Therapy options for breast cancer

Synonyms in a broader sense

Breast carcinoma, breast cancer, invasive ductal breast cancer, invasive lobular breast cancer, inflammatory breast cancer

Definition

Breast cancer (breast carcinoma) is a malignant tumor of the female or male breast. The cancer can originate either from the ducts of the glands (milk ducts = ductal carcinoma) or from the tissue of the glandular lobules (lobular carcinoma).

Possible therapeutic approaches

The therapy of breast cancer depends on the size of the tumor, its location (localization) and its type (see breast cancer types). It is also important whether the cancer cells have already settled (metastasized) in other organs. In principle: are used.

  • The surgical therapy
  • Chemotherapy (see Chemotherapy for breast cancer)
  • The radiotherapy
  • The hormone therapy
  • Immunotherapy/Antibody therapy

Surgical therapy

Basically, we try to operate in a breast-conserving manner (BET = breast-conserving therapy) as far as possible. In this case, the tumor is removed with a safety distance (preferably 1 cm) to all sides. To determine the exact stage of the tumor, the lymph nodes of the armpit on the same side are also removed.

If there is only one tumor node, it is now possible to identify the first lymph node in the lymph drainage area using special diagnostic procedures. This is called sentinel node and can be removed in a targeted manner. Recent studies have shown that in the case of a metastasis-free sentinel lymph node, the removal of further lymph nodes is not necessary.

This can significantly reduce the rate of operation-related side effects, especially lymph fluid congestion (lymphedema) in the affected arm. However, if the sentinel lymph node is infested with tumor cells, the other lymph nodes in the armpit (at least 10 are required here) are removed. The removal of the lymph nodes is important for the therapy on the one hand, and for predicting the course of the disease after the operation on the other.

After a breast-conserving operation, the breast is always irradiated again. In comparison to the removal of the entire breast (mastectomy), the overall survival rates are the same after a breast-conserving therapy with subsequent radiation. Exclusion criteria (contraindications) for a breast-conserving therapy are Complete removal does not succeed even after several attempts Inflammatory (inflammatory) breast carcinoma Residual breast irradiation is not possible If breast-conserving therapy is not possible, the entire breast including the affected lymph nodes should be removed (mastectomy) There are three different methods.

In the RotterHalsted breast removal (radical (classic) mastectomy), the mammary gland and the fatty tissue of the pectoral muscle (M. pectoralis) are removed in addition to the mammary gland body and the fatty tissue. In the Patey method (modified radical mastectomy), the pectoral muscle is left in place. The third method of breast removal (subcutaneous mastectomy) involves only the removal of the mammary gland and fatty tissue, but leaves the pectoral muscle under the breast and especially the skin above the glandular body.

An operation is only useful if the complete removal of the tumor can be achieved. If it is foreseeable in advance that this will not be successful, other therapeutic procedures (chemotherapy, radiotherapy) should precede the operation. All statements are of a general nature, the decision on the individual form of therapy can only be made by the treating specialist in gynecology, as only he knows all the necessary facts of the most promising form of therapy.

After a breast-conserving operation, the breast is always irradiated again. In comparison to an ablation of the entire breast (mastectomy), there are the same overall survival rates after a breast-conserving therapy with subsequent irradiation. Exclusion criteria (contraindications) for a breast-conserving therapy are If a breast-conserving therapy is not possible, the entire breast including the affected lymph nodes should be removed (mastectomy).

There are three different methods. In the case of breast removal after surgery, it only makes sense if complete removal of the tumor can be achieved.If it is foreseeable in advance that this will not be successful, other therapy procedures (chemotherapy, radiotherapy) should precede the operation. All information provided is of a general nature; the decision on the individual form of therapy can only be made by the treating specialist in gynecology, as only he or she knows all the necessary facts about the most promising form of therapy.

  • Several tumor foci in the breast
  • Complete removal does not succeed even after several attempts
  • Inflammatory (inflammatory) breast carcinoma
  • Residual breast irradiation is not possible
  • RotterHalsted (radical (classic) mastectomy) is removed in addition to the mammary gland and the fatty tissue of the pectoral muscle (M. pectoralis).
  • The Patey method (modified radical mastectomy), on the other hand, leaves the pectoral muscle intact.
  • The third method of breast removal (subcutaneous mastectomy) involves only the removal of the mammary gland and fatty tissue, but leaves the pectoral muscle under the breast and especially the skin above the glandular body.

After a removal of the breast, it can be restored in a further surgical procedure. There are several methods to restore (reconstruct) the breast. On the one hand, one can use the body’s own (autologous) material, on the other hand, foreign (heterologous) material can be used.

If the nipple has been removed, several additional methods are available to reconstruct it. One would be for example the tattoo.

  • Body materials would be muscles, for example.
  • Materials foreign to the body would be expander or silicone prostheses.