15 Frequently Asked Questions : Breast Cancer Treatment and Surgery in India for Bangladeshi Patients

Q1 · What is Breast Cancer Treatment and Surgery?

Breast cancer treatment is a group of medical and surgical treatments used to diagnose, control or treat cancer arising in breast tissue.

Treatment may involve one or more of the following

• Breast-conserving surgery
• Mastectomy
• Sentinel lymph-node biopsy
• Axillary lymph-node surgery
• Breast reconstruction
• Chemotherapy
• Hormone therapy
• Targeted therapy
• Immunotherapy
• Radiation therapy
• Neoadjuvant treatment before surgery
• Adjuvant treatment after surgery
• Follow-up and surveillance

Breast-Conserving Surgery

Breast-conserving surgery, commonly called a lumpectomy or wide local excision, removes the cancer together with a margin of surrounding tissue while preserving much of the breast.

Radiation therapy is commonly considered after breast-conserving surgery, depending on the patient's circumstances.

Mastectomy

Mastectomy involves removal of breast tissue. Different types may be considered depending on the tumour, breast anatomy, genetic risk and treatment plan.

Lymph-Node Surgery

Cancer can spread to lymph nodes, particularly those in the armpit. Depending on the patient's diagnosis, the surgeon may perform sentinel lymph-node biopsy or other lymph-node surgery.

Breast Reconstruction

Some patients undergoing mastectomy may consider immediate or delayed breast reconstruction.

Reconstruction can use implants, tissue from another part of the patient's body, or a combination of techniques.

Systemic Treatment

Some patients require treatment that acts throughout the body, including chemotherapy, hormone therapy, targeted therapy or immunotherapy.

The exact treatment is determined by the cancer's biological characteristics and stage.

Q2 · How much does Breast Cancer Treatment and Surgery cost in Bangladesh compared with India?

Breast cancer treatment costs vary significantly because some patients require surgery alone, while others require a combination of surgery, chemotherapy, radiation therapy, targeted medicines, hormone therapy or immunotherapy. The cost can also vary according to the type of surgery, hospitalisation, reconstruction, medicines and diagnostic investigations.

For planning purposes, this guide uses

• US$1 ≈ BDT 122
• US$1 ≈ INR 96

Indicative Breast Cancer Treatment Cost Comparison

Note: Potential savings are indicative only and are not guaranteed. The final cost can be substantially different depending on the cancer stage, pathology, treatment protocol, medicines, reconstruction and hospital stay.

Patients should ask whether the quotation includes

• Surgeon fees
• Anaesthesia
• Operating-room charges
• Hospital room
• Nursing
• Pathology
• Imaging
• Lymph-node assessment
• Surgical consumables
• Medicines
• Reconstruction, if planned
• ICU care, if required
• Blood products
• Additional procedures
• Follow-up consultations

Patients should also clarify whether chemotherapy, targeted medicines, immunotherapy and radiation therapy are included or quoted separately, because these treatments can substantially affect the overall cost. Bangladeshi patients should obtain a detailed written quotation before travelling and confirm what is included and excluded.

Q3 · Which Indian cities can Bangladeshi patients consider for Breast Cancer Treatment and Surgery?

Bangladeshi patients may consider major Indian medical cities where breast surgery, oncology, pathology, imaging, chemotherapy, radiation therapy and multidisciplinary cancer services are available.

The most appropriate location depends on the patient's diagnosis, required treatment, specialist availability, expected duration of treatment and follow-up needs.

Q4 · Which hospitals in India can Bangladeshi patients consider for Breast Cancer Treatment and Surgery?

Bangladeshi patients can consider hospitals offering breast surgery, surgical oncology, medical oncology, radiation oncology, pathology and multidisciplinary cancer services.

Patients should confirm that the selected centre has the required breast-cancer services for their specific diagnosis and treatment plan.

Q5 · What types of Breast Cancer Treatment and Surgery are available?

Treatment depends on the stage and biological characteristics of the cancer.

1. Breast-Conserving Surgery

A lumpectomy or wide local excision removes the tumour while preserving much of the breast.

2. Mastectomy

Removal of breast tissue may be recommended for certain cancers or when breast-conserving surgery is not appropriate.

3. Sentinel Lymph-Node Biopsy

The surgeon identifies and removes selected lymph nodes to determine whether cancer has spread.

4. Axillary Lymph-Node Surgery

Additional lymph-node surgery may be recommended in selected patients.

5. Skin-Sparing Mastectomy

In selected cases, much of the breast skin may be preserved while the breast tissue is removed.

6. Nipple-Sparing Mastectomy

For carefully selected patients, the nipple-areola complex may be preserved.

7. Breast Reconstruction

Reconstruction may be performed immediately or at a later stage.

8. Neoadjuvant Therapy

Chemotherapy, targeted treatment, hormone therapy or other systemic treatment may sometimes be given before surgery.

9. Adjuvant Treatment

Additional treatment after surgery may be recommended to reduce the risk of recurrence.

10. Radiation Therapy

Radiation may be recommended after breast-conserving surgery and in selected patients after mastectomy.

11. Hormone Therapy

Patients with hormone-receptor-positive breast cancer may receive endocrine treatment.

12. Targeted Therapy

Certain breast cancers have molecular characteristics that make them suitable for targeted medicines.

13. Immunotherapy

Selected patients may be considered for immunotherapy depending on cancer subtype and clinical circumstances.

Q6 · Who may be suitable for Breast Cancer Treatment and Surgery?

Almost every treatment decision depends on the individual diagnosis.

Patients may require breast cancer evaluation when they have

• A breast lump
• Abnormal breast imaging
• Biopsy-confirmed breast cancer
• Enlarged lymph nodes
• Nipple or skin changes associated with breast disease
• A previous breast cancer diagnosis requiring further treatment
• Suspected recurrent breast cancer
• A genetic or familial risk requiring specialist assessment

Treatment planning depends on factors such as

• Cancer stage
• Tumour size
• Lymph-node involvement
• Histological type
• Tumour grade
• Estrogen receptor status
• Progesterone receptor status
• HER2 status
• Other molecular characteristics
• Patient age and general health
• Menopausal status
• Previous cancer treatment
• Patient preferences

A breast cancer diagnosis does not automatically mean that mastectomy or chemotherapy is required. The treatment plan must be individualised.

Q7 · What tests are required before Breast Cancer Treatment and Surgery?

The diagnostic work-up depends on the patient's presentation and previous investigations. Common investigations may include:

Breast Imaging

• Mammography
• Breast ultrasound
• Breast MRI in selected cases

Tissue Diagnosis

• Core needle biopsy
• Fine-needle procedures in selected circumstances
• Surgical biopsy when required

Pathology

The pathology report may evaluate

• Histological type
• Tumour grade
• Estrogen receptor
• Progesterone receptor
• HER2
• Other relevant biomarkers

Staging Investigations

Depending on the stage and symptoms, the treating team may request

• CT scan
• PET-CT
• Bone imaging
• MRI
• Blood tests
• Other organ-specific investigations

Preoperative Assessment

Patients undergoing surgery may require

• Complete blood count
• Kidney-function tests
• Liver-function tests
• Blood sugar
• Coagulation tests
• ECG
• Chest assessment
• Anaesthesia evaluation

Not every patient requires every test.

Q8 · What medical records should Bangladeshi patients send before travelling?

Patients should send their complete breast cancer medical records for preliminary review.

Recommended documents include

• Biopsy report
• Histopathology report
• Immunohistochemistry report
• ER report
• PR report
• HER2 report
• Ki-67 or other biomarker report, if available
• Mammography report
• Breast ultrasound report
• Breast MRI report, if performed
• CT/PET-CT reports, if performed
• Actual imaging files
• Previous surgery report
• Previous chemotherapy records
• Previous radiation records
• Current medication list
• Blood-test reports
• Previous discharge summaries
• Genetic testing reports, if available
• A summary of current symptoms

Patients should send the actual scan images and pathology documents, rather than relying only on summaries. If treatment has already started, the dates and doses of previous chemotherapy, targeted treatment, hormone therapy or radiation should also be provided.

Q9 · How does Breast Cancer Treatment and Surgery work?

Breast cancer treatment usually follows a structured process.

Step 1: Diagnosis

A breast abnormality is evaluated through clinical examination, imaging and tissue diagnosis when required.

Step 2: Pathology Characterisation

The tumour is examined to determine its type and biological characteristics.

Step 3: Staging

The oncology team determines the extent of disease.

Step 4: Multidisciplinary Treatment Planning

Depending on the case, breast surgeons, medical oncologists, radiation oncologists, radiologists and pathologists may contribute to treatment planning.

Step 5: Systemic Treatment Before Surgery

Some patients may receive chemotherapy, targeted treatment, hormone treatment or other systemic therapy before surgery.

Step 6: Surgery

Depending on the tumour and treatment plan, surgery may include

• Lumpectomy
• Mastectomy
• Sentinel-node biopsy
• Axillary surgery
• Reconstruction

Step 7: Final Pathology

The removed tissue is examined to determine the final pathological characteristics.

Step 8: Additional Treatment

Depending on the final results, the patient may require

• Chemotherapy
• Radiation therapy
• Hormone therapy
• Targeted therapy
• Immunotherapy

Step 9: Follow-Up

Long-term monitoring is arranged to assess recovery, treatment response and possible recurrence.

Q10 · What are the alternatives to Breast Cancer Surgery?

Surgery is an important treatment for many patients with localised breast cancer, but the overall treatment plan can include several other approaches.

Chemotherapy

Chemotherapy may be used before or after surgery or for advanced disease.

Hormone Therapy

Hormone-receptor-positive cancers may respond to endocrine treatment.

Targeted Therapy

Patients with particular tumour characteristics may receive targeted medicines.

Immunotherapy

Selected patients may receive immune-based treatment.

Radiation Therapy

Radiation can be used as part of breast-conserving treatment and in selected patients after mastectomy.

Neoadjuvant Treatment

Systemic treatment before surgery can sometimes shrink the tumour and influence the subsequent surgical approach.

Treatment for Advanced Disease

When breast cancer has spread to distant organs, treatment may focus on systemic disease control, symptom management and maintaining quality of life.

The appropriate combination depends on the cancer subtype and stage.

Q11 · What should Bangladeshi patients ask before accepting a Breast Cancer Treatment quotation?

Patients should ask detailed questions before confirming treatment.

Diagnosis

• What is the exact type of breast cancer?
• What is the cancer stage?
• What are the ER, PR and HER2 results?
• Is additional pathology review required?
• Is molecular or genetic testing recommended?

Surgery

• Is breast-conserving surgery possible?
• Is mastectomy recommended, and why?
• Will lymph-node surgery be required?
• Is reconstruction possible?
• Can reconstruction be performed during the same operation?

Medical Treatment

• Is chemotherapy required?
• Will chemotherapy be given before or after surgery?
• Is targeted therapy required?
• Is hormone therapy required?
• Is immunotherapy appropriate?

Radiation

• Will radiation therapy be required?
• How many radiation sessions may be needed?
• Can radiation be completed in India or continued in Bangladesh?

Cost and Stay

• What exactly is included in the surgery quotation?
• Are pathology and imaging included?
• Are medicines included?
• Are reconstruction costs included?
• How many hospital days are expected?
• How long should the patient stay in India?
• What follow-up will be required after returning to Bangladesh?

Patients should request a written treatment plan and cost estimate before finalising travel arrangements.

Q12 · How long should Bangladeshi patients stay in India?

The duration depends on the treatment pathway. For surgery alone, hospitalisation may be relatively short, but patients requiring reconstruction or additional treatment may need a longer stay. A broad planning estimate is: Hospital stay: approximately 2–7 days for many breast operations, although complex procedures may require longer. Total India stay: approximately 1–3 weeks may be sufficient for some surgical patients, while patients undergoing chemotherapy, radiation, reconstruction or additional investigations may need several weeks or longer. Patients should not arrange an inflexible return flight until the treating team confirms that they are medically fit to travel. If chemotherapy or radiation is planned in India, the stay may extend substantially beyond the surgical recovery period.

Q13 · What is recovery like after Breast Cancer Treatment and Surgery?

Recovery depends on the type of treatment.

After breast surgery, patients may experience

• Pain or discomfort
• Swelling
• Tiredness
• Temporary restriction of arm movement
• Changes around the surgical wound
• Numbness
• Scar formation
• Temporary drainage from surgical drains

Arm and Shoulder Movement

The surgical team may recommend appropriate exercises to restore shoulder and arm movement.

Wound Care

The surgical wound and any drains should be monitored according to the surgeon's instructions.

Reconstruction Recovery

Patients undergoing reconstruction may require a longer recovery period.

Chemotherapy Recovery

Chemotherapy can cause side effects such as fatigue, nausea, changes in blood counts, appetite changes and other treatment-specific effects.

Radiation Recovery

Radiation can cause skin and tissue reactions in the treated area, depending on the treatment.

Hormone and Targeted Therapy

These treatments can have their own side-effect profiles and require appropriate monitoring.

Patients should receive individual discharge instructions before leaving India.

Q14 · How can follow-up be managed after returning to Bangladesh?

Before returning to Bangladesh, patients should obtain a complete treatment file.

This should include

• Final diagnosis
• Stage
• Final pathology report
• Operative report
• Lymph-node results
• ER/PR/HER2 results
• Molecular test results, if performed
• Discharge summary
• Chemotherapy records
• Radiation records
• Targeted-treatment records
• Hormone-treatment plan
• Medication list
• Follow-up schedule
• Recommended imaging
• Blood-test requirements

Follow-up can be coordinated between the patient's oncology team in Bangladesh and the treating team in India.

Depending on the treatment, follow-up may involve

• Clinical breast examination
• Mammography
• Breast imaging
• Blood tests when clinically indicated
• Oncology review
• Hormone-therapy monitoring
• Targeted-treatment monitoring
• Assessment for treatment-related side effects

Patients should seek medical attention promptly for concerning symptoms such as persistent fever, severe pain, wound infection, significant swelling, breathing difficulty, unexplained bleeding or other new symptoms.

Q15 · Should a Bangladeshi patient travel to India for Breast Cancer Treatment and Surgery?

The decision should be based on the patient's individual diagnosis, treatment requirements and access to appropriate cancer care.

Before travelling, patients should establish

• The exact breast cancer diagnosis
• Cancer stage
• ER, PR and HER2 status
• Whether surgery is required
• Whether breast conservation is possible
• Whether lymph-node surgery is required
• Whether reconstruction is appropriate
• Whether chemotherapy is required
• Whether radiation is required
• Whether targeted or hormone treatment is required
• Expected treatment duration
• Estimated total cost
• Follow-up requirements in Bangladesh

For some patients, the most appropriate pathway may involve surgery in India followed by part of the treatment in Bangladesh. For others, completing a larger portion of the treatment in one centre may be practical. A specialist review of the complete medical records before travel can help establish the likely treatment pathway and whether an in-person consultation in India is appropriate.