Modern Breast Cancer Care
Modern breast cancer care requires the skills of different professionals and varied patient care according to the stage of the disease when diagnosed. Finland has a high level of expertise in breast cancer care, and treatment results are among the best in the world.
All abnormal symptoms in breasts are worth examining.
- All lumps
- Retraction of breast skin
- Blood leakage from a nipple
- Breast inflammation (mastitis) in women who are not pregnant
All these symptoms should be examined by mammography and ultrasound. A needle biopsy should be taken from every suspicious change in breast tissue. A biopsy can be taken with a true cut or with vacuum aspiration, guided by ultrasound, MRI or stereotacticly with mammogram.
In diagnostics, the histological analysis of the needle biopsy is important as it affects the surgeon's operation plan. It is imperative to define the size and the location of the breast tumour as the operation plan depends on these factors. The examination of the healthy breast is also carried out. An MRI examination is needed when tumour size and location are unclear, for example in a lobular type of breast cancer, which presents itself poorly in a mammography.
Breast Cancer Surgery
Breast conserving surgery or mastectomy? It depends on the stage of the disease.
With oncoplastic techniques we can perform more breast-conserving surgery. In 2017, in the Savonlinna district 75% of the breast cancer procedures were performed with a breast conserving technique.
By reducing and reshaping large breasts it is possible to successfully operate on relatively big tumours. The surgical radicality (clear margins around the tumour) is assessed by radiological and pathological examination after the operation.
A breast removal (mastectomy) is necessary, when a tumour in the breast is very large in proportion to the breast size or it is multilocular. Carriers of the breast cancer gene defect will also go through mastectomy.
In mastectomy cases it is possible to spare the skin of the breast area and add an expander prothesis below the pectoral muscle. By filling the expander, the size of the breast can be restored while in cancer treatment. Depending on the size and location of the tumour, the nipple can be spared. The final breast reconstruction will be done after the patient has recovered from her disease. In selected cases it is possible to perform an immediate breast reconstruction during the mastectomy.
Axillary status is established by sentinel node examination
Lymph fluid drains from the breast tumour area to the axilla (armpit). The first lymph nodes in the lymph vessels are called sentinel nodes. They are marked with isotope mapping by injecting technetium isotope into the breast tissues before the operation. The isotope is then detected during the operation using a gamma detector.
The sentinel nodes are removed during the operation. When needed, they are sent to a pathologist for a frozen section analysis. If the sentinel nodes are healthy, axillary lymph node dissection is not needed.
The evacuation of the armpit lymph nodes is done if the disease is found in the sentinel nodes. Prior to the operation, suspected lymph nodes are examined by ultrasound and fine needle biopsy. If metastasis are found, the evacuation is performed.
Postoperative patient care
Following breast cancer surgery most people go home on the second day after the operation. Most often patients go home with a drain from the operation area. The drains are removed after their outputs are under 50 ml per day. The stitches are removed 8 days after the operation.
Blood leakage after the operation is possible, but a rare complication. Most often it happens during the first postoperative day, in which case a new operation (hematoma evacuation) is needed. Treating this kind of complication is included in the price of the operation.
Infection complications are very rare. The treatment of infections in the operation area within a week from surgery is included in the price of the operation.
After surgical care a pathological analysis of all tissue sections is performed, and the final evaluation of the state of the disease is given.
The type and size of the tumour; the aggressiveness (gradus); cell invasion in neighboring tissue like small vessels, lymph ducts or nerves; immuno-histological receptor status (estrogen-, progesteron-, herseptin) and cell proliferation activity (Ki67) define the oncological after care.
After this, an oncologist plans so-called adjuvant care: possible cytostatic therapy, antioestrogen therapy and radiotherapy of the breast depending on the stage of the disease. All patients who undergo a breast conserving surgery in Savonlinna receive radiotherapy.
Patients from abroad can be treated in Savonlinna or they can return home for after care.