IrradiationRadiation therapy
An irradiation (radiotherapy) is performed with high-energy X-rays (photon radiation) and/or electron beams (particle radiation). The standard in radiation therapy here is irradiation of the whole breast for a period of about five weeks (25 to 28 irradiations on five days per week). Depending on the risk situation, irradiation of the tumor region is also necessary for a further five to ten treatment days.
After a breast-conserving therapy, irradiation is always performed. This reduces the probability of recurrence of breast cancer at the same site (local recurrence) and increases the overall survival rate. If several lymph nodes in the armpit are affected or if the tumor cells exceed the lymph node capsule, irradiation of the lymph drainage tracts is also necessary. Patients are also irradiated if the tumor has already progressed so far that they can no longer be operated on (primarily inoperable patients). This reduces the size of the tumor and alleviates the symptoms (palliative irradiation).
Chemotherapy
Chemotherapy can be used both before and after surgical therapy (neoadjuvant or adjuvant therapy). Depending on the patient’s situation, several chemotherapeutic agents are used in a specific combination (polychemotherapy). Standard schemata are: Newer schemata include taxanes.
These inhibit cell division and seem to be somewhat more effective, but also have more side effects. The therapy schemes may become obsolete in the short term, so that the information given is no longer up to date.
- CMF scheme (cyclophosphamide + methotrexate + 5-fluorouracil four-weekly for 6 cycles)
- EC-scheme (epirubicin + cyclophosphamide three weeks with 4 cycles)
- AC-scheme (Adriamycin + cyclophosphamide three times a week for 4 cycles).
Hormone therapy
Some malignant tumors of the breast have hormone receptors and respond to the hormonal stimulus. This means that the cancer cells react to sex hormones (estrogens, gestagens) and are stimulated by these to grow (grow). In pre-menopausal women, this is 50-60% of all breast cancers, in post-menopausal women 70-80%.
This fact can be used therapeutically by removing these sex hormones from the body and thus also from the cancer cells. In the past, this was achieved by surgical removal of the ovaries (ovariectomy), the place where hormones are produced, or by radiotherapy (ablative hormone therapy). Today, these procedures have been replaced by drugs that intervene in the control cycle of hormone production or action.
These include various groups of drugs: As a rule, such hormone therapy is carried out for about five years after the tumor has been removed and irradiated.
- Antiestrogens (z.B. Tamoxifen or Faslodex): Occupy the estrogen receptors on the tumor cells and thus prevent the effect of the hormone
- GnRH analogues (e.g.
Zoladex): indirectly lead to a reduction in oestrogen formation
- Aromatase inhibitors (e.g. Aromasin or Arimidex): Inhibit enzymes that are involved in the formation of estrogen and thus directly prevent the formation of estrogen.
Tamoxifen belongs to the group of drugs known as selective estrogen receptor modulators, i.e. antihormone therapy for breast cancer. This means that Tamoxifen binds to the estrogen receptors in the body and has either a stimulating or inhibitory effect.
The effectiveness in breast cancer is that tamoxifen has an inhibitory effect on the oestrogen receptors in the breast, i.e. also in breast cancer, and thus the growth of breast cancer can no longer be stimulated by oestrogens. It is important to note that tamoxifen has a stimulating effect on the lining of the uterus and thus, when taken, increases the risk of a tumor of the inner lining of the uterus (endometrial carcinoma). Side effects of tamoxifen include hot flashes, nausea and a higher risk of thrombosis.
In total, Tamoxifen should be taken for 5 years. Aromasin is a so-called aromatase inhibitor and is used in the anti-hormone therapy of breast cancer in post-menopausal women. It inhibits the formation of estrogen, which can therefore no longer have a stimulating effect on the breast or on any remaining cells of the breast cancer. It is given for 5 years after surgery. Possible side effects include hot flashes, nausea, headaches, sleep disturbances or depression.
