cannot be recognized by hand with a wire before the surgery.The surgeon follows this wire and completed the surgery without any unnecessary damage to the breast.The main aim of the marking is to ensure the best cosmetic result while removing a minimal of tissue volume, but ensuring that the whole lesion is removed. In recent years, radioisotopes have been developed as an alternative to marking with wire method and began to be used in the developed medical centers. The radioisotope method is more sensitive and successful than the wire marking method. It is known as the ROLL (radionuclide occult lesion localization) technique.

How is the surgery performed?

There is a direct correlation between the probability of success for the cure of breast cancer and early diagnosis. When diagnosed at an early stage, the 5-year rate of survival may increase to 96 percent. Surgery is the most important part of the breast cancer treatment. The aim of the surgery is the removal of the tumor as a whole from the body. Treatment methods other than surgery aim to prevent the recurrence of tumors or their spread to other organs. There are three basic surgery types:

Mastectomy: This involves the removal of the breast as a whole together with the tumor. In the same session or in the late phase (after 1-2 years), silicone prosthesis can be placed or new breast with patient’sown tissue can be established by the surgeon.

Skin Protective Mastectomy: This is performed when it is necessary to remove the breast tissue but it is possible to keep breast skin. Instead of the breast tissue, silicone prosthesis can be placed in the breast skin for cosmetic purposes. In particular, it is preferred for the risk reducing breast surgery (prophylactic mastectomy).

Breast Protective Surgery: In this method of surgery, only the tumor and surrounding normal breast tissue is removed. The aims are, first of all, to preserve the breast and the cosmetic appearance; secondly, to ensure that the physiological and physical damage to the patient is kept to a minimum. After surgery, the patient receives 5-7 weeks of radiotherapy.

The following patients should not undergo breast protective surgery:

• Those who have received radio therapy to the breast and chest membrane
• Patients who are pregnant
• Multifocal tumor within a breast
• Those with widespread, suspicious or malignant micro calcifications.

Cases that can be decided according to the patient’s condition:

• Patients who have collagen vein diseases
• Patients with large scale tumors
• Patients whose breast size is not suitable
• Presence of a bifocal tumor which necessitates two cuts.

Protection of the Lymph node: The first place the breast cancer spreads is the underarm lymph nodes. In breast cancer surgery, these would have been removed even if the tumor had not spread to the under arm lymph nodes. However, it was found that there were side effects after the treatment, including the swelling of the arms, and functional or emotional effects. Thus, a new technique has been developed: the Sentinel Lymph Nodule Biopsy (SLNB). With this technique during the surgery the first lymph node (sentinel lymph node)affected by the tumor is determined by a special color and medicine,than found and removed. During the surgery, it is determined whether or not cancer cells have reached this lymph node through a pathological examination (frozen section). If the tumor has not spread to this lymphnode,other lymph nodes are left alone. The aim of this operation is to prevent any unnecessary surgery and thereby prevent any complications related to the arm. The newest technique used in Sentinel lymph nodule biopsy is the radioisotope. It has more successful results than the colour technique. In Acibadem Healthcare Group Hospitals, SLNB operation is being performed by using two techniques in combination.