Breast cancer is one of the most common types of cancer among women globally as well as in India. According to the World Cancer Report 2020, the most effective way for breast cancer control is early detection and rapid treatment. The only way to detect breast cancer early is awareness among people. If detected early or on time, breast cancer has higher survival rate.
When a person is diagnosed with breast cancer, not only does her life change, but the people associated with the patient are also affected in the process. Family, friends, and caregivers are expected to provide support for the loved one while also balancing their own needs. Sometimes this may become overwhelming for the people close to the patient, but it can be handled with the right attitude and emotions.
Recently, actor Chhavi Mittal’s diagnosis of breast cancer has attracted people to know more about disease. She is a breast cancer survivor because she got her diagnosis on time. However, early diagnosis and treatment is one phase of breast cancer. Another important phase is the post-treatment care that is less talked about.
How to manage if you are suffering with breast cancer?
Breast cancer can mean making new lifestyle changes as the treatments can bring physical alterations to your body. After a surgery, there can be body scars that are visible, and some might also experience hair loss after chemotherapy.
Breast cancer patients can also experience swelling in the hand, arm, or breast area because of built-up lymph fluid in the tissue surface called lymphoedema. If a woman has lymphoedema, she might have to wear full sleeves tops and dresses that will cover the area.
Three important changes affecting women undergoing breast cancer treatment:
Loss of breast
Breast cancer surgery does not mean a woman has to loose her breast. Our present practice of breast surgery is known as ‘Oncoplastic Breast Preservation Surgery’ (OBPS). It involves simultaneous restructuring of breast after removal of the affected part/quadrant of breast by mobilising tissues from the same breast. If the defect is large or whole breast is removed then reconstruction of the part or whole breast is done by mobilising tissue from the either back or abdomen or an implant can also be inserted. Ninety-five times our patient leaves the operation theatre with breast. All the women who have lost their breast due to breast cancer and our cancer free at present can get their breast back with the help of advanced reconstructive techniques.
Swelling in the ipsilateral arm
More than 30 women post breast cancer treatment experience swelling in the ipsilateral arm which is sometimes associated with pain/tingling/numbness. This can be majorly prevented by taking right and appropriate measures during treatment. Breast cancer majority of times spread to axillary lymph nodes before spreading to other parts of the body. Henceforth, alongwith removal of breast tumour axillary lymph nodes are also removed/cleared as a part of breast cancer surgery. In standard axillary lymph node dissection majority of the lymph nodes are removed; which leads to swelling of the arm known as lymph edema due to interruption of lymph drainage from arm. Radiation compounds the lymph edema. If the patient is diagnosed at early stage and cancer has not spread to armpit i.e., axillary lymph nodes; the surgical procedure to address the axillary lymph nodes should be Sentinel Lymph node biopsy (SLNB) rather than axillary lymph node dissection (ALND). In Sentinel Lymph node biopsy special dyes are used to identify first station of axillary lymph nodes, the lymph node are identified and sent for biopsy. It is said if these lymph nodes are negative/clear, then 97 per cent times the cancer has not spread further and axillary lymph node dissection can be avoided, thus reducing the incidence of arm edema to less than 3 per cent. In patients who present with advanced cancers, now the norm is to give systemic therapy in form of chemotherapy/targeted therapy/immunotherapy/hormonal therapy before surgery and depending on the response those patients who show very got response can be subjected to SLNB instead of ALND.
Even in patients undergoing ALND certain techniques like reverse axillary mapping, lymph venous anastomosis have led to decrease in lymphedema rates.
Post-surgery all the patients of ALND should be coerced to start early rehabilitation in form pf physiotherapy, yoga and massages which delay/decrease lymphedema.
For patients who have already developed lymph edema post-surgery, the initial management is in form of physiotherapy and pressure garments. Certain form of yoga also helps in decreasing lymphedema. Majority patients, if they do these measures diligently does get relieve, also the important factor is early intervention, the lymphedema should not be allowed to progress, then it becomes difficult to treat.
Lastly, surgical interventions in form of secondary lymph venous anastomosis and lymph node transfer can be considered, but results are guarded.
Loss of hair/skin changes and weakness
This majority of times is a temporary phenomenon. Certain measures like cold cap and ayurvedic packs and supplements can decrease the intensity of these changes and enhance the recovery.
However, these changes can be dealt with the following tips:
1. Getting comfortable to the changes
The sooner a person accepts the changes in body, it will be easier for them to become confident. This will be a little difficult initially for the patient at they might be shocked at first but over time they get more used to how it looks and feels after the treatment.
2. Maintain a proper diet and ensure regular exercise
Breast cancer medications can lead to weight gain, and they may increase appetite and patients may eat more due to anxiety. Weight gain in patients can also be due to less activity during the treatment. Women are concerned about how their bodies look and weight gain can leave them with low self-esteem. However, with proper diet and routine exercise, breast cancer patients can lose weight.
3. Don’t worry about the hair loss
The main reason for hair loss is chemotherapy. Losing hair drastically can impact the confidence in a woman. However, this is a temporary side-effect that can be treated once the treatment is completed.
4. Reconstruction and prosthesis
Women might want to reconstruct their natural appearance after a breast cancer surgery. While the reconstruction can give a breast shape, it might not be able to bring back the original breast but, will help them gain confidence.
How to take care of someone suffering with breast cancer?
Taking care of someone with breast cancer requires dedicated time and energy for the patient. Sometimes this might put burden on the family, emotionally and economically.
A person suffering with breast cancer does not only need medical care but also need practical care like preparing meals, doing grocery, laundry, etc for the patient. Depending about the condition of the patient, they may also require assistance in eating food, going to the washroom or even getting dressed.
Apart for physical assistance, emotional care is another aspect to keep in mind while taking care of the breast cancer patient. A caregiver should understand the fear of pain, recovery, and death that a patient goes through. Emotional care means listening to the patient, supporting during the therapy and show empathy and validation without minimising the person’s feelings.
At times, while caring for the breast cancer patients there may be situations that are beyond a caregiver’s abilities to manage alone. In situations like, change in medication, concern about self-harm/suicide or a change is person’s physical health, medical help should be taken.
Dr Mandeep Singh Malhotra is a surgical oncologist at CK Birla Hospital in New Delhi
The opinions expressed in this article are those of the author’s and do not purport to reflect the opinions or views of THE WEEK.