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Care n CureBreast Cancer: Causes, Symptoms and Treatment

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Early detections helps in treatmentBreast cancer originates from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas.Prognosis and survival rate varies greatly, depending on the type or stage of cancer. Computerised models are available to predict the survival rate. With best treatment and early detection, 10-year disease-free survival varies from 98-10 per cent. Treatment includes surgery, drugs (hormonal therapy and chemotherapy), and radiation.Worldwide, breast cancer comprises 10.4 per cent of all cancer incidence among women, making it the most common type of non-skin cancer in women, and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide. Breast cancer is about 100 times more common in women than in men, although males tend to have poorer outcomes due to delays in diagnosis.Some breast cancers are sensitive to hormones such as progesterone or oestrogen, which makes it possible to treat them by blocking the effects of these hormones in the target tissues. These have better prognosis and require less aggressive treatment than hormone-negative cancers.Breast cancers without hormone receptors, or cancers which have spread to the lymph nodes in the armpits, or which express certain genetic characteristics, are at higher risk and are therefore treated more aggressively.

Watch out for breast cancer!

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Cause of Concern for Women

Breast Cancer is the most common type of cancer among women

By Dr. Avril StauntonSr. Consultant Obstetrician & GynaecologistRAK Hospital

The most common forms of BREAST CANCER are found in North America, Europe, Latin America and Australia. Over the past few decades, the incidence of breast cancer has been increasing by about 1-2 per cent every year.

Prevalence: It is the most common cancer in women.•30 per cent of cancer in women occurs in the •breast.41,000 diagnosed with breast cancer every year.•13,000 die of breast cancer every year.•80 per cent of post-menopausal women are •affected by it.Nine out of 10 lumps are not-cancerous.•90 per cent of cancers are ‘self-detected’.•One per cent of breast cancer is also found in •men.

The chances of contracting breast cancer increases with age, with a rapid increase in the fifth decade (55 per cent of those diagnosed with breast cancer are over 55 years of age). In western countries, this is the most frequent cause of death for those between 40-50 years.Nobody knows for certain why some women develop breast cancer and others do not.

Common Causes are genetic, hormonal, dietary and environmental. If your mother, sister, or daughter has developed breast cancer before menopause, you are three times more likely to develop the disease. If two or more close have/had breast cancer, you are at increased risk as well. Recently, scientists have found that mutations in genes BRCA1 and BRCA2 increase one’s susceptibility to breast cancer. If you’ve had breast cancer, even if benign, you have an increased risk of getting it again. Early menstruation and taking birth control pills may increase the chances of getting breast cancer.

Additional Risk Factors include childlessness; child-bearing at a late age (30+), most common among western women; menopause at 55 or older; higher oestrogen levels; and use of Hormone Replacement Therapy (HRT).

Lifestyle: Several studies found a lower incidence of breast cancer among women who exercise regularly, higher proportion of breast cancer among obese women, and increased risk with increased alcohol use.

Hormonal factors:Clear relation to sex hormones.•Literature strongly supports oestrogen as a prime •factor.Early menarche and late menopause.•Shorter times between menstrual periods.•Long-term use of oral contraceptives.•Protective effect of full-term pregnancy over 30 •years

Pathology: Cell-division takes place from 85 days to 15 months, and it takes several years before detection.

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Breast Self-Exam: It is easy to do a BSE and the more you do it, the better you will get at it. When you get to know how your breasts normally feel, you will quickly be able to feel any change, and early detection is the key to successful treatment. A breast self-exam could save your breast -- and your life. Most breast lumps are found by women themselves, but in fact, most lumps in the breast are not cancer. The best time to do a BSE is right after your period, when breasts are not tender or swollen. If you do not have regular periods or sometimes skip a month, do it on the same day every month.Remember, you are looking for changes, so you need to collect a month or two of data before you really understand what change looks or feels like. You must also realise that nine out of every 10 breast lumps found, are not cancerous. In addition to the size, shape, lumps and symmetry between both the breasts, the other signs you can look out for are: sores or oily skin, skin discolouration or dimpling, discharge from or puckering of the nipple.

Here’s what you might find during your BSE:Tender, lumpy breastsThis is usually part of your regular menstrual cycle due to swelling because you retain more water.Overall small lumps and a bumpy/grainy textureIf this texture is found on both breasts in the area around your nipples and the upper and outer parts of your breasts, you might only have fibrocystic breasts. Single lump that feels like an oval and is hard on the outside, squishy on the inside.This may be a cyst. You can usually move a cyst under the skin and they sometimes produce a dull pain. A cyst is a fluid-filled sac that can vary in size from a pea to a half-dollar. Cysts appear most often in women aged 35 to 50 and increase as menopause approaches. They are benign.Single, solid lump that feels round like a small rubber ball and can be moved.This may be a fibroedenoma, A benign and painless tumour made up of connective tissue and other cells. A fibroedenoma may vary in size from a marble to a lemon. They are more common in women in their late teens and early 20s or older women on Hormone Replacement Therapy.Single, solid lump that cannot be moved.Look for hard, irregular borders to the lump. Also, determine if the lump appears in only one breast and if it remains the same size throughout your menstrual cycle. Note that thickened or dimpled skin is a sign of a lump that cannot be moved (other benign lumps are movable because they are filled with fluid or lumps of fat).

If all of the above occur, these are symptoms of breast cancer. Get it checked immediately.

If you find that you exhibit any characteristics that are abnormal or concern you (aside from normal menstrual lumpiness or water retention), don’t wait. Go see your physician immediately for a clinical breast exam and other tests. While some of the abnormalities mentioned are usually benign, nothing is 100 per cent and it’s good to keep your doctor in the loop.

Treatment:For younger women (under 35 years), it is Ultrasound, as more fibrous tissue makes mammogram difficult to interpret.Above 35 years, it is Mammogram.The breast can be imaged with mammography, ultrasound or MRI.Mammography is the most sensitive of breast imaging modalities.Sensitivity is reduced in young women due to the presence of increased glandular and fibrous tissue.For symptomatic patients, imaging must always be performed as part of triple assessment.

Surgical Options for treatment include Lumpectomy, Subcutaneous Mastectomy, Simple Mastectomy + Reconstruction, Radical Mastectomy + Reconstruction, Combination with Radiation Therapy, Combination with Medication, Chemotherapy, and Hormonal Therapy.

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Al Qusaidat, P.O. Box 11393, Ras Al Khaimah, UAETel.: 07 2074444 | Fax 07 2074455

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RAK Hospital performed a colon resection for a 65-year-old German woman RAK Hospital joins an elite group of healthcare facilities globally to provide an advanced method of laparoscopic surgeries -- the single port surgery. In a case performed recently at the hospital, the surgeons performed a colon resection for 65-year-old German national Elizabeth Dagmar Boerngen. A UAE resident for the past three years, she had visited several doctors in her home country for a recurrent attack of abdominal pain on the right side -- right iliac fossa, as is known in medical parlance. She was unable to find a correct diagnosis and had practically given up hope of finding a solution.

She eventually visited the urologist at RAK Hospital who internally referred her to the gastroenterology department. She was diagnosed with colonic block and was referred to Dr Anup Panigrahi, HoD, Minimal Access Surgery, for further action. Dr Anup performed a colonic resection in which he excised a minimal piece of her colon and fixed the remainder to the lateral wall, all through the single port technique. Elizabeth is now smiling and back home.

COMPETITION

COMPETITION

Single port surgery performed

Tie-up with India’s top heart institute

RAK Hospital opens paediatric cardiac unit in association with FEHIRAK Hospital is all set to open Middle East’s first fully-functional dedicated paediatric interventional cardiac unit in association with the globally respected Fortis Escorts Heart Institute (FEHI). The hospital is set to extend its portfolio of cardiac care services by adding an array of cardiac surgeries as well as setting up the paediatric unit following this association. A formal MoU (Memorandum of Understanding) signed between the two entities signalled the official entry of the Indian giant, into the region. The signing took place at a ceremony which was formally inaugurated by HH Sheikh Saud bin Saqr Al Qasimi, Ruler of Ras Al Khaimah and Member of the Supreme Council.

Speaking at the function, Sheikh Saud said: “We are honoured to have this partnership between RAK Hospital and a renowned institution like Fortis Escorts Heart Institute as we focus on enhancing the healthcare provision capabilities of the emirate and make it a destination for quality healthcare in the region.”

As part of the opening day agenda, a continued medical education programme was organised with Dr Ashok Seth, chairman, Cardiac Sciences & chief cardiologist at FEHI. He took participants through an understanding of drug-eluting stents and their benefits. In attendance were top cardiologists and medical practitioners of the region.

HH Sheikh Saud with Dr Ashok Seth, Dr JM Gauer and Raza Siddiqui

Elizabeth Dagmar Boerngen