Breast cancer: treatment and aftercareWomen who develop breast cancer (mammary carcinoma) will make decisions about the individual treatment steps in consultation with their doctor. AOK-Curaplan helps you with important information on treatment and aftercare.
Treating breast cancer: the contents of AOK-Curaplan
Breast cancer is the most common cancer in women. If breast cancer is not treated, the malignant tumor cells can spread throughout the body and form new tumors (metastases) there. Early diagnosis can prevent this by initiating the correct treatment as quickly as possible. Women should therefore regularly take advantage of offers for early detection of breast cancer. If a diagnosis of breast carcinoma is made, the treatment plan will be discussed individually with your doctor.
In the AOK-Curaplan breast cancer treatment program, everyone involved ensures that you as a patient receive treatment tailored to your individual situation:
The gynecologist accompanies you from the beginning. It provides comprehensive information about the entire course of the disease – from the suspicion of breast cancer to possible therapies and follow-up care after treatment has been carried out. In addition, you will be actively involved in all decisions. The gynecologist or family physician coordinates medical care – for example in the hospital, with other specialists or if psychosocial support offers are taken up. All those involved in treatment and aftercare work closely together. This avoids unnecessary stress. Avoiding delays. You will also benefit from the great transparency of the procedures. More safety through high treatment quality. For AOK-Curaplan Breast Cancer, the AOK has signed contracts with gynecologists and certified breast cancer centers that ensure high quality standards. The treatment recommendations for the participating physicians are based on scientific guidelines. Correspond to the current state of medical knowledge. Psychosocial care. Since the diagnosis of breast cancer is always a heavy psychological burden, you can take advantage of psychosocial or psychological support during the entire treatment period.
Decision about the treatment method
How the breast cancer is treated depends on the nature of the cancer, how extensive it is and whether the tumor has already spread. Breast cancer therapy is therefore always planned individually. The general state of health is taken into account as well as the personal needs of the patient.
Surgery for breast cancer
Surgery is an important component of breast cancer treatment. There are two options for this:
– The breast-conserving operation (BET). Increasingly, breast-conserving surgery can be performed. The tumor is completely removed with an appropriate distance in the healthy tie. Surgical removal of lymph nodes may be necessary if it has been shown in advance that the sentinel lymph node is infested with tumor cells – that is, the one that is located first in the drainage area of the lymph fluid of a malignant tumor. A pathologist then examines the tumor under the microscope to determine whether it has been completely removed. Additional examinations can also be performed to determine certain markers that influence further therapy. The final diagnosis is usually available about one to two weeks later. The so-called TNM stage is then determined from all the examination results (see below). Only then is it clarified with the attending physician what further treatment is recommended. – Breast gland removal (mastectomy). If breast-conserving surgery is not possible, a mastectomy will be required. The whole glandular body with the surrounding connective and fatty tie is removed. A scar is left behind that runs across the chest wall. During this breast surgery it may also be necessary to remove the adjacent sentinel nodes or lymph nodes. However, this is only necessary for a few patients. A variant of this surgical method is the skin-sparing mastectomy, in which the nipple and part of the areola are removed in addition to the mammary gland tie. However, large parts of the skin remain intact. It can be used to reconstruct the breast if breast reconstruction is performed at the same time.
Chemotherapy or hormone therapy is often used as an adjunctive therapy to surgery.
Breast cancer surgery: facts for decision making
The diagnosis "breast cancer" is certainly frightening at first. If the tumor is small, there is an important question to be answered: breast-conserving surgery or removal of the breast? To help you make the right decision, we have compiled the most important facts.
– In the case of both breast conservation and removal, the following applies: Approximately 90 out of 100 women with a small tumor do not develop breast cancer again in the following ten years (no recurrence). – 80 to 90 out of 100 patients live for at least another ten years after both surgical procedures.
In a comparison of the two procedures:
– Without radiation therapy, approximately 15 to 20 percent of women who choose breast conservation will have another tumor in the same breast (local recurrence). – How high the risk is also depends on whether and to what extent lymph nodes are affected. – The risk of a tumor returning is slightly increased with breast-conserving therapy with radiation compared to removal of the breast. However, this does not affect the length of time the patient has left to live.
Questions about breast conservation and breast removal
When weighing the pros and cons of the two treatment alternatives, additional questions may arise. Please make a note of these questions for your discussion with the doctor, for example:
– What would my breast look like after breast conservation surgery?? – Breast-conserving therapy should be combined with radiation therapy, if possible, to reduce the risk of tumor return. If personal or medical reasons speak against radiation treatment. So that against a breast-conserving surgery? – Which treatment path makes me feel better and safer? Do I want breast reconstruction?
Deciding on follow-up treatment after breast cancer surgery
After the operation, the pathologist examines the tumor tie with regard to tumor biological parameters such as size, grading and hormone dependence. This is necessary to decide whether chemotherapy is also necessary. Grading describes the extent to which the cells of the tumor tie have changed compared to healthy tie. The TNM classification is an international label for tumor diseases. Used to assess the extent of the cancer. This classifies tumor size (T), lymph node involvement (N), and distant metastasis (M). This also allows the chances of a cure for breast cancer to be assessed.
– Tumor size (T) quantifies the size of the tumor (TX, T1 to T4). – Lymph node involvement (N) indicates the number of affected lymph nodes (NX, N0, N1, N2). – Metastasis (M) provides information about the presence of distant metastases (MX, M0, M1), when the cancer "spreads". Further examinations are necessary for this. – The suffix X stands for "not assessable or not assessable at this time". The suffix 0 stands for "not present.
Therapies for breast cancer
Radiation therapy for breast cancer
After breast-conserving surgery, subsequent radiation therapy is usually necessary.
This is the course of radiation therapy
In breast-conserving therapy, the diseased breast must be treated with radiation in most cases to prevent the tumor from recurring. In the case of breast removal, this is only necessary if the tumor could not be removed completely.
Radiation therapy is also used for patients with metastases. For example, it can be important in bone metastases to stabilize the bones and relieve discomfort.
Based on the findings, the doctor draws up an individual treatment plan for the patient. During therapy, the diseased breast is irradiated to destroy any residual tumor cells in the breast. Tumor cells usually have a poorer repair capacity for DNA damage than normal cells. In order to spare the healthy tie and destroy the tumor cells, this difference is exploited by distributing the total dose over small daily individual doses.
In the breaks between the individual appointments, the healthy cells can recover from the treatment.
Treatment with radiation reduces the number of recurrences
Radiation therapy significantly reduces the likelihood of tumor recurrence, known as the risk of recurrence, after breast conservation therapy, increasing the chances of cure for breast cancer.
Side effects of radiation
Possible side effects are skin irritation, skin changes and general dullness. Sometimes it makes sense to irradiate an area of the breast more intensively than the rest of the breast by means of so-called boost irradiation. This results in an average treatment duration of five to seven weeks with a total of about 30 to 33 radiation treatments. Radiation therapy is usually administered on an outpatient basis. Patients then come to the clinic every day (except on weekends). holidays) to a breast center or a specialized practice for radiation therapy. The radiation itself lasts only a few minutes at a time.
Chemotherapy for breast cancer
During chemotherapy, the patient receives so-called cytostatic drugs. The chemical substances inhibit the growth of the cancer cells and cause them to die off.
Treatment with chemotherapy
Whether chemotherapy is necessary depends on individual tumor characteristics and individual extent. The patient's need for safety and quality of life, as well as the chances of curing the breast cancer, also play an important role. The decision for or against chemotherapy is independent of whether the breast is to be preserved during breast surgery or whether a breast removal, also known as a mastectomy, is to be carried out.
Effect of chemotherapy on breast carcinoma
Chemotherapy involves the administration of chemical substances known as cytostatics, which inhibit cell division and thus cause tumor cells to die. These drugs act on all cells in the body that divide rapidly, especially tumor cells. In many cases, therefore, cytostatic drugs are very effective in cancer therapy. Healthy cells also divide. Thus lead to side effects during chemotherapy. The cells of the bone marrow, mucous membranes, digestive tract and hair roots are particularly affected. Therefore, the possible side effects of chemotherapy include temporary hair loss, weakness, nausea and vomiting. A sharp drop in the number of white blood cells leads to temporarily increased susceptibility to infections.
Duration of chemotherapy treatment
Chemotherapy can take place both before surgery to shrink the tumor to allow surgery (neoadjuvant chemotherapy) or following surgery to destroy any tumor cells that may be circulating in the blood (adjuvant chemotherapy). If the cancer has already metastasized, i.e., there are daughter tumors in other organs, chemotherapy may be used to prevent further spread and shrink existing tumors (palliative chemotherapy).
Chemotherapy is administered in different cycles, consisting of the treatment phase and a treatment break. The intervals between the phases vary depending on the treatment regimen chosen. During the treatment phase, the drugs are given as infusions or, less frequently, in tablet form. During the break, the healthy cells can recover.
Since the number of drugs administered as well as the cycles and length of breaks vary depending on the treatment regimen, the duration of treatment varies. Chemotherapy and radiation therapy may last longer than half a year in total.
Biomarker test in breast cancer: is chemotherapy useful?
Whether chemotherapy is recommended during treatment for breast cancer depends on several factors. In addition to purely clinical data such as the characteristics of the tumor and the patient's age, personal aspects such as the patient's need for safety or her assessment of the side effects also play an important role.
Approximately 70 women are diagnosed with breast cancer in Germany every year.000 women suffer from breast cancer; in about two out of three women, the tumor is found at an early stage and lymph nodes are not yet affected. In many cases, after complete removal of the tumor, the findings are sufficient to make a conscientious decision as to whether additional, preventive chemotherapy will have more advantages or more disadvantages. In some cases, however, there is uncertainty as to whether chemotherapy is really useful.
In such cases of doubt, biomarker tests, also called gene expression tests, can help. In patients with early stage breast cancer, where the risk of recurrence cannot be determined with certainty, the test can be used. The AOK generally covers the costs of these tests if the physician is unable to make a clear therapy recommendation based on the tumor characteristics and clinical aspects.
Specifically, public health insurance currently covers the cost of the Oncotype DX gene expression test, the Prosigna, the Endopredict and the Mammaprint. For more information, please contact your local AOK health insurance provider.
Does biomarker testing require additional breast surgery?
The tests are performed on tumor tie that has been removed during biopsy or surgery and fixed for pathological examination. For the patient, the biomarker test therefore means no further surgical intervention.
How should the results of the biomarker test be classified??
The significance of the biomarker tests has been investigated in studies. Depending on the test variant, the activity of 11 to 70 relevant genes in the diseased tie is measured. This activity enables conclusions to be drawn about the risk of tumor recurrence.
The test result can complement the clinical and pathological criteria in estimating the risk of recurrence and can thus be included in the decision for or against chemotherapy.
Ultimately, the decision for or against chemotherapy is made by the patient together with her doctors. The patient's assessment of the risk of recurrence in relation to the stresses and risks of chemotherapy also plays a decisive role here.