Once the diagnosis has been made, it is decided which is the most appropriate treatment, which can be a combination of several of them: surgery, chemotherapy, radiotherapy, hormone therapy and / or others. The patient must make a first visit to the Oncology Service to find out, and other analytical and radiological tests may be necessary in order to finally decide the optimal one.
Surgical treatment
Surgical treatment
Surgical treatment can be performed with admission or on an outpatient basis, depending on the type of surgery and the woman's state of health.
Type
- Conservative surgery: consists of the removal of the tumor preserving the breast. This treatment is indicated in 70-80% of cases. If the tumor is not palpable, it will be necessary to perform a pre-intervention marking, which will be done at the Radiology Service of the UDIAT). If possible, hidden scars (periareolar, inframammary groove, axillary line) or oncoplastic surgery are performed.
- Mastectomy: consists of the total extraction of the breast. Sometimes a reconstruction can be performed at the same time (see section 'Reconstructive Surgery')
- Armpit surgery: consists of the removal of the sentinel node or all nodes. The sentinel node is the first drainage ganglion in the tumor and in order to be able to locate it, a radiopharmaceutical is injected at the tumor level at the UDIAT Radiology Service the day before the operation. The process can take 3 to 6 hours, as there is a waiting period between the administration of the drug and the radioimaging test. The patient must fast.
In cases of mastectomy or removal of all lymph nodes, drains are left that patients will have to wear for a few days and will be monitored by the Home Hospitalization Unit.
Information prior to the intervention
See the recommendations prior to surgery as well as the circuit of a no-entry intervention in the space of the Anesthesiology Service.
Information for after the intervention
- Medication
To control the pain of the wound, painkillers are prescribed. These can be in continuous doses or at 4-hour intervals. The usual treatment of the patient will be assessed at the Anesthesiology Service, and it will be decided how it should be taken during admission. Sometimes you also need to take antibiotics.
- cures
Upon leaving the operating room the patient will wear a dressing that will heal the next day; then you need to put on a cotton bra without hoops. Depending on the type of intervention, it may be necessary to place drains.
- Breast prostheses
A temporary post-surgical prosthesis is given to the plant, and when it is discharged, a prescription is given for the silicone prosthesis.
Discharge nursing tips after a breast surgery [CAT🇧🇷ES]
In the case of a outpatient surgery, the patient and her relatives can attend a health education visit. The operation is performed at the Outpatient Surgical Center (CQA) or at the Hospital de Sabadell (Taulí building), and discharge is given on the day of the operation.
Reconstructive surgery
Parc Taulí has a Plastic and Reconstructive Surgery Unit. The care team assesses each case, and performs the reconstruction immediately or deferred, as appropriate.
Medical treatment
Medical treatment
There are several types of medical treatments:
Chemotherapy
The set of drugs or chemicals used to slow the progression of malignant cells is what is known as chemotherapy or antineoplastic drugs. With their administration, these substances are introduced into our body to destroy these cells or stop their uncontrolled multiplication. Because, in most cases, they also affect healthy cells as it is generally targeted at those that divide more quickly, what we know as side effects appear. The combination of drugs used or the type of treatment will depend on the type of cancer and the stage in which the disease is, but also on the patient's state of health, their underlying pathologies that could contraindicate some drugs, as well as the response of the tumor to previous treatments.
Chemotherapy is prescribed in the form of cycles with a variable frequency, depending on the drugs administered. It can also vary in the way it is administered, the intravenous and oral being the most common.
Based on the diagnosis and study of each specific case, specialized medical professionals recommend to each patient the need or not to receive treatment with chemotherapy, as well as the type of drug to be administered, how to do it and the duration of treatment.
Chemotherapy is administered at the Oncology Day Hospital (new Taulí Building, 2nd floor, waiting room 2A)
Other treatments
Hormone treatment
Hormone treatment is used in those patients diagnosed with hormone-sensitive breast cancer, ie malignant cells have receptors that bind to estrogen or progesterone and stimulate cell division. tumor growth.
Hormones are chemicals that secrete certain glands, circulate in the bloodstream, and regulate the activity of other cells. Estrogen and progesterone are hormones that are produced primarily in the ovaries. They regulate functions such as menstruation, pregnancy or breast milk production, but they are also involved in the functioning of the cardiovascular system, bones and other tissues.
Hormone treatment in breast cancer can act by nullifying or slowing the body's ability to produce estrogen and / or progesterone, or by preventing hormones from binding to its receptors on malignant cells and stimulating their division. and proliferation. Like any drug, you also need to know the side effects that come from using it.
The type of treatment and its duration will vary depending on whether the patient is pre or post menopausal, and the stage of the disease. The oncologist will provide the information, and will recommend the hormonal treatment that he considers most appropriate for each patient so that he can make the most appropriate decision based on the proposed options.
Targeted therapies
As a result of advances in the knowledge of tumors and the molecular alterations involved in their development, growth and dissemination, drugs called targeted therapies acting on a specific molecular structure, a specific site involved in the development of cancer. They have a mainly cytostatic action, that is, they stop or delay the growth of cancer cells, and prevent their spread to other tissues. Some examples would be monoclonal antibodies or kinase inhibitors, and may be prescribed alone or in combination with chemotherapy or hormone therapy.
Much of current research is focused on designing and developing new targeted therapies. Some of them have already been approved by health agencies, but many others are in the research phase, and are only available for the treatment of cancer patients through participation in clinical trials.
The oncologist will determine if it is possible to incorporate biological therapy into the treatment of each patient and what type of therapy is most appropriate.
Resources of interest
Patient's manual for chemotherapy treatment. Parc Taulí Oncology Service.
Updated treatment guide. Spanish Society of Medical Oncology (SEOM).
Radiotherapy
Radiotherapy
Radiation therapy lasts approximately 3 to 5 weeks and is performed atTerrassa Hospital.
At the first visit you will be informed of the number of sessions required and a marking of the area to be irradiated will be made. The Terrassa Hospital will also explain the necessary care during the treatment.
Rehabilitation
Rehabilitation
There will be a follow-up by the referent of the Physical Medicine and Rehabilitation Service.
Axillary post-lymphadenectomy rehabilitation exercises
After the operation she has undergone (axillary lymphadenectomy) she may notice that, when mobilizing the affected arm, both the chest area, the armpit and the shoulder are stiff and sore; you may also notice alterations in sensitivity.
The following video is designed to make it easier to practice the exercises at home.
Guide to perform post-lymphadenectomy rehabilitation rehabilitation exercises. [Spanish]. Physical Medicine and Rehabilitation Service of Parc Taulí.
Rehabilitation exercises and prevention of lymphedema
After surgery and / or radiation therapy in a breast cancer patient, movement restrictions, impaired sensitivity, pain, loss of shoulder strength, and concomitant areas may occur. In treatments in which the lymph nodes are removed and / or irradiated, there is an increased risk of suffering from lymphoedema.
With the intention of preventing and rehabilitating these possible complications, we recommend the practice of the following physical exercise program:
More information: Guide to lymphoedema rehabilitation and prevention exercises. Physical Medicine and Rehabilitation Service. [Catalan] - [Spanish]
