Dr. Nanda Rajaneesh, an eminent Surgeon, endowed with rich and diverse experience and distinguished academic record, has established herself as a Specialist in Minimal invasive Gastrointestinal surgery( Laproscopy) and Surgical Oncology. She has acquired many degrees through extensive training in surgical field and is member of royal college of surgeons.
• MBBS, MS, MRCS(Edinburgh),AFCRSI(Colorectal)
• FICS, FAMS(Laproscopy), Fellow in GI Surgical Oncology • Fellow in Bariatric Surgery, St.Nicolas Hospital, Belgium .
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The breasts, also known as mammary glands, are a pair of glandular organs that produce milk in response to the hormone changes of childbirth. They are mainly made up of fatty tissue that starts high on the front of the chest and extends down and around into the armpit. They are supported by ligaments and large muscles.
Each breast has 15-20 lobes with a number of lobules and ducts supportive tissue (see diagram). Each lobule has about 30 major ducts that open onto the nipple. The darker area of skin around the nipple is called the areola. At the edge of the areola there are large glands that produce fluid to lubricate the nipple.
In each armpit there are about 20-30 lymph nodes (glands) that drain fluid from the breast. These form part of the lymphatic system that helps the body to fight infection.
What is breast cancer?
Breast cancer is an abnormal growth of cells which are not controlled . These cells cause invasion and destruction of the breast tissue. That changed cell gains the ability to keep dividing to form a cancerous growth.
What is the incidence of breast cancer?
Cervical cancer is the most common cancer in women in India with breast cancer competing fast with it for the top position. In a survey conducted by ICMR (Indian Council of Medical Research), it is seen that 1 out of 22 women are affected compared to 1 in every 8 women affected in US.
What are the causes for Breast Cancers?
• Positive family history of breast cancer: If a woman has mother who has had breast cancer, her risk increases about 3 folds. If the woman has a sister with history of breast cancer, the risk increases by 2-3 folds.
• Women who have had breast cancer in one breast
• There is slightly increased risk in women who :
- have had their first childbirth late in life
- had an early menarche
- have no children
- have a late menopause
• Obesity predisposes to breast cancer after menopause
• Increased and long usage of OC pills
• Women who taken hormones for more than 10 years
• Oncogenes- related to BRCA1 and BRCA2 genes
What is HER2 –positive breast cancer?
Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells have too many copies of this gene, cells -- including cancer cells -- grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk of recurrence than those who do not have this type
What are the symptoms of Breast cancers?
Usually breast cancers present with:
1) A painless mass in the breast- up to 10% of cases have pain and no mass
2) Breast changes- thickening, swelling and skin irritation or distortion (Dimpling of the skin in the area of the lump appearing like orange peel)
3) Nipple changes- discharge, erosion, inversion and tenderness( pain)
4) Presence of patch of dry flaky skin on the nipple and change in appearance or texture of the breasts – Usually seen in Paget’s disease.
5) General Symptoms- fever, loss of appetite, fatigue
What are the changes I should be aware of in Breast Cancer?
• Change in size
• Inverted nipple
• Rash in and around the nipple
• Discharge from one or both nipples
• Puckering or dimpling of skin
• Swelling in your armpits
• Swelling in the breast
• Constant pain in breast and armpit
How is breast cancer diagnosed?
The earlier the breast cancer is found, the better the chances that treatment will work. The goal is to find cancers before they start to cause symptoms. The size of a breast cancer and how far it has spread are the most important factors in predicting the outlook for the patient. Most doctors feel that early detection tests for breast cancer save many thousands of lives each year. Following the guidelines given here improves the chances that breast cancer can be found at an early stage and treated successfully.
Guidelines for Early Breast Cancer Detection
The following are the guidelines for finding breast cancer early in women without symptoms:
• Mammogram: A mammogram is an x-ray of the breast that is used to detect breast disease.
During a mammogram, the breast is pressed between 2 plates to flatten and spread the tissue. The pressure lasts only for a few seconds and usually causes minimal discomfort. Very low levels of radiation are used. The whole procedure takes approximately 20 minutes.
Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. While mammograms can miss some cancers, they are still a very good way to find breast cancer.
• Clinical breast exam: Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert, preferably every 3 years. After age 40, women should have a breast exam by a health expert every year. It might be a good idea to have the CBE shortly before the mammogram. You can use the exam to learn what your own breasts feel like
For any spontaneous change, see your physician without delay!
Make sure you compliment your BSE with a yearly physical exam of your breasts by a trained professional and ask about risk factors and breast screening
• Breast awareness and breast self-exam (BSE):
BSE is an option for women starting in their 30s. If you decide to do BSE, you should have your doctor or nurse check your method to make sure you are doing it right. If you do BSE on a regular basis, you get to know how your breasts normally feel.
When to do breast self- examination?
Women more than 30 years of age should do BSE regularly.
BSE should be performed about one week after the beginning of each cycle.
If the periods have stopped, it should be done in the beginning of each month.
1. While standing in front of a mirror, look at the breasts. The breasts normally differ slightly in size. Look for changes in the size difference between the breasts and changes in the nipple, such as turning inward (an inverted nipple) or a discharge. Look for puckering or dimpling.
2. Watching closely in the mirror, clasp the hands behind the head and press them against the head. This position helps make subtle changes caused by cancer more noticeable. Look for changes in the shape and contour of the breasts, especially in the lower part of the breasts.
3. Place the hands firmly on the hips and bend slightly toward the mirror, pressing the shoulders and elbows forward. Again, look for changes in shape and contour.
Many women do the next part of the examination in the shower because the hand moves easily over wet, slippery skin.
4. Raise the left arm. Using three or four fingers of the right hand, probe the left breast thoroughly with the flat part of the fingers. Moving the fingers in small circles around the breast, begin at the nipple and gradually move outward. Press gently but firmly, feeling for any unusual lump or mass under the skin. Be sure to check the whole breast. Also, carefully probe the armpit and the area between the breast and armpit for lumps.
5. Squeeze the left nipple gently and look for a discharge. (See a doctor if a discharge appears at any time of the month, regardless of whether it happens during breast self-examination.)
Repeat steps 4 and 5 for the right breast, raising the right arm and using the left hand.
6. Lie flat on the back with a pillow or folded towel under the left shoulder and with the left arm overhead. This position flattens the breast and makes it easier to examine. Examine the breast as in steps 4 and 5. Repeat for the right breast.
Early detection guidelines:
• At Age > 40 years- Annual mammogram, annual Clinical Breast examination ( CBE) and optional monthly breast self- examination ( BSE)
• At Age 20-39- Every three years a CBE and optional monthly BSE
• For women at average risk- who have a family history of breast cancer should talk to their doctor about when to start screening
What happens when breast cancer is suspected ?
If there is any reason to think you might have breast cancer, your doctor may suggest further tests such as the ones below to confirm it
Tests to confirm breast cancer :
a) Fine needle aspiration cytology (FNAC): This involves taking out a few cells from the lump with a thin needle and examining them under a microscope.
b) Biopsy: Sometimes, even after doing FNAC it may not be possible to find out the nature of the lump. The lump may then have to be in part or totally under following methods, under local or general anesthesia.
• Stereotactic core needle biopsy: The needle used for this test is larger than the one for fine needle biopsy. It is used to remove several cylinders of tissue. The biopsy is done with local anesthesia (the area is numbed) on an outpatient basis.
• Surgical biopsy: Sometimes surgery is needed to remove all or part of a lump so it can be looked at under a microscope. The entire lump as well as some normal tissue around it may be removed. Most often this is done in the hospital on an outpatient basis. Local anesthesia is used and sedation may also be given to relax you and make you less aware of the process
c) Mammography: This special type of x-ray of the breast is done to assess the extent of tumor in the affected breast and ascertain whether there is any abnormality in the other breast.
d) Sonography of the breast: Sometimes a mammography is supplemented with this test. Both the tests are useful to detect tumor and its extent but do not offer a definitive diagnosis as is done by FNAC or a biopsy.
Tests to check if breast cancer has spread:
• Chest x-ray: This test may be done to see whether the cancer has spread to the lungs.
• Bone scan: This test can help show whether the cancer has spread to the bones. The patient is given a very low dose of radiation. The bone attracts the radiation which will show up on the scan as a "hot spot." These hot spots could be cancer but other problems such as arthritis can also be the cause. Therefore, x-rays of hot spots may be needed.
• CT scan (computed tomography): A CT scan is a special type of x-ray. Many pictures are taken from different angles. These images are combined by a computer to produce a detailed picture of the internal organs. This test can help tell if the cancer has spread to the liver or other organs. It can also be used to guide a biopsy needle into a suspicious area.
• MRI (magnetic resonance imaging): An MRI scan uses radio waves and strong magnets instead of x-rays. This test can be helpful in looking at the brain and spinal cord.
• PET scan (positron emission tomography): This test uses a form of sugar that contains a radioactive atom. Cancer cells absorb high amounts of this sugar. A special camera can then spot these cells. PET is useful when the doctor thinks the cancer has spread but doesn’t know where. It may also be useful in checking lymph nodes for cancer before they are removed.
What are the stages of Breast Cancer?
Breast cancer has been divided into four stages; but it is classified into three categories for the purpose of planning treatment:
a) Early breast cancer- where the cancer is limited to the breast and lymph nodes in the armpit. The primary aim to treatment in this stage is to cure as well as to conserve the breast. Surgery is the first line of treatment here. Supplementary hormone therapy, chemotherapy and radiotherapy may be required later.
b) Locally advanced breast cancer- where the cancer has advanced but is still confined to the breast and the lymph glands. The doctor may first give chemotherapy to shrink the lump and then operate. Hormone therapy and radiotherapy are also mandatory.
c) Metastatic breast cancer-where the cancer has spread to other parts outside the breast and lymph glands
Here the treatment cannot cure the cancer but may control it for some time. The treatment involves judicious use of hormone therapy, chemotherapy, radiotherapy and rarely surgery.
What are the standard treatments for Breast Cancer?
Treatment is most successful when the cancer is detected early, before it has spread.
• Surgery: Breast-conserving surgery (lumpectomy- removes the tumor and surrounding tissue), mastectomy( removes the breast), and lymph node dissection, are different types of surgeries
• Radiation therapy: is a highly targeted, effective way to destroy cancer cells in the breast that may stick around after surgery.
• Chemotherapy-a cancer treatment in which drugs are given orally/ intravenously to stop the growth of the cells and to kill the cancer cells.
• Hormone therapy It is a very effective treatment against breast cancer that is hormone-receptor-positive
• Monoclonal antibody therapy are with Trstuzumab( Herceptin) and Lapatinib
Often, two or more methods are used in combination with each other.
Surgery forms the mainstay of treatment of breast cancer. It involves removal of the cancerous lump with either preservation or complete removal of the breast.
• Lumpectomy: Also called breast conservation therapy, lumpectomy involves removing only the breast lump and some normal tissue around it. Radiation treatment is often given for about 6 weeks after this type of surgery. If chemotherapy is going to be used as well, the radiation may be postponed until the chemo is finished.
• Partial (segmental) mastectomy : This surgery involves removing more of the breast tissue than in a lumpectomy. It is usually followed by radiation therapy.
• Simple or total mastectomy: In this surgery the entire breast is removed but not the lymph nodes under the arm or muscle tissue from beneath the breast.
• Modified radical mastectomy: This operation involves removing the entire breast and some of the lymph nodes under the arm.
• Radical mastectomy: This is extensive removal of entire breast, lymph nodes, and the chest wall muscles under the breast. This surgery is rarely done now because of disfigurement and fewer side effects.
How is breast reconstruction done?
There are various re-constructive plastic surgery procedures that can reconstruct the breast mound. The surgery involves utilisation of your muscle on the back or abdomen to reconstruct a breast. Breast reconstruction can also be done by implantation of’ silicon prosthesis’.
What is an external breast prosthesis?
It is possible to have artificial breast (prosthesis). These prostheses can either be worn externally or a special type of prosthesis can be surgically implanted beneath the skin so as to give the mound
What are the complementary therapies which can help in the healing process?
1) Relaxation exercise
3) Psychological counselling
4) Support of family and colleagues
Is breast size a risk factor for breast cancer?
It is proved that greater the breast tissue, greater is the area for the cancer to develop and higher risk for development of breast cancer. It is always seen that most cancers develop at outer rim of the breast due to more tissue mass.
Is the risk of having breast cancer present if either parent’s side have it?
If anyone from the paternal side has breast cancer, there is no chance of developing breast cancer. The risk doubles if a first degree relative (mother > or sister) suffers from it. If more than two first degree members suffer, the risk increases to 50 times.
Do birth control pills cause Breast cancers?
• 30-40 % risk is seen in girls under the age of 18 who regularly use this method of contraception
• HRT used by post -menopausal women increases the risk (63%) of development of breast cancer.
• Does wearing an under-wired bra increase the risk of getting breast cancer?
• It does not cause breast cancer but women who wear ill-fitting bras may get fat necrosis not cancer.
How is Breast cancer prevented?
Breast cancer can be prevented by the following measures:
1) Having your first child between 20 -25 years and second before 28 years
2) Do breastfeeding for a year and maintain healthy diet and weight
3) Abstain from alcohol
4) Regular self- examination of the breast for lumps.
5) If there is a positive family history of breast cancer, after 30 years, regular mammography should be conducted
Does getting annual mammogram increase the risk of cancer?
It does expose the patient to radiation but in a very negligible amount. It is advisable to get routine physical check- ups after the age of 50 years, once in two years for prevention.
Do only women get breast cancers?
No men get it too. Data has shown that for every 100 women diagnosed with breast cancer, one male is diagnosed too.
What is the latest development in Breast cancer treatment?
1) Some drugs which cancer patients used to take are being developed for taking by women who have breast cancer for prevention of breast cancer.
2) Oncoplasty is a procedure which is being developed for reconstructing the breast after mastectomy using woman’s own healthy breast tissue
3) Trastuzumab is a drug under pipeline for reducing the risk of recurrence
Hernia surgery in bangalore, Hernia surgeon in bangalore
Hernia is protrusions of the viscous trough a normal gap or gap that is created abnormally due to stretching or congenital absence of the coverings. Body muscles are thrown like a cloth in different directions. Tissues are held in particular position. Shin and subcutaneous tissue is like a cloth that completely covers the body. There are normally some orifices in the body that are created for tissues to be placed in particular pattern. These orifices can stretch and open up for contents to come out beneath the skin through the sac.
Repair of hernia is only by surgical correction. In simple words it is like body cloth is torn and we repair it. Repair is done with mesh reinforcement. Noway days it is even more easier with Laparoscopy from patients point of view. Mesh is placed by Laproscopic procedure which reinforces of gap that is farmed. Contents and sac are pulled back to normal position.
cancer awareness and prevention with lifestyle
Human Biology is far more complicated than we imagine. Cells in our body are supposed to function and grow in a particular manner. In the process they are likely to become abnormal. Cancer is unrestricted growth of as abnormal cell. Cells get into abnormal cycle in two stages(medically 'two hit theory'). One abnormal cell formation where in there is a genetic change in the cell (called mutation). These cancer cells have changes in the gene. These changes are related in 10 to 15% with inherent genetic abnormality , and 80 to 85% with environmental mainly lifestyle related risk factors.With mutation there is initiation processes. At any given point of time it is scary to think that there are many initiated cells in the body. In the presence of good body immunity these cells are either killed or made to remain in static phase. In the absence good immunity or presence high risk factors ( poor lifestyle) these cells get into promotion phase to get into cancer cycle. Once these cells grow excessively they start spreading through blood vessels and lymphatics.
It sounds bizarre, but lifestyle could be secret weapon against cancer. We humans have capacity to control our lifestyle for better, than any other living beings. There is a need to restrict environmental influence on us with knowledge. We need give space and time to maintain our body and mind. We need to be focused about maintaining our own body like how we take care of anything we are passionate about. It is easy to get addicted to bad lifestyle. But if we make good lifestyle a part of our routine the body gets good of everything we do. The lifestyle related factors include cigarette smoking, diet ( fried foods and red meat), alcohol , sun exposure, infections, stress, obesity, environmental pollutants, and physical activity. Therefore Cancer prevention requires smoking cessation , increased ingestion of fruits and vegetables, moderate use of alcohol, calorie restriction, exercise, minimal meat consumption, use of whole grains, use of vaccination, and regular check ups. By choosing the healthiest lifestyle options possible, you can empower yourself and make sure your cancer risk is as low as possible.
What are the potential complications of an abdominal hernia? - Dr. Nanda Rajaneesh
What is mastalgia and how is it treated? - Dr. Nanda Rajaneesh
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