Women care about men's nipples

Breast cancer

Breast cancer(Breast cancer): Malignant tumor of the breast. In Germany, every 8th woman will develop it in the course of her life; Breast cancer is the most common cancer in women, with almost 70,000 new cases and 25% of all malignant tumors. With 0.1% of all breast cancer cases, under 30-year-olds develop it very rarely, afterwards the incidence increases, 75% of all new cases affect women after the age of 50.

Men can get breast cancer too, but it affects less than 1% of all cases.

Leading complaints

There are no early symptoms in breast cancer. The only way to detect the tumor in its early stages is diagnostic imaging, particularly mammography and MRI.

In around 80% of all breast cancer cases, the first warning signal is the lump felt by the woman herself, most often in the upper, armpit area.

Possible complaints:

  • Tangible, coarse knot, shiftable or non-shiftable, fused with the surrounding tissue or skin
  • Typically non-tender nodules
  • Retraction of the skin (dent) or bulges in one or more parts of the chest
  • Reinforcement of the dent when pushing the skin together with two fingers
  • Unilateral, especially bloody secretions from the nipple
  • New dent in the nipple
  • Inflammatory, itchy skin changes on the nipple and areola
  • Change in breast shape and size on one or both sides.

Possible symptoms and findings in breast cancer: palpable, indistinct tumor (a), newly emerging asymmetry of the breasts (b), plateau phenomenon, d. H. the skin pulls in over the palpable tumor when it is pushed together (c), orange peel, d. H. wrinkled skin over the tumor (d), retracted nipples (e).
Georg Thieme Verlag, Stuttgart

When to the doctor

Over the next two days, though

  • a lump in the breast is felt.
  • bloody secretion leaks from the nipple.
  • Changes in the chest such as dents, bulges, and sores are discovered.

The illness

causes

If the genetic information of cells changes in such a way that they divide in an uncontrolled manner, cancer develops. In breast cancer, palpable lumps or growths develop in the breast tissue over time. The causes of the changes and the development of the cells depend on several mutually influencing factors. To put it somewhat simply, around 10% of all malignant breast tumors can be traced back to a hereditary predisposition and around 90% result from risk factors.

Risk factors

Much research has been carried out on the risk factors for non-hereditary breast cancer and it is accepted worldwide that the risk of developing it is increased by:

  • Taking estrogen after menopause (including long-term hormone replacement therapy)
  • Early first menstruation (˂ 11 years) and late menopause (˃ 54 years) = many menstrual cycles during the fertile phase of life
  • Childlessness or first pregnancy after the age of 30
  • Meat and high fat diet
  • Very overweight and lack of exercise (especially after menopause)
  • Consumption of more than 20 g alcohol per day (corresponds to ~ 0.4 l beer or 0.2 l wine)
  • Smoke
  • Mastopathy grade II or III
  • Uterine, ovarian, or bowel cancer (triple risk)
  • Cancer of the other breast (ten times the risk)
  • Mother or sister breast cancer (five times the risk)
  • Radiotherapy of the chest in childhood or adolescence.

Breastfeeding. Studies have shown that breastfeeding reduces the risk of breast cancer. Breastfeeding has a 25% lower risk for mothers who have not been pre-stressed. But women with a family history also benefit: By breastfeeding, they can reduce their risk by almost 60%.

course

If the tumor begins to grow and penetrates the affected milk duct or the affected mammary gland lobule, it is called invasive tumor growth. Without treatment, it spreads to the neighboring lymph nodes via the lymphatic system (lymphogenic metastasis) or via the bloodstream to the whole body (hematogenic metastasis). This is followed by metastases (daughter tumors) in the lungs, brain, liver or spinal column and pelvic bones. This metastasis occurs relatively early in breast cancer: even with a tumor only 20 mm in size, there is a 50% probability that metastases are already present.

As long as the breast cancer is still within a milk duct and does not grow into the surrounding tissue, one speaks of a preliminary stage, the DCIS (Ductal carcinoma in situ). In the case of tumors of the glandular lobules, this is called the preliminary stage CLIS (Carcinoma lobulare in situ) or LCIS (Lobular carcinoma in situ).

Classification

The type of tumor can be determined in the tissue analysis: About 75% of breast cancers belong to the invasive ductal typethat emanates from the milk ducts. About 17% belong to the invasive lobular typethat comes from the glandular lobules. Studies suggest, however, that the origin of breast cancer does not lie solely in the milk ducts or in the glandular lobules. The majority of breast cancers appear to originate from the transition between the tissue areas, the ductulo-lobular unit (TDLE). The cells in this region divide very quickly and are more prone to genetic changes that lead to cancer growth.

These are among the rarer forms with a predominantly good prognosis tubular breast cancer and the papillary breast cancer, to those with a poor prognosis that medullary carcinoma and the mucinous carcinoma.

The different types of tumor show characteristic patterns under the microscope. B. through individual, one behind the other tumor cells - the term "single file pattern" is often used for this.

The type of tumor, along with its size, spread and the presence of lymphatic or distant metastases, determine this Breast cancer stage. The widely used TNM method is used to classify tumors. "T" stands for the extent of the primary tumor, "N" means nodus (= lymph node). The third letter "M" stands for (distant) metastases. In simplified terms, the classification looks like this:

  • T0 = ​​no tumor detectable in the breast
  • T1 = the tumor is <2 cm
  • T2 = the tumor is> 2 cm but <5 cm
  • T3 = The tumor> 5 cm but <10 cm
  • T4 = Regardless of its size, the tumor has already grown into the chest wall or skin beyond the breast tissue
  • N0 = no lymph node involvement detectable
  • N1 = detection of 1–3 affected lymph nodes in the armpit
  • N2 = detection of 4-9 affected lymph nodes in the armpit
  • N3 = detection of> 10 affected lymph nodes in the armpit and / or the collarbone
  • M0 = no distant metastases detectable
  • M1 = detection of distant metastases

Special forms

This is a special form of breast cancer Paget's carcinoma. Here the tumor is located near the nipple, so that individual tumor cells reach the tissue layers of the nipple and the areola and trigger an inflammatory, itchy skin change (eczema) there. Breast-conserving surgery cannot be performed with this type of tumor. An amputation is necessary.

Another special form is that inflammatory breast cancer, which is difficult to distinguish from a breast inflammation by its appearance (reddened, overheated and painful breast region).

Diagnostic assurance

Left: high-speed punch device for obtaining punch biopsies of the breast. The device produces the best tissue cylinders with relatively few complications, which is essential for a correct diagnosis. The doctor performs the biopsy under ultrasound guidance. Right: mammotome; the patient lies on her stomach on an examination table.
GTVL

Anamnese. Here the doctor asks for important information that will help him to make a diagnosis, for example underlying diseases such as high blood pressure and diabetes mellitus, but also existing cancers in the family.

Palpation. In many cases, the doctor finds clues as early as the palpation as to whether a palpated lump is suspect or not. He looks and feels for swelling, redness, inflammation and changes in the shape of the breast and nipple. He also examines the areas around the clavicle, sternum and armpits.

Blood and urine test. The results of the examination indicate whether the kidney, liver and other organ systems are functioning.

Genetic test. Women whose sister (s) or mothers have breast cancer are twice as likely to have breast cancer. This is particularly high if the cancer occurs in relatives before the age of 35, because around a third of breast cancers in these early cases are hereditary.

Two genes are responsible for half of hereditary breast cancers: BRCA-1 and BRCA-2. Those who carry the BRCA-1 gene in their genome have a 60% risk up to the age of 50 and an 80% risk of developing breast cancer up to the age of 70. Other so-called breast cancer genes are probably responsible for the other half. One of these genes, the RAD51C gene, has recently been identified. Experts also speak of the BRCA-3 gene.

That is why the German Consortium of Cancer Aid recommends the following risk groups BRCA genetic test:

  • Affected and unaffected relatives 1st (children, siblings) and 2nd degree (grandchildren, cousins) from a family with 2 or more people with breast cancer, at least 2 of them before the age of 50
  • Affected and unaffected relatives 1st and 2nd degree from a family in which breast cancer has occurred at least once and ovarian cancer once
  • Affected and unaffected first-degree relatives from a family with 3 or more family members with breast cancer - regardless of the age at which the disease occurred.

The genetic tests also have a downside. Many doctors and psychologists view them critically, because apart from the high costs, a negative result does not mean the all-clear. And in the case of a positive diagnosis, the pre-stressed women are recommended exactly what women are recommended to do anyway: to use all opportunities for early detection and to reduce risk factors as much as possible.

Genetic subtype determination. Compared to the genetic tests, which show a familial predisposition, the genetic subtype determination determines molecular factors that are decisive for the course of the disease and the success of the therapy. Due to varying genetic characteristics, the disease manifests itself differently in each breast cancer patient. The question of how malignant the cancer is also depends on the type of breast cancer, i.e. with the molecular subtype present. The subtype also decides whether the patient has a good or bad prognosis and also provides information on whether chemotherapy is effective or not. Scientists have now developed a method that makes it possible to determine the molecular subtype of a patient, i.e. her gene signature, as scientists call it. They also succeeded in identifying patients who had a good prognosis even though they developed a very aggressive breast tumor - triple negative breast cancer (TNBC).

Biopsy. If the suspicion of breast cancer is confirmed, a tissue sample (biopsy) is taken from the suspected breast region. This is done under local anesthesia, which is usually achieved by applying a cream to the skin. The biopsy is done with a thin hollow needle. The needle either fills with tissue when it is pushed in (punch biopsy), or a tissue sample is sucked in by vacuum (vacuum biopsy). Under ultrasound control, the biopsy needle is pushed to the suspicious focus that the patient or the doctor has felt. If the change can only be seen in the mammography, several tissue samples are taken and examined by means of the vacuum biopsy under a special mammography device (mammotome) for further clarification.

If the biopsy does not provide a sufficient assessment, the suspicious lump is completely removed under general anesthesia. The tissue examination of the lump is usually done during the operation as a quick section examination. If breast cancer is detected, the operation is extended under the same anesthetic. In the past, this procedure was also widely used for biopsy in order to spare the patient the burden of two procedures - one for the biopsy and one for the operation. In the meantime, however, it is used less often because the accuracy of the rapid section examination is limited and the psychological stress is difficult to bear, at least for some patients.

Imaging procedures

Mammography. The best time for a mammography is the days after the menstrual period because this is the best time to assess the breast tissue. During the examination, both breasts are pressed one after the other between two plates in order to also accurately represent the structures inside the breast. The compression is not painful, but it is uncomfortable. The doctor needs one image from above and one from the side of each breast. Depending on the findings, additional images may be necessary. With mammography, the doctor can identify small accumulations of calcium particularly well (Micro-lime), which appear in the early stages of breast cancer and cannot be palpated. In addition, the shape of tissue changes and their expansion into neighboring tissues can be assessed.

Two techniques are used in mammography: in analog mammography, the image is captured on film; in digital, the image data is electronically stored and examined on the computer screen. The difference lies less in the image quality than in the radiation exposure, which is halved with digital mammography.

Note: The younger the woman, the more cautiously mammography should be used because of the radiation exposure. For this reason, only women between 50 and 69 years of age are invited to the screening.

Breast ultrasound. In addition to or as an alternative to mammography, many gynecologists recommend an ultrasound examination of the breasts. It is sometimes referred to as a "gentle" and risk-free alternative, especially for younger women. According to the prevailing opinion, breast ultrasound is only of sufficient informative value in conjunction with mammography - it does not replace mammography at any stage of life. According to one study, a combination of mammography and ultrasound is the best way to increase the rate of tumor detection.

MRI. An MRI or magnetic resonance scan of the breast is very informative, but expensive. Therefore, the health insurance fund only covers the costs (upon request) in the case of unclear mammography findings or in high-risk cases (breast cancer in the family). One disadvantage of MRI is that microcalcifications are not detected.

Medical societies recommend women between the ages of 24 and 49 whose mother or sister has breast cancer to have an MRI of the breast every year, among other things in order to avoid the radiation exposure of the otherwise very often necessary mammography. However, the additional costs are considerable.

MRI breast cancer. The finding in the left picture suggests a malignant tumor (arrow). In the picture on the right, the contrast agent-enriching tumor clearly stands out from the rest of the mammary gland tissue and confirms the suspicion of breast cancer.
Georg Thieme Verlag, Stuttgart

Galactography. If one of the milk ducts secretes bloody or brownish secretion, the doctor makes these very fine ducts visible during the mammography. To do this, he injects contrast medium into the milk duct and its ramifications via a probe (Galactography). If the light-colored liquid encounters an obstacle, e.g. B. a tumor, it flows sideways; If the tumor closes the entire milk duct, the flow of contrast medium is "interrupted". The doctor sees where the lump or tumor is and surgically removes it later.

Ductoscopy. In the case of an endoscopy of the milk duct (ductuscopy), the doctor pushes a thin endoscope with a maximum diameter of 1 mm with a light source and a saline solution into the milk duct. While the saline solution washes through the milk duct, the doctor follows the course of the duct and its branches on a screen. If he sees something conspicuous, he inserts a thin wire. This can be used to mark a very small tumor. The patient is given a short anesthetic during the examination.

Elastography. Elastography is a special form of ultrasound that measures the elasticity of breast tissue. This method helps doctors to confirm breast cancer diagnoses and to protect patients from unnecessary biopsies. Because malignant cancer tissue is less elastic than benign tissue. Doctors use the elasticity value to determine how elastic the tissue is. If the value is above 4, the fabric is not very elastic. The probability that a malignant tumor is present is therefore high. In such a case, a subsequent biopsy is necessary. A value below 4, on the other hand, indicates that it is elastic benign cancer tissue.A biopsy is therefore not indicated. In practice, this means that if doctors detect a tumor (tissue proliferation) during mammography, they should first check it with elastography. Doctors should only perform a biopsy when the evidence of a malignant cancerous ulcer is confirmed.

Ultrasound, X-ray and / or CT. When breast cancer is diagnosed, an additional check is made to see whether the tumor has spread to the other breast or to another part of the body. An ultrasound or X-ray examination will be done on the unaffected breast, and the chest will also be X-rayed. The liver is examined either with an ultrasound or a CT scan.

treatment

Successful breast cancer treatment depends on many factors, including: of:

  • Size, location and tissue type of the tumor
  • Number of tumor foci
  • Influencing tumor growth by hormones
  • Presence of distant metastases
  • You have had breast cancer or any other cancer in the past.

Operational

With the exception of incurable cases, breast cancer therapy always begins with the complete surgical removal of the tumor. In addition, axillary lymph nodes must be removed and examined for tumor infestation in order to record the spread of cancer and for further therapy planning.

Wire marking. In some cases, a cancer focus cannot be felt in the breast. In order for the surgeon to operate in the right place anyway, this must be carried out by a Wire marking must be marked beforehand. This is done with 1 or 2 thin, soft wires that are placed with the help of a hollow needle. In order to correctly hit the knot, the breast tissue is made visible during the needle marking using mammography or ultrasound. The patient is given a local anesthetic for this five to ten minute procedure.

Breast-conserving surgery. There is one in about 70% of all breast cancer cases breast-conserving surgery possible if the tumor is only small in relation to the size of the breast, is in a favorable location and has neither grown into the skin nor into the muscles. During the operation, the tumor is removed together with the overlying skin and a safety margin of at least 5 mm on all sides. A distinction is made in detail:

  • Tumorectomy or Lumpectomy (pure tumor removal with a safety margin)
  • Segmentectomy (an entire breast segment is removed)
  • Quadrantectomy (Removal of a quarter of the breast gland body).

Breast-preserving can, however, mean that the breast looks visually different. Therefore, if large tissue defects are to be expected, a plastic surgeon is involved in the operation in order to achieve the best possible result.

Radical operation. It used to be the radical removal of the breast (Mastectomy, Mastectomy) together with the axillary lymph nodes are the rule, today it is limited to cases in which the cancer is very large in relation to the breast (˃ 5 cm), comprises several nodes or the patient so wishes. According to new scientific findings, the procedure also protects patients who suffer from familial breast cancer. Women in whom doctors detect mutations in the breast cancer genes BRCA-1 and BRCA-2 have a significantly lower risk of developing the disease again after a mastectomy.

After a mastectomy, plastic-surgical breast reconstruction (breast reconstruction) with your own tissue or implants is usually possible. The implants are made of either saline or silicone. Both variants are harmless to health. Even silicone no longer poses any dangers since it was used as a gel. They only differ in terms of comfort. In a US study, for example, patients with silicone implants were significantly more satisfied than those with saline implants. The breast reconstruction is either carried out at the same time as the breast is removed (simultaneous radical-modified mastectomy) or after an interval of 3–6 months.

Another option are loose Breast prostheses, which are worn in combination with a special bra and are available in medical supply stores.

The costs for all measures are usually covered by the health insurance companies.

Lymph node removal. For further treatment and to assess the prognosis, several axillary lymph nodes are removed from the affected side and examined in fine tissue. In order to avoid unnecessary lymph node resections, only a single one (sentinel or sentinel lymph node) is removed and examined first, provided the cancer does not exceed a certain size. To do this, the doctor injects dye and / or a radionuclide around the tumor, which shows the lymphatic drainage and thus also the first lymph node station in the area where the cancer has spread. This removes this first stage of lymphatic drainage from the tumor in a targeted manner. If this is affected by cancer cells, the remaining lymph nodes are removed in a second operation.

If these lymph nodes contain cancer cells, this indicates that the cancer is no longer confined to the breast. This node-positive finding is a bad sign and usually prompts doctors to recommend subsequent chemotherapy, hormone or antibody therapy as aggressively as possible. Conversely, a node negative result means that the examined lymph nodes do not contain any malignant cells.

chemotherapy

Chemotherapy is currently necessary in over 90% of all patients. This is often a treatment with a three-way combination according to the so-called FEC scheme (5-fluorouacil, epirubicin and cyclophoshamid) or the TEC scheme (docetaxal, epirubicin and cyclophoshamide). The treatment is carried out in several cycles. Chemotherapy is available on an outpatient basis in oncological practices or day clinics, unless there are serious side effects.

In certain cases it makes sense already in front the operation to perform chemotherapy, the primary or neoadjuvant chemotherapy: It can be used when the tumor is so large that the entire breast needs to be removed. In this way, doctors try to reduce the size of the tumor in order to operate in a way that conserves the breast.

radiotherapy

Post-operative radiation. After every breast-conserving operation, often also after the mastectomy, radiation (radiotherapy) is carried out on the affected area in order to kill any cancer cells that may still be present and to reduce the risk of tumor growth again.

Intraoperative radiation. Several studies have shown that after the tumor has been removed, the breast can also be irradiated once intraoperatively, i.e. during the operation, instead of postoperatively. The results are equivalent, at least in strictly selected cases. The advantage is that the intraoperative radiation is much less stressful for the patient than the postoperative one, which takes weeks. However, it is still unclear in which cases patients should be offered intraoperative radiation without any disadvantage for the success of the therapy.

Preoperative radiation. Radiation before the operation is only justified in the case of extensive tumors that cannot be completely removed with a primary operation - i.e. without pretreatment. This should make the subsequent breast and tumor removal more successful. The operation usually takes place 3–4 weeks after the radiation is complete.

Palliative (soothing) radiation. If the tumor is already so large or has grown so strongly with its surroundings that it can no longer be operated on, the breast is immediately irradiated. In the case of tumor recurrences or metastases in the chest region, irradiation of the metastases also relieves the pain and reduces tumor growth in these areas for a few weeks to months.

Hormone therapy

The term "hormone therapy" is misleading because it is actually an "anti-hormone therapy". Treatment consists of administering anti-estrogens (e.g. tamoxifen, raloxifene, fulvestrant) to stop the tumor from growing.

Recently, aromatase inhibitors such as exemestane, anastrozole or letrozole have increasingly been given instead of anti-estrogens, which bring better survival rates but are very expensive. The prerequisite is that the tumor reacts to the existing female sex hormones estrogen and progesterone with increased growth.

Palbociclib (Ibrance) has been approved for the treatment of advanced hormone-receptor-positive breast cancer since 2016. The active ingredient is combined with an aromatase inhibitor or the anti-estrogen fulvestrant as part of anti-hormone therapy. It treats women for whom further surgery, radiation or chemotherapy aimed at healing is no longer an option. It is not yet clear whether the new drug will enable people to live longer in advanced breast cancer.

Note: Be in the doctor's letter hormone sensitive Tumors (hormone-sensitive tumors) abbreviated to ER + (estrogen receptor positive) or PR + (progesterone receptor positive).

Whether a tumor is hormone-sensitive can only be determined during the tissue examination after the operation. The result is assessed using a points system (Immune Reactive Score, IRS).

Antibody therapy

Antibodies act against foreign substances that have penetrated the body, i.e. bacteria, viruses or toxins, but also against "foreign" substances that have developed in the body, such as components of cancer cells. Antibodies can also be produced in the laboratory and used as drugs.

The monoclonal antibody trastuzumab (Herceptin®) is of particular importance in the treatment of metastatic breast cancer. This antibody binds to the HER2 receptor and thus prevents the growth of breast cancer cells that carry precisely this receptor. HER2 is detectable in every fourth breast cancer patient. The result of this targeted therapy ("Targeted Treatment"): Cancer cells with HER-2 do not divide any further, but perish. According to study results, the risk of a relapse is reduced by up to half.

Because of its relapse preventing effect, Herceptin® is used for the treatment of early breast cancer prevention of breast cancer recurrence.

Further monoclonal antibodies against breast cancer (recurrences) are in development.

Psycho-oncological care

In every phase of cancer, a psycho-oncologist is recommended as a contact person who looks after both the woman concerned and the relatives. This happens during the inpatient stay or in the post-inpatient environment. During the psycho-oncological counseling, questions about the illness and treatment, problems in everyday life and at work can be discussed. In addition, it is clarified what kind of support family and friends can provide or need themselves.

Psycho-oncological offers are run by various professional groups, especially psychotherapists, psychologists, social workers, social pedagogues, physiotherapists or employees from the care sector.

Aftercare

Follow-up examinations, especially within the first five years after diagnosis, are one of the decisive factors for the success of breast cancer treatment. If a tumor recurs (relapse), it can be identified and treated early through follow-up care. Follow-up care includes regular check-ups in order to detect relapse and the occurrence of metastases as well as long-term effects of cancer therapy at an early stage:

  • Every 3 months in the 1st to 3rd year
  • Every 6 months in the 4th and 5th year
  • From the 6th year onwards, once a year as part of the cancer screening program.

The time intervals can vary from case to case and depend on the stage of the disease, type of therapy, individual risk of relapse, long-term consequences of the therapy and possible concomitant diseases.

Follow-up visits include:

  • The conversation with the gynecologist or oncologist
  • Examination of the breast, including the surgical scars, armpits and arms, and weight control
  • A physical examination, mammography and ultrasound are necessary for the early detection of recurrences or metastases
  • Investigation and treatment of lymphedema, which often occurs as a result of axillary lymph node removal.

Not all doctors consider this to be sufficient, but also recommend regular liver ultrasound and lung x-rays. We authors agree: liver, lung or lung metastases do not cause any symptoms for a very long time. However, there are treatment options, which is why it is worthwhile to use all options for early diagnosis.

Complications

After the operation. As with all operations, there are rare cases of wound healing disorders and / or infections. Since skin is also removed, temporary feelings of tension occur after the operation until the remaining skin has stretched. When the axillary lymph nodes are removed, small nerves are severed, so that in rare cases the mobility of the shoulder and arm is impaired. Other long-term effects of lymph node removal are lymph drainage disorders (lymphedema) and sensory disorders.

After chemotherapy. During treatment with natural or synthetic substances that are supposed to inhibit cell growth and cell division (cytostatics), the rapidly regenerating tissue in particular is damaged: hair roots, mucous membranes of the stomach and intestines and the blood-forming system in the bone marrow. Possible side effects are hair loss, nausea, vomiting, diarrhea and increased susceptibility to infections. The side effects are largely alleviated by appropriate medication. They usually go away completely after the end of chemotherapy.

After radiation therapy. Acute consequences occur days after the radiation and usually subside within a few weeks. These include diarrhea and / or irritable bowel symptoms. According to a study, these can be avoided if the women take selenium as the sodium salt during treatment: Thanks to this dietary supplement, only 21% of the treated women had to fight with diarrhea compared to 45% of the women without selenium. Selenium reduced radiation-related symptoms without impairing the benefits of radiation.

After hormone therapy. Treatment with hormones also leads to undesirable side effects - especially since the treatment lasts for many years. Nausea and weight gain are the most common but go away after treatment is stopped. The risk of blood clots (thrombosis and pulmonary embolism) increases with hormone therapy.

The administration of GnRH analogs (e.g. Enantone Gyn®, Trenantone®, Zoladex®) suppresses the production of hormones in the ovaries. This puts (even young) women into menopause - with the typical menopausal symptoms that set in abruptly.

The antiestrogen tamoxifen is suspected of increasing the risk of hormone-insensitive secondary tumors. One study showed that the active ingredient reduced the incidence of hormone-sensitive tumors by 60%, as expected - but the risk of the more aggressive hormone-insensitive tumors was 4 times higher after 5 years of use.

After antibody therapy. The antibody trastuzumab (Herceptin®) often causes diarrhea and headaches. Severe damage to the heart muscle occurs in around 1% of cases, which is why the heart function must be checked (especially cardiac ultrasound) before starting treatment and at three-month intervals during treatment. After treatment, monitoring should be continued every 6 months for at least 2 years. Simultaneous use of anthracyclines is contraindicated.

forecast

Due to multiple advances in therapy, the chances of survival for breast cancer patients have improved significantly. 1 in 3 women in Germany still dies of the consequences of their breast cancer. The prognosis depends on whether and how many lymph nodes in the armpit are involved and how early or late the tumor is discovered. On average, over 80% of women with breast cancer survive the next 5 years and over 70% the next 10 years. The 5-year chance of survival after breast-conserving surgery is just as high as after a mastectomy. If the lymph nodes are not involved, the 5-year survival rate is around 95%.

One can never speak of a definitive cure for breast cancer: Late recurrences, i.e. the recurrence of the tumor or breast cancer metastases (daughter tumors) after 5 to 30 years of symptom-free time, are unfortunately often, v. a. in women under 40 years of age when breast cancer was first diagnosed. While recurrences are treated according to similar rules as the first tumor and can be treated well, metastases usually do not cure. If men develop breast cancer, their prognosis is worse than that of women: the 5-year chance of survival is only 73%.

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What you can do yourself

The first days.

Diagnosing breast cancer is a major turning point in a woman's life. For relatives, friends and acquaintances too, the diagnosis is usually a shock that has to be dealt with. The question "Why me?" the best doctor will not be able to answer you, and you must try to cope with the difficult situation and adapt to it.

Don't suppress your feelings - desperation, anger, sadness, and the fear of relapse are all part of dealing with such an illness. Usually these feelings appear in phases and lose their intensity again. However, many women also report that they have never completely left their fear, even after successful therapy. Try to find out what is essential for your emotional balance and avoid anything that unbalances you. Every woman will find her own way to do this.

Choice of therapy center.

Every breast cancer patient wishes to get rid of the tumor as quickly as possible. However, only in rare cases is it medically necessary to have an operation immediately. After the diagnosis, take about two weeks to decide whether you would like the treatment and subsequent therapy to be carried out in a hospital or in a breast center. Your future quality of life may depend heavily on which facility and which surgeon you choose.

By awarding the "Certified Breast Center" quality seal, the German Cancer Society wants to ensure that patients can be sure that they will be treated in the certified center according to the current state of science. The aim is to significantly improve care for breast cancer patients. However, the term "breast center" is not protected and any clinic can use it without it providing any information about the quality of the offer. If in doubt, it is worth asking whether this designation has been awarded by the German Cancer Society.

Nutrition.

A balanced diet is v. a. important during chemotherapy. However, so-called cancer diets have no proven success. Eat what you feel like eating. And if you don't feel like it: wear it with composure, the pleasure of eating will come back! Anyone who suffers from nausea and has no appetite should try to eat small meals and be sure to drink; small sips of tea or still water are best tolerated.

Nicotine.

If you haven't already quit smoking, you should do so at the latest after the diagnosis. Women who continue smoking after being diagnosed with breast cancer have a 72% higher risk of dying of breast cancer recurrence in the following 11 years compared to non-smokers.

Move.

Basically, sport and any active lifestyle increases well-being. Exercise, practiced without excessive demands, improves the mood, strengthens self-esteem and body awareness and can improve the immune system and therapy tolerance.

It helps to prevent lymphedema after an axillary lymph node removal Move. Specially designed fitness courses with weights or just lifting weights alleviate the discomfort. Women do not need to spare their arms - as doctors have often recommended up to now. You can also lift weights over 2.5 kg. As one study shows, all breast cancer patients benefited from lifting weights - regardless of how many lymph nodes they were missing in total. As with strength training, compression bandages should always be worn for light weightlifting.

Quiet.

If you are exhausted or tired, you should listen to your body, do not overwhelm yourself and, if necessary, refrain from exercising. Take frequent breaks in everyday life and practice strenuous activities while sitting rather than standing.

Relaxation procedure.

For deep physical and mental relaxation z. B. Progressive muscle relaxation according to Jacobson and autogenic training, but also yoga, mindfulness training, Tai Chi or Qigong and meditation. In addition, if used regularly, they improve body awareness and promote mental equilibrium. However, it takes 2-3 months for such a relaxation technique to work.

Skin, hair, body care.

Your skin can tolerate radiation better if you wear comfortable clothing that does not rub or pinch. Garments made of cotton or silk are well tolerated. During the therapy you must not bring the irradiated region into contact with water (i.e. also do not wash it!), Because this increases the locally damaging effect of the radioactive rays. To protect against solar radiation, the very light-sensitive skin in the area of ​​the radiation field must initially be covered by opaque clothing. Later you can use sunscreen preparations with a high sun protection factor.

Hair loss during and after chemotherapy is a hard-to-bear symbol of the disease for many women. Some women cut their hair short before chemotherapy or get along with confidently worn baseball caps or scarves. Others take care of a suitable wig as early as possible. In fact, you should buy a wig when you still have your own hair. Then it is easier to find an inconspicuous wig that matches the color of your skin type. But some women also prefer a wig that makes them a completely different type and has nothing to do with their natural tone. During the period of greatest hair loss, some women sleep with stretch turbans (available in drugstores) so that the hair that has fallen out does not have to be laboriously picked up from the pillow. Some also shave their hair off in advance so that they do not have to experience the slow hair loss. About three months after the end of chemotherapy, a wig is usually no longer necessary, the hair has then grown back, after about six months one can speak of a short hairstyle.

During chemotherapy, personal hygiene is very important for many women. Take the needs your body signals to you seriously and take the time to meet them. Try to be good to your body as appropriate. Treat yourself to a longer stay in the bathroom, the use of body creams, cosmetics and wellness treatments.

Maintain self-esteem.