Introduction of Breast Cancer:
- Breast Cancer manifests generally in women above the age of 40 years.
- Familiar susceptibility is known.
- Single, nulligravida women carry a greater risk of suffering from breast cancer.
- It is generally unilateral, arises generally from ductal epithelium.
Breast Cancer- Ayurvedic Treatments
Types of Breast Cancer:
These are of two types as below.
1) Ductal carcinoma of the breast:
This is the commonest variety of breast carcinoma. It is again subdivided in two types.
Ductal carcinoma in situ: The proliferation of malignant epithelial cells remains confined to the duct system and does not involve the surrounding tissue. But when the disease continues for 10-15 years, it shows features of invasion into surrounding tissues.
Invasive ductal carcinoma: The intraductal carcinoma, once it invades the basement membrane, has the ability to infiltrate into surrounding tissue.
Based on the histopathological examination, it may be of different types as-
a) Infiltrating ductal carcinoma with productive fibrosis
b) Medullary carcinoma
c) Tubular carcinoma
d) Mucinous carcinoma
e) Papillary carcinoma
f) Adenoid cyst carcinoma
2) Lobular carcinoma of the breast:
As this does not form a palpable mass, the diagnosis is by chance, during HPE. It may be of in situ or invasive types. When in situ, there is a uniform proliferation of cells within the lobule. But there is always a risk of it becoming invasive in nature. The invasive type sometimes mimics inflammatory or benign lesions. This type is known for its bilaterality and multicentricity.
Symptoms of Breast Cancer:
1) Generally occurs after 40 years of age, but can occur during any age after puberty.
2) Patients present with a painless lump in the breast, generally in the upper, outer quadrant.
3) Any lump in the breast is always considered as breast cancer until it is proved otherwise.
4) Initially, it is painless. Gradually as it enlarges, it causes discomfort, which is generally termed by the patient as pain. In the advanced stages, pain may become an associated feature.
5) Retraction of the nipple may be one of the important features.
6) Inflammatory carcinomas are painful.
7) Discharge through nipple is occasionally seen.
Examination of Breast Cancer (O/E):
- The nipple may be raised or retracted.
- Peau d’ orange look is an important feature.
- Breast cancer is hard, irregular and fixed within the breast substance.
- Axillary lymph nodes may be enlarged and hard sometimes when fixed to the deeper tissues.
- Opposite breast has to be checked for the presence of lumps.
- Examination of a patient for the presence of distant metastasis is compulsory.
Investigations in Breast Cancer: Mammography and Biopsy are two basic and important investigations to rule out breast cancer.
Stages of Breast Cancer:
According to TNM Classification, staging of Breast Cancer areas below.
In which, T means- Tumor, N means- Node, M means- Metastasis.
Stage 1-T1, N0, M0
Stage 2-T1, N1, M0/ T2, N0, M0/ T0, N1, M0/ T2, N1, M0
Stage 3-T3, N2, M0/ T4, N2, M0
Stage 4– Any T, Any N with M1
1) Tumor (T)-
T0– No demonstrable tumor in a breast
T1- Tumor size is 2 cm or less than 2 cm
T2- Tumor size is 2 to 5 cm
T3- Tumor is greater than 5 cm
T4- Tumor of any size with any one of the following- Skin infiltration, ulceration, skin edema, pau d’ orange, attachment to pectoral muscle or chest wall.
2) Regional Lymph Nodes (N)-
N0– No palpable axillary lymph nodes.
N1- Clinically palpable axillary nodes.
N2- Clinically palpable, fixed axillary lymph nodes
N3- Homolateral supra or infraclavicular nodes considered to contain metastases, edema or arm.
3) Distant metastases (M)-
M0- No distant metastasis
M1- Clinical and radiological evidence of metastases except those to homolateral axillary or infraclavicular lymph nodes includes skin involvement beyond the breast.
Ayurvedic Treatment of Breast Cancer-
As per ‘Sushruta’ (School of Ayurvedic Surgery), the cancer tumors should be radically excised. Radical surgery for cure of malignancy, involves removal of a primary tumor, along with a rim of surrounding healthy tissue and the regional lymph nodes. This cures the primary lesion and reduces the chances of metastasis through lymphatic channels. Do hot fomentation first and then excised the tumor completely when it become clear and complete hemostasis achieved, suture the wound.
Reconstructive surgery: After excision of the primary lesion and secondary metastatic deposits, ensures a return of normal physiology or improves the cosmetic appeal of the region.
Ayurvedic Panchakarma Therapy: Body purification and rejuvenation by Ayurvedic Panchkarma Therapy (includes Vamana Procedure(Medical Emesis), Virechana Procedure (Purgation), Basti Procedures (Medicated Enema)- Anuvasana & Asthapana Basti, Siravyadha Chikitsa (Bloodletting)) play a great role for the treatment of cancer through Ayurveda.
Ayurvedic Palliative Treatment for breast cancer:
External application: Karanjadi taila (Karanjadi oil).
Oral medication: Triphala Kwath, Kanchnar guggulu tablet, Gomutra Haritaki tablet, Navak guggulu tablet, Triphala guggulu tablet, Vidangarishta, Ayaskriti (a type of medicated wine)
Treatment of early breast cancer (Stage 1 & 2): Initially breast cancers were treated by radical mastectomy, but nowadays greater importance is laid on the conservation of breast tissue, thus we now have various procedures viz. lumpectomy, tumourectomy, segmental mastectomy etc.
Breast conservation is indicated in those having a tumor of size less than 4 cm without extensive lymph node involvement or metastasis.
Micrometastasis occurs even before the accurate diagnosis of breast cancer can be carried out. Hence along with surgical procedures, adjuvant chemotherapy and adjuvant hormonal therapy play a vital role in prolonging disease-free intervals and also the survival rates.
Treatment of advanced cases of breast cancer (Stage 3 & 4): Advanced cases of breast cancer are associated with local ulcerations, metastases in bone, metastases into lungs resulting in dyspnoea etc. Once the carcinoma has spread beyond the breast and regional lymph nodes, only palliative treatments, no curative treatments can be provided.
Locally advanced cancers are those tumors which are greater than 5 cm. in diameter or have associated fixed axillary lymph nodes, but with no evidence of distant metastases. Thus it includes not only large fungated mass in the breast but also a small tumor in the breast with large and fixed axillary lymph nodes. Locally advanced carcinomas have poor prognosis and high rates of recurrence. For managing them, surgery along with chemotherapy and radiotherapy are highly essential. The aim of these combined modalities of treatment is to provide local control of the disease and to prevent or delay distant metastasis.