Bilateral breast cancer (BBC) is a rare clinical entity. Only about 0.2 percent to 3 percent of all breast cancer cases occur in both breasts at the same time, which is referred to as synchronous bilateral breast cancer. One such case was seen at BGS Gleneagles Global Hospitals, where a young unmarried woman in her forties, came in for a second opinion.
Ramya (name changed), 43 years, felt a painless lump in the left breast. She had this checked out at a nearby hospital where they diagnosed it to be a non-cancerous lesion. Ramya continued to feel uneasy so she decided to go in for a second opinion. She went to BGS Gleneagles global Hospitals for a complete evaluation. Here, doctors first recommended a bilateral mammography which revealed multiple small lumps in the right breast too. Following this, she underwent an ultrasound scan guided biopsy of the lesion. Results indicated she had cancer in both the breasts.
Doctors decided a whole body PET CT scan was required next to check if the lumps in both sides were independent or whether they were a part of a metastatic process which was very crucial to decide the course of treatment and whether it can be curative or not. This scan confirmed that the cancer was limited to the lumps and the armpit on the right side.
Oncologists from all three divisions: Surgical, Medical and Radiation oncology came together to discuss the treatment plan in tumor board. It was then decided that the patient will undergo surgery wherein the lump in the left breast will be removed. Also, the right breast would be removed entirely but the doctors decided to go in for breast reconstruction to retain and preserve the physical appearance of the patient.
The lump that was removed in surgery was sent for a special investigation called ‘Frozen section’ pathology to see if margin of tissue removed with lump excision was adequate. This investigation helps the surgeon to do a successful lump excision with least local failure rates. Additionally, a dye was injected around the lump before its removal to precisely locate the lymph nodes that might be involved with this cancer in the axilla and only those lymph nodes were removed. This special surgical technique (sentinel lymph node biopsy) is done for patients with no axillary nodal involvement in scans to prevent long term side effects like arm edema (swelling) and loss of sensation in the arm.
These are some specific advancements that has happened in the past decade in the management of breast cancers to not only improve local tumor control, faster recovery with lesser complications and better cosmesis but also to reduce long term side effects.
After chemotherapy, she underwent 4 weeks of Radiotherapy. There are lots of challenges that are faced in the field of radiotherapy when treating both sides. Both the breasts (chest wall) should be irradiated with no union of the fields avoiding over or under dosing of the treated areas. The doses to heart and both lungs should be kept minimal.
With these intentions in mind, the patient was taken up for deep breath hold training for one week. The software detects her respiration in deep breath hold and 4D CT scan is done only in this phase. When the patient holds her breath in deep inhalation the lung balloons out between the chest wall (the area to be treated) and the heart. In short, the heart moves away from the treatment area. This simple technique helps the doctor to plan the treatment with least dose to the heart.The Gating software with the state of art treatment machine – “TrueBeam STx” linear accelerator keeps it simple and sophisticated by allowing treatment only if the patient holds the breath in the specified phase and automatically going off when it is not so.
“As seen in Ramya’s case, if you are diagnosed with breast cancer in one breast, insist that your doctors evaluate both sides, because there is a 3% chance of having cancer on both sides. The severity of tumours in each breast may vary and this will require a customized treatment plan. We try to give every lady an option to preserve her breasts and her femininity and so breast conservation procedures can make a huge difference to the patient. The aim is to cure cancer with care; not just add years to life but add ‘life’ to the added years.” said Dr Mathangi J, Senior Consultant &In Charge, Department of Radiation Oncology, BGS Gleneagles Global Hospitals, Bengaluru.
Today Ramya has been cancer and complication free for three years.