Kathmandu
Cancer Center
Kathmandu
Cancer Center
Complete breast cancer care including lumpectomy(remove cancer only ,not whole breast) , mastectomy, modern radiotherapy (IMRT), targeted therapy, hormone therapy, chemotherapy and immunotherapy..
Breast cancer is not one disease. ER, PR, HER2, and Ki-67 results define your subtype — and your subtype determines everything: whether you receive hormone therapy, HER2-targeted drugs, chemotherapy, immunotherapy, or a combination. KCC tests all four markers on every new breast cancer biopsy before any treatment is recommended.
A 3cm ER+ tumour and a 3cm triple-negative tumour require completely different treatment — different chemotherapy regimens, different systemic drugs, different follow-up. This is why the biopsy result, not the scan alone, is what drives your entire treatment plan.
Most breast cancers follow a predictable sequence. Your specific path is decided at KCC's multidisciplinary tumour board — attended by surgeon, medical oncologist, radiation oncologist, and pathologist.
Core needle biopsy · ER, PR, HER2, Ki-67 · Staging CT · Bone scan if symptomatic · BRCA for selected cases
Chemotherapy ± trastuzumab/pertuzumab (HER2+) OR pembrolizumab (TNBC) before surgery — shrinks tumour, tests chemo response
Lumpectomy · OR · Modified radical mastectomy + axillary node dissection · Reconstruction discussed
Whole-breast IMRT (15 fractions) after lumpectomy · Post-mastectomy IMRT if high-risk · Heart-sparing for left-sided
Hormone therapy 5–10 years (HR+) · Anti-HER2 to 12 months (HER2+) · CDK4/6 inhibitors (metastatic HR+)
KCC performs breast oncological surgery — lumpectomy and mastectomy — with the goal of complete tumour removal and accurate lymph node staging. The choice between breast-conserving surgery and mastectomy is made jointly with the patient after full discussion. All procedures are performed via open approach.
Removal of the tumour and a clear margin of normal tissue, preserving the breast. Always followed by whole-breast IMRT. Achieves equivalent survival to mastectomy for most early-stage patients. Suitable when the tumour-to-breast size ratio allows for a good cosmetic result.
Removal of the entire breast with chest wall muscles preserved, plus axillary node dissection. Indicated for large or multifocal tumours, when breast conservation is not possible, or at patient preference. Breast reconstruction discussed pre-operatively with the surgical team.
Provides accurate nodal staging that determines whether post-mastectomy IMRT and extended systemic therapy is needed.
Immediate or delayed reconstruction after mastectomy using implant or autologous tissue (latissimus dorsi or pedicled TRAM flap). Planned pre-operatively. Post-mastectomy IMRT timing is coordinated with reconstruction to achieve the best oncological and cosmetic result.
For large HER2+ or TNBC tumours, starting chemotherapy ± targeted/immunotherapy before surgery can shrink the tumour — converting a mastectomy case into a lumpectomy candidate. Achieving pathological complete response (no residual cancer at surgery) is associated with excellent long-term survival.
Before any breast cancer surgery at KCC, the case is presented at the multidisciplinary tumour board attended by breast surgeon, medical oncologist, radiation oncologist, and pathologist. This ensures the surgical approach is coordinated with systemic therapy and radiation planning — and that no patient undergoes surgery without the full picture.
Radiation after breast cancer surgery reduces local recurrence risk by approximately half. KCC uses IMRT (Intensity-Modulated Radiotherapy) from its LINAC — delivering precisely shaped dose distributions that closely conform to the breast or chest wall while protecting the heart and lungs.
Irradiation of the entire conserved breast after lumpectomy. Typically given over 3-5 weeks. A boost to the tumour bed (additional dose) is added for some patients.
IMRT to the chest wall and regional lymph nodes (supraclavicular, axillary, internal mammary) is recommended for ≥4 positive axillary nodes, T3/T4 tumours, positive surgical margins, or 1–3 positive nodes in high-risk patients. Delivered in 15–25 fractions. Timing coordinated with reconstruction when applicable.
For left-sided breast cancer, KCC uses Deep Inspiration Breath-Hold (DIBH) to reduce radiation exposure to the heart. During treatment, the patient holds a deep breath, increasing the distance between the heart and chest wall so radiation can avoid the heart. Treatment is delivered using IMRT or VMAT with optimized beam arrangement, and the dose-volume histogram is reviewed for every case. Our goal is to keep the heart dose very low to minimize long-term cardiac risk.
Short courses (5–10 fractions) to control bone pain from metastases, ulcerating chest wall disease, or brain metastases from breast cancer. Rapid, effective symptom relief — often within days. KCC schedules palliative radiation promptly so patients are not left waiting in pain.
Beyond chemotherapy, KCC provides the full range of modern breast cancer systemic treatment — HER2 dual blockade, CDK4/6 inhibitors, PARP inhibitors, and immunotherapy — each matched precisely to the patient's biomarker profile. This is not one-size-fits-all treatment.
For the 20% of breast cancers that are HER2-positive, targeted therapy has transformed prognosis. A subtype once considered the most aggressive now has some of the best outcomes — because of trastuzumab and pertuzumab. All agents below available at KCC for appropriate patients.
Trastuzumab is administered as a 30–90 minute IV infusion every 3 weeks — at KCC's chemotherapy day ward. Subcutaneous trastuzumab (5-minute injection) may also be available. Confirm drug availability with your KCC oncologist at consultation.
For HER2-positive patients with tumours >2cm or node-positive disease, KCC offers neoadjuvant TCHP — docetaxel, carboplatin, trastuzumab, pertuzumab — for 6 cycles before surgery. Patients who achieve pathological complete response (no residual tumour) continue trastuzumab to complete 12 months. Patients with residual disease switch to T-DM1 for 14 cycles (KATHERINE trial data). This adaptive approach is now the international standard.
For the 70% of breast cancers that are hormone receptor positive, hormone therapy is the backbone of long-term treatment — a daily oral tablet or injection for 5–10 years. Modern CDK4/6 inhibitors combined with hormone therapy have transformed metastatic HR+ outcomes, with median progression-free survival more than doubled in key trials.
SERM (selective oestrogen receptor modulator). Daily oral tablet. Reduces recurrence risk by ~40%. Extended to 10 years for higher-risk patients based on ATLAS and aTTom trial data. Side effects: hot flushes, joint pains, small increased uterine cancer risk — managed with regular gynaecologic follow-up.
Block peripheral oestrogen synthesis. More effective than tamoxifen in post-menopausal women. Side effects: joint pains, bone loss — managed with calcium, vitamin D, and bone density monitoring every 1–2 years. Upfront or switched after 2–3 years of tamoxifen. All three AIs available at KCC.
Monthly or 3-monthly subcutaneous injection causing medical ovarian suppression — oestrogen falls to post-menopausal levels. Combined with tamoxifen or an AI for high-risk pre-menopausal patients (positive nodes, large tumour, high Ki-67, BRCA carrier). Reverses on stopping — important for fertility counselling. Available at KCC.
Added to an AI (or fulvestrant) in metastatic HR+/HER2- breast cancer. MONALEESA-2 (ribociclib), PALOMA-2 (palbociclib), and MONARCH-3 (abemaciclib) trials all showed near-doubling of progression-free survival. Taken as oral tablets on 21-days-on / 7-days-off cycles or continuously (abemaciclib). Abemaciclib also has adjuvant indication for high-risk early breast cancer (monarchE). Available at KCC — confirm specific agents at consultation.
ER downregulator (SERD) — monthly intramuscular injection. Used in metastatic HR+ after progression on AIs, or as first-line with a CDK4/6 inhibitor. Oral SERDs (elacestrant, camizestrant) are emerging options in later lines as ESR1 mutations drive AI resistance. Available at KCC.
Chemotherapy is recommended for triple-negative and HER2-positive subtypes, for high Ki-67 luminal tumours with node involvement, and for metastatic disease. Delivered as IV infusions at KCC's chemotherapy day ward, with anti-nausea premedication and CBC monitoring before every cycle.
Doxorubicin + cyclophosphamide (4 cycles) → paclitaxel or docetaxel (4 cycles). Most common early breast regimen. Trastuzumab ± pertuzumab added from paclitaxel phase onwards for HER2+. Each cycle 3-weekly; 4–6 months total.
Docetaxel + carboplatin + trastuzumab + pertuzumab for 6 cycles. Preferred when anthracyclines are contraindicated or for high-risk HER2+ neoadjuvant — achieves high pathological complete response rates. Each cycle 3-weekly.
For PD-L1+ TNBC — pembrolizumab added to neoadjuvant chemo significantly improves pathological complete response rate (64.8% vs 51.2%). Pembrolizumab continued as adjuvant monotherapy for 9 cycles after surgery.
Oral chemotherapy tablet taken at home (2 weeks on, 1 week off). Used in metastatic HR+ or TNBC after anthracyclines/taxanes. Combined with lapatinib for metastatic HER2+. Convenient for outstation patients.
Active in metastatic TNBC. Platinum especially effective in BRCA-mutated disease. Used as second-line when taxanes have been exhausted.
Oral targeted therapy for germline BRCA1/2-mutated, HER2-negative metastatic breast cancer. OlympiAD (olaparib) and EMBRACA (talazoparib) trials showed superior outcomes vs standard chemo in BRCA carriers. BRCA testing arranged at KCC for eligible patients.
Treatment is always individualised. Stage alone is not enough — subtype determines the systemic therapy. These are general frameworks; your KCC oncologist will tailor based on your specific pathology, menopausal status, and fitness.
| Stage / Subtype | Standard Treatment Approach at KCC |
|---|---|
| Stage I–II · Luminal A (HR+/HER2-/low Ki-67) | Surgery (lumpectomy or mastectomy) → whole-breast IMRT if lumpectomy → Hormone therapy 5–10 years (tamoxifen or AI) · Chemotherapy often avoidable in low-risk · Oncotype DX score guides chemo decision in intermediate cases |
| Stage I–II · Luminal B (HR+/high Ki-67 or HER2+) | Surgery → IMRT → Hormone therapy + chemotherapy (AC-T) · HER2+ Luminal B: add trastuzumab + pertuzumab · CDK4/6 inhibitors for high-risk post-surgery (abemaciclib, monarchE) |
| Stage I–II · HER2-enriched (HR-/HER2+) | Neoadjuvant TCHP (6 cycles) → surgery → IMRT → Adjuvant trastuzumab to 12 months · If residual disease: T-DM1 (14 cycles, KATHERINE) · If pCR: trastuzumab alone or with pertuzumab |
| Stage I–II · Triple-Negative (ER-/PR-/HER2-) | Neoadjuvant paclitaxel + carboplatin ± pembrolizumab (if PD-L1+, KEYNOTE-522) → AC (4 cycles) → surgery → IMRT → adjuvant pembrolizumab 9 cycles · If no pembrolizumab: capecitabine adjuvant if residual disease (CREATE-X) |
| Stage III · Any subtype | Neoadjuvant systemic therapy (subtype-specific as above) → surgery → post-mastectomy IMRT → adjuvant systemic therapy completion · MDT board decision on surgery timing and extent |
| Metastatic · HR+/HER2- | AI + CDK4/6 inhibitor (ribociclib/palbociclib/abemaciclib) as first-line · Fulvestrant ± CDK4/6 after AI progression · Capecitabine, gemcitabine later lines · PARP inhibitors if BRCA-mutated · Bone-directed therapy (zoledronic acid) for bone mets |
| Metastatic · HER2+ | Trastuzumab + pertuzumab + taxane (1st line) → T-DXd (Enhertu) (2nd line, DESTINY-Breast03) → lapatinib + capecitabine or tucatinib regimen (3rd line) · Trastuzumab maintained throughout |
| Metastatic · TNBC | Pembrolizumab + chemo if PD-L1+ (KEYNOTE-355) · Sacituzumab govitecan (Trodelvy) if available · Gemcitabine + carboplatin · PARP inhibitors if BRCA-mutated |
Most breast cancers are detected by the patient themselves — as a new lump or change in the breast. Regular self-examination and awareness of these signs is the most important screening tool currently available in Nepal.
Any new breast lump or breast change at KCC is investigated with triple assessment:
All three components together achieve >99% diagnostic accuracy. KCC can typically complete triple assessment within 3–5 days of the first appointment.
Any new breast lump — at any age — warrants a doctor's assessment. Do not delay out of fear. Early detection is the single most important factor in breast cancer outcomes. Book a screening appointment at KCC →
From lumpectomy and IMRT to trastuzumab, CDK4/6 inhibitors, and pembrolizumab — KCC provides the complete modern breast cancer treatment programme without requiring you to travel to India for any component.
City Clinic — New Baneshwor · Main Campus — Bhaktapur · 24-hour helpline
