Breast cancer treatment options may include surgery to remove cancerous cells, chemotherapy and radiation, all or any combination of the three. My treatment plan follows all three, and I started on with breast cancer surgery. It is important to note that the treatment of breast cancer must be individualized as there is no one size fits all. It is important to consult widely and consider all the factors in play and what treatment works best for the individual.
Treatment options are based on what stage the disease is, that is stage I, II, II or IV. Updatedate.com defines the stages as follows:
Stage I and II breast cancer is early stage localized breast cancer and refers to a tumor less than 2cm in size that is node negative. Stage II tumours are those with spread to the axillary lymph notes and/or a tumour size larger than 2cm but not larger than 5 cm.
Stage III breast cancers are those that are locally advanced and consist of large breast tumours, greater than 5cm across, have extensive axillary nodal involvement or nodal involvement of the soft tissues above or below the collarbone. A stage III tumour is also designated this stage if it extends to the underlying muscles of the chest wall or the overlying skin. Stage III breast cancer aslo includes inflammatory breast cancer, a rapidly form of cancer that makes the breast appear red and swollen.
Stage IV breast cancer refers to those tumours that have metastasized to areas outside the breast and lymph nodes to the brain, bones, skin, or other organs. The primary tumour may be any size, and there may be any number of affected lymph nodes.
On December 15, 2012, I was officially staged as a Stage III and recommended treatment was surgery, chemotherapy and radiation. Prior to my staging, I underwent the following tests:
Final Needle Aspiration – On November 7, 2012, I underwent a biopsy that removes cells which showed highly cellular aspirate with ductal cells appearing singly or in loose clusters. Diagnosis: Features od ductal carcinoma in situ (DCIS). According to the OSU Comprehensive Cancer Center, DCIS is a non-invasive type of breast cancer that usually does not spread but it is important to surgically remove all traces of the DCIS ti improve local control of the cancer. The FNA is the test that confirmed my breast cancer diagnosis.
Bone Scan – On November 15, 2012, I took a full body bone scan what was essentially negative for skeletal metastasis. That was good news!
CT Scan Chest, Abdomen and Pelvis – In the thyroid gland region, a 5mm nodule was seen in the left thyroid love but the right thyroid lobe is normal. In the breast/chest wall, small masses were seen in the right breast representing the known tumour. My lungs were clear with no suspicious pulmonary nodule or evidence of consolidation or pneumothorax. This was extremely good news especially for someone like me who did smoke a few cigarettes in my lifetime! In my abdomen, my liver size was normal but a small nodule was seen and may need further investigation. My gallbladder, spleen, pancreas, kidneys, stomach/bowel, pelvis/bowel, ureters/bladder, uretus/adnex are all normal. Very good news!
With all those tests under the bag and my doctor confirming that I was operable upfront, I had to make a decision on the type of surgery that would work best for me. My options were either a lumpectomy or a mastectomy.
A lumpectomy or breast conservation is the removal of cancerous tissues and noncancerous tissues from around the edges of the tumours (margin of tumour), and the breast is retained. Normally the breast is still normally rounded but may need reconstructive surgery to give it a normal shape.
A mastectomy refers to the total removal of the breast tissue. There are three types of mastectomy’s; Total Mastectomy- removal of all the breast tissue, the skin and nipple; Modified Radical Mastectomy (MRM)- removal of all the breast tissue, skin, nipple and axillary lymph nodes; and Radical Mastectomy – removal of all breast tissue, skin, nipple and lymph nodes and all or part of the chest wall muscle (a rarely performed procedure).
New Delhi, December 6, 2012 – I visited my breast surgeons Dr Herman Singhal and Dr Kanchan Kaur at the Medanta, The Medicity to discuss my surgery options. The two options they gave me were:
Option A: Modified Radical Mastectomy on my right breast with an immediate reconstruction option where tissue and muscle would be moved from my abdomen to reconstruct the new right breast, and also reduce the left breast so they appear symmetrical. This was to be an intense surgery also involving a plastic and reconstructive surgeon and was scheduled to take at least 8-9 hours.
Option B: A lumpectomy on my right breast and removal of the axillary lymph nodes and breast reduction on my left breast to provide symmetry with the right breast. This surgery was estimated to take 4- 5 hours.
On December 10, 2012, two days before my 37th birthday, I consulted with the closest women in my life, my mum and my sister and we decided on Option B.
My surgery took place on 12/12/12. I will never forget that date in my life. It is the day that marked my Second Chance in Life.