Breast Cancer Treatment At CLIS Beirut
About Breast Cancer
When breast tissue divides and grows at an abnormal rate, a mass of extra tissue can develop into a tumor. To continue growing, a tumor generates its own blood supply to provide oxygen and nutrients. Although the cancerous cells can grow in size in the breast, they can also travel throughout a person’s blood stream and become embedded in other organs, a process known as metastasis. Typically, 20 percent of breast cancer develops in the lobules where milk is produced, while 80 percent originates in the mammary ducts that carry milk from the lobules to the nipple.
As vascular experts, interventional radiologists are uniquely skilled in using the vascular system to deliver targeted treatments via catheter throughout the body. In treating cancer patients, Dr. Abbas Chamsuddin can attack the cancer tumor from inside the body without medicating or affecting other parts of the body. For breast cancer, Dr. Abbas Chamsuddin use thermal ablation, as well as some laser therapy, to kill the cancer cells. Although the devices used are FDA approved, research to evaluate the long-term effects of these treatments is ongoing.
- Women 50 years of age and older account for approximately 80 percent of all breast cancers.
- Between age 40 and 50 the incidence of breast cancer doubles, and by age 70 it doubles again.
- African Americans have the highest death rate from breast cancer compared to any other racial group.
- Breast cancer is the most common cancer among women.
- the breast is the leading cancer site and is second only to lung cancer in deaths.
Patients with invasive breast cancer are at risk for liver cancer. The liver serves as a way-station for cancer cells that circulate through the bloodstream. These cells may grow and form tumors in the liver. It is estimated that as many as 70 percent of all people with uncontrolled cancer will eventually develop secondary liver tumors, or metastases (tumors formed by primary cancer cells that have spread from other cancer sites). AT CLIS Beirut Dr. Abbas Chamsuddin offers nonsurgical treatments for liver cancer, including embolization to cut off the blood supply to the tumor, radioembolization that delivers radiation directly inside the tumor, and chemoembolization, which delivers the cancer drug directly into the tumor and then cuts off the blood supply.
Breast Cancer Diagnosis
There are a number of tests that can help in the diagnosis of cancer, including blood tests, physical examination and a variety of imaging techniques including X-rays (e.g., chest X-rays and mammograms); computed tomography (CT); magnetic resonance (MR) and ultrasound. Usually, however, the final diagnosis cannot be made until a biopsy is performed. In a biopsy, a sample of tissue from the tumor or other abnormality is obtained and examined by a pathologist. By examining the biopsy sample, pathologists and other experts also can determine what kind of cancer is present and whether it is likely to be fast or slow growing. This information is important in deciding the best type of treatment. Open surgery is sometimes performed to obtain a tissue sample for biopsy. But in most cases, tissue samples can be obtained without open surgery with interventional radiology techniques.
Large core needle biopsy
In this technique, a special needle is used that enables the radiologist to obtain a larger biopsy sample. This technique is often used to obtain tissue samples from lumps or other abnormalities in the breast that are detected by physical examination or on mammograms or other imaging scans. Because approximately 80 percent of all breast abnormalities turn out not to be cancer, this technique is often preferred by women and their physicians because it:
- is less painful and requires less recovery time than open surgical biopsy,
- avoids the scarring and disfigurement that may result from open surgery.
A similar technique called fine needle aspiration can be used to withdraw cells from a suspected cancer. It also can diagnose fluids that have collected in the body. Sometimes, these fluid collections also may be drained through a catheter, such as when pockets of infection are diagnosed.
Many interventional radiology procedures for the diagnosis and treatment of cancer can be performed on an outpatient basis or during a short hospital stay. In many cases, the procedures:
- offer new cancer treatment options
- are less painful and debilitating for patients
- result in quicker recoveries
- have fewer side effects and complications
For cancerous tumors, radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing the healthy breast tissue. Because of the localized nature of this treatment, RFA does not have any systemic side effects. Radiofrequency ablation can be performed without affecting the patient’s overall health and most people can resume their usual activities in a few days.
In this procedure, Dr. Abbas Chamsuddin uses imaging to guide a small needle through the skin into the tumor. From the tip of the needle, radiofrequency energy is transmitted into the target tissue, where it produces heat and kills the tumor. Most patients experienced mild to moderate discomfort during the 15 minute RFA time. Following the RFA, the dead tumor tissue shrinks and slowly forms an internal scar. Because there is no surgical incision, RFA barely affects the appearance of the breast.
Depending on the size of the tumor, RFA can shrink or kill the tumor, extending the patient’s survival time and greatly improving their quality of life while living with cancer. RFA can extend patients’ lives or in a small number of cases cure patients.
Because it is a local treatment that does not harm healthy tissue, the treatment can be repeated as often as needed to keep patients comfortable. RFA is a very safe procedure, with few complications. It is effective for small to medium-sized tumors, and emerging new technologies should allow the treatment of larger cancers in the future. One study showed 100 percent tumor cell death using RFA, with no complications after the procedure. 10 RFA is often reimbursed by insurance carriers.
Currently, the protocol is to “ablate and resect,” in other words, to kill the tumor with heat and then remove the dead cells to ensure all the cancer cells were destroyed. As research progresses, the treatment pattern will become “ablate and follow”-simply treat the patient with RFA and track their progress over the following years.
For some women, surgery is not an option, due to other health concerns. For these patients, RFA is an excellent treatment option. In one study of postmenopausal women 60 years of age and older, 95 percent of women would be willing to have RFA again and 95 percent would be willing to have RFA without definitive surgery if it was known that RFA could kill their entire tumor.
Although the use of RFA in other organs, especially in the liver, has shown promising results for killing cancer cells, the technique is not a mainstream treatment option for breast cancer patients. Current research is underway to further explore this treatment and the long-term effects on the disease and patients.
- Has low complication rates
- May be performed under conscious sedation or general anesthesia
- Is well tolerated. Most patients can resume their normal routines the next day and may feel tired only for a few days.
- Can be repeated if necessary
- May be combined with other treatment options
- Can relieve pain and suffering for many cancer patients
- Causes minimal postprocedure pain
Cryoablation is similar to RFA in that the energy is delivered directly into the tumor by a probe that is inserted through the skin. But rather than killing the tumor with heat, cryoablation uses an extremely cold gas to freeze it. This technique has been used for many years by surgeons in the operating room, but in the last few years, the needles have become small enough to be used by interventional radiologists through a small nick in the skin, without the need for an operation. The “ice ball” that is created around the needle grows in size and destroys the frozen tumor cells.
Laser therapy causes cell death through the delivery of laser energy by a fiberoptic probe that is inserted into the tumor using imaging for guidance. During the procedure, local anesthesia is applied around the tumor, followed by the insertion of four metal markers. Next, using imaging for guidance, an interventional radiologists inserts a laser needle into the center of the tumor through a small nick in the skin, followed by the insertion of a multisensor thermal needle through another site. The laser needle is then replaced with an optic fiber through which the energy is transmitted into the tumor. It is an outpatient procedure.
The current research is promising, with one study finding that complete tumor necrosis (death) was achieved in 66 percent of the tumors treated10 and another study showing 93 and 100 percent tumor death in two groups, with no adverse effects.
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