Cancer treatment has undergone a remarkable transformation over the past two decades. Today, the goal is not only to help patients survive cancer but also to ensure that they maintain their quality of life, confidence, and overall well-being. Personalized cancer care is at the heart of this change, allowing treatment decisions to be tailored to the unique biology of each patient's cancer rather than relying on a one-size-fits-all approach.
Dr. Geeta Kadayaprath, Principal Lead at Apollo Athenaa Women's Cancer Centre, shares a recent patient's journey which highlights how advances in precision oncology are helping women live better, longer lives.
When Treatment Decisions Go Beyond the Diagnosis
A 55-year-old woman came to the centre with a lump in her right breast. During her clinical examination, a suspicious lymph node was also detected in her armpit. A biopsy of the breast lump and a Fine Needle Aspiration Cytology (FNAC) of the lymph node confirmed that she had hormone receptor-positive breast cancer, and that the disease had spread to the lymph node.
As part of her staging workup, she underwent a PET-CT scan. Fortunately, there was no evidence of cancer elsewhere in the body. The scan showed only the breast tumour and a single involved lymph node.
When discussing treatment options, the patient was clear about two priorities. She wanted to preserve her breast if possible, and she hoped to avoid chemotherapy. Because she had node-positive disease, it was difficult at that stage to guarantee that chemotherapy would not be necessary. Traditionally, patients with positive lymph nodes were routinely advised to undergo chemotherapy.
Preserving the Breast While Treating the Cancer
Since the tumour was not very large, breast-conserving surgery was a feasible option. The patient underwent a wide local excision, where the tumour was removed along with a margin of healthy tissue. At the same time, an axillary dissection was performed to remove lymph nodes from the armpit.
The final pathology report showed that the tumour had been completely removed with clear margins. However, three of the fifteen lymph nodes removed contained cancer cells. Historically, the presence of even one positive lymph node would almost certainly have led to a recommendation for chemotherapy. But advances in cancer treatment have changed the way such decisions are made.
The Role of Precision Oncology
Today, certain women with hormone receptor-positive breast cancer and up to three positive lymph nodes may be eligible for specialized genomic testing. These tests analyze the biology of the tumour and generate a recurrence score that helps determine whether chemotherapy is likely to provide meaningful benefit.
After discussing the options, the patient chose to undergo genomic testing, despite the cost and the need to send the sample abroad for analysis. The results showed a favourable score. This was a significant turning point in her treatment journey. Based on the genomic test results, she was no longer considered a candidate for chemotherapy. Instead, she continued with other recommended treatments, including radiation therapy and hormonal treatment.
For her specific type of cancer, these therapies are highly effective and can provide outcomes comparable to, or in some situations even better than, chemotherapy.
A Better Quality of Life Alongside Excellent Outcomes
Nearly three years after treatment, the patient remains disease-free. She was able to preserve her breast, avoid chemotherapy, and continue her life without the physical and emotional burden that unnecessary treatment can sometimes bring.
This case demonstrates how cancer care has evolved. Fifteen to twenty years ago, the same patient would most likely have undergone a mastectomy, axillary dissection, and chemotherapy. Today, treatment decisions are guided not only by the size of the tumour or the number of lymph nodes involved, but also by the tumour's unique biological characteristics.
The benefits extend far beyond medical outcomes. Women who can preserve their breast and avoid unnecessary chemotherapy often experience greater confidence, improved body image, and a better quality of life. They move forward knowing that their treatment was specifically designed for their cancer.
Personalized cancer care represents the true promise of modern oncology, delivering effective treatment while reducing unnecessary physical and emotional burdens. It is helping women achieve not only longer survival but also a better life after cancer.
