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How to Treat Breast Cancer?

Surgical Treatment

Surgical treatment It is the main treatment for patients with early-stage breast cancer. This is useful in controlling the disease and the biopsy taken from surgery can be examined for pathology. to know the true stage of the disease.

It is the main treatment for patients with early-stage breast cancer. This is useful in controlling the disease and the biopsy taken from surgery can be examined for pathology. to know the true stage of the disease It helps to plan the right treatment and make the prognosis more accurate. The surgical procedure for breast cancer is divided into two parts: breast surgery and armpit lymph node surgery. There are also additions that are not direct treatment, such as breast reconstruction. to increase the quality of life for patients.

1. Breast surgery can be divided into two methods:

• Total or Simple mastectomy is surgical removal of the entire breast ( including the skin above the tumor and the nipple ) . But now doctors choose to use with patients with large tumors. have multiple cancerous lumps small breast high chance of recurrence or patients who are inconvenient or have contraindications to radiation to the breast after surgery
• Partial mastectomy or breast-conserving surgery is the removal of the cancerous mass and surrounding normal breast tissue. By cutting about 1 – 2 cm from the edge of the tumor, most of the nipples, the base of the nipples and most of the breast tissue are left behind. Most often used in cases where the cancer is small. There is only one cancer and/or breasts are fairly large After surgery, the patient can still maintain the shape of the breast well. All patients must always be accompanied by radiation to the breast. A partial mastectomy is as effective as a full mastectomy. And the shape of the breast is still beautiful, close to the original

2. Armpit lymph node surgery can be divided into 2 methods:

• Axillary dissection is a standard mastectomy to remove lymph nodes in the armpit that may have spread cancer . making it useful in both disease control Know the true stage of the disease and used in treatment planning, all of which are beneficial for the treatment of disease. On the other hand, such surgery May cause complications such as numbness in the inner upper arm. There is a nerve injury that has caused some muscles to work impaired. Or in the long term, there may be swelling of the arm and the shoulder joint. The likelihood of complications increases if radiation therapy ( radiotherapy ) is also required. Therefore, this group of patients need to take special care of the surgical side, such as avoiding heavy lifting, repetitive use. Injury or infection of the same arm to reduce the likelihood of arm swelling. At present, complete axillary lymph node removal is performed in patients who have palpated abnormal lymph nodes in the armpit before starting treatment. Because these patients have a 70% chance of having cancer spread to the lymph nodes, and in patients who have been diagnosed with metastases to the sentinel lymph nodes.
• Sentinel Lymphnode Biopsy is the most widely accepted method of surgical removal of the armpit lymph nodes today. It is suitable for patients with a low chance of cancer spreading to the armpit lymph nodes. For example, patients with palpation did not find enlarged lymph nodes in the armpits. Patients in the early stages and the tumors are small. These patients were less than 30% more likely to have cancer spread to the lymph nodes. This was the first lymph node where the cancer had spread. and the lymph nodes are taken for examination to confirm whether the cancer has spread or not If no cancer has spread to the lymph nodes No other lymph node surgery is required. This reduces the chance of swollen arms (lymphedema) , but if the cancer has spread to the sentinel lymph nodes, the patient will be treated by removing all the axillary lymph nodes.(Axillary dissection)

Sentinel lymph node surgery is now the standard treatment. For patients with early stage breast cancer This is to reduce the chance of complications. that may be caused by the removal of all the axillary lymph nodes (axillary dissection) without any negative effects towards breast cancer treatment.

Determining which surgery to choose depends on the stage of the cancer and the size of the tumor. the patient’s physical condition The expertise of the surgeon often allows the patient to choose more than one surgical procedure. Therefore, the surgeon will recommend each surgery. to allow patients to choose the most suitable surgical procedure for themselves

Currently, because breast cancer treatment is clearly better than in the past. As a result, the patient has a longer life. There is a lower chance of recurrence, especially in early-stage cancers. Therefore, in addition to curing life and curing the disease. Breast preservation or breast shape retention.

More important because it helps build confidence Reduce the feeling of loss which will improve the quality of life for patients after surgery. As a result, new surgical methods were born. that helps rebuild the breast or replace the missing part (Breast reconstruction) without negative effects on the overall treatment of breast cancer

3. Breast reconstruction

Breast reconstruction is surgery to remove tissue in another area of ​​the body or use a material that mimics the breast. come to augment or rebuild the breast help patients feel confident To return to work and live a normal life. Breast reconstruction surgery can be performed simultaneously with Immediate reconstruction or after delayed reconstruction.

• Transverse rectus abdominis myocutaneous flap or TRAM flap is used to replace the entire breast that has been removed. The doctor will take the skin, fat tissue and abdominal muscles to replace the original breast that has been removed. This surgery takes longer than a mastectomy alone. The surgery will take approximately 3 to 5 hours. The patient may need to stay in the hospital for about a week . The patient will have a surgical incision on the abdomen that can be hidden in the bikini line after the surgery. do surgery The patient may have decreased abdominal wall strength. But it doesn’t have much effect on daily life. One of the advantages of this surgery is to bring tissue from the abdomen to be augmented in place of the original breast. This helps to reduce excess fat tissue around the abdomen, making the abdomen flatter. and the results of the surgery can last for a long time.
• Latissimus dorsi myocutaneous flap or LD flap is most commonly performed in conjunction with a partial mastectomy. Especially in cases where breast tissue has lost too much to maintain its beauty without other tissues to replace it. A surgeon can use tissue around the scapula to reconstruct part or all of the breast, or a prosthesis may be used to increase the size of the breast. In this surgery, the patient has an incision on the back that can be hidden in the bra line. Some operations may have some effect on the muscles that help move the shoulder blades.
• Prosthesis to replace part or all of the breast. Artificial breasts come in many shapes. Many sizes and various materials are used. The advantage is that the patient does not have any surgical wounds. more than usual But there may be limitations in some patients with breast characteristics. It is not suitable to use breast implants. In addition, if the patient needs Must receive radiation (radiation therapy) together with a chance to occur. complications such as Constriction of tissues around the breast implant, which can cause the breast to be deformed. However, breast augmentation surgery may require cosmetic surgery later. such as breast implant replacement or fascia removal
• Fat grafting lipofilling is often used to correct breast deformities caused by partial mastectomy. By taking fat tissue from suction or cutting other parts of the body, such as The abdomen or thigh will be prepared for injection or inserted into the desired area.
• Nipple areolar reconstruction: In cases where the entire breast is required to be removed, a nipple and nipple reconstruction is performed using nearby skin along with medical tattooing. This is usually done after breast augmentation surgery.

In general, breast augmentation surgery uses various methods. The above will not cause any harm. towards breast cancer treatment But it is necessary to select the patient accordingly. depending on the stage of the disease, the size, and the location of the cancer The general condition includes the patient’s readiness for surgery and general anesthesia. The surgeon needs to provide information on the feasibility of different methods. to patients as appropriate on a case by case basis

Conventional breast cancer surgery is usually performed under general anesthesia and takes approximately 1.5 to 2 hours, except in cases where breast reconstruction is performed, it takes longer.

depending on the method of surgery After the surgery, the surgeon will sew the skin together to make it as close as before. Using melted threads and sutures hidden under the wound for a beautiful look. This eliminates the need for thread cutting after surgery. In addition, after surgery, the patient must wear a tight fitting shirt specially designed for breast surgery and to cover the wound tightly. To make the skin firmly attached to the chest to prevent a lot of blood and lymph after surgery. and reduce the pain caused by breathing and moving

In addition, 1-2 small plastic tubes will be inserted to drain blood and lymph from the wound. This plastic tube will be removed around the 2nd day after surgery, or when the blood and lymph flow is minimal, the patient will usually stay in the hospital for a few days and return to recuperate at home . In about a week, a doctor will schedule a return visit. to open all the bandages. If the wound is completely healed The treating physician will advise the patient to bathe normally. Some people may have lymphatic retention under the surgical wound, which the doctor will use a needle to suck out from time to time and this is not considered dangerous or complication at all.

Chemotherapy 

Chemotherapy is a drug that has the ability to destroy or inhibit the growth of cancer cells. Such drugs can work throughout the body. It is different from surgery which is effective only at the surgery area. Therefore, if you are treated in this way, you will have a greater chance of being healed and living longer. Chemotherapy, in addition to destroying cancer cells. It may also affect normal cells of the body that are dividing rapidly, such as the bone marrow (which produces blood cells and platelets), the lining of the gastrointestinal tract, hair and feathers, and the reproductive system. (ovaries) Some of these cells are destroyed as well. which will cause side effects But because normal cells have the ability to create new cells to replace them, the side effects are usually temporary. when the treatment is completed Everything will be back close to normal.

At present, it is popular to administer several types of chemotherapy drugs together because they provide better results than a single drug. Patients will also be given medications that will reduce the side effects to relieve the symptoms. Doctors often schedule patients to come to chemotherapy without staying in the hospital. In other words, they can come in the morning and go home in the evening. In addition, dosing is usually spaced from one to three or four weeks, depending on the prescription of the medication your doctor chooses. so that the patient’s body is rested and ready to receive the next dose The duration of conventional chemotherapy takes about 3 to 6 months, in some cases longer, such as a year. depending on the treating physician Patients receiving chemotherapy are able to go about their daily activities, go to work, live with family and socialize.

All chemotherapy drugs can cause side effects. in patients receiving these drugs Some people may not have any symptoms at all. Some people may have mild symptoms and others may be quite severe. which will vary depending on the patient’s response to medication, the size and type of medication used But it’s important to keep in mind that most side effects usually only occur on the day of the medication or only a few days later, and then gradually disappear without any treatment.

Some medications that the patient is currently taking may affect chemotherapy. Therefore, it is imperative that you tell your doctor or nurse about your original medication.

Most chemotherapy drugs cause nausea and vomiting. Patients should take the medication prescribed by their doctor to reduce the symptoms. And should eat foods that are easy to digest, eating small meals at a time. but eat more often If symptoms do not improve, consult a doctor.

certain chemotherapy drugs It can cause dry mouth and throat or mouth sores. have pain Therefore, patients should drink plenty of water. to prevent symptoms, but if there is a wound It is best to eat liquid foods such as porridge, porridge, certain fruits, and ice cream to make it easier to swallow.

Chemotherapy drugs can affect bone marrow function. Which serves to make white blood cells, red blood cells and platelets White blood cells play an important role in the body’s defense against infection. Therefore, if the white blood cell count is lower, the patient is at greater risk of infection.

Chemotherapy may cause hair and hair loss. But these symptoms are temporary. when the treatment is over Hair and hair will grow back, so you shouldn’t worry too much about these things.

in patients who are still menstruating Chemotherapy may cause irregular menstrual periods. Or in some cases, there may be no menstruation at all. There may also be symptoms similar to People who are approaching menopause, such as hot flashes, but keep in mind that you still have a very small chance of getting pregnant and that chemotherapy can harm the unborn baby. Therefore, during the period of receiving chemotherapy drugs should have to have contraception You may consult a doctor about how to control it. Patients with breast cancer should not be contraindicated by taking birth control pills or injecting contraceptives. Because those pills contain sex hormones as a component. Makes the risk of stimulating cancer cells to grow again.

in young patients Menstrual periods usually return to normal after treatment is over. six months or longer These patients also have a chance of conceiving a new pregnancy. And the children who are born usually do not have any abnormalities. However, patients should be on birth control for at least 2 years to ensure that the cancer is less likely to recur. For patients who are close to menopause In some cases, after stopping the medication, the period may not come again. Enter menopause. In addition, chemotherapy has no direct effect on the patient’s sexual performance. Patients after receiving complete chemotherapy able to have sex as usual

Radiation therapy 

is the use of a special device that emits high-energy radiation particles to stop the growth and division of cancer cells. This radiation destroys both cancerous cells and normal cells that are dividing rapidly. But because cancer cells are cells that divide very quickly. Therefore, it will be destroyed more and moreover, normal cells have the ability to create new cells to replace the damaged cells. thus making tissues and organs It retains its shape and works normally.

in breast cancer treatment Radiation is often used in combination with surgery in all patients with breast conserving surgery . The breast is completely removed (total mastectomy) , but also requires radiation therapy, for example, in patients whose tumor size is greater than 5 cm . The cancer has invaded the deep skin or chest muscles or has spread. to a large number of armpit lymph nodes, etc.

Generally, treatment takes about 4 weeks, 5 days a week, from Monday to Friday. Saturday and Sunday off To allow the body and skin to have time to rest and repair the damaged tissues. Once the treatment has begun, it should be continued until the due date, otherwise the amount of radiation is less than it should be. The results of the treatment were not as good as expected. Each day’s exposure lasts only a few minutes. And during the light, he felt no pain at all.

For the treatment of breast cancer It is often a shallow projection. The radiation does not reach the vital organs. deep Therefore, severe side effects are rarely encountered.

During radiation, some patients may feel tired and exhausted. Therefore, you should rest as much as possible and plan exercises, but sometimes the skin in the area exposed to radiation may change, such as redness, darkening, itching, or a burning sensation. Therefore, while you are irradiating, you should treat the skin in that area carefully. If you are unsure, do not expose it to water. But if it gets wet, you should use a soft towel to gently blot it, not wiping it vigorously. will cause the skin to peel off and become a wound, try not to let anything interfere with the skin,Do not use soaps, cosmetics, perfumes. All kinds of ointments and all kinds of heat Do not expose it to sunlight or very cold weather. If necessary, the area must be shaved. It must be shaved with special care. The safest way is to use an electric shaver. If itching, try not to scratch, as scratching can cause chafing and infection. And should always be careful to keep the skin dry.

Armpit irradiation can cause shoulder stiffness and arm swelling. Therefore, during the irradiation You should be exercising regularly. and must act to prevent arm swelling Due to the current development in the field of light projection has progressed a lot. both in terms of equipment and expertise of radiologists The effect of radiation therapy is therefore much better than in the past. Therefore, patients should change their attitude towards radiation therapy. can be treated with good results and there were few complications from treatment. In addition, patients can perform tasks like normal people in all respects.

Therefore, if the treating doctor has recommended that you treat by radiation therapy, you should follow. in order to get the best results of treatment

Hormonal Therapy

We have long known that breast growth and breast function depend on sex hormones. It was later found that the growth of some breast cancers was also hormone-dependent. Depending on the results of a special examination by a pathologist to determine whether your cancer is a hormone receptor type, if it is positive, it can be a clue as to whether anti-hormone therapy is appropriate. According to statistics from Thailand, approximately two-thirds of cases of breast cancer are found. will have a response to the use of anti-hormonal drugs making it possible to use this group of drugs in the treatment When the doctor determines that you deserve this treatment.

The doctor will need to see how old you are and if you still have your period. How long have you been out of menstruation? or no menstruation from hysterectomy? This is because the medications used for treatment may differ.

Antihormonal drugs can be divided into two main groups: those that act by inhibiting the action of hormones. and drugs that act by inhibiting hormone production

Drugs that act by inhibiting the action of hormones. Known as tamoxifen, it can be used in both menstruating and menopause women. It can cause vaginal bleeding, so doctors usually recommend that patients have a yearly internal examination. It should also not be used in people with a history of blood clots in the legs or the brain, as the risk of these conditions increases when patients are given the drug.

Drugs that act by inhibiting hormone production. These drugs can only be used in women who have gone through menopause. May affect bones and muscles Therefore, before treatment, your doctor will usually recommend a bone mass examination to assess for osteoporosis and may prescribe medication to strengthen the bones as appropriate.

The administration of antihormonal drugs is quite convenient because they are administered orally. In general, patients receive the drug for 5 to 10 years, and side effects are rare. and most of them are not severe. If the patient has abnormal symptoms after receiving such drugs. You should consult your doctor for advice.

Treatment with specific active drugs (Targeted Therapy)

drugs in this group are classified as new drugs, such as antiherotomy drugs. Which has a different mechanism of action than traditional drugs, that is, breast cancer cells in some patients have hertore receptors on the cell surface. This makes it possible to use the drug to bind to these receptors and allow the drug to act on the cancer cells. so other cells Without a receptor, it is not affected by this group of drugs. treatment is quite specific. have fewer side effects than chemotherapy But there are restrictions that can only be applied to certain patients. In addition, the drug is very expensive. As a result, the use of this drug is not very widespread and should consult a doctor about using it.