Introduction

Cancer is a disease in which abnormal cells divide uncontrollably and have the ability to infiltrate and destroy body tissue.

It is one of the most dreaded diseases of the 20^th century and spreading further with continuance and increasing incidence in 21^st century. In the United States, as the leading cause of death, it accounts for 25% of all the deaths in humans presently. Multidisciplinary scientific investigations are making best efforts to combat this disease, but the perfect cure is yet to be brought into world.

Recently, a greater emphasis has been given towards the researches on complementary and alternative medicine that deals with cancer management. Several studies have been conducted on herbs under a multitude of ethno-botanical grounds. Ayurveda, a traditional Indian medicine of plant drugs has been successful from very early times in using these natural drugs and preventing or suppressing various tumours using various lines of treatment.

The broad aim of this article is to provide a general outline on descriptions of breast cancer and their management through modern and ayurvedic perspective underlying its scientific principles involved in treating these conditions. This article reviews the available literatures regarding researches on anti-cancerous ayurvedic herbs and also includes a summary of treatment strategies for various breast cancers. It is done to raise awareness and encourage implementation of ayurvedic therapies for combating cancer and suggesting an integrated approach in tumour management and treatment.

Charaka and Sushruta Samhitas, two well-known Ayurvedic classics, describe cancer as Inflammatory or Non-inflammatory swelling and mentions them as either Granthi (minor neoplasm) or Arbuda (major neoplasm). Ayurvedic literature defines three body-control systems, viz., the nervous system (Vata or air), the venous system (Pitta or fire), and the arterial system (Kapha or water) which mutually coordinate to perform the normal function of the body. In benign neoplasm, (one or two of the three bodily systems (Vataja, Pittaja or Kaphaja) are out of control and is not too harmful because the body is still trying to coordinate among these systems.

• He explains 10 Peshi in Stana region, 5 in each, while describing extra 20 additional Peshi in female.
• While mentioning about Vaksha Marma, he explained Stanamoola, Stanarohita & Hridaya Marmas in relation to Stana. With these references location of Stana can be fixed as it is located one Angula above Stanamoola, on either side of Hridaya Marma & Stana Chuchuka is present two Angulas below Stanarohita Marma.
• Development of Stana takes place at adolescent age.

Two parts of Stana:

1. Stana Mandala
2. Krishna Mandala.

Stanasampat Lakshanas:

1. Not much more to upper side (Natiurdhvam)
2. Not much elongated (Natilambam)
3. Not very much thin (Anatikrusha)
4. Not very much big (Anatipinau)
5. Easy to suck for the baby (Sukhaprapanau)
6. Having nipples of appropriate size (Yukta-Pippalakau)

Arbuda - Malignant Tumor/Cancer/Carcinoma

According to Susrutha Samhita:

Samprapti (Pathogenesis)

गात्रप्रदेशे क्वचिदेव दोषाः संमूच्छिता मांसमभिप्रदूष्य ।
वृत्तं स्थिरं मन्दरुजं महान्तमनल्पमूलं चिरवृद्धयपाकम् ।।
कुर्वन्ति मांसोपचयं तु शोफं तमर्बुदं शास्त्रविदो वदन्ति । (Su.Sa.Ni.11/13)

Aggravated Doṣās causing vitiation of the Muscle tissue, produce muscular swelling, anywhere in the body which is round, static (immovable) with mild pain, big in size, deep rooted, growing slowly and not ripening (forming pus); this disease is called as Arbuda by those learned in the science.^[1]

Bheda (Types)

वातेन पित्तेन कफेन चापि रक्तेन मांसेन च मेदसा च ।
तज्जायते तस्य च लक्षणानि ग्रन्थेः समानानि सदा भवन्ति ।। (Su.Sa.Ni.11/14)

It is produced by Vāta, Pitta, Kapha, Rakta (Blood), Māmsa (Muscles) and Medas (Fat); their symptoms are similar to those of corresponding kinds of Granthi (Benign tumor).^[2]

Mamsa Arbuda

मुष्टिप्रहारादिभिरर्दितेऽङ्गे मांसं प्रदुष्टं प्रकरोति शोफम् ।।
अवेदनं स्निग्धमनन्यवर्णमपाकमश्मोपममप्रचाल्यम् ।
प्रदुष्टमांसस्य नरस्य बाढमेतद्भवेन्मांसपरायणस्य ।।
मांसार्बुदं त्वेतदसाध्यमुक्तं (Su.Sa.Ni.11/17-18)

At the place on the body hit by the fist etc., the muscle there in, getting vitiated, gives rise to a swelling which is painless, unctuous, of the same colour of the body, not forming pus, stone like and not moveable; this occurs specially in persons who have vitiated muscle and who partake meat constantly, Mamasārbuda is incurable.^[8]

Rakta Arbuda

दोषः प्रदुष्टो रुधिरं सिरास्तु संपीड्य सङ्कोच्य गतस्त्वपाकम् ।।
सास्त्रावमुन्नह्यति मांसपिण्डं मांसाङ्करैराचितमाशुवृद्धिम् ।
स्रवत्यजस्त्रं रुधिरं प्रदुष्टमसाध्यमेतद्रुधिरात्मकं स्यात् ।।
रक्तक्षयोपद्रवपीडितत्वात् पाण्डुर्भवेत् सोऽर्बुदपीडितस्तु । (Su.Sa.Ni.11/15-16)

Aggravated Doşās associating with blood and getting localised in the veins (blood vessels), produce squeezing and contraction in them, and give rise to slight ripening (forming pus) or no ripening; make a ball of muscle, which exudes, bulges up, covered with sprouts of muscle, increasing in size quickly, exuding vitiated blood continuously; this Rakta Arbuda (produced by blood), is incurable; the person suffering from this disease, because of having secondary diseases due to loss of blood, becomes a patient of Pandu Roga (Anaemia).^[9]

Prognosis

साध्येष्वपीमानि विवर्जयेत्तु ।
संप्रस्रुतं मर्मणि यच्च जातं स्रोतःसु वा यच्च भवेदचाल्यम् ।।
यज्जायतेऽन्यत् खलु पूर्वजाते ज्ञेयं तदध्यर्बुदमर्बुदज्ञैः ।
यद्द्वन्द्वजातं युगपत् क्रमाद्वा द्विरर्बुदं तच्च भवेदसाध्यम् ।। (Su.Sa.Ni.11/19-20)

• Even among the curable ones, the following kinds are fit to be rejected; that which is exudating greatly, that situated in the vital spots/organs or channels; that which is immovable.
• That which develops (grows) over an earlier one, is known as Adhyarbuda by those having the knowledge of Arbudas (tumors), that which is produced either at the same time or after some time is known as Dvirarbuda; all these are incurable.

Pittaja Granthi

पित्तात्सदाहः पीताभो रक्तो वा, पच्यते द्रुतम् ।
भिन्नोऽस्त्रमुष्णं स्त्रवति (As.Hr.Ut.29/4a)

Pitta tumour has burning sensation, is yellow or red in colour, ripens (suppurates) quickly, discharges hot blood when pricked.^[14]

Kaphaja Granthi

श्लेष्मणा नीरुजो घनः ॥
शीतः सवर्णः कण्डूमान्, पक्वः पूयं स्त्रवेद्धनम् । (As.Hr.Ut.29/4b-5a)

Kaphaja tumour has no pain, is hard, cold, is of the colour of skin, has itching and exudes thick pus.^[15]

Raktaja Granthi

दोषैर्दुष्टेऽसृजि ग्रन्थिर्भवेन्मूच्र्छत्सु जन्तुषु ।।
सिरामांसं च संश्रित्य सस्वापः पित्तलक्षणः । (As.Hr.Ut.29/5b-6a)

A tumour (Granthi) is produced when blood is vitiated by the Doshas. It contains worms, which attack veins and muscles and is associated with numbness (loss of sensation of touch) and has the features of Pittagranthi.^[16]

Sonitha Arbuda

सिरास्थं शोणितं दोषः सङ्कोच्यान्तः प्रपीड्य च।|
पाचयेत तदानद्धं सास्त्रावं मांसपिण्डितम् ।।
मांसाङ्कुरैश्चितं याति वृद्धि चाशु स्त्रवेत्ततः ।
अजस्त्रं दुष्टरुधिरं भूरि तच्छोणितार्बुदम् ।। (As.Hr.Ut.29/16-17)

The Dosha, after being deranged, vitiates the blood in the veins, produces contraction and pressing and suppuration and creates a growth of mass of muscle with spread of muscle sprouts and with continuous bleeding. It grows very fast and exudes blood, which is vitiated, in large quantity. This is termed Soņitārbuda.^[17]

Mamsaja Granthi

मांसलैर्दूषितं मांसमाहारैर्ग्रन्थिमावहेत् ।।
स्निग्धं महान्तं कठिनं सिरानद्धं कफाकृतिम् | (As.Hr.Ut.29/6b-7)

Māmsa (muscle tissue-body element) gets vitiated by excessive use of meat as food (bad meat) and results in a Granthi which is oily, big in size, hard and covered with veins and has features of Kapha (aggravation).^[18]

Medo Granthi

प्रवृद्धं मेदुरैर्मेदो नीतं मांसेऽथवा त्वचि ॥
वायुना कुरुते ग्रन्थि भृशं स्निग्धं मृदुं चलम् ।

स्थूलः खरश्चापि भवेद्विवयों यश्चापि बालस्थविराबलानाम् ।। (Ch.Sa.Chi.12/86)

Granthis

The located in Kukshi (pelvic region), abdomen, neck and vital parts and also that which is very big and rough and also of children, old and women or debilitated persons is rejectable or should be left or is incurable.^[24]

Arbuda Chikitsa

According to Susrutha Samhita

Vataja Arbuda

कर्कारुकैर्वारुकनारिकेलप्रियालपञ्चाङ्गुलबीजचूर्णैः ।।
वातार्बुदं क्षीरघृताम्बुसिद्धैरुष्णैः सतैलैरुपनाहयेत्तु ।।
कुर्याच्च मुख्यान्युपनाहनानि सिद्धैश्च मांसैरथ वेसवारैः ।।
स्वेदं विदध्यात् कुशलस्तु नाड्या शृङ्गेण रक्तं बहुशो हरेच्च ।।
वातघ्ननिर्यूहपयोम्लभागैः सिद्धं शताख्यं त्रिवृतं पिबेद्वा ।। (Su.Sa.Chi.18/29-31)

Arbuda produced by Vāta should be fomented by applying warm poultice prepared from seeds of Karkäruka, Ervāruka, Nārikela, Priyāla, and Pañcāñgula, similarly important poultices made from Mamsa (meat) or Vesavāra (mutton broth); the skilled physician should then, administer sudation through Nādi Sveda (steam coming out from tube), remove blood in more quantity (often) using the sucking horn. Then the patient is made to drink Trivṛt Sneha (mixture of ghee, oil and muscle-fat) cooked a hundred times with the decoction of Vāta mitigating drugs, added with milk and sour liquids (Sauvīraka etc).^[25]

Pittaja Arbuda

स्वेदोपनाहा मृदवस्तु कार्याः पित्तार्बुदे कायविरेचनं च ।।
विघृष्य चोदुम्बरशाकगोजीपत्रैर्भृशं क्षौद्रयुतैः प्रलिम्पेत् ।।
श्लक्ष्णीकृतैः सर्जरसप्रियङ्गपत्तङ्गरोधाञ्जनयष्टिकाद्वैः ।।
विस्त्राव्य चारग्वधगोजिसोमाः श्यामा च योज्या कुशलेन लेपे ।।
श्यामागिरिह्वाञ्जनकीरसेषु द्राक्षारसे सप्तलिकारसे च ।।
घृतं पिबेत् क्लीतकसंप्रसिद्धं पित्तार्बुदी तज्जठरी च जन्तुः ।। (Su.Sa.Chi.18/32-34) 

In Arbuda produced by Pitta, sudation, applying warm poultices and purgation to the body should be administered mildly; the tumor should be rubbed with (rough) leaves of Udumbara, Säka and Gojihvä and then a fine paste of Sarjarasa, Priyangu, Pattañga, Rodhra, Añjana (Srotoñjana) Vaşțika, Aragvadha, Gojihvā, Soma and Syāma mixed with honey should be applied.

After it becomes clean, oil boiled with Bhārīgi, Vidanga, Pāthā and Triphalā be used (for healing). If the tumor becomes ripe on its own accord, then the physician well versed in procedure should treat it like a ripened tumor.^[29]

Medo Arbuda

मेदोर्बुदं स्विन्नमथो विदार्य विशोध्य सीव्येद्गतरक्तमाशु ।
ततो हरिद्रागृहधूमरोध्रपतङ्गचूर्णैः समनः शिलालैः ।
व्रणं प्रतिग्राह्य मधुप्रगाढैः करञ्जतैलं विदधीत शुद्धे ।। (Su.Sa.Chi.18/41)

Arbuda produced by Medas (fat), should be fomented first, then cut open, cleaned of the blood and sutured quickly. Then the wound is sprinkled with powder of Haridrā, Grhadhūma, Rodhra, Pattañga, Manaśśilā and Ala; next Karañja Taila added with more of honey and should be applied to cleanse the wound.^[30]

Arbuda Punarutpatti - Recurrance of Tumors/ Metastasis

सशेषदोषाणि हि योऽर्बुदानि करोति तस्याशु पुनर्भवन्ति ।
तस्मादशेषाणि समुद्धरेत्तु हन्युः सशेषाणि यथा हि वह्निः ।। (Su.Sa.Chi.18/42)

Those Arbuda (malignant tumors) in which remnants of Dosha (remnants of tumor tissue) remain, they develop again quickly; hence they (malignant tumors) should be excised/removed without leaving any residue; any residue left will kill the patient just like fire (a spark of fire developing into big fire and destroying the house).^[31]

According to Ashtanga Hrdaya

Granthi Chikitsa

ग्रन्थिष्वामेषु कर्तव्या यथास्वं शोफवत् क्रिया । (As.Hr.Ut.30/1)

Granthi, which is not yet ripe, is to be treated like swelling.

बृहतीचित्रकव्याघ्घ्रीकणासिद्धेन सर्पिषा ।।
स्नेहयेच्छुद्धिकामं च, तीक्ष्णैः शुद्धस्य लेपनम् ।

The patient, who is desirous of purificatory therapies, is to be administered oleation with ghee medicated with Brhati, Citraka, Vyāghri and Kaņā. After purification, smearing with the paste of drugs with Tīksna (Sharp, Penetrating) quality is to be done.^[32]

संस्वेद्य बहुशो ग्रन्थि विमृद्भीयात् पुनः पुनः ।।
एष वाते विशेषेण क्रमः, पित्तात्रजे पुनः ।
जलौकसो हिमं सर्वं, कफजे वातिको विधिः ॥ (As.Hr.Ut.30/2-3)

Arbuda of recent origin is cured by the following process - excreta of goat, root of Sigru, Läkşa, Surasa, Lavana and Kşära are tied in cloth and boiled in fermented gruel and with this fomentation is given to the tumor, which is covered with leaves of Upodaka and then bandaged. By this method Arbuda of recent origin subsides. If the tumor is chronic, it is to be covered with the leaves of Arka, Sudha, salt, jaggery and Kāñjika. Pracchāna is to be undertaken after tying at the calves and by this process the tumour dissolves.^[37]

According to Charaka

Granthi Chikitsa

संशोधिते स्वेदितमश्मकाष्ठैः साङ्गुष्ठदण्डैर्विलयेदपक्वम्
विपाट्य चोद्धृत्य भिषक् सकोशं शस्त्रेण दग्ध्वा व्रणवच्चिकित्सेत् ।।
अदग्ध ईषत् परिशेषितश्च प्रयाति भूयोऽपि शनैर्विवृद्धिम् ।
तस्मादशेषः कुशलैः समन्ता- च्छेद्यो भवेद्वीक्ष्य शरीरदेशान् ॥
शेषे कृते पाकवशेन शीर्या- त्ततः क्षतोत्थः प्रसरेद्विसर्पः ।
उपद्रवं तं प्रविचार्य तज्ज्ञ- स्तैर्भेषजैः पूर्वतरैर्यथोक्तैः ॥
निवारयेदादित एव यत्ना- द्विधानवित् स्वस्वविधिं विधाय ।
ततः क्रमेणास्य यथाविधानं व्रणं व्रणज्ञस्त्वरया चिकित्सेत् | (Ch.Sa.Chi.12/82-85)

After applying cleansing measures (to the patient) the unsupported Granthi should be properly sedated and then pressed with stone, wood, stick or staff for its dissolution or disintegrations. (If suppurated or remains undissolved then) It (skin over the Granthi) should be incised with instrument and the Granthi along with its capsule should be removed and remanent cauterized. Further treatment should be just like wound. If smallest remanent is left cauterized, it will recur and increase gradually.

That is why the expert physician considering its location or body part should remove it from all around completely. However, if some remanent is left, it degenerates by suppuration and erysipelas is caused by wound spreads. The expert physician observing this complication should prevent it in very beginning carefully by applying respective procedures or therapies very properly and also use those described above. Then the wound should be treated quickly and systematically by specialist of wound treatment (surgeon) as per prescribed methods.^[38]

General line of treatment

It is a Kapha Vriddhi in Kapha Sthana with Rakthanubandam.

Emblica officinalis Gaertn (Amalaki): Plant-derived phenolic compounds manifest many beneficial effects and can potentially inhibit several stages of carcinogenesis. In an investigation, the efficacy of Emblica officinalis polyphenol fraction (EOP) on the induction of apoptosis in mouse and human carcinoma cell lineses and its modulatory effect on N-nitrosodiethylamine (NDEA) induced liver tumors in rats was studied.

Phenolic compounds and the major components from the fruit juice of EO, branches, leaves and roots showed stronger inhibition against B16F10 cell growth than against HeLa and MK-1 cell growth.

Zingiber officinale (Ginger): In a study it has been noted that ginger supplementation suppressed liver carcinogenesis by scavenging the free radical formation and reducing lipid peroxidation.

Other such drugs:

• Ocimum sanctum Linn (Tulasi)
• Tinospora cordifolia willd.Miers.Ex.hook (Guduchi)
• Aegle marmelos Linn conr. (Bilva)
• Moringa oleifera Linn (Shigru)
• Trigonella foenum graecum Linn (Methi)
• Azadirachta indica A.juss (Neem)
• Alstonia scholaris R.Br (Saptparna)
• Syzygium cumini Linn skeels (Jambu)
• Phyllanthus niruri sensu Hook F (Bhumiamalaki)
• Tribulus terrestris (Gokshura)
• Tephrosia purpurea Linn Pers (Sharapunka)
• Elettaria cardamomum Maton (Ela)
• Myristica fragrans Henlt (Jatiphala)
• Saraca asoka (Roxb) DC (Ashoka)
• Swertia chirata Buch Ham (Kiratathikta)
• Bauhinia variegate (Kanchanara)
• Momordica charantia Linn (Karavellaka)
• Syzygium aromaticum (Lavanga)
• Santalum album Linn (Sweta Chandana)
• Semecarpus anacardium Linn (Ballathak)
• Holoptelea integrifolia (Roxb) planch (Chirabilva)

Invasive lobular carcinoma

• It is a type of breast cancer that begins in the milk-producing glands (lobules) of the breast.
• Invasive cancer means the cancer cells have broken out of the lobule where they began and have the potential to spread to the lymph nodes and other areas of the body.
• It's the second most common breast cancer in the United States.

Angiosarcoma

• Angiosarcoma is a rare type of cancer that forms in the lining of the blood vessels and lymph vessels.
• The lymph vessels are part of the immune system. The lymph vessels collect bacteria, viruses and waste products from the body and dispose of them.
• This type of cancer can occur at any place in the body.
• But most often occurs in the skin on the head and neck. Rarely, it may form in the skin on other parts of the body, such as the breast, or it may form in deeper tissue, such as the liver and the heart.
• Angiosarcoma can occur in areas that were treated with radiation therapy in the past

Less common breast cancer types include:

Triple-negative breast cancer (TNBC):

• It is a kind of breast cancer that does not have any of the receptors that re commonly found in breast cancer like estrogen, progesterone and human epidermal growth factor.
• This invasive cancer is aggressive and spreads more quickly than other breast cancers.

Inflammatory breast cancer (IBC):

• IBC is a form of breast cancer that causes breast swelling and skin changes.
• IBC happens when growth of cells forms in the breast tissue.
• The cells break away from where they started to grow and travel to the lymphatic vessels in the skin.
• The cells can block the vessels and cause the skin on the beast to look swollen.

• PR-positive (PR+) breast cancers have progesterone receptors.
• HR-positive (HR+) breast cancers have estrogen and progesterone receptors.
• HR-negative (HR-) breast cancers don't have estrogen or progesterone receptors.

Symptoms

Some breast cancer symptoms are very distinctive. Others may simply seem like areas of the breast that look very different from any other area. Breast cancer may not cause noticeable symptoms either. But when it does, symptoms may include:

• A change in the size, shape or contour of the breast.
• A mass or lump, which may feel as small as a pea.
• A lump or thickening in or near breast or at underarm that persists throughout menstrual cycle.
• A change in the look of skin on the breast or nipple. the skin may look dimpled, puckered, scaly or inflamed. It may look red, purple or darker than other parts of the breast.
• A marble-like hardened area under the skin.
• A blood-stained or clear fluid discharge from your nipple.
• Pulling in of the nipple or pain in the nipple area

Causes

Breast cancer happens when breast cells mutate and become cancerous cells that divide and multiply to create tumors but not sure what triggers that change. However, research shows there are several risk factors that may increase the chances of developing breast cancer. These include:

Age: Being 55 or older.

Sex: Women and people AFAB are much more likely to develop condition than men and people AMAB.

Family history: If your parents, siblings or other close relatives have breast cancer, you're at risk of developing the disease.

Genetics: Up to 15% of people with breast cancer develop the disease because they have inherited genetic mutations. The most common genetic mutations involve the BRCA1 and BRCA2 genes.

Stage II:

• The cancerous cells have formed a tumor or tumors. The tumor is either smaller than 2 centimeters across and has spread to underarm lymph nodes or
• larger than 5 centimeters across but hasn't spread to underarm lymph nodes.
• Tumors at this stage can measure anywhere between 2 and 5 centimeters across, and may or may not affect the nearby lymph nodes.

Stage III:

There is cancer cells in nearby tissue and lymph nodes. Stage III is usually referred to as locally advanced breast cancer.

Stage IV:

Cancer has spread from breast to areas like your bones, liver, lungs or brain.

Treatment

Surgery is the primary treatment for breast cancer.

Breast cancer surgeries include:

• Breast reconstruction.

Combined treatment includes, surgery with one or more of the following treatments:

• Radiation therapy, including intraoperative radiation therapy (IORT).
• Hormone therapy, including selective estrogen receptor modulator (SERM) therapy.
• Targeted therapy.

Side effects of treatments:

Common chemotherapy and radiation therapy side effects include fatigue, nausea and vomiting.

Targeted therapy, immunotherapy and hormone therapy have similar side effects, including gastrointestinal issues like constipation and diarrhea.

Complications of breast cancer surgery:

All surgeries have potential complications, and breast cancer surgery is no exception. As you're considering your options, it's important to remember that surgery removes potentially life- threatening cancer. In general, the risks of breast cancer outweigh the complications.

Conclusion

Breast cancer is the most common type of tumor in women in most parts of the world. Although stabilized in western countries, its incidence is increasing in other continents. Prevention of breast cancer is difficult because the causes are not well known. Ayurvedic perspectives on the development, treatment, side-effects and supportive care for breast cancer offer valuable insights. This article is a compilation of points utilizing multidisciplinary approaches for the prevention and treatment that would probably simultaneously or sequentially act on different molecular targets based on Samhitas and previous research articles. In addition to being the least effective and most expensive treatment options, targeted therapies are also associated with multiple adverse effects including fever, nausea, weight loss, hairloss and diarrhoea. Thus the multi-targeted Ayurveda herbs described in different kinds of literature for breast cancer with Dushtasopha (malignant oedema), Dushtavrna (malignant wounds or ulcers), Dushtagranthi (malignant nodes), Dushtaarbuda (malignant tumors), Dushtavisarpa (malignant spreading cellulitis), Dushtaapachi or Gandamala (suppurative lymphadenitis ) are needed for futuristic research to combat this deadly disease.

References