Dr. Marcela Koleva, oncologist, head of the Department of Medical Oncology at St. Sofia Medical Center Dr. Marcela Koleva is a specialist oncologist with over 30 years of medical experience. Performs drug treatment of solid tumors, including rare localizations, complex assessment of the patient’s condition and the degree of spread of the malignant disease. Specialized in leading oncology institutes in the world: Austria, Belgium, Great Britain, Germany, Denmark, Poland, Latvia, Spain, Italy, Greece, Israel Actively participates in international and national projects for testing new drugs and approaches to tumor treatment as a principal investigator . For 2 years, he has been the head of the Department of Medical Oncology at St. Sophia Hospital in the capital. – What are some of the early symptoms of breast cancer? It is important for people, women and men, to be familiar with what their breasts normally look like so that they can assess the appearance of any changes. The most common symptom is a lump or hard mass in the breast, which is usually not painful. Other changes that should also alarm are: swelling of the breast, wrinkling of the skin, pains not related to trauma. Especially important are changes in the skin of the breast such as dryness, redness and thickening, leakage of secretion, as well as swelling of lymph nodes, especially in the armpits and on the neck and above the collarbones. It’s a good idea to self-examine your breasts at least once every 1-2 months, and this is most effective in the shower and on soapy skin. The time in the middle between two cycles is most suitable for assessing breast structure in menstruating women. – Once we suspect cancer, what should we do first? The first step when you suspect a breast lump is, of course, to make an appointment with your GP, who can refer you to a specialist mammologist. The first examinations that will be scheduled are: a physical examination and a mammogram, and it is possible that an ultrasound or MRI (nuclear magnetic resonance) of the mammary glands, armpits and supraclavicular areas may also be required. It is important to mention that for women over 45, screening for breast cancer by examination and mammography is recommended, as there is an increased risk after this age group, and in turn, early detection is key to successful treatment. – What methods are usually used for diagnosis and are there any that are more accurate? After imaging studies such as: mammography, echomammography or MRI, biopsies give the most accurate diagnostic answer. For breast cancer, a core-needle biopsy is preferred, by which tissue is taken from the area with suspected malignant degeneration. A core needle biopsy uses a needle that is guided by an ultrasound machine to the area to be examined, thereby taking tissue from the most suspicious site for a tumor. The tissue is examined in order to more accurately determine the type of tumor, and additional features specific to the tumor must be examined.These specific data are determined by the pathologist through a test called immuno-histo-chemistry. From a sample taken in this way, there is also the possibility of genomic tests, which will examine the tumor in even more detail, find its “weak” places and direct the treating team to the type of treatment and help determine the risk of recurrence of the disease, which determines to some extent the duration of treatment. These tests must also be applied to the tumor removed during surgery. – What type of treatments are used for this type of cancer – universal or rather individualized? Breast cancer treatment is individual and depends on several factors: the stage of the disease, the type of cancer, its size and location, the biological profile and the general health of the patient. There is no one-size-fits-all treatment for breast cancer, as these specifics differ from patient to patient. Breast cancer often requires so-called neoadjuvant therapy, which consists of drug treatment before surgery, thus aiming to shrink the tumor, preserve as much of the breast as possible, and also begin to remove micrometastases, small “break-off” pieces of the tumor that “float” through the blood throughout the body. Determining factors for choosing the therapeutic approach are: patient’s age, sex, concomitant diseases, the already determined biological characteristics of the tumor, degree of spread in the body, the ability of the body to cope with the removal of toxins obtained from the death of the tumor. For example, in the presence of certain receptors on tumor cells, there are different options for specific treatment, while in the absence of these receptors, as well as other specific markers, more aggressive, non-specific therapies are used. – Who can patients get breast cancer treatment options from? Breast cancer patients should receive their treatment plan and advice from a team of doctors. This team includes: an oncologist familiar with cancer drugs; a surgeon who specializes in the surgical treatment of cancer; a pathologist who studies and evaluates tissue and cell samples and determines biological characteristics; an imaging diagnostician who evaluates the images obtained from scanners and resonance and a radiation therapist who knows methods for specific irradiation at the site of the tumor or if other parts of the body are affected. Later, a plastic surgeon can be included in the team to reconstruct the shape of the breasts. A multidisciplinary approach is most successful in the treatment of cancer, since the disease has many specificities and many faces, and teamwork and coordinated work between all these specialists implies the best possible outcome. – Who provides the final treatment plan for each patient with this type of cancer? The treatment of each patient received a definite diagnosis and after establishing the type and stage of his tumor, is determined by the oncology committee described above. There are such committees in every oncology center in the country.The committee examines all available documents and studies and determines what type of treatment is most appropriate according to the type and characteristics of the tumor. A sequence of treatment methods is determined and it is assessed whether the specific case is suitable for operative intervention at the specific moment or if another type of treatment effects is necessary before it. Sometimes the committee may require additional research before recommending a final treatment plan. Each patient has the right to submit his documents for a second opinion in several committees, in case he needs confirmation that the treatment proposed by the first committee is the best chosen and most active for his variant of the disease. – Are there any innovations in oncology medicine and specifically in treatment that, in your opinion, have improved the outcome for patients? New developments in oncology medicine are emerging every day and the prognosis for patients is improving. Breast cancer treatment has evolved significantly over the past 30 years, with major advances seen in the treatment of certain tumor subtypes. For them, a specific therapy called targeted is available to complement classic endocrine and chemotherapy. Targeted therapy is fully available in Bulgaria. Such treatment is done with so-called monoclonal antibodies, which aim to block certain receptors on cancer cells, thereby causing the tumor to die without unnecessarily damaging the body’s healthy cells. It is possible to achieve more often a complete remission – complete removal of tumor cells, when applying the targeted treatment, and we observe that the survival exceeds more than 90% in this subtype of breast cancer. In recent years, we have seen constant progress and the identification of new and more effective modifications in the application of targeted treatment. Medicines that contain both a target and a cytostatic part are now being used. Of course, it should always be borne in mind that the chances of successful treatment are greatly increased with the early detection of cancer, and therefore regular preventive screening examinations are extremely important.Breast cancer treatment has evolved significantly over the past 30 years, with major advances seen in the treatment of certain tumor subtypes. For them, a specific therapy called targeted therapy is available to complement classic endocrine and chemotherapy. Targeted therapy is fully available in Bulgaria. Such treatment is done with so-called monoclonal antibodies, which aim to block certain receptors on cancer cells, thereby causing the tumor to die without unnecessarily damaging the body’s healthy cells. It is possible to achieve more often a complete remission – complete removal of tumor cells, when applying the targeted treatment, and we observe that the survival exceeds more than 90% in this subtype of breast cancer. In recent years, we have seen constant progress and the identification of new and more effective modifications in the application of targeted treatment. Medicines that contain both a target and a cytostatic part are now being used. Of course, it should always be borne in mind that the chances of successful treatment are greatly increased with the early detection of cancer, and therefore regular preventive screening examinations are extremely important.Breast cancer treatment has evolved significantly over the past 30 years, with major advances seen in the treatment of certain tumor subtypes. For them, a specific therapy called targeted therapy is available to complement classic endocrine and chemotherapy. Targeted therapy is fully available in Bulgaria. Such treatment is done with so-called monoclonal antibodies, which aim to block certain receptors on cancer cells, thereby causing the tumor to die without unnecessarily damaging the body’s healthy cells. It is possible to achieve more often a complete remission – complete removal of tumor cells, when applying the targeted treatment, and we observe that the survival exceeds more than 90% in this subtype of breast cancer. In recent years, we have seen constant progress and the identification of new and more effective modifications in the application of targeted treatment. Medicines that contain both a target and a cytostatic part are now being used. Of course, it should always be borne in mind that the chances of successful treatment are greatly increased with the early detection of cancer, and therefore regular preventive screening examinations are extremely important.