Symptoms of breast cancer:

Most people will not experience any symptoms when the cancer is still early hence the importance of early detection. Symptoms of breast cancer can include:

• • Breast lump or thickening, often without pain. 
  • Change in size, shape or appearance of the breast.
  • Dimpling, redness, pitting or other changes in the skin.
  • Change in nipple appearance or the skin surrounding the nipple (areola). 
  • Abnormal or bloody discharge from the nipple.
  • Breast pain that doesn’t go away after your next period.
  • Peeling, scaling, crusting or ulcerating of the skin on the breast.

Risk factors:

Factors that may increase the risk of breast cancer include:

• • A family history of breast cancer. If a parent, sibling or child had breast cancer, your risk of breast cancer is increased. The risk is higher if your family has a history of getting breast cancer at a young age.
  • A personal history of breast cancer. If you've had cancer in one breast, you have an increased risk of getting cancer in the other breast.

o    Beginning your periods before you were 12, or went through the menopause after you turned 55

o    Have not given birth, or gave birth for the first time after 30

o    Did not breastfeed your children

• • Being female. Women are much more likely than men are to get breast cancer. Everyone is born with some breast tissue, so anyone can get breast cancer.
  • Dense breast tissue. Breast tissue is made up of fatty tissue and dense tissue.
  • Drinking alcohol. Drinking alcohol increases the risk of breast cancer.
  • Increasing age. The risk of breast cancer goes up as you get older, especially above 50.
  • Inherited genetic mutations that increase cancer risk. The most well-known changes are called BRCA1 and BRCA2.
  • Menopausal hormone therapy. Taking certain hormone therapy medicines to control the symptoms of menopause may increase the risk of breast cancer.
  • Obesity. People with obesity have an increased risk of breast cancer.
  • Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is higher.

Diagnosis:

Breast cancer diagnosis often begins with an exam and a discussion of your symptoms. Imaging tests can look at the breast tissue for anything that's not typical. To confirm whether there is cancer or not, a sample of tissue is taken as a biopsy from the breast for pathological testing.

Staging breast cancer

Once your healthcare team diagnoses your breast cancer, you may have other tests to figure out the extent of the cancer. This is called the cancer's stage.

Tests and procedures used to stage breast cancer may include:

• • Blood tests, such as a tumor markers, complete blood count and tests to show how well the kidneys and liver are working.
  • Bone scan.
  • CT scan.
  • MRI.
  • Positron emission tomography scan, also called a PET scan.

Not everyone needs all of these tests. Your healthcare team picks the right tests based on your specific situation.

Treatment:

Treatment for breast cancer depends on the subtype of cancer and how much it has spread outside of the breast to lymph nodes or to other parts of the body.

Breast cancer treatment often starts with surgery to remove the cancer. Most people with breast cancer will have other treatments after surgery, such as radiation, chemotherapy and hormone therapy. Some people may have chemotherapy or hormone therapy before surgery. These medicines can help shrink cancer and make it easier to remove.

Doctors combine treatments to minimize the chances of the cancer coming back (recurrence). These include:

• • Surgery to remove the breast tumor.
  • Radiation therapy to reduce recurrence risk in the breast and surrounding tissues.
  • Medications to kill cancer cells and prevent spread, including hormonal therapies, chemotherapy or targeted biological therapies.

Treatments for breast cancer are more effective and are better tolerated when started early and taken to completion. 

Surgery

Breast cancer surgery typically involves a procedure to remove the breast cancer and a procedure to remove some nearby lymph nodes. Operations used to treat breast cancer include:

• • Lumpectomy: lumpectomy is surgery to remove the breast cancer and some of the healthy tissue around it.  Other names for this surgery are breast-conserving surgery and wide local excision. Most people who have a lumpectomy also have radiation therapy. This procedure may be appropriate for early breast cancer cases where the tumor is still small.
  • Mastectomy: In a typical mastectomy surgery, the tumor and the entire breast are removed. There are several different types of mastectomies, including procedures that spare the breast’s skin and nipple/areola. Often a mastectomy and breast reconstruction can be performed in the same procedure.
  • Removing both breasts: In some cases, both breasts are removed (double mastectomy). This can help prevent the development of new breast cancer. It is typically done for patients who have an elevated risk of developing breast cancer due to family history or their own genetic profile, such as a BRCA mutation.
  • Removing lymph nodes: In both lumpectomies and mastectomies, surgeons may also remove nearby lymph nodes. Breast cancer can spread through nearby lymph nodes. Doctors will study the ones that are removed to determine if there are cancer cells within the nodes.

Radiation therapy

For breast cancer treatment, the radiation is often external beam radiation. During this type of radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

Radiation therapy is often used after surgery. It can kill any cancer cells that might be left after surgery. The radiation lowers the risk of the cancer coming back.

In metastatic breast cancer cases, radiation therapy can also be used as a palliative treatment to reduce symptoms caused by cancer spreading to other parts of the body and improve the patient’s quality of life.

Chemotherapy

Chemotherapy uses powerful drugs to directly kill cancer cells, control their growth or relieve pain.

Treatment often involves a combination of chemotherapy medicines.

You may have chemotherapy for breast cancer:

o    before surgery to help make the cancer smaller

o    after surgery if the cancer has spread to your lymph nodes or is growing quickly

o    if you have advanced breast cancer to help make the cancer smaller and control your symptoms.

Chemotherapy side effects depend on which medicines you receive. Common side effects include hair loss, nausea, vomiting, feeling very tired and having an increased risk of getting an infection.

Hormone therapy

Some breast cancers are affected by different hormones in the body, which can make them grow faster. Healthcare professionals call these cancers estrogen receptor positive and progesterone receptor positive.

Hormone therapy uses medicines to either:

o    lower the amount of certain hormones in the body

o    block certain hormones from getting to breast cancer cells

Hormone therapy may be used:

o    before surgery to help make the cancer smaller

o    after surgery to lower the chance of the cancer coming back

o    if you have advanced breast cancer to help control your symptoms

Targeted therapy

Cancer cells rely on specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies stop or slow the growth of cancer by interfering with, or targeting, these molecules or the genes that produce them.

The most common targeted therapy medicines for breast cancer target the protein HER2. Patients with HER2-positive breast cancer receive a different set of targeted therapy drugs both before and after surgery.

Immunotherapy

Immunotherapy is a treatment with medicine that helps the body's immune system to kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy might be an option for treating triple-negative breast cancer. Triple-negative breast cancer means that the cancer cells don't have receptors for estrogen, progesterone or HER2.

Palliative care

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals provides palliative care. The team can include doctors, nurses and other specially trained professionals. Their goal is to improve quality of life for you and your family.

Palliative care specialists work with you, your family and your care team to help you feel better. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

Breast cancer care at Shefa-El orman:

People with breast cancer who seek care at shefa-Elorman will find dedicated breast cancer specialists who provide expert, personalized care using the latest treatment innovations and technology. Shefa-Elorman hospital offers a truly integrated practice, with a variety of specialists regularly working together and meeting to discuss cases. This ensures that you receive whole-person care that takes into account all of your needs.

Your breast cancer care team might include: Breast cancer surgeons, Medical oncologists, Pathologist, Physical therapists, Plastic surgeons, psychologist, Radiation oncologists and Radiologists.

The specialist care team looking after you will:

o    explain the treatments, benefits and side effects

o    work with you to create a treatment plan that is best for you

o    talk to you about how treatment may affect you, for instance if there are any side effects

If you have any symptoms or side effects that you are worried about, talk to your specialists. You do not need to wait for your next visit.

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1-      Diagnosis:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • biochemical blood test
  • inflammation markers (CRP, ESR)
  • blood coagulation analysis (aPTT, PT, INR)
  • tumor markers (CEA, CA 15-3)
• mammology examination (if indicated clinically):
  • breasts ultrasound
  • mammography
• ultrasound of pelvic organs and abdomen (if indicated clinically)
• MRI of the breasts (if indicated clinically)
• GUIDED biopsy with histological study (if indicated clinically), with essential immunology, HER2 status, estrogen and progesterone receptors analysis (ER, PR).
• nursing services
• consultation of related specialists (intervention radiology for biopsy).
• treatment by chief physician and all leading experts
• explanation of individual treatment plan.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: On request

Type of program: Outpatient

Expected duration of the program: 5 days

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2- chemotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• physical examination
• laboratory tests:
  • complete blood count
  • biochemical analysis of blood
  • tumor markers
  • inflammation indicators
  • indicators of blood coagulation
• mammology examination (if indicated clinically):
  • breasts ultrasound
  • mammography
• ultrasound of pelvic organs and abdomen (if indicated clinically)
• MRI of the breasts (if indicated clinically)
• MRI/CT scan for staging (if indicated clinically)
• histological study (if indicated clinically), with essential immunology, HER2 status, estrogen and progesterone receptors analysis (ER, PR).
• consultations of related specialists
• 1 course of chemotherapy 
• nursing services
• explanation of individual treatment plan

How program is carried out

• During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function, ultrasound scan. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).
• Chemotherapy is carried out as a daily hospital procedure, without mandatory admission to the hospital. Before starting the chemotherapy session full detailed instructions regarding chemotherapy side effects and treatment explained to you. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.
• After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. If your general condition is good, your doctor will allow you to leave the hospital. You will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Outpatient

Expected duration of the program: 3 days

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3- surgery

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • inflammation indicators (CRP, ESR)
  • indicators blood coagulation
  • tumor markers (CEA, CA 15-3)
• mammology examination:
  • breast ultrasound
  • mammography
• MRI of the breast (if indicated clinically)
• ultrasound examination: pelvis, abdomen (if indicated clinically)
• MRI/CT scan for staging (if indicated clinically)
• preoperative care
• operations:
  • radical mastectomy
  • breast conservative surgery and axillary clearance
  • axillary lymph node dissection
  • breast reconstruction with own tissue or implant
  • breast reconstruction with an expander or allo prosthesis
• histologically examination of the excised tissue (if clinically indicated) with immunohistochemistry testing for ER (estrogen) and PR (progesterone) the HER2 status (for targeted therapy ) ( all if clinically indicated ) .
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results

Price from: on request

Type of program: Inpatient

Expected duration of the program: 3 - 8 days

___________________________________________________________________________________________

4-      Radiotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • tumor markers (CEA, CA 15-3)
  • indicators of inflammation (CRP, ESR)
  • indicators of blood coagulation
• CT simulation and planning of radiation therapy
• Physics calculation
• full course of radiation therapy with different modalities (3D, IMRT, VMAT) according your treatment plan .
• symptomatic treatment (for side effects of chemo and radiotherapy that may developed).
• cost of essential medicines and materials
• nursing services
• control examinations
• consultations of related specialists
• explanation of future recommendations

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation in order to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Radiation therapy is carried out as the day hospital procedure, without mandatory admission to the hospital. At each visit, the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded radiation therapy room, on a special table.

Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will visit the hospital from 1 to 3-5 times a week.

After the completion of the radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 day