Annually, around 9,000 Romanians are breast cancer. It is the number one affection among women, with nearly 2.1 million globally registered illnesses.
In Stages 1 and 2, cancer can be treated successfully, and for early detection, women should go to a doctor regularly for examinations, analyzes, ultrasound and mammography. Mammography is made after 50 years after new international recommendations, and earlier, only in people with relatives of first degree breast cancer or carriers of BRCA 1 and 2 mutations.
Treatment of breast cancer has changed radically
Any suspicion of cancer should be evaluated in a medical committee, including the imaging physician, oncologist, surgeon, radiotherapist and reconstructive surgery specialist. If surgery was the first treatment option in breast cancer 50 years ago, today the protocols have changed, and doctors in Romania, specializing in prestigious clinics in the West, respect them in order for patients to have maximum healing chances .
"Over the past years, in terms of breast cancer treatment, things have changed a lot, and collaboration with the imaging and oncologist has improved the success of therapies. Now, apply protocols other than those of residence: in cold surgery, when we do not have emergency patients and have time to examine them, as is the case with breast cancer, then the chances are that patients will get rid of this condition . I work with an imaging radiologist who makes mammography, mammography, CT and MRI. This doctor follows these lesions echographically.
I do not operate a patient with a breast tumor unless she is biopsy, she does not have the histopathological exam and did not go to the oncologist first. Maternal pathology is a sensitive pathology, and before I intervene, I assure that the patient was correctly diagnosed and evaluated by the oncologist and the imaging specialist. In these cases, the decision is made according to what all specialists involved in treating breast cancer say. In the case of mammary pathology, you can not intervene if there is no case assessment by all the specialists I mentioned, "says surgeon Stefan Tuca, who performs interventions to remove breast tumors.
So, cancer treatment is today inconceivable without addressing the multidisciplinary committee, regulated by law. And the diagnosis of accuracy is based on tumor biopsy and histopathological examination. Depending on this, the physician team decides the type of therapy.
"There are tumors that the imagist analyzes, finds that it is a carcinoma, and the oncologist, depending on the histopathological examination, studying some genes, estrogen receptors and a lot of other elements, may recommend postponing surgery to provide the patient's chance of a first-time therapy much more effective than surgery.
There are situations when chemotherapy is recommended first. I have cases in which the oncologist recommended the imagist to place an intratumoral harpoon, and under chemotherapy, these tumors decreased to disappearance. These situations are valid for incipient stages because Stages 3 and 4 have oncological indication at baseline, chemotherapy or radiotherapy. It has been found that it is better to start with chemoradiotherapy and then continue with the surgery when the tumor is reduced rather than mastectomy at first, with entry into the axilla. The oncologist decides on a case-by-case basis which is the treatment protocol ", the physician adds.
The sentinel ganglion
An important aspect in the treatment of breast cancer is the approach of the sentinel ganglion. This is the first one invaded by the cells in the tumor, but the disease may involve several ganglia. To assess the situation correctly, surgeons pull out one or two ganglions during surgery. Depending on the histopathological analysis of the lymph nodes, the team of physicians decides whether to reintermine to remove more lymph nodes from the axilla. The intervention should be avoided if the lymph nodes are not affected.
"Lymphadenectomy (extirpation of the lymph nodes) of the breast predisposes to complications, there are collections of lymph that appear in the axilla, edema of the arm appears, nerves can be broken. There are many risks associated with axillary interventions where the vein and axillary artery, many nerves and many nerve plexuses. Thus, lymphadenectomy implies potential risks and therefore, the idea of assessing the sentinel gang appeared ", says surgeon Stefan Tuca, surgeon.
As for bilateral mastectomy, primary surgeon Stefan Tuca recommends it only if the patients with breast lesions have BRCA 1 or 2 mutations. But the doctor also draws attention to benign formations that can become dangerous.
Preserving fertility in younger patients
"Evolution of each case decides the intervention. Let's take the example of fibroadenomas. These are benign tumors that occur in women up to 30 years of age. If, however, after 30 years, these benign formations persist, grow in size, become susceptible to the BIRADS score that assesses the risk of cancer, they reach BIRADS 3 (4 and 5 are neoplastic lesions) to be removed. The rest is regularly monitored by your doctor. There is also a different type of fibroadenoma, the so-called phyillodes tumor, which needs to be removed with safety margins because it can invade the whole breast. And even if we take it safely, there is a risk of recurrence. So in this situation, we have a surgical indication from the start, "the specialist says.
Another category of patients is young people who have no children. Women who develop cancer at younger age should consult a specialist in fertility before starting oncology therapy. Nowadays, reproductive medicine offers solutions for the cryopreservation of ova and embryos, which may, after completing therapy, lead to a pregnancy.