By Tedler D. Depaynos, MD
The patient underwent breast surgery more than 2 decades ago because of breast cancer. During that time the mode of surgical treatment was Radical Mastectomy where the whole breast tissues together with the muscles behind it called Pectoralis Minor and Major muscles were excised. The axilla was then dissected to remove any metastatic lymphnodes. At present, the mode of surgical treatment is called Modified Radical Mastectomy or MRI where the Pectoralis muscles were left behind. The tissues surrounding them are however excised to remove the attached lymphnodes some of them could not be grossly visualized yet. Studies show that both surgical modalities have the same end results so that the less extensive surgery, MRM is presently being done.
She could recall that she did not undergo any radiation or chemo theraphy after surgery. Perhaps her malignancy was diagnosed early. She then emphasized early diagnosis.
Stage 1 and 2 may be curable by surgery alone but to make sure that microscopic cancer cells would be destroyed most surgeons refer patients for radiation and/or chemotherapy especially at Stage 3. The radiation experts as well as the well trained oncologists have their criteria where they based their treatment. At stage 4 where there are obvious nodal and even lungs or liver metastasis, surgery is just for palliation. It is just to make the patient comfortable because the tumor may become huge, foul smelling and even fungating like a cauliflower. Even the chemotherapies given are just palliative and non-curable.
Being a survivor and with a family history of malignancy, she read a lot about breast cancer mostly in the internet. She was very concerned with her daughters because they have a higher chance of developing malignancy. Although the cancer(Ca) usually appear more when one is 50 years old or above, they still could be found in the age group 20 to 40. Males could be affected but it is rare. Those that have early menarche (before 12 years old) and those that have late post menopausal syndrome have a greater chance of developing the malignant lesion. It is believed that estrogen may play a role in the development of this type of malignancy.
If a cancer is detected in one breast one has a 10% chance of having the same in the other breast. When a nodule was discovered later in her other breast, she insisted that it would be removed despite the benign histopathologic results of the biopsy that was done. Besides she argued that it is already a useless organ. She then underwent Simple Mastectomy in her other breast.
She taught her daughters breast self-examination.
The self-examination should preferably be done 8 to 10 days after menstruation because by that time, the swelling of the breasts that accompanies menstruation is expected to have already subsided. It is done with the arms on the side while standing in front of a mirror to see if there is asymmetry, dimpling or even a mass. The arms are then raised over the head and later at the hips pressing it to contract the muscles beneath the breasts (pectoralis) making the breasts protrude outwards, hence emphasizing any abnormality. Each breast is then palpated while lying down by the opposite hand. The other hand is placed over the head and preferably a pillow is placed beneath the breast being examined. The axilla should also be palpated together with the areas above the clavicles called supraclavicular areas. In the palpation, slide the fingers initially over the breast tissues.
In general, a palpable mass that has its margins well delineated just like a marble is benign. A mass that has vague edges is mostly malignant. It could also be adherent to the overlying skin or fixed posteriorly and may cause dimpling or nipple retractions which are positive signs of malignancy. An areolar ulcer or seemingly skin lesion which may be interpreted as allergy may actually be a sign of Paget’s disease which is a type of breast Ca. Edema and redness of the breast which may be accompanied by pain maybe signs of Inflammatory type of breast Ca which in general is very malignant and metastasize early. This is due to lymphedema underneath the breast skin and may be interpreted as a sign of breast infection or mastitis. Again in general, malignant lesions are painless.
Masses or lymphnodes at the axilla and in the supraclavicular areas may be signs of metastasis.
One of her daughters detected a small vague lesion in one of her breast. When a surgeon was consulted, an ultrasound was done which localized the lesion. Actually this is now a routine procedure for most surgeons before any surgery is contemplated. It may show whether the lesion is solid and cystic. In the patient, the nodule appeared cystic and when an excision biopsy was done, they were all with smiles when the histopath result revealed a benign lesion.
It is very important then that early diagnosis is a must and it starts with self-examination to be a survivor.**
