Managing Breast Diseases

Breast Cancer is still the number one cancer killer of women in Malaysia. It is therefore essential when one is diagnosed with this disease to get the best care possible provided by highly qualified specialists and personnel. At Prince Court Medical Centre we combine some of the most hi-tech facilities, using advanced equipment and procedures available worldwide to provide excellent care with a caring human touch.

Breast cancer

Breast cancer is a malignant tumor in the breast. It forms when cells undergo abnormal growth and become cancerous – invading normal healthy tissue and organs and spreading throughout the body. Unfortunately there is no single identifiable cause of this deadly disease. There are many possible contributing factors such as poor lifestyle choices , poor dietary habits stress.

However there are certain genetic traits that do play a part in determining whether a person develops breast cancer. For people with the BRCA 1 and BRCA 2 gene the likelihood of getting breast cancer is nearly 100 percent.

Screening

The real frightening reality is that early breast cancer has no discernible symptoms. Often the first signs are when a woman feels a lump in her breast. But this usually occurs 6 months to a year after the initial onset of the tumor. Therefore one of the most effective means of curing breast cancer is by early detection. It is thus best advised for women to get screening done on an annual regular basis.

At Prince Court the Breast Centre provides the gold standard in terms of screening: the ultra-sound, the mammogram and the MRI. Experienced and knowledgeable physicians and specially trained nurses and medical personnel assist and help evaluate patients to see which imaging modality suits them.

Skilled personnel

It can be a daunting experience to step foot in a hospital. It can be torture to find out whether one has cancer or if it’s just a false scare. At the Breast Centre , The attending surgeon, the specialist breast nurses and staff are specially trained to deal with breast health issues and can offer counseling as well as aid to anxious and bewildered patients and their loved ones.

A high ratio of nurses and doctors at the Centre are women and this alleviates some of the fears and trepidation that many women have when seeking consultation.

Highly trained surgeons specializing in breast cancer surgery are always in discussion with the patients and their families – enabling them to provide a comprehensive breast cancer care management plan that takes into account the patient’s requirements , individual and family needs.

Gold Standard Treatment

Prince Court Medical Centre provides one of the best and most advanced treatments and procedures. At the Breast Center the gold standard in managing breast cancer is practiced. The Sentinel Node Biopsy is the procedure of choice in early breast cancers for the management of lymph nodes.. In 2008 Prince Court became one of the first hospital in the nation to offer this procedure.

Before, women with breast cancer not only had the cancer removed but also all the lymph nodes on the affected side via conventional surgery. This is because the lymph nodes are the first points which the cancer spreads to outside the breast tissue.

In conventional surgery up to 75% of the lymph nodes is removed from under the women’s armpit. This is often not cost-effective. In early cancer, there is the chance none of the lymph nodes have been affected. In effect a woman loses all her lymph nodes thus risking the onset of lymph edema – a progressive swelling of the arm that is not only painful but also reduces the arm’s effectiveness.

To avert this and provide a safer and minimally invasive method for the patients, the sentinel node biopsy was developed. It is a method of identifying the first lymph node that drains the cancer and is a specialized technique requiring trained expertise and a high degree of skill.

At the Breast Centre this is provided by a Specialist Consultant, the Breast and Endocrine surgeon who is accredited in this procedure. Alongside her radiologist, both working in tandem with the rest of the team to ensure patients can get excellent treatment available here.

Sentinel Node Biopsy: How it works

It involves injecting a radioactive isotope around the nipple the day before the surgery or in the morning if the surgery is in the afternoon. This radioactive isotope will then travel through the lymphatic channels to the first lymph node, the sentinel node. Afterwards a special scan called a lymphoscintigram is used that will show the lymph node brightly highlighted. The nuclear physician confirms it and marks it.

When the patient reaches the Operating Theater, the surgeon will proceed to locate the sentinel node or nodes using a specialized gamma probe to locate the radioactive node. The surgeon will then make a small cut and very precisely find and remove the node with minimal dissection to the surrounding tissue. Occasionally a blue dye may be used along as well. The lymph node removed is then sent to the lab immediately while patient is still in theater.

In the lab, the pathologist does a frozen section, looking at the sample under a microscope. If no cancer cells are detected, it’s unlikely there are cancer cells in the rest of the lymph nodes. She will then immediately inform surgeon of the result . If it’s all clear there is no need for further surgery to the axillary nodes and the patient can be discharged the same day or the next day. It is a minimally invasive procedure, so little tissue damage occurs and recovery is good.

Process Before Surgery

The process before surgery is very straightforward. For low risk patients who have no other medical issues it is a straightforward admission on the morning of surgery or the night before depending on their convenience. Some standard blood examinations and xrays or scans as needed will be conducted. Then they are seen to by the surgeon and the anesthetist for a preoperative assessment before proceeding to the surgical theater. Breast cancer surgery is usually all done within One to One and half hours. Once surgery is done and the anesthesia wears off patients generally are up and about with minimal discomfort often only requiring simple pain killers.

For elderly patients in their 70s to 80s and those with co morbidities additional assessments for their heart and fitness for surgery may be required and will be dealt with appropriately before surgery.

Reconstructive surgery

The Breast Center also provides patients with a choice of reconstructive surgery techniques with either the simple implant reconstruction which can be done by the breast surgeon .

Or they can opt for the autologus flap option – where the patient’s own body tissue like the fat from the tummy or the muscles from the back – is used to reconstruct the breast. The breast surgeon will consult with her fellow plastic surgical collegues and they work together as a team.

Every woman is given a choice on the type of surgery she chooses to have. Every woman is given the option of breast reconstruction should a mastectomy be needed. The best options are given to these women tailoring to their choice and needs as well so that they recover well with confidence.

Treatment of Locally advanced cancers

Sometimes due to delays in seeking treatment some women end up with locally advanced tumors. If there is no significant metastatic disease these women are offered surgery as well. Surgery can give these patients good quality of life . they will require radical surgery with reconstruction to close the defect if necessary.

Quality of Life and Palliative Care

Unfortunately for some patients there comes a time when all treatment fail to keep the disease under control and it progresses . The primary surgeon works closely with the palliative care physician in the management of these patients. It is team effort and the palliative care physician plays a big role in discussing end of life issues and management of the patient as well to guide, assist the patients, their families and loved ones in this most trying of times.

It’s all about quality of life care and the palliative physician is instrumental in the administration of drugs and medication and supervising nutritional intake as well. Together with other medical personnel the doctors also provide counseling for the patients and their loved ones – engaging with them on their fears and worries for the present and the future and doing all they can to make this difficult period as painless as possible.

The Breast Centre

A multidisciplinary approach to breast care management is practiced at the Breast Centre. Here a comprehensive and holistic approach is used in the management of breast cancer and it is tailored to meet the patient’s medical, psychological and emotional needs. Being diagnosed with cancer is not the end of the world. Advances in medical treatment along with the genuine human concern of the personnel makes the overall experience comforting.

The peer support group made up of breast cancer patients ie.The Pink Ladies of Prince Court help newly diagnosed patients to better understand what they are due to go through. The support they get from one another is invaluable. This encourages them to live a full life as there is life after breast cancer and it can get better.

 

List of Doctors:

Breast and Endocrine Surgery Consultant:
Dr. Harjit Kaur

Radiology & Nuclear Medicine Consultant:
Dr. Sumithra Ranganathan
Dr. Shahrin Merican

Pathology Services:
Prof. Dr. Elizabeth George
Prof. Dr. Ngeow Yun Fong
Dr. Norizan Mohd Annuar
Dr. Roziana Ariffin