Breast cancer, mammary gland cancer or mammary carcinoma is a malignant cancer of the mammary glands. Women are the most likely to develop this tumor. There are approximately 60,000 burst cancer patients per year in Germany. Typical signs of breast cancer are lumps and nodular growths in the breast area. Since there are hardly any other symptoms, an annual examination is useful for early detection.
What is breast cancer?
Schematic diagram showing the anatomy and structure of female breasts in breast cancer. Click to enlarge. Breast cancer or mammary carcinoma is a malignant disease of the lobules of the mammary glands (lobular carcinoma) or more commonly of the ductal epithelium (ductal carcinoma). In Germany, it is the most common cancer in women, with approximately one in eight to one in ten women developing the disease during their lifetime. The incidence continues to rise, but good screening programs (especially mammography from the age of 50) mean that breast cancer can often be detected at an early stage. Treatment options have also improved continuously, resulting in a significant reduction in mortality. In Germany, up to 70% of breast cancers can be cured or at least brought to a halt.
Causes
A single direct cause of breast cancer is rarely identifiable. Exceptions are, for example, the genetically caused breast cancers, which account for only about five percent (mutations in the genes BRCA-1 and BRCA-2). Otherwise, the individual risk can be estimated via risk factors. In addition to a familial accumulation, a long hormone confrontation also plays a decisive role. Accordingly, early menarche, late menopause and no or late pregnancies are risk factors. Breastfeeding and many gravidities have a protective (protective and preventive) effect. Hormone dependence is also often reflected in the tumor itself. Thus, some forms are able to form estrogen and progesterone receptors. This fact is also used therapeutically. General factors such as obesity, smoking, other history of cancer, and exposure to ionizing radiation also increase the risk of developing breast cancer.
Symptoms, complaints, and signs
Not all lumps in the breast, indicate breast cancer. Nevertheless, they should be clarified in the mammogram. Possible breast cancer symptoms include lumps, retractions of the breast gland, and watery or bloody discharge from the breast gland. However, in the beginning, breast cancer does not cause any discomfort or pain. Only as the disease progresses can there be hardening or lumps in the breast, which can usually be felt from the outside. As the disease progresses, swelling may occur in the armpit area, often below the collarbone or next to the breastbone. Occasionally, swelling also occurs in the abdomen and base of the back, depending on the severity of the disease of any metastasis. Some women notice enlargement in one or both breasts. As the disease progresses, the nipples may change and become inflamed. Dimples, dimples, or enlarged pores around the breasts also indicate disease that needs to be examined by a doctor. As the disease progresses and the tumors metastasize, nonspecific symptoms become increasingly common. Depending on the location of the metastases, pain may occur in the bones or in the abdomen, for example. There may also be shortness of breath, nausea and vomiting, exhaustion, and a persistent feeling of illness.
Complications
Complications of breast cancer are particularly related to surgical treatment of the disease. The wound cavity may become infected and form scars. Infection and severe scarring are factors that are particularly common in smokers and diabetics. Since patients do not move during the operation, and hardly at all afterwards, the risk of thrombosis and embolism increases considerably. Furthermore, subsequent opening of the blood vessels and subsequent bleeding may occur. Usually, this problem can be solved by a pressure bandage. However, in a small percentage of patients, further surgery is required. In this so-called revision surgery, drains must then be placed. These are plastic tubes that transport blood, wound secretions and other fluid accumulations to the outside.Complications in the treatment of breast cancer also often occur as side effects of the chosen therapy. The cells in the gastrointestinal tract as well as in the hair divide with similar frequency as cancer cells. Therefore, they often suffer very severely during chemotherapy. Nausea, vomiting and gastrointestinal bleeding occur. Hair falls out and does not renew itself as long as chemotherapy continues.
When should you see a doctor?
If you regularly palpate your breasts yourself, it is quicker and easier to detect any changes that may occur. Anything can be behind it. Skin changes on the nipple, a retraction of the nipple, or fluid leaking from the nipple should be examined by a gynecologist as soon as possible and without waiting long. Skin changes on the breast that have a resemblance to orange peel skin are also among the warning signs. A sudden change in the size of one of the breasts or an altered mobility of the breast can also be signs that breast cancer is present. Pain rarely occurs with breast cancer disease, but if there is burning pain in the breast, a visit to the gynecologist is strongly advised. If swelling of the lymph nodes under the arm is found during breast palpation, this should also be observed. Lymph node swellings can, of course, also have harmless causes. In this case, a quick clarification by the gynecologist is necessary. Only there can further examinations such as mammography and ultrasound clarify what these changes are. Very often there is a harmless explanation, but the timely visit to the doctor can also be life-saving.
Treatment and therapy
Mammography is an examination method for the early detection of breast cancer (mammary carcinoma), the most common cancer in women in Germany. The first priority for breast cancer is surgical therapy. If possible, breast-conserving surgery is performed. Accordingly, only the tumor with a sufficient safety margin is removed. However, if the tumor is localized in several places (multicentric), if it is very large in relation to the rest of the breast, or if it is already fused to the skin or pectoralis muscle, removal of the entire breast must be performed (ablation). Intraoperatively, the sentinel lymph node is also removed in the case of invasive breast cancer. Only if this is histologically affected, level II and III axillary lymph nodes are also resected. If breast-conserving surgery was performed, radiation of the remaining breast is mandatory. After ablatio mammae, a decision is made depending on risk factors, tumor stage, and patient preference. Complementary chemotherapy may be performed. If the tumor is very large or if there is an inflammatory breast cancer, a so-called neoadjuvant therapy can also be performed before surgery to reduce the tumor mass. Postoperative chemotherapy is given depending on the risk constellation, tumor stage and metastasis. If the breast cancer forms hormone receptors, hormone therapy (depending on menopausal status) is to be used adjuvantly. This therapy is used as a direct measure, but also for recurrence prophylaxis. A rather new form of therapy is tumor-specific antibodies (Herceptin). This antibody against the Her-2/neu receptor is used primarily in metastatic breast cancer.
Prospect and prognosis
The prognostic outlook for breast cancer has improved considerably in recent years. With early diagnosis and prompt treatment, the chance of cure for breast cancer is markedly good. Out of 100 patients, measured from the time the disease is detected, almost 90% are still alive after 5 years. If no further complications occur, most patients can be discharged as cured after surgery and subsequent cancer therapy. In many cases, new tumors or daughter tumors form at the tumor site in the further course. This must be monitored and treated in time to prevent a new cancer outbreak. Patients under the age of 35 are more likely to suffer a relapse of the disease and thus a recurrence of the breast carcinoma. If the breast tissue is completely removed, the risk of recurrence decreases significantly. The prognosis of breast cancer changes with the size of the tumor discovered. The larger it is, the higher the probability that the lymphatic system is also affected by cancer cells in addition to the breast.The prospects of a cure also dwindle once metastases have formed on the body. Furthermore, the prospect of cure depends on the type of breast cancer. Tubular breast carcinoma has a more favorable prognosis compared directly with inflammatory breast carcinoma.
Follow-up
In breast cancer, being symptom-free by no means means that everything is fine. Follow-up care has a high priority in cancer. Based on current knowledge, breast cancer is considered a chronic cancer. The possibility of sequelae and recurrences is high. Many sufferers experience fatigue for years after chemotherapy, radiation and surgery. Severe side effects can occur during treatment. The psychological strain should also not be underestimated. In addition, follow-up care is important because many breast cancer patients are given anti-hormonal preparations for years. Adjuvant therapies must be monitored. As long as the breast cancer has not spread, follow-up care begins immediately after primary care. Clinical check-ups become necessary at regular intervals to detect recurrences at an early stage. Therapeutic sequelae usually have to be treated over a longer period of time. Rehabilitation measures and psychotherapeutic services are also part of the aftercare. In most cases, gynecologists or general practitioners are the contact persons for aftercare following the rehabilitation phase. Regular palpation examinations and detailed interviews provide information about possible treatment options. If necessary, counseling centers or self-help groups can provide some emotional support. Aftercare measures should follow a specific schedule. The German Cancer Society has drawn up guidelines for this. The frequency of follow-up care changes over time. However, how often follow-up is necessary also depends on individual circumstances, family history, and the severity and type of breast cancer.
Here’s what you can do yourself
For those affected, a diagnosis of breast cancer always means a change in previous lifestyle habits. In addition to medical treatment, nowadays various accompanying measures are offered by which the affected persons and their relatives can deal with the disease more easily. Through conversations with other breast cancer patients, but also with friends and family members, one’s own experiences in the daily handling of the disease can be exchanged. This and measures such as exercise, a change in diet and finding new hobbies can improve the quality of life. Expert support can also be obtained from psychological cancer counseling centers. In the longer term, those affected can turn to a psychotherapist or seek out self-help groups. Counseling is also advisable because of the social risks of cancer, for example, if returning to work is at risk or it is no longer possible to provide for the family. In these cases, experts trained in social law can help to regulate personal matters. Lastly, those affected can also resort to alternative healing methods. While the efficacy of these methods has not necessarily been proven by the means of scientific clinical testing. However, additional steps can give hope and facilitate everyday life with the disease.
