Introduction
Follow-up care for breast cancer should be started after surgery or immediately after completion of the overall therapy and should continue for at least 5 years. The focus here is on physical, but also psychosocial aspects. The leading tasks of the aftercare consist in a close meshed care and in the preservation of the therapy success.
Assistance can be given in the reintegration into everyday life and possible rehabilitation can be organized. In addition, aftercare should identify any therapeutic consequences, such as lymphedema, and address them at an early stage with appropriate therapy. In addition to the physical examination, mammography is an important diagnostic method in the context of aftercare in order to detect secondary tumors at an early stage.
What is the aftercare after breast cancer?
Aftercare after breast cancer has been precisely structured by the Association for Gynecological Oncology. In the best case, it begins during the postoperative therapy. At each follow-up appointment, a specific anamnesis is taken to check the tolerability of the hormone or antibody therapy and to counteract a discontinuation of the therapy.
In addition, early detection of metastases can be achieved through a specific anamnesis. Subsequently, at each appointment an examination of the breasts is performed, which also serves the early detection of secondary tumors and checks the wound healing in the operation or radiation field. A mammography is performed at fixed intervals.
In the case of a complete removal of the breast, this is only carried out on the non-affected side. It is important that both breasts must be examined in the mammography in the case of breast-conserving therapy, since a second tumor can also form in the breast already operated on. Other diagnostic methods such as ultrasound examination of the breast (mammary sonography) or MRI are only used in the case of unclear findings and if a secondary tumor is suspected, as they do not show any advantage over the clinical examination.
Initially, the focus is on infection-free healing of the surgical wounds. These are more extensive during complete removal of the breast than during breast-conserving therapy. Attention is paid to excessive hardening of the scars, large bruises or inflammations.
If lymph nodes were removed from the armpit during the operation, any lymphedema that may have developed must be monitored in the follow-up care by measuring the circumference of the arm. If lymphedema occurs, it can be treated in time by various measures. Even the smallest nerves can be damaged during lymph node removal, since they run close to the lymph nodes.
After the operation, this leads to sensations or pain in the shoulder or upper arm. These so-called nerve pains must be detected and treated early in the postoperative care, otherwise they develop into chronic pain. If a complete removal of the breast was performed, it is also the task of the aftercare to inform the patient about the possibilities of breast reconstruction and, if she agrees, to take the necessary steps.
In the follow-up appointments after chemotherapy, either before or after surgery, we pay special attention to side effects and damage caused by the chemotherapy. Anthracyclines, for example, are one of the most important chemotherapeutic agents in the treatment of breast cancer. However, they can also damage the heart, which is why regular ultrasound examinations of the heart are advisable.
In general, chemotherapeutic drugs damage the mucous membrane of the stomach and intestines, which is why attention should be paid to infections in the gastrointestinal tract. Another well-known side effect of chemotherapy that should be monitored is the suppression of bone marrow, which is characterized by increased infections, spontaneous bleeding or fatigue. After breast-conserving surgery, the surgical field is irradiated.
Especially during, but also after the irradiation, it is important to take good care of the skin with powder and to wash it as soap-free as possible. In the aftercare, skin damage such as inflammation caused by the radiation is observed and post-treated. The first mammography of both breasts should be performed 6-12 months after the radiation treatment is completed.
Patients with triple-negative tumors receive chemotherapy before surgery or afterwards.Antibody or hormone therapies are not effective with them. For this reason, in addition to anamnesis and physical examination, the aftercare focuses on side effects of the operation or chemotherapy. Triple-negative tumors are considered to be very malignant, which is why special emphasis should be placed on the early detection of secondary tumors.
All articles in this series:
