Sonali Bendre, Manisha Koirala, Lisa Ray, Mumtaz and more such celebrities are an inspiration and source of motivation for cancer survivors. The veteran actress Mumtaz has been an advocate for breast cancer survivors since her diagnosis of breast cancer in 2002 when she was 54 years old. While many of us know about the care, tests and habits one can adopt to prevent breast cancer, most are lost about the after-care and healing process of breast cancer survivors.
To further highlight Breast Cancer Awareness, TC46 connected with Medical Oncologist Dr Uma Dangi of Fortis Hospital Mulund & Hiranandani Hospital, Mumbai. Here she talks about the treatment options, side effects, the correlation between pre-existing conditions and breast cancer and how to cope with the changes.
1. What is breast cancer and what are the treatment options available?
Cancer can affect any part of the body and when it affects the breast, it is called Breast Cancer. Breast Cancer can be of various types like non-invasive or In-situ Carcinoma, Ductal Carcinoma, Lobular Carcinoma, Phyllodes Tumour and more. When we talk about Breast Cancer, we most often refer to Ductal or Lobular Carcinoma.
Treatment of Breast Cancer depends upon various factors including the type of cancer, the stage of disease, age, and additional illnesses the patient may suffer from. It may include various modalities like:
- Surgery
- Chemotherapy
- Targeted Therapy
- Hormone Therapy
- Radiation Therapy
2. What are the physical changes that can be seen in women undergoing treatment for breast cancer?
Surgery for Breast Cancer may mean complete removal of the involved breast and lymph nodes, which is a physically mutilating surgery. However, newer surgical techniques like Oncoplasty can help preserve the breast and most of the lymph nodes, especially if Breast Cancer is detected at an early stage. Also, breast reconstruction and implants are options for patients requiring complete breast removal. Chemotherapy is another treatment dreaded by most patients. Its associated hair loss leads to social and psychological strain on the patient, in addition to the physical changes. There may be darkening of skin and nails, loss of eyebrows which alter physical appearance to a great deal. These effects however are temporary and revert completely after treatment has ended, over a period of time. Radiation may lead to certain local skin changes like darkening of the treated breast with redness, and sometimes skin peeling. Again, these are temporary and resolve over time after completion of therapy.
3. What are the side effects of each treatment option?
Surgery can lead to some pain which can be controlled with medication. There may be a collection of some fluid in the armpit or surgery site called ‘Seroma post surgery’ which may need aspiration but resolves over time. Chemotherapy can cause hair loss, skin and nail changes as discussed. The most important side effect of chemotherapy is the possible decrease in Hemoglobin, resulting in fatigue and weakness, decrease in White Blood Cells leading to increased susceptibility to infections and reduced platelets which may rarely cause bleeding. In case of fever, it is important to start antibiotics immediately without any delay or there is a risk of the infection becoming life-threatening. Constipation is another very discomforting problem and liberal use of laxatives is recommended to pass at least one stool per day. Excellent medicines for nausea and vomiting have lessened the frequency of side effects. However, eating small, frequent, bland meals and a regular intake of fluids may decrease these further. Some patients have a change in the taste or a bitter taste for which one can use flavoured lozenges.
4. Will treatment cause menopause and other problems related to menstruation?
Chemotherapy can induce menopause especially in women who are near that age or perimenopausal. Many times, for Breast Cancer, menopause may be induced with hormone treatment for better outcomes. During Chemotherapy, menstruation cycles tend to become irregular, and women may miss their periods. This is a side effect of Chemotherapy. It is recommended that contraception be used during Chemotherapy as pregnancy is best avoided due to the adverse effects of Chemotherapy on the fetus. In most premenopausal women, the periods may return to normal after completion of Chemotherapy.
5. How will each treatment affect one’s daily life? Can women undergoing treatment continue working?
Quality of life is largely affected due to the side effects of treatment as discussed. Not everyone will have all side effects and some patients tolerate treatment better than others. It is important to remain as physically active as possible and eat well to reduce the intensity of these adverse events, at the same time not neglecting any symptom and contacting your doctor at the earliest sign of any reaction.
6. What are the emotional changes that one has to go through during treatment?
Being diagnosed with any cancer is emotionally draining not only for the patient but also for the family and caregivers. The prolonged treatments with their side effects and regular hospital visits can be challenging to deal with and it is important to seek counselling and psychiatric help for these issues. Patients have to deal with Anxiety of the diagnosis and treatment, and also the social stigma associated with it. This can lead to depression and negative thoughts. At this time, it is important that the patient feels free to discuss these emotional issues with their doctor and family.
7. When should the follow-ups be done?
Even after the treatment is over, regular follow-ups are recommended for at least 5–10 years and longer in some cases. This is mainly for the risk of disease recurrence as well as cancer developing in the other breast. For an average risk patient, a clinical check-up once every 3 -4 months for the first two years, every 6 months for the next 3 – 5 years and thereafter once a year is recommended. In addition, Mammography is to be done once a year.
8. What symptoms should one lookout for after the treatment is completed to know if the cancer is back?
Even after the treatment is completed, cancer can recur. If you notice any new lumps or swellings anywhere, back pain or new-onset pain anywhere which is not resolving with usual medicines, cough or shortness of breath, loss of appetite or weight loss which is unintentional, you must inform your treating doctor so additional investigations may be done to rule out recurrence.
9. How can one get used to these changes and cope with the emotional stress?
Dealing with the diagnosis of cancer is not easy and one requires a lot of social and psychological support throughout the treatment and after. Most important of all is to first accept the diagnosis and understand the therapeutic options. Try to focus on the treatment of the disease rather than the disease itself. This helps to stay positive. Do not feel shy to discuss your problems with your close ones or your doctor. Try to maintain as active as possible and concentrate on things that make you happy. Explore your hobbies. There are many support groups you can connect with and meet people who have been through this already.
