Mastectomies and lumpectomies remained the mainstay of breast cancer treatment well into the 20th century. This “one-size-fits-all” treatment approach was symptomatic of the limited understanding experts had of the disease, explained Dr Esther Chuwa, Consultant Breast and General Surgeon at Gleneagles Hospital. She made this statement while speaking at the inaugural State-of-the-Art Diagnostics and Therapeutics in Cancer Symposium. The two-day event held in July was jointly organised by Parkway Cancer Centre and Gleneagles Hospital. Today, with advances in medicine, it is now possible to offer a wider variety of treatments that are less invasive and offer patients a better quality of life. Parkway Hospital Singapore has made great strides in recent years to make such treatments more accessible to cancer patients here in Sri Lanka as well. Offering them a chance to access world-class healthcare and treatment options that would allow them to be cancer-free and live long-fulfilling lives.
Experts now recognise breast cancer as a heterogeneous disease thanks to advances in medicine and the availability of new research. This means that the condition may differ greatly in terms of clinical presentations and response to treatments. Some individuals could even present with different types of breast cancer tumours, said Dr Chuwa.
She pointed out that recognising variations in the disease has been critical in helping doctors formulate the best possible treatments for patients. In addition, she noted that patients now have more treatment options available to them, ranging from surgery to hormone and targeted therapies, a far cry from traditional methods of “disfiguring” surgeries which were not always successful in preventing the further spread of cancer.
Attacking cancer from many fronts
Senior Consultant for Medical Oncology at Parkway Cancer Centre, Dr Wong Chiung Ing who spoke at the same event said, with the discovery of new classifications of breast cancer, the battle has now become a multi-faceted one. She urged multi-disciplinary experts to work together, not just to beat the disease, but also to provide a better quality of life for patients.
Beginning with state-of-the-art diagnostics, doctors were now able to detect even smaller malignancies, with the aim of providing treatment sooner rather than later. Explaining further, Dr. Wong noted that diagnostic tools could also move further upstream. For example, patients with a family history of the disease can choose to undergo genetic screening for BRCA gene mutations, which have been shown to significantly increase the risk of developing breast cancer. This form of detection gained prominence in 2013 after Oscar-winning actress, Angelina Jolie, documented her mastectomy journey following a positive BRCA gene mutation test, noted Dr Wong.
Tailored therapies for a better fit
Once a diagnosis was confirmed, treatment regimes could then be tailored accordingly. In line with the heterogeneous nature of the disease, specialists often employed a combination of systemic and targeted therapies. For example, Dr. Wong pointed out that patients with hormone receptor-positive breast cancer will benefit from anti-hormonal therapy. Furthermore, another receptor that can be targeted is the HER2 (human epidermal growth factor receptor 2). By blocking the targets that stimulate the growth of cancer cells, tumour growth can be effectively controlled with minimal side effects to normal cells.
Improved surgery for better recovery
In addition to systemic and targeted therapies, improvements in surgical techniques have also improved the long-term survival rates of patients. Known as oncoplastic surgery, this combines the latest in oncological and plastic surgery. This surgery not only removes diseased tissue but also reshapes and remodels the breast.
Where traditional surgeries left asymmetry, loss of volume, puckered scars or nipple deviations, oncoplastic surgery aims to retain the aesthetics of the patient’s breast, with a reduction in surgical trauma and physical deformities. The result is an improvement in the quality of life for patients who experienced less physical and emotional scarring, without compromising survival rates, said Dr Chuwa.
A new ice age
With advances in medical technology, researchers are now exploring a technique known as cryoablation or the destruction of cancer cells through freezing. The procedure involved the use of hollow needles to inject freezing agents into the cancerous growth. A series of freeze-thaw processes results in the cancerous cells bursting and exposing their cancerous DNA to the immune system hence inciting an immune-specific response.
In theory, this procedure may combine a physical kill of the cancerous cells as well as a potential systemic impact similar to immunotherapy. Though still in the testing phase, results for cryoablation in breast cancer treatment have been positive. If successful, the technique could be used effectively to target and treat small, early-stage tumours without surgery, said Dr Chuwa. “The future of breast cancer surgery is one where we can achieve minimal change to a woman’s body image and quality of life, and give our patients the confidence and courage to face the rest of her treatments.”
Oncoplastic surgery: A new option
Breast cancer patients, typically, had two choices of surgical treatment – mastectomy which involved the removal of the entire breast or lumpectomy where sections of tissue were removed. Now, oncoplastic surgery has been shown to be a viable third option. Here’s what you need to know:
- Oncoplastic surgery aims to remove cancerous tissue while retaining the breast for an aesthetic outcome.
- The procedure combines oncological surgical techniques with the latest in plastic surgery to remodel and reshape the breast.
- Research has shown that when done properly, oncoplastic surgery can be as effective as traditional mastectomies and lumpectomies in treating certain types of breast cancer.”
Parkway Cancer Centre offers comprehensive cancer treatment with a highly skilled, multi-disciplinary team comprising Oncology and Hematology doctors, nurses, counsellors and other para-medical professionals with cutting edge technology to meet the specific needs of cancer patients. In Sri Lanka, CanHope Colombo is dedicated to providing patients with a seamless experience in Singapore for their healthcare. Contact CanHope Colombo, No 389, Highlevel Road, Nugegoda. Hotline: 0773460000