Provide diagnostic services Comprehensive cancer treatment with highly experienced and skilled personnel under international standards The doctor will assess the risk, screening, diagnosis, assessing the stage of the disease. and follow-up to find recurring lesions quickly, accurately, accurately

Breast Cancer

What is Breast Cancer?

Breast cancer is an abnormal cell growth which originates in breast tissue. Breast cancer is one of the most common cancer in woman and can occur at any age. Men can also develop breast cancer but rarely happens. Breast cancer that spreads to other parts of the body is called metastatic breast cancer. In such case, additional biomarker testing such as HER2 and Hormone receptor tests will be done to determine which treatment would be effective for the patient.

Risk Factors

◼️ Gender: Female are much more likely to develop breast cancer

◼️ Increasing age

◼️ Previous history for breast cancer

◼️ Family history for breast cancer

◼️ Genes mutation (BRCA1, 2) inherited from parents

◼️ Obesity

◼️ Menstruation starts before 12 and/or menopause at older age thereby exposing to estrogen for a longer time

◼️ Smoking

◼️ Alcohol consumption

◼️ Previous radiation therapy to chest

◼️ Hormone Replacement Therapy usage

Symptoms

        Symptoms that may alert you to go to your doctor when in doubt are:

◼️ Change in your breast characteristics (Size, shape, and contour)

◼️ Mass or lumpy feelings upon self-inspection

◼️ Changes to skin over the breast such as inflamed, scaly, dimpled

◼️ Hardened area under breast skin

◼️ Blood-stained or discharge from nipples

◼️ Newly inverted nipples

Breast Cancer Screening and Diagnosis

        Your doctor will do breast examination and evaluate family history, medical history, and your symptoms. Testing includes:

◼️ Mammogram – An x-ray of the breast commonly used for breast cancer screening

  ◻️ There are updated guidelines for patients who benefit from screening. Discuss with your doctor for appropriate screening interval

◼️ Ultrasound

◼️ Magnetic resonance imaging (MRI)

◼️ Biopsy – removing a sample of breast cells sent to laboratory to check if the cells are cancerous

After breast cancer has been diagnosed, your oncologist will work up further to stage the cancer. The stages range from 0 to IV. Stage 0 is a noninvasive cancer and contained within milk ducts while stage IV cancers are metastatic cancers which means the cancer has spread from its primary site to other parts of the body. Other characteristics of cancers will also be determined as necessary for each case such as estrogen, progesterone, and HER2 receptors. The oncologist will be able to determine the prognosis and treatment.

Treatment

        There are many options for each patient to take for breast cancer treatment. Treatment depends on type of breast cancer, stage, hormone sensitivity, grade, and size. Patients may receive surgical treatment with chemotherapy, hormonal therapy, or radiation therapy. Treatment options are as followed:

◼️  Surgery – Options are removal of breast cancer (lumpectomy) or entire breast (total mastectomy) and removing lymph node depending on each case

◼️  Radiation Therapy

◼️  Chemotherapy

◼️  Hormone Therapy

◼️  Targeted Therapy

◼️  Immunotherapy

Cancer cachexia

Cancer cachexia is one of a malnutritional condition which can often be found in cancer patient. It is a complex syndrome leading to continuous loss of skeletal muscle and/or loss of fat (adipose tissue) in the body. The condition will result in lower immunity and increase frequency and severity of infection, complications, fatality rate, and lower quality of life.

Cachexia also results in lower efficacy of treatment including lower response rate of chemotherapy, increased side effects from drugs, increased risk to complication after surgical treatment, increase time of hospitalization. Patients who has this condition will also be classified in poor prognosis category which result in decreased survival time therefore nutritional care is critical in prevention of cancer cachexia, increase treatment effectiveness, and improves quality of life.

Causes and Factors for Loss of Appetite and Cancer Cachexia

1. Tumor factor

    1.1 Cancer cell secrets cytokine, hormone, and tumor derived factor which increases metabolism of carbohydrate, fat, and protein thereby increasing           nutritional needs for cancer patient especially energy and protein to meet the requirement of the body. If the body do not receive enough                   energy, muscles and fats will be broken down to compensate for the needs even in resting state.

    1.2 Large tumor size may block the patient’s digestive tract

2. Anti-neoplastic (cancer) treatment

   2.1 Chemotherapy and radiotherapy most like result in side effects reducing quantity of food eaten such as nausea, vomiting, diarrhea, mucositis, and          changes to taste.

   2.2 Surgical treatment may result in changes to food consumption for example surgery on neck area may result in difficulty swallowing.

Symptoms

1. Muscle mass continuously decreased and/or fat tissue decreased (Obvious and important symptom indicating cancer cachexia)

2. Rapid weight loss

3. Loss of appetite

4. Prolonged nausea

5. Anemia

6. Asthenia (Weakness)

7. Depression

Note: Symptoms number 1 and 2 may not return to normal state only with nutritional replenishment.

Treatment

        Treatment of patients with cancer cachexia comprises of 3 methods below:

1. Treating the root cause which is cancer

2. Nutrition Care Process and Nutritional Support in cancer patient (Must consider as adjunctive treatment to other methods)

3. Pharmacotherapy intervention (Must consider as adjunctive treatment to other methods)

    1. Increasing appetite

       1.1 Progestational agent ex) Megestrol acetate

       1.2 Corticosteroids

       1.3 Cannabinoids

       1.4 Serotonin modulators

2.Cytokine inhibition

       2.1 Inhibition of synthesis or secretion of cytokine; Pentoxifylline, Thalidomide, Melatonin, Statins, ACE-inhibitors, Anti-COX2

       2.2 Proteosome inhibitor; EPA

Nausea and Vomiting from Chemotherapy

Nausea and vomiting are frequently found side-effects of patients who receive chemotherapy (90% if anti-emetic medication was not administered). Ineffective prevention of chemotherapy induced nausea and vomiting (CINV) will result in patients having severe and uncontrolled nausea and vomiting and ultimately lead to complications such as dehydration, electrolyte imbalances, perforation of digestive tract, aspiration pneumonia, anorexia, severe weight loss, and malnutrition.

        Uncontrolled nausea and vomiting also results in dramatic decrease in cancer patient’s quality of life and affects mental health causing anxiety and leads to denial of cancer disease treatment with chemotherapy.

Types of chemotherapy induced nausea and vomiting (CINV)

        Chemotherapy induced nausea and vomiting (CINV) can be classified from their onsets into 5 types:

1. Acute CINV is nausea and vomiting which occur within 24 hours after receiving chemotherapy

2. Delayed CINV is nausea and vomiting which occur after 24 hours until 120 hours of receiving chemotherapy

3. Anticipatory CINV is nausea and vomiting which occur before receiving chemotherapy because of patient’s anxiety in receiving treatment

4. Breakthrough CINV is nausea and vomiting which occur although the patient has received appropriate anti-emetic regimen

5. Refractory CINV is nausea and vomiting which occur from failure in using anti-emetic medication for Breakthrough CINV

Risk factor of chemotherapy induced nausea and vomiting (CINV) can be classified into 2 groups which are:

1. Emetogenicity of each chemotherapeutic agent

2. Patient-specific factor which causes high risk in chemotherapy induced nausea and vomiting

2.1 Patients with history of nausea and vomiting from previous chemotherapy administration

2.2 Patient not consuming alcohol

2.3 Patient who has Motion sickness

2.4 Woman and children

Nausea Treatment Vomiting from chemotherapy drugs

1. 5-HT₃ (Serotonin) receptor antagonist is most effective during the first 24 hours after receiving chemotherapy or acute CINV

2. Anti-dyspeptic drug such as metoclopramide is effective from day 2 to 3 after receiving chemotherapy

3. NK-1 receptor antagonist is effective for both acute and delayed CINV

4. Glucocorticoids is effective for both acute and delayed CINV

Oncology Center

Open daily from 08.00 - 17.00

Floor B1, Thonburi Bamrungmuang Hospital

Ask for more information 02 220 7999