Mastectomy

Metastasis
Oncologist
https://www.cancer.gov/about-cancer/treatment/types
https://www.mayoclinic.org/diseases-conditions/cancer/diagnosis-treatment/drc-20370594
https://www.nhs.uk/conditions/biopsy/#:~:text=A%20biopsy%20is%20a%20medical,skin%2C
%20organs%20and%20other%20structures.
https://www.cancer.org/cancer/managing-cancer/making-treatment-decisions/planning-
scheduling-treatment.html#:~:text=A%20cancer%20treatment%20plan%20is,the%20planned
%20course%20of%20care.
https://www.who.int/health-topics/cancer
https://www.nhs.uk/common-health-questions/operations-tests-and-procedures/what-do-cancer-
stages-and-grades-mean/
https://www.cancer.net/navigating-cancer-care/how-cancer-treated/surgery/what-cancer-
surgery#:~:text=Cancer%20surgery%20is%20an%20operation,is%20called%20a%20surgical
%20oncologist.
https://www.moffitt.org/treatments/systemic-therapy/#:~:text=Systemic%20therapy%20refers
%20to%20any,cancerous%20cells%20in%20multiple%20locations.
https://www.mayoclinic.org/tests-procedures/radiation-therapy/about/pac-
20385162#:~:text=Radiation%20therapy%2C%20also%20called%20radiotherapy,methods
%20of%20radiation%20are%20precise.

Treatment Approach
Confronting a cancer diagnosis necessitates a strategic and carefully considered approach. The
types of treatment that a patient will receive depend on the type of cancer the patient has and
how advanced it is. Fortunately, contemporary medical science offers a diverse, well-equipped,
and continuously evolving arsenal of treatment options. Some people with cancer require only
one way of treatment approach. But most of the patients require a combination of treatment
approaches, such as surgery with chemotherapy and radiation therapy. That’s why it is very
important to know about the various approaches of treatment for a cancer patient.

Cancer Diagnosis
Early detection of cancer is pivotal for successful treatment outcomes. Screening programs and
diagnostic tools play a crucial role in identifying cancer at its nascent stages when interventions
are most effective. Doctors may use one or more approaches to diagnose cancer depending on
the type of cancer. There are various approaches for diagnosing cancer.
Physical exam: The doctors generally start after taking a detailed medical history, including
information about the patient’s symptoms, family history of cancer, lifestyle factors and other
relevant medical issues. Then they assess the patient’s body looking for relevant signs and
symptoms. Skin abnormalities in the patient’s body like lumps, changes in skin color, texture,
abnormal rashes or swelling of an organ may indicate the presence of cancer. After physical
examination, if the doctors feel the possibility of the presence of cancer, they go for further
evaluation.
Laboratory tests: Laboratory tests like blood tests and urine tests may help the doctors identify
abnormalities that can be caused by cancer. For example, a standard blood test called a
Complete Blood Count, may detect an unusual quantity of white blood cells in people with
leukemia. Complete Blood Count (CBC) is often prescribed by the doctors as the primary
laboratory test to know about the irregularities within the body. If they find unusual reports in
CBC, they go for further high-precision imaging techniques.
Imaging tests: Noninvasive imaging examinations allow the physician to examine the bones and
internal organs. A computed tomography (CT) scan, bone scan, magnetic resonance imaging
(MRI), positron emission tomography (PET) scan, ultrasound, and X-ray, whole body PET-CT
scan are some of the imaging techniques used to diagnose cancer. These modern high-end
technologies help physicians to visualize tumors with unprecedented details. The integration of
these imaging modalities allows healthcare providers to analyze anatomical structures and
physiological processes in a way that enhances diagnostic accuracy.
Biopsy: During biopsy, doctors
collect a sample of tissue or
cells from the suspected
location of the body for detailed
examination under microscope.
This process is frequently used
to confirm or rule out the
presence of cancer. It also helps

Fig: Treatment Flow

to identify the type of cancer, to analyze its characteristics such as finding the molecular traits of
cancer. It also plays a crucial role in cancer staging and grading. Biopsies are useful in directing
treatment decisions and providing valuable prognostic information. Depending on the location
and nature of the suspected abnormality, the doctors may suggest different types of biopsies.
Among the most prevalent biopsy procedures are:
i. Needle Biopsy: Tissue or fluid is extracted from the body through a thin needle in this
kind of biopsy. Fine-needle aspiration (FNA) is minimally invasive and requires a small
amount of fluid or a small tissue fragment. Core needle biopsy, on the other hand,
involves a larger needle to obtain more substantial tissue samples.
ii. Surgical Biopsy: Surgical biopsies are more invasive procedures that involve the
removal of a larger portion of tissue or even an entire tumor. Excisional biopsy involves
removing the entire suspicious area, while incisional biopsy involves removing a portion
of it for examination.
iii. Endoscopic Biopsy: In this process, doctors use a flexible tube with a light and camera to
visualize and biopsy areas inside the body, such as the gastrointestinal tract or respiratory
system.
iv. Bone Marrow Biopsy: This procedure involves the extraction of a small amount of bone
marrow using a special needle, typically from the hipbone. It is commonly suggested by
doctors in probable cases of bone marrow cancer.
Specific biomarkers: The discovery of certain biomarkers has transformed the diagnosis and
planning of individualized cancer treatments. Genetic alterations or abnormal protein expressions
are examples of biomarkers, which are molecular indicators of the existence of cancer. These
biomarkers can be precisely identified by molecular diagnostic procedures like PCR and next-
generation sequencing, which gives doctors the ability to personalize patient treatments based on
the specifics of each patient's cancer.

Treatment Planning
Cancer is an extremely complicated fatal disease. Thus, the planning phase for cancer treatment
serves as the foundation for effective cancer treatment as this process is very complex and
highly individualized for each patient. Depending on various aspects like the condition of the
cancer cells, how vast it has spread etc., the doctors suggest different treatment planning for
different individuals. Treatment planning is a comprehensive strategy designed to address the
unique characteristics of each patient's cancer, ensuring that interventions are not only effective
but also tailored to the individual's overall well-being.
Cancer Staging: Once cancer is diagnosed, staging becomes paramount in determining the
extent of the disease and guiding treatment decisions. Staging involves evaluating the size of the
tumor, its invasiveness, and whether it has spread to nearby lymph nodes or distant organs,
providing a standardized framework for assessing the progression of cancer. Staging not only
aids in treatment planning but also offers prognostic information, helping patients and clinicians
understand the likely course of the disease. Worldwide, there are mostly two kinds of staging
systems.
  Number Staging System
i. stage 0 – the cancer is where it started and hasn't spread.
ii. stage 1 – the cancer is small and hasn't spread anywhere else.
iii. stage 2 – the cancer has grown but hasn't spread.
iv. stage 3 – the cancer is larger and may have spread to the surrounding tissues
and/or the lymph nodes (or "glands", part of the immune system).
v. stage 4 – the cancer has spread from where it started to at least 1 other body
organ, also known as "secondary" or "metastatic" cancer.

 TNM Staging System:

i. T describes the size of the tumor, with numbers 1 to 4 (1 for small, 4 for large).
ii. N stands for lymph nodes, with numbers 0 to 3 (0 means no lymph nodes have
cancer, 3 means many do).
iii. M stands for metastases or whether the cancer has spread to another part of the
body, with numbers 0 or 1 (0 means it has not spread, 1 means it has).
Multidisciplinary Approach to Personalized Treatment: Cancer is so complex that it is not
possible for only one doctor to plan and execute effective cancer treatment. The complexity of
cancer necessitates a multidisciplinary team comprising oncologists, surgeons, radiologists,
pathologists, and other specialists. Collaborative discussions among these experts are crucial for
devising comprehensive treatment plans depending on the individual characteristics of each
patient's cancer. This multidisciplinary team plans further roadmap of treatment which may
involve a combination of surgery, chemotherapy, radiation therapy, immunotherapy etc.
depending on the unique features and stage of the cancer. For some patients, surgery is needed
first followed by chemo and radiotherapy. Again, for some patients, surgery is done later after
completing some doses of chemo or radiotherapy. For this reason, a multidisciplinary team of
experts discusses and decides what is best for the patient and what are the future steps of
treatment for that individual.

Surgery
In most cases, surgery is a vital option for cancer treatment. A surgical oncologist performs
surgery to remove the tumor or the affected lymph nodes from the body. For some patients it is
done before chemotherapy whereas for some patients it is done after completing partial or full
courses of chemotherapy depending on the cancer stage and individual profile. If it is possible,
sometimes some surrounding healthy tissues are also removed for safety purposes so that no
cancer cells remain in the body after surgery. Doctors suggest different types of cancer surgery
based on the patient’s cancer type and stage.
Curative Surgery: Curative or primary tumor resection is performed with the intent of removing
the entire tumor from its original location. This approach is often applied when cancer is
localized and has not spread to other parts of the body.
Debulking Surgery: When it is not possible to remove the tumor entirely, part of it is removed
by surgery which is known as debulking surgery. For some cancers, debulking surgery might be
advised if removing the entire tumor would harm other body parts or if it is too large.
Palliative Surgery: The goals of palliative surgery are to control symptoms like pain or
obstruction or to enhance the quality of life for patients with advanced cancer. These treatments
can improve the patient's well-being and reduce discomfort, but they are not intended to be
curative.
Reconstructive Surgery: To recover the function and appearance of the affected body parts,
reconstructive surgery might be required after the tumor is removed. This is particularly relevant
in cases of breast reconstruction following mastectomy or facial reconstruction after head and
neck surgery.

Systemic Therapy
Any form of cancer treatment that targets the entire body is referred to as systemic therapy.
Unlike surgery or radiation therapy, which target a specific tumor or region, systemic therapy
circulates throughout the bloodstream to reach cancer cells that may have spread to different
parts of the body. Systemic therapy includes chemotherapy, immunotherapy, targeted therapy,
and hormonal therapy, each with distinct mechanisms of action and applications in the treatment
of various cancers.
Chemotherapy: Chemotherapy is the most common type of systemic therapy which involves the
use of powerful drugs to disrupt the growth and division of rapidly multiplying cancer cells.
These drugs can be administered intravenously, orally, or through injections. Chemotherapy is
effective in treating both localized and metastatic cancers and is often used in combination with
other treatment modalities. For certain patients, chemotherapy is followed by surgery to destroy
the remaining metastatic cancer cells. For some patients, surgical intervention is done after few
courses of chemotherapy, when a large tumor gets a bit reduced in size due to chemotherapy.
The type and stage of cancer again determines the number of chemotherapy sessions, the dose,
the schedule, and the overall treatment plan, all of which are determined by oncologists. Though
it is a powerful and effective treatment, it has some serious side effects. These side effects can
vary depending on the specific drugs used, the dose, and the individual patient's response. Some
common side effects are nausea, fatigue, hair loss, weakened immunity, mouth sores, and
changes in appetite. Not everyone will experience the same side effects, and the severity can
also differ.
Immunotherapy: Immunotherapy harnesses the body's immune system to recognize and attack
cancer cells. This can be achieved through various approaches, including immune checkpoint
inhibitors, adoptive cell transfer, and monoclonal antibodies. Immunotherapy has shown
remarkable success in treating certain cancers by boosting the body's natural defenses against
cancer cells.
Targeted Therapy: Targeted therapy uses drugs that specifically target molecules involved in the
growth and survival of cancer cells. Unlike chemotherapy, which affects both cancer and normal
cells, targeted therapy aims to minimize damage to healthy tissues. Examples include tyrosine
kinase inhibitors and monoclonal antibodies.
Hormonal Therapy: Hormonal therapy is primarily used in the treatment of hormone-sensitive
cancers, such as breast and prostate cancer. It works by interfering with the body's hormonal
signaling pathways, suppressing the growth of hormone-driven tumors.

Radiation Therapy
Radiation therapy (radiotherapy) is a treatment that uses high-energy radiation to kill cancer
cells and shrink tumors. It is an essential part of the broad approach to cancer treatment and is
frequently used alongside immunotherapy, chemotherapy, and surgery. Radiation therapy's main
objectives are to reduce tumor size, stop cancer cell growth, and lessen cancer-related
symptoms. Radiation therapy might be used at different times or for different reasons during
your cancer treatment.
Radiation therapy is categorized into two main types: internal radiation, brachytherapy, and
external radiation. In external beam radiation, a machine directs high-energy rays from outside
the body into the tumor. This method is commonly used for tumors located in accessible areas
such as the breast, lung, or prostate. Brachytherapy involves placing a radioactive source
directly inside or very close to the tumor. This technique is often utilized for cancers in or
around body cavities, like the uterus or the esophagus.
Radiation therapy works by damaging the DNA within cancer cells, preventing them from
dividing and growing. While normal cells can also be affected, they have a greater ability to
repair themselves compared to cancer cells. The treatment is carefully planned to maximize its
effectiveness while minimizing damage to healthy tissues.

Follow-Up and Monitoring

Follow-up and monitoring are crucial components of cancer care, aimed at tracking the patient's
progress after initial treatment. Regular medical check-ups, imaging studies, and laboratory tests
are conducted to detect any potential recurrence or complications. This ongoing surveillance
allows healthcare professionals to intervene promptly if needed, ensuring the best possible
outcomes, and providing support for the patient's overall well-being. Follow-up care also
includes addressing any lingering side effects, addressing concerns, and offering guidance on
maintaining a healthy lifestyle. Additionally, considering the mental health of both the patient
and their family is paramount. The psychological impact of cancer can be profound, and familial
support involves recognizing and addressing these challenges. Encouraging open conversations,
seeking professional counseling when needed, and fostering a supportive atmosphere contribute
to the overall well-being of both the patient and their family during the whole journey of
treatment as well as afterwards.