Breast Cancer Care at Vejthani

Breast Cancer Care at Vejthani

When the patient arrives at the Breast Center, breast specialist/breast surgeon will start off with examination then evaluate what kind of investigations patients need. 

The investigations include:

• Mammogram
• Breast ultrasound 

If a mammogram shows suspicious signs, such as a Breast Imaging Reporting and Data System (BI-RADS) score above 3, a biopsy may be recommended. The BI-RADS scoring system is used by radiologists to categorize and communicate mammogram findings. It helps in determining the level of suspicion for breast abnormalities and assists in guiding further evaluation and management.

A BI-RADS score of 3 indicates that the findings are probably benign but still need further evaluation. In this case, a biopsy will help obtain a tissue sample for further examination. It will determine if the suspicious area is indeed cancerous or if it has any other benign condition.

Biopsies for breast abnormalities are performed by breast radiologists using advanced medical equipment such as core needle biopsy and stereotactic biopsy.

Core needle biopsy is a minimally invasive procedure that involves the insertion of a hollow needle into the suspicious area of the breast to extract a small tissue sample. This sample is then sent to a pathologist for examination to determine if there are any cancerous or abnormal cells present.

Stereotactic biopsy is a type of core needle biopsy that uses mammography or other imaging techniques to precisely locate the suspicious area in the breast. It involves taking multiple tissue samples from different angles to ensure accurate sampling.

Our breast radiologists are specialists who have expertise in performing and interpreting breast imaging. They are trained in using imaging guidance techniques, such as stereotactic guidance, to perform precise and targeted biopsies.

If your doctor specializes in stereotactic biopsy, it means they have specific training and experience in performing biopsies using this technique. They will utilize imaging guidance to accurately locate and sample the suspicious area, which can aid in obtaining precise and reliable results.

Our breast radiologist will ensure proper technique, accurate sampling, and minimal discomfort for the patient. Staging is an essential step in cancer diagnosis. It typically occurs after the biopsy and involves assessing various factors to determine the extent and spread of the cancer. Staging helps determine the tumor’s size, whether it has spread to nearby lymph nodes, and if it has metastasized to other parts of the body. This information is crucial for developing an appropriate treatment plan.

Imaging techniques, including CT scans, are commonly used to aid in staging.

Breast Cancer Specialist Team 

• Breast surgeon
• Breast radiologist 
• Body radiologist
• Radiotherapists
• Medical oncologists

Planning Course of Treatment

Surgical treatment options for breast cancer have different approaches depending on the stage and characteristics of the cancer, as well as the patient’s preferences and overall health. Two common surgical options are lumpectomy (also known as breast-conserving surgery) and mastectomy (which can be either radical or modified).

1. Lumpectomy (Breast-Conserving Surgery): This surgical option involves removing the tumor along with a margin of normal surrounding tissue. The goal is to preserve the breast while effectively removing the cancerous cells. Lumpectomy is usually considered for early-stage breast cancer, where the tumor is relatively small and localized.
2. Mastectomy: Mastectomy involves the surgical removal of the entire breast tissue. There are two primary types of mastectomy:
   • Radical Mastectomy: Radical mastectomy is a more extensive procedure where the breast tissue, underlying chest muscles, and lymph nodes in the armpit (axillary lymph nodes) are removed. This procedure is less common today and is usually reserved for advanced cases or specific situations where the tumor has spread extensively.
   • Modified Radical Mastectomy: This is the most common type of mastectomy performed today. It involves removing the breast tissue, including the nipple and areola, as well as some lymph nodes in the axillary region. The chest muscles are generally preserved.

It’s important to note that the choice of surgery depends on various factors, including the stage and characteristics of the cancer, the patient’s preferences, and discussions with the surgical team and oncologists. 

Tumor Conference

Before constructing the course of treatment, our flow begins with Tumor Conference. Tumor conference is an essential part of the treatment planning process for patients undergoing breast cancer treatment.

During a Tumor Conference, a team of healthcare professionals, including surgeons, radiologists, oncologists, pathologists, and other specialists, come together to discuss and evaluate each patient’s case. The purpose of the conference is to review all relevant diagnostic information, such as imaging results, biopsy findings, pathology reports, and clinical history, to develop an optimal treatment plan for the individual patient.

Tumor Conference offers several advantages and benefits for patients. It allows all specialists involved in a patient’s care to collaborate and share their perspectives, knowledge, and experience to develop an individualized treatment plan. This comprehensive approach helps ensure that the patient receives the most appropriate and effective treatment based on the specific characteristics of their breast cancer.

The decisions made during the tumor conference are then discussed with the patient, and the treatment plan is tailored to their specific needs, preferences, and overall health. The involvement of multiple specialists in the tumor conference helps optimize treatment outcomes and provides a holistic approach to breast cancer care.

Tumor conference is the best and most comprehensive treatment for cancer patients. Because the sequence of treatment is the most important aspect of cancer treatment principle. 

If the tumor is large, sequence of treatment may start with medications then followed by concurrent chemoradiation therapy (CCRT). Once the tumor has sufficiently shrunk, surgical intervention will be perused. 

If surgery is initiated and the complete removal of the tumor is not possible, residual cancer may remain, leading to a significant and dramatic difference in the prognosis for achieving a cure.

If it is determined that the entire tumor can be successfully removed through surgery, it is considered a curative treatment approach. However, if the tumor has not been completely eradicated after surgery, additional treatment with cancer drugs is necessary. This treatment is referred as palliative treatment. It is important to note that the prognosis and life expectancy can vary significantly between curative and palliative treatment approaches.

If the tumor is too large and surgical removal is not feasible without affecting vital organs, alternative treatment methods like cancer drugs are used prior surgery. This is why Tumor Conference is crucial and immensely beneficial.

The NCCN (National Comprehensive Cancer Network) guidelines are internationally recognized and widely used in the field of cancer treatment. The NCCN guidelines are considered comprehensive and provide detailed information on diagnostic evaluation, treatment options, and supportive care for different cancer types.

However, recent research has revealed that the primary concern for cancer patients is not only the location of the cancer, but also the advanced stage of the disease, the presence of specific gene mutations, and their respective locations. This has led to the development of treatment guidelines for advanced cancer that involve gene sequencing.

By sequencing the patient’s genes, we can identify which genes have experienced mutations. This information is crucial as it helps us determine the most effective treatment approach. In cases of non-advanced cancer, our focus is typically on two key factors. Firstly, if the patient is young, we conduct BRCA and HER2 testing. If mutations are detected in either of these genes, we can proceed with targeted therapies that specifically inhibit the activity of the mutated HER2 or BRCA gene. These targeted therapies can effectively block the action of the mutated genes, providing a more precise and personalized treatment strategy.

Vejthani Hospital is conducting a clinical trial where participation is free of charge. This trial offers an opportunity for patients to explore and select the most suitable cancer drug based on their individual needs and circumstances.

Refractory cancer or cancer that is resistant to conventional treatments, multiple approaches are needed to provide assistance. Precision medicine plays a crucial role in tailoring treatment specifically to the individual’s genetic and molecular characteristics. Additionally, immunotherapy offers valuable support.

Immunotherapy is particularly beneficial as it harnesses the body’s natural defence mechanisms to combat abnormal elements. By stimulating and enhancing the immune response, immunotherapy helps strengthen the body’s ability to fight against cancer. Moreover, it functions like a radar, precisely identifying cancer cells and directly attacking them. Recent advancements have even enabled the use of radar-like capabilities in T cells.

Hence, immunotherapy provides a comprehensive approach to effectively address advanced or treatment-resistant cancers. These therapies not only leverage the body’s own defences but also incorporate targeted strategies to directly combat cancer cells.