Breast¹ It is different types of fatty, fibrous, and glandular tissue. Inside the breast there are numerous small glands where breast milk is produced. The glands are connected to the lining of the breast by a delicate duct, this gland is called the mammary glands. Breast tissues and lymph glands are also present under the armpits.The lymph glands, which are part of the lymphatic system, extends to the rib cage and to the back of the collarbone. Physicians identify these lymph glands as nodes.

Body’s tissue is made up of tiny cells. During breast cancer, the breast cells grow uncontrollably and turn into a lump. These lumps are called tumors, and if malignant then these are detected as primary Cancer. Sometimes cancer cells can spread to other parts of the body through the blood or the lymphatic system, they are secondary cancer or metastasis. The treatment of breast cancer varies, depending on the nature of the cancer. Both men and women can get breast cancer. However, women are more likely to be infected with this disease.

1. The risk of breast cancer also increases with age
2. Family History
3. Previous history of breast cancer or any other tumour
4. Unusually large breast
5. Hormone therapy
6. Previous history of radiotherapy
7. Obesity
8. Excess drinking of alcohol

Click to know more about Breast Self Examination

●Cancer stage explains the extent of the size of the cancer, also the spread.
● Cancer grade refers to how fast the cancer can grow, the level of abnormality of the cells compared to healthy ones.

Receptor

Breast cells contain a variety of receptors that regulate the normal functioning of the breast by combining hormones and proteins, but sometimes these receptors become overly sensitive. As a result, excess hormones and proteins attach to the receptors and start abnormal cell division, which later leads to cancer.

Receptor-based classification

◆ Hormone receptor positive: (ER/ PR/ Both positive)
◆ HER2 receptor positive breast cancer
◆ Triple negative breast cancer ( ER, PR and HER2 - all of them are negative in these cases)

Treatment for breast cancer includes:

1. Surgery
2. Medicinal such as: Chemotherapy, hormonal therapy, targeted therapy
3 Radiotherapy

Physicians prescribe multiple treatment modalities according to the nature of the cancer. Such as surgery and then chemotherapy and / or radiotherapy or chemotherapy / radiotherapy before or after the operation

1. Surgery:¹

It is the first step in the treatment of primary breast cancer. Based on the shape and size of the tumor, the doctor surgically removes the tumor and some of the surrounding healthy tissue. Physicians usually operate in two ways

◆ Lumpectomy: Removal of part of breast where the cancer had spread along with some healthy tissues.
◆ Mastectomy- Removal of the whole breast.

During the operation, if there are cancer cells present in a lymph node, the surgeon usually removes it as well

The life of a cancer patient after surgery ⁶

The bad news of being diagnosed with breast cancer is hard for most patients and their relatives. At this time it is necessary to have a loved one with strong morale to help to cross the difficult path of a cancer treatment.

After initial psychological trauma, the first challenge a patient faces after the surgery is adapting to the new body shape. It is normal for a person to be mentally disturbed for a couple of months after a drastic change in their body, in particular, the signs and side effects of the surgery haunts her. During this time, along with psychological support, the patient needs some physical exercises and appropriate balanced food. To gain back physical recovery, none of the exercises that are needed are difficult to perform. Doing the following physical exercises regularly and correctly will help you to adapt to this new condition.

Rules on how to exercise⁷

1st week after the surgery
Practice some warm up and cool down exercises. This includes exercises number one and two

2nd week after the surgery
Practice the basic warm up and cool down exercises. The duration of the exercise is given as a guideline and you can exercise at your own pace.

◆ You can exercise from the day after the surgery
◆Take a 5 minute break in between each exercise
◆ Try to exercise three times a day, be it in the morning, at noon and in the afternoon.

If you have had breast surgery, talk to your doctor or physiotherapist before starting exercise. Do note that there might be slight pain during the first days of exercise. It is normal to feel some tension in the muscles but if you feel uncomfortable while exercising, do consult your doctor.

Warm up and cool down exercises

Alway begin and end with the first and 2nd exercises. These can be done by standing or you can sit and do them.

1

● First relax the whole body.
● Squeeze the shoulders and lift along the ears and return to normal position in the same way.

2

● First relax the whole body.
● Squeeze the shoulders, lift them along the ears towards the front and turn them down towards the back.

Basic exercises

These exercises, you can start doing them after one week of the surgery. You can do them while sitting down or even standing up. Always remember to start with warm up before doing these exercises. Also make sure during exercise you do not raise your arm over 90 degrees from the shoulders

3

● Lift both hands up and place them in front of the body.
● Fold the elbows and gently place the hands on the shoulders.
● Now slowly bring the elbow down and lift up

Another way to do so-
● Raise both hands up and extend to both sides.
●Fold the elbows and gently place the hands on the shoulders
● Now slowly bring the elbow down and lift up.

4

● Extend the arms in both directions and bend the elbows and take them down.

● Now join both hands below the shoulder bone.

5

● Place your hands behind your head and bring your elbows together in front of your face.
●With both hands in the same position, extend the elbows to both sides and bring them back to the previous position.

Some advanced exercises

6

● Stand straight by facing a wall.
● Place your palm against the wall, hands at shoulder level.
● While looking straight at the wall, gently lift your hands upwards.
● You can raise your hand using your fingers and try to lift it to the maximum height until you feel pain.
● After raising your hand, hold it there and count to 10.
● In the same way, slowly bring both hands to the previous position.
● Try to lift to the maximum height every time.

● Stand sideways against the wall, a little closer.
● Keep the shoulders normal and place the hands on the walls with the elbows down.
● Looking forward, gently lift the hand upwards and try to straighten the elbow.
● After lifting up, stay and hold that position and count to 10.
● Very slowly bring the hand back to its previous position.

7

● Lie on the floor or bed and put a cushion or pillow under your head to stay steady.
● Take three to four deep breaths after lying down.
● Keep the shoulders normal so that they do not bend under the ears.
● Make both hands into fists, keep the elbows straight and bring the hands above the head and keep lowering towards the back of the head until there is difficulty.
● Stand still and count to 10 then bring the hand to its previous position.

Alternative exercise
● If you have difficulty lying down or have difficulty breathing, you can do the exercises while sitting and leaning backwards.

8

● Lie on your back and place your hands behind your head and extend your elbows
● Now lower both elbows down along the floor until you feel any discomfort.
● After lowering, settle down and count upto 10. Patients who receive radiotherapy, for them this exercise is very helpful. Radiotherapy is given in this position.

See yourself in the mirror ⁶

It is normal to have difficulty adapting to the new shape of your body after surgery. Hence many psychologists forbid their patient to stand in front of the mirror right after the surgery. After two to three days, when the patient becomes somewhat accustomed to their body, then she should stand in front of the mirror. There is nothing to be afraid of after seeing the postoperative marks. Accepting this is the first step to win this war. If you are a patient, have someone near you who can give you the courage to fight this battle. If you are a relative of the patient, stay by her side so that you can provide support and courage to fight against cancer.

Talk to someone who has won the battle against breast cancer ⁶

There are some experiences that only the victims can comprehend. Talk to someone about the side effects of surgery and its subsequent treatment, and the ways they overcame that period. After surgery, patients often ask themselves why chemotherapy and radiotherapy are needed if the tumor is not present in the body.
There are about two reasons why chemotherapy and radiotherapy is needed after surgery. First, it is often not possible for a physician to completely remove the tumor. Second, the possibility of the cancer recurring. To make sure that the cancer does not come back to haunt the patient, physicians suggest one and/ or both of them.

2. Radiotherapy⁸

Radiotherapy destroys the cancer cells by the use of high-energy X-rays. In most cases radiotherapy is given after the operation area has dried up. Use of radiotherapy reduces the risk of the cancer coming back.

3. Chemotherapy⁹

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

4. Targeted therapy^17,18

In addition to chemotherapy and hormonal therapy, new and more effective treatments are targeted therapies that can destroy specific cells without damaging normal cells. It can also prevents the growth or rapid spread of cancer.
Sometimes targeted therapy works in areas where chemotherapy has failed to work. The side effects of targeted therapy are limited compared to chemotherapy. 1 in 5 women have a special protein ( HER2) positive in their breast cancer cells and such cancers are more aggressive than other cancers. Many types of targeted therapies are used to target such proteins. These include, trastuzumab, pertuzumab, trastuzumab emtansine, lapatinib, etc.

There may be some side effects due to cancer treatment. These side effects may vary from drug to drug, including:

● Feeling tired or sick
● Diarrhea or constipation
● Ulcers inside the mouth
● Hair loss
● Anemia
● Increased risk of infection
● Loss of appetite
● Increase in weight, or sudden weight loss
● Abnormal bleeding

All these side effects can be treated by certain medication prescribed by the doctors, usually they are gone once the treatment regime is finished. Cancer treatment does differ from the usual regular treatments of other diseases. Even when the treatment is over, patients need to keep on following up with their doctors. Physicians schedule this follow-up according to the patient's condition. Most specialists usually ask patients to do follow up once every three months for 2-3 years after treatment and 1-2 times in subsequent years. These follow up are important because the doctor monitors the patients and checks if the cancer has returned. ¹⁶

Although breast cancer is completely cured after surgery and subsequent treatment, the possibility of its reoccurrence cannot be ruled out. In many cases, the cancer may unknowingly spread to different parts of the body, including the brain, bones, liver and lungs. There are possibilities that the cancer has settled in the same place or can attack a healthy breast; in this case, if the nature of the cancer is a little aggressive, it can spread to the surrounding tissues, armpits and skin. Regular medical advice ensures timely diagnosis and treatment which in turn increases the chances of survival.

The main barrier to cancer treatment is anxiety, fear and panic. Repeated visits to the hospital during or after the treatment and at the same time continuing the treatment is a cause of anxiety or fear in many. The thought of the process of treatment and how long this will continue, gives rise to many uncertainties about life between the patient and their relatives. These anxieties disrupt normal daily life which may delay the recovery of the patient, it also affects their sleep and eating habits. So the role of a psychologist or psychiatrist can help to keep this anxiety, fear and panic away from you ( the patient). Your doctor may advise you about counselling during this period of life, to help you get along and help you become mentally more stronger to fight this disease.

Depression is considered to be the most neglected symptom of cancer treatment. In fact, it is difficult for a patient and her/ his family to accept that cancer is in their life. Therefore, after being diagnosed with cancer, depression can overwhelm the patient during the treatment and even after the treatment is over. One might wonder the question over and over again,” why me?”. Depression is often underestimated and neglected by the risk of cancer diagnosis and treatment. However, many doctors take it seriously and treat depression along with cancer. If you are frustrated and indifferent about life, and the company of people, even close ones, seems unbearable then it can be assumed you are suffering from depression. Talk to your doctor about your worries or you can even seek a psychologist’s advice yourself. Remember, the patient's strong mental strength is essential to get the full results of the treatment. Without increasing your worries and sadness, consult an expert so that your chances of success in cancer treatment increases and you can find a better way to deal with your situation.

● Help yourself

It is normal to get sick, and you have no control over it. Therefore, it is not wise to blame oneself for this. Rather, it increases the likelihood of depression. Try to do the things you like and enjoy life. Believe in yourself. History has shown that people who are confident in themselves have won against all obstacles over and over again.

● Think of each day as a brand new day

Set small goals and try to achieve them gradually. Don't worry too much about the future. Set goals such as - ‘I’ll talk to my old friend on the phone’ or ‘I’ll walk around the house for a while’. This can be a significant achievement for those who are depressed or anxious. You may not feel the change overnight but you will find it much better over time.

● Exercise

Exercise increases the levels of a chemical in the body called endorphins, which helps to feel better and happy. So regular exercise keeps both body and mind cheerful. Exercise according to your physical ability and at the same time take care not to put extra pressure on the body. You can start with light physical exercises such as simple yoga exercises or some time walking.

● Having a balanced diet

Eating a balanced diet is an important part of cancer treatment. Balanced and moderate diet will increase your physical strength which will help in overcoming depression as well as coping with the stress of chemotherapy and radiotherapy.

● Recreation techniques

In some cases, recreation is considered a complementary treatment for depression. Recreation techniques such as meditation, hypnotherapy, massage can help you overcome depression.

● Talking to others

Do not be afraid to talk to your close ones. Although it is not easy for everyone to find the right person to express their thoughts easily. Expressing your thoughts or worries to someone else will surprisingly make you feel better which will indirectly reduce your anxiety and depression.

● Information will give you strength

A good book or writing will help you to understand your thoughts or feelings, as well as make you brave and it might remove the fears and help you move forward. Many books or magazine articles about the life of a cancer patient are very readily available on the internet. Take a moment to read or take a look at the lives of the brave people who have fought this war with courage. It can relieve you of anxiety or worry. Also, make sure that no wrong or partial information comes to you. Seek the help of your doctor if necessary.

● Insomnia

We all know how a sleepless night makes a person tired, irritable and exhausted. In the case of a patient, depression can have a significant effect on their sleep. Tell your doctor if you have frequent sleep disturbances. Following below tips can help you overcome insomnia.
1. Try to go to bed and wake up at the same time every day.
2. Do some light exercise every day
3. Avoid frequent sleeping habits during the day, it will help you sleep longer and deeper at night.
4. Avoid caffeine (tea, coffee, chocolate) during and after evening
4. Having a light meal before bed reduces the chances of falling asleep due to hunger.
6. Listen to soft music before going to bed or read a light book while lying in bed.
7. Try to sleep in a quiet environment and at a normal temperature.

If you can't sleep at all, get up and watch TV, listen to music or read something until you fall asleep and try to sleep again later.

● Learn to live with cancer

It is wise to accept reality. Just as life cannot be run by ignoring cancer, it cannot be removed by fear of it all the time. The best way is to adapt to it. Take your medication regularly, follow your doctor's advice, and move on to eliminating anxiety and fear. Try to enjoy life as much as possible.

● The return of cancer

No recognized medical system in the world can guarantee that cancer will never return to a patient's life. Therefore, the treatment should be continued with the idea that the cancer may come back. Physicians try to keep you disease free as long as possible and take immediate medical action by identifying the recurrence of the disease at an early stage.

Side effects of medications and therapies during and after cancer treatment are very common, often affecting the patient's appetite, hunger or food menu. At the same time, the routine or amount of food may vary due to mental anxiety or fear.
Usually the patient can start eating normally after a few days of surgery. A balanced diet is very effective in restoring the body's energy at this time.
The most common side effects of cancer treatment have been seen since starting chemotherapy. So it is very important to determine the right food at this time. Since it is very difficult to predict exactly what kind of side effects chemotherapy will cause or how the body will receive this treatment, what kind of food to eat depends on the patient's physical condition. In this case, it is better to take the advice of a nutritionist. There are normal rules of eating which are effective in almost all cases.
Example-

● Eat small meals 5-6 times a day instead of 3 meals a day.
● If you have difficulty eating solid foods, you can eat liquid foods such as soups, juices, milkshakes. In the case of diabetic patients, the amount of sugar in the drink should be kept in mind before taking it.
● Definitely drink more water. A normal person should drink 6-8 glasses of water daily. So try to increase the amount of water because it can help remove toxins from the body. However, the doctor can determine the amount of water according to the type of cancer.
● Eat plenty of fresh fruits and vegetables.
● It is best not to drink too much fluids during or before meals as this may reduce your appetite.
● Depending on the type of breast cancer, the patient is often treated with steroids. In this case, weight gain may occur as a side effect. For this, the infected person has to follow some normal rules. In that case, try to eat low fat food and intake appropriate drinks.
● Measure your blood sugar regularly and try to control high sugar foods such as rice, sugar, sweets.

Chemotherapy can cause short-term sores on the face that can cause more discomfort during meals. The following things can be done to get rid of it:

● Choose a soft toothbrush to brush your teeth and floss very slowly.
● Liquid foods such as soups, juices, milkshakes are quite effective in this condition.
● Suck on an ice or sugar cube, ice cream, which may feel good.
● Use a straw to take liquid food.
● It is better to avoid chips, salty foods, spicy and extra hot foods at this time

The weight of the affected person may increase or decrease abnormally after the cancer treatment is over. Again maintaining the desired weight often becomes challenging. Seek the help of a nutritionist or your doctor without getting frustrated or upset.

Hair loss is one of the most discussed side effects of chemotherapy. Hair loss begins within 2-3 weeks of starting chemotherapy. Sometimes it can be very slow or abrupt. The first thing to do in this situation is to accept it. Remember it is a temporary event and a temporary sacrifice for a great outcome. It can be very annoying for you despite knowing that. However, it is possible to reduce the amount of damage by taking some measures. Thing you can do at this time:

● It is best not to wash your hair within 48 hours of chemotherapy
● Use unscented and mild shampoos and conditioners
● It is better to avoid hot water at this time
● Dry hair normally, avoid rubbing with a towel
● Comb hair with wide toothed comb
● Avoid braiding that can damage your hair
● It is better to use elastic bands to tie long hair
● Dye, hair spray, iron or any other chemical or any special treatment can be harmful for hair, hence avoid them.

Remember to protect your scalp from the sun. Cover your head when going out of the house as the scalp is very sensitive. Cover your head even if there is a possibility of losing a lot of heat from the head due to extra cold weather. If your scalp is dry, you can use a moisturizer or natural oil, such as almond or olive oil. Some people use aromatherapy oils, but it is better to consult a doctor.

You can cover your head with a wig, muffler, hat or other cloth. Choose something that suits the weather, your religion or society, so you don't feel uncomfortable using it. Always think about your comfort, you can wear any of these during special occasions or when you go out. However, if you wish to cover your head in the house, wear a soft comfortable cap.

After completing cancer treatment Congratulations on completing your cancer treatment. It’s time for you to rejoice. Yet at the same time you can be sad and worried about certain things. It is normal to be tensed about whether the cancer will come back and what to do after treatment. Once the cancer treatment is over, you can expect to return to your former life. It may take time to recover. You may have permanent scars on your body or many things may not be as easy as before. Going in public because of spots or hair often causes discomfort. You may wonder- What will people think? Or am I not like before? Such thoughts can stop your daily life. The easiest way to get rid of this condition is to increase self-confidence. Remember that when a patient crosses a difficult path in life she/he needs infinite courage, determination and unyielding mentality. So don’t think of yourself as small. Get out of the corner of the room and face reality with a smile on your face.
We wish you all the best for the future.