Breast Cancer

Breast Cancer

Acıbadem Breast Cancer Center has been providing service for 30 years to breast cancer patients. It is the first and only high education board-certified institute breast cancer in Turkey.  It is called Acıbadem Senology Research Institute. There are more than 30 doctors and specialists from other departments such as general surgery, radiology, pathology and genetics, medical oncology, radiation oncology, cosmetic surgery and plastic surgery where multidisciplinary approach is adopted for all patients.

Symptoms

Breast cancer can cause several changes to skin around the breast such as, swelling, redness, nipple retraction or inversion, breast or nipple pain, lymph node changes, dimpling, nipple discharge, changes to the skin’s texture. According to Prof. Cihan Uras who is the director of Acıbadem Senology Institute; “Women should be aware of the status of their breasts. If they check their breast per month, she can be aware of the changes which may occur at the beginning of cancer. Anyone who notices any of these changes should immediately see a doctor.

Causes

Lifetime risk of a woman for developing breast cancer is about 12%. The main risks are age and having breast cancer in your family. Up to 10% of breast cancer cases are caused by inherited gene mutations.  Nowadays, the risk of developing breast cancer for patients with family predisposition can be analyzed where preventive measures can be taken. Gaining weight increases the risk of breast cancer, especially in menopausal women. Consumption of alcohol also increases the risk, while effects of smoking is still a question mark. Meanwhile regular exercise and physical activities decreases the risk of breast cancer. The precise causes of breast cancer are still unclear. One of the missions of Acıbadem Senology Institute is to explore the causes of breast cancer.

How Is Breast Cancer Diagnosed?

Among the services available for diagnosis of breast cancer at Acıbadem are clinical examination of breast, 3D tomosynthesis digital mammography and 4D ultrasound and biopsy. Breast cancer screening programs are developed by educating patients on self-examination of breast.

Moreover, women who are at high risk of breast cancer are followed up regularly along with personalized counseling. Here, it is aimed to ensure early diagnosis for women who are at risk in order to minimize future risks.

Treatments for Breast Cancer

Doctors can apply to multiple treatment options according to stage and type of breast cancer. Surgery is inevitable for the treatment of breast cancer, but it is not always the first step. In some cases, patient needs radiotherapy before surgery while in some cases, chemotherapy can be applied before the surgery.

Briefly, every patient and every tumor has a different background, and it requires individualized approach and treatment.

Breast-protective surgery

Breast cancer is vital for patients due to systemic recurrence, or in other words spread (metastasis). In this context, removing tissue with a tumor by protective surgery is preferred instead of removing whole breast. Tumor tissue is excised with about 1-2 cm normal breast tissue around the tumor in breast protective surgery (large excision, tumorectomy, lumpectomy).

Other techniques based on larger excisions of that region in the breast are called “quadrantectomy” or “partial mastectomy”. As for lumps being thought as malign and marked by wire through mammography or ultrasound are filmed after excision by wire guided or ROLL (Radionuclide-Guided Occult Lesion Localisation) techniques.

In Acıbadem Breast Cancer Center, we always try to choose the breast protective surgery.

Total Mastectomy

Mastectomy is a method applied in situations that breast protective surgery is not suitable. In some cases, it is required to remove the entire breast in surgical treatment for breast cancer. It becomes necessary to remove all of the breast tissue when the tumor inside the breast is multicentric, which means that it is present in multiple points at different locations. Such cases require removal of the entire breast tissue even if the cancer is not in an advanced stage. It is also necessary for the entire breast tissue to be removed in breast cancer types which manifest themselves in extensive calcification within the breast, referred to as microcalcification and detected during mammograms.

Robot-assisted breast cancer surgery

The surgery is performed far more precisely, as the robot magnifies the surgical site by 12 times. Thus, the risk of tumor formation is also substantially reduced Robot-assisted surgery is performed with a single tube, called “port,” similar to those used in laparoscopic surgery. On the other hand, two high-definition fiber optic cameras transmit the magnified (min. 12x) three-dimensional image of the surgical site to the console. Thus, the surgical site can be clearly visualized in details. Furthermore, the robotic instruments which can rotate by 540 degrees on its own axis can reach anywhere that is so difficult to manipulate. As a result, it provides physicians with more flexibility compared to open surgery.

Radiotherapy

During surgical treatment of breast cancer, doctors can apply a single dose of radiotherapy on some patients while the incision is still not closed. This requires for the patient to conform to certain criteria. It is necessary for the patients to be over 50 and for their tumors to have a biological structure which does not require chemotherapy. Patient who meets these criteria need to receive radiotherapy for post-operative period. A single application of radiotherapy on the open tissues saves them from a longer period of radiotherapy.

Acıbadem Breast Cancer Center uses a special robotic device which involves a lead plate that is placed over the target region on the chest wall during radiotherapy. The device focuses and locks on the target, allowing only for the targeted tissue to receive radiation. This protects the rest of the body and organs from the effects of radiotherapy. The procedure both protects the healthy body parts of the patient and ensures for the patient to complete the treatment with a shorter time.

Chemotherapy

In Acıbadem Breast Cancer Center, we especially try to avoid starting treatment with surgery in tumors of stage 2 and above. In such advanced cases, taking samples from the tumor, analyze the biological structure of it, discuss the case in tumor board and come with a treatment plan.

One of the advantages of starting with medical treatment, which is chemotherapy, is the possibility that the nature of the surgical procedure to be applied can change for the better. For instance, surgery on a patient with locally advanced breast cancer which also involves the axilla area requires  to remove all lymphatic glands. However, chemotherapy can eliminate cancer from the said glands and revert them to their condition in the early stages of the disease. This allows doctors to try the early-stage method of removing a gland sample for analysis.

If it turns out that cancerous cells are entirely eliminated from the sample, then all lymphatic glands are not removed. This completely eliminates the risk of developing lymphedema in later stages of life for the patient. This is one of the most important innovations of the recent years.

Another benefit of starting with medical treatment is being able to see the effectiveness of the applied drug. When the tumors are removed at the very beginning in patients who are bound to receive chemotherapy in any case, it becomes impossible to understand the effectiveness of chemotherapy.  Otherwise, it is easily possible to judge whether the chemotherapy has any effect and this is helpful because it may still be necessary to resume chemotherapy after the surgery, depending on the results of the post-operative pathological analysis.

In short, starting with medical treatment entails many advantages for the benefit, particularly in cases of advanced stage cancer. Therefore, the first choice in some cases can be medical treatment instead of surgical treatment.

Breast Reconstruction

Breast restoration is performed to restore the natural form of the breast after cancer. In this context breast restoration is not a cosmetic surgery but a restoration (reconstruction), in other words, it should be seen as replacement of a lost limb due to disease. Through new improvements in medical science, surgeons can now generate a lifelike breast. Plastic and reconstructive surgery specialists are also found in the treatment team of breast cancer. These specialists perform operations to transform the breast naturally if required.

“It is possible for us to reconstruct the breast tissue in cases where we remove the entire breast. This is what we prefer in any case. Rather than delayed breast reconstruction, we prefer to perform the procedure at the same time as the removal of the breast,” states Prof. Cihan Uras.

Medical Technologies

Acıbadem Senology Institute has state of the art health technology. The senology institute is one of the rare centers in the whole world which have all health technologies on breast cancer treatment and diagnosis.

Life After Breast Cancer Treatment

Patients should be followed up through detailed health assessments in first 3 years after treatment of breast cancer. Breast cancer relapses locally – at the surgical site- by 30 percent and in distant organs by 70 percent. Recurrence generally occurs within the first 3 years. Therefore, it is necessary to follow up patients very closely especially in the first three years. Follow-up visits are generally scheduled as follows: At 3-month intervals in the first three years, semi-annually in subsequent two years and annually beyond five years.


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