Once one is diagnosed of Breast Cancer, a whole lot happens. It is now time to manage that person that has the disease. The main aim is not to just rid the person of the disease but to give the person a better quality of life.

So,  management of breast cancer involves:
1. Treatment of the Disease.
2. Treatment of the Person who has the disease.

The first point is an aspect we mostly dwell on – therapies to fight the disease, but in reality, it requires more than that, we should also help the person find fulfillment in Life while combating breast cancer. Breast Cancer, like other terminal disease has physical, social, psychological and economic effects. That’s why it is very important to understand the management of breast cancer.

Please note: what would be shared here should not substitute for expert management by a Specialist in a Hospital. This should just give us an overview of breast cancer management.

Breast Cancer Management is multidisciplinary with Doctors (Surgeons and Oncologists, mostly), Nurses, Psychologists, Nutritionists/Dieticians and sometimes Physiotherapists involved.

When one is diagnosed of Breast Cancer, the Doctor would carry out further tests. Decisions about the best treatment are based on the results of these tests. The tests give information about:

• how quickly the cancer may grow.
• how likely it is that the cancer will spread through the body.
• how well certain treatments might work.
• how likely the cancer is to recur (come back).

Tests include the following:

1. On the cancer tissue itself:

• Estrogen and progesterone receptor test : A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing. A drug, Tamoxifen, can be administered to those with Estrogen receptor positive nodes.

• Human epidermal growth factor type 2 receptor (HER2/neu) test : A laboratory test to measure how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer is called HER2/neu positive. This type of breast cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target the HER2/neu protein, such as trastuzumab and pertuzumab.

2. Radiological assessment. Computer Tomograms (CT), MRI and sometimes, X-ray and Ultrasound investigations can be done to find out the extent of the disease – has it spread?

When the management team arrives at a conclusion from the tests, then treatment can commence.

Treatment for the disease include:
1. Chemotherapy. Use of drugs
2. Radiotherapy. Use of radiation to treat the disease
3. Surgery
4. A mixture.

There are other measures like
• Pain relief
• Reduction of nausea/vomiting
• Increase of appetite.

Treatment is usually individualized and depends on several factors:
• Stage of the Cancer – from size and spread
• Extra features: Estrogen receptor positive or not
• State of health of the Individual
• Resources available – that of the Patient and the Managing team

Resource of the Managing team also includes the competence of that team.

Chemotherapy
Use of drugs in treatment of the cancer. The usual drugs used are
• Cyclophosphamide
• Methotrexate/Adriamycin
• 5-Fluorouracil
These come with side-effects which the managing Doctor would inform the Patient about. It is usually given as a course – over time. They would ensure you’re strong enough to start. Some blood tests would first be conducted to ensure this and used to monitor the progress.

Radiotherapy
This is the use of radiation in treatment of cancer. This is almost always combined with surgery. There is a special machine used which delivers the right dose to the right part of the breast helping to destroy as many cancer cells as possible. It also has side effects which the Doctor would tell you about.

Surgery
Means removal of part or whole of the affected breast. It has indications which those tests and the size of your breast would determine. For example, if I discover you have a DCIS (ductal carcinoma in situ) affecting most of the breast below the nipple and the pathologist also say it is moderate grade, and your breasts are very small (A Size), a simple mastectomy (removal of the breast without the lymph nodes and muscle beneath) would suffice. I can then reconstruct that breast using material from other parts of your body.

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Always Remember: prevention is better than cure, early detection saves. Get screened today

Ladies, please take note:
• there are ways of making you still feel like a Woman after removal of the breast. This involves reconstruction of the breast. The Nipple and areola, if unaffected can be saved for this procedure.

• Little parts of the breast can be removed – lumpectomy*
IF you have a relative or loved one that has the disease and the Doctors inform her that she needs that procedure, please encourage her to do so, it is life saving.
Some side effect of large surgeries include: lymphedema (the arm close to the site becomes enlarged), some part of the blood and lymph may accumulate in the affected breast, there could be infection post operation.

IT is a good Clinical Practice for your Doctor to discuss in detail with you before starting any management and give you time to think and plan. Please note: everyone is very important.

There are other aspects of the Management.
People with this disease require a lot of help: they may be weak (from the disease and/or the treatment) and will need people to aid them with usual life activities. They also experience depression and sadness, which will require support.
IF unchecked, it can affect how they respond to treatment – may skip their clinic and drugs.
So,

1. Support groups (one of the future goals of this platform. There are very few to none in Nigeria and most African Countries)

2. A Clinical Psychologist. May need sessions with a trained Personnel

3. Hospice – place where people are trained to take care of terminally ill people.
Close relatives should also be trained and managed.
You know, this is one area we neglect.
These people could also suffer depression from caring for the Cancer Patients.
They, the Relatives, are also humans and should be factored in the overall care of the Cancer Patient, especially if they are really close and help out
Once they understand what is really going on and also benefit from counselling et al, most will be effective in the care of the Cancer Patients.
Support groups are made up of
• Cancer Survivors
• Patients with Cancer
• Clinical psychologists
• Doctors

Read more about Breast Cancer here

Read more about Support groups here 

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