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Breast Cancer

Breast cancer is the most common female cancer with a good recovery rate. The most common treatment method nowadays is surgery if there are no metastases. Aesthetic remodeling guarantees a satisfying result for most patients. It can be performed during primary treatment stage or afterwards.

 

Breast cancer

What is it and for whom?

Breast cancer is malign tumor that develops into breast tissue. Breast cancer is the most common cancer in women and has increased a lot in last decades due to grown life expectancy of females. In Nordics every ninth woman gets breast cancer during her life. It becomes a much more common after turning 45 years. There has been a global increase of mammography screening of breast cancer which has also made incidence of breast cancer larger.

Signs and symptoms can be a lump in the breast, change in breast shape or size or in the skin. Sometimes there may be red scaly patches in the skin or fluid coming from nipple as well. In metastatic stage there may be bone pain or swollen lymph nodes in armpit or neck.

There are many risk factors which include obesity, alcohol, hormone replacement therapy in menopause, late menopause and early menstruation. Also, there are some renowned genes that give a 50-80% probability for breast cancer – most common of these are the BRCA gene family. Regular physical exercise, young age at first pregnancy and ovary removal after menopause among other options decrease risk for breast cancer.

Recovery rate for breast cancer varies a lot and is dependent on the cancer type, extent of disease and patient’s overall medical condition. However, it belongs to the cancers with highest recovery rate being over 80-90% in 5 to 10 year prognosis. With metastases the recovery rate drops but is still treatable in some cases.

Diagnosis of breast cancer starts usually at doctor’s appointment which then leads to mammography. When diagnosed with cancer there is need for biopsy to specify the tumor type – this will help in treatment planning. Sometimes an additional CT scan is needed. Only then a proper treatment path can be planned by overseas or local physicians.

Read more about breast cancer from here

Traveling

If you have been to extensive imaging and evaluation in local physician and the diagnosis and treatment path in the Nordics are clear the arrival can be arranged one or two days prior to treatment.

Duration of your trip is fully dependent on the treatment type. Surgery is a straightforward solution and results in the shortest trip length, around 4 weeks if postoperative radiation treatment is performed overseas as well. Cytostatic treatment may require you to visit hospital weekly or monthly for 4-5 months. This is negotiated individually with the hospital.

Treatment

Surgery saving breast tissue is the most common and preferred operation technique with local breast cancer. It is done under general anesthesia and lasts from 2 to 3 hours depending on the operation specifics. Imaging results and palpation will help surgeon to determine tumor size and location.

In modern surgeries the operating physician tries to remove the tumor with around 1-2 centimeter macroscopic margins to make sure the whole tumor is removed. As much healthy tissue as possible is left into breast. Sometimes due to large size or aggressive nature of the tumor more healthy-looking tissue need to be removed. Mastectomy or removal of all breast tissue is performed if wished so by patient, the aesthetic result is likely to be bad, margins are not large enough, patient is not fit for radiation treatment, or due to some other medical conditions.

Breast reconstruction can be performed during the same operation or afterwards as well. This depends on upcoming treatment (chemotherapy or radiation) schedule and is not recommended if the disease has progressed to lymph nodes. There are different type of reconstruction techniques available. Silicone implant, liposuction and adipose tissue injections or perforator flaps from elsewhere in the body are commonly used as reconstructive solutions. Sometimes a combination of these is used as well.

Postoperative radiation treatment is common and used with every patient nowadays after removal of local breast cancer. Radiation therapy lasts around 3 to 5 weeks during which around 15-20 times of radiation is needed. During this period patient doesn’t have to stay under hospital surveillance if condition allows so. Research tells that postoperative radiation is useful after mastectomy as well.

Treatment with cytostatic medication can start before surgery already. This is often the treatment path with more progressed breast cancers where more control of the disease spreading or tumor size decrease is needed. For postoperative treatment with medication a 10-year risk of 10% for cancer recurrence is used as a threshold to start the treatment.

Hormonal treatment is always started if there are hormone-sensitive cells in the tumor tissue. This treatment might continue for up to 5 years of a decade especially with premenopausal patients. Additional treatment to prevent osteoporosis is important especially.

Metastatic breast cancer treatment path is always individual. Patient age, overall medical condition and cancer type are important factors to consider when planning for treatment. Surgery is not a primary solution as there are tumors elsewhere in the body as well. Ovary suppression and hormonal treatment is a primary treatment with premenopausal women. For postmenopausal women hormonal treatment is common. At the moment there are no methods to cure a metastatic breast cancer but with help of modern medication patient may live up to some years.

Recovery and rehabilitation

Patient is usually discharged from hospital a day or two after the operations. Physical rehabilitation with proper stretching instructions is important to prevent stiffness of chest and upper limb after surgery. After mastectomy a breast prosthesis is to be worn at home to help in symmetric shoulder load.

Daily physical exercise is important and helpful. Lymphatic therapy and massage may help to reduce swelling in upper limb. Sick leave is determined based on treatment duration and is highly flexible up to a year.

Risks

Common risks are the aesthetic result of the cancer as well as immediate surgery symptoms such as swelling, pain, upper limb stiffness and infection. Aesthetic result can be seen in months after surgery and it can be re-modified with aesthetic breast surgery.

Although cancer is removed successfully there is always risk for cancer recurrence which cannot be foreseen in advance. Patient may be without symptoms for up to 20 years.

Hormonal and cytostatic treatment provide their own side effects as medication carries a lot of symptoms like nausea, tiredness, loss of appetite and hair loss. However, this medication is important for your recovery.

 

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