Tumour marker
In breast cancer, two receptors of the tumor play a major role. The determination of these receptors, or markers, is of great importance for the therapy and also for the prognosis. Firstly, the HER2 receptor is determined.
A positive receptor status is initially associated with a poorer prognosis, since tumours are usually more aggressive. However, these tumours can be treated very well with antibodies. Secondly, the hormone receptor status is routinely determined.
Other tumour markers, which are determined in colon or pancreatic cancer, for example, are usually useful in breast cancer. In advanced breast cancer, the tumour marker CA 15-3 can be determined. However, it cannot be used to detect metastases, but only to monitor the course of therapy.
Surgery in the treatment of breast cancer is a central pillar of therapy. As long as no metastases have been detected, surgery is sought for every patient. A breast cancer can be treated with two different surgical methods.
Either a breast-conserving operation (BET, breast-conserving therapy) is performed or the breast is removed by mastectomy. Which method is used depends on the extent and location of the tumour. Mastectomy is the older of the two methods.
During the operation, the entire breast (glandular tissue and skin) and, if necessary, the underlying breast muscle is removed. At a fixed interval after the operation or radiation, breast reconstruction with breast implants can take place. In the newer BET, only the tissue with the tumour and a small piece of skin is removed.
The rest of the glandular tissue and skin is left in place. BET is now performed in about 70% of all patients and inevitably involves radiation of the remaining tissue. As a rule, every operation also includes the removal of lymph nodes from the armpit.
How many lymph nodes have to be removed depends on whether tumour cells are found there or not. Chemotherapy (chemo for short) is very important in the treatment of breast cancer. Not every form of breast cancer can and must be treated with chemotherapy, there must be a clear reason for this.
Each type of breast cancer must be treated differently and each time an individually targeted and carefully selected therapy must be given. With chemotherapy as part of the treatment plan for breast cancer, depending on the stage of the disease, a distinction is made between: Primary chemotherapy is usually carried out before an operation. This can be particularly important if, for example, surgery is not possible, if the tumour is too large or inflamed.
In most cases, surgery is then performed to remove the tumour permanently. One speaks of adjuvant therapy if the chemotherapy is carried out after an operation and there are no tumour metastases in other organs. If tumour metastases have already been detected, chemotherapy can also be useful, this is known as palliative therapy.
This palliative chemo can be useful to treat symptoms such as pain from metastases, shortness of breath or skin symptoms. When choosing chemo drugs (chemotherapeutic agents), many factors have to be taken into account, such as organ functions (especially heart and bone marrow), tumor metastases, symptoms and much more. Since many different chemotherapeutic drugs are approved in Germany for the treatment of breast cancer, an individual and optimal therapy can be achieved.
Here you can also find information about the general therapy for breast cancer and radiation therapy for breast cancer. – primary (neoadjuvant)
- Adjuvant or
- Palliative therapy. After each breast-conserving operation, the remaining breast tissue and possibly also the armpit on the side is irradiated.
This is to prevent a second tumour from forming locally. So far, radiation is only dispensed with in rare cases, e.g. in older patients with a certain tumour constellation. After a complete breast removal, follow-up radiation is only initiated in the case of advanced tumours or if the entire tumour tissue could not be removed.
However, the individual indication for irradiation must be made by the treating team of doctors and general statements cannot be made here. Furthermore, irradiation of the lymph drainage channels in the armpit is possible after surgical removal of lymph nodes. This should improve overall survival.
Similar to the irradiation after mastectomy, the decision to irradiate the lymph drainage channels must be made by an interdisciplinary team. In young patients, so-called boost radiation can still be performed. Here, the former tumour bed is irradiated with a higher dose after surgery in order to reduce the risk of recurrence.
In addition, inoperable tumours can also be irradiated with the aim of reducing the tumour mass to such an extent that surgery becomes possible. Hormone therapy, or antihormone therapy, is used to treat hormone-receptor-positive tumours. Hormone receptor-positive means that the tumour has receptors for oestrogen or progesterone.
It is usually carried out after surgery and also after possible chemotherapy. In general, hormone therapy should be carried out for at least 5 years. A longer administration of the preparations can then be weighed against the individual risk of relapse.
However, as hormone therapy has significant side effects, many discontinue the therapy before the 5 years are over, which increases the risk of death. Which preparation is used for hormone therapy depends on whether the woman is still before the menopause or is already in the menopause. Younger women who are not yet menopausal are usually prescribed tamoxifen.
It blocks the oestrogen receptors of the tumour and reduces hormone production in the ovaries. This means that the tumour cannot receive growth signals from oestrogen. Common side effects of this therapy are hot flashes, nausea and rashes.
In women who have already gone through menopause, aromatase inhibitors are given as hormone therapy. It also inhibits the formation of oestrogen, which can therefore no longer have a stimulating effect on the breast or on any remaining breast cancer cells. The side effects are similar to those of tamoxifen.
Antibody therapy is used for HER2 receptor positive breast cancer. The antibody blocks the HER2 receptors on the tumour, preventing it from receiving growth signals via this receptor. The therapy is carried out in parallel with chemotherapy and lasts for 1 year.
The most common active substance is called trastuzumab and is administered by infusion at intervals of one to three weeks. The most important side effect of the antibody is damage to the heart. Therefore, a cardiological examination must be performed every 3 months during the therapy.
The treatment of breast cancer consists of several forms of therapy. An important component is surgery with possible follow-up radiation and the systemic therapies, such as chemotherapy, immunotherapy or hormone therapy. Depending on the findings and constellation of the tumour, chemo- and immunotherapy can also be started before the operation.
The post-operative follow-up treatment then consists of the so-called adjuvant systemic therapy, in which the preoperative medication is continued and possibly hormone therapy is added. If hormone therapy is indicated (in the case of a positive receptor status), this is carried out over a period of at least 5 years. Post-operative treatment after mastectomy, i.e. breast removal, usually includes reconstruction of the breast.
Here, the patient’s own tissue or implants can be inserted. After the primary treatment is completed, the patient automatically moves on to the follow-up treatment. This should last for 10 years in order to be able to detect and treat recurrences early.
Aftercare includes regular physical examinations and consultations with the doctor, as well as annual mammograms of the remaining breast tissue. If possible, we always try to carry out a breast-conserving therapy. However, some tumours grow so unfavourably that such an operation is not possible.
This is the case, for example, with many large tumours which have infiltrated right into the skin. Since in such cases it is not always possible to be sure that the entire tumour has been removed or if the remaining skin layer is not sufficient for a conservative therapy, a mastectomy, i.e. the removal of the breast, would be more appropriate. Even in the case of smaller tumours, where it is not possible to remove all parts of the tumour safely, a mastectomy would be considered.
Since after a breast-conserving operation, post-irradiation is always necessary, amputation of the breast is also performed in patients who for various reasons cannot or do not wish to be irradiated. Furthermore, mastectomy is necessary in the case of inflammatory breast cancer and also if there are several tumour foci in the breast. After a mastectomy, the removal of the breast, has been performed, a reconstruction of the breast is performed either immediately in the same session or at a later time interval. For this, either the patient’s own fatty tissue is used or a breast implant is inserted.
