Breast cancer

Breast cancer: Description

Breast cancer is a malignant tumor of the breast. Breast cancer is one of the most common cancers in women, which men can also suffer in extremely rare cases. The malignant tumor cells often spread in the breast area with the greatest proportion of glands, therefore the upper outer areas of the breasts are most vulnerable to attack.

Breast cancer: Symptoms

In the initial stage, breast cancer often does not cause painful symptoms. However, a number of signs and complaints can contribute to early detection of the disease. These include nodular growths or lumps in the breast, retracted skin or nipple, different breast sizes at rest or when lifting the arms, and watery-bloody discharge from the nipple or enlarged lymph nodes in the armpit, among others.

In advanced stages bone, back or joint pains may occur. Depression or weight loss are other possible consequences of the disease.

Breast cancer: Causes and Risks

Definitive causes of the tumor are largely unknown, but several risk factors provoke and promote the development of breast cancer. Advanced age significantly increases the risk of breast cancer. Other factors may be childlessness or late pregnancy, a continuous high-fat diet, abuse of alcohol or taking female sex hormones over a prolonged period.

Genetic predisposition must not be underestimated as a risk factor in this disease. In approximately 5-7 percent of the women affected, genetic mutation of the so-called tumor genes BRCA1 and BRCA2 is the cause of the cancer.

Breast cancer: Examination and Diagnosis

Women who regularly check their breasts themselves can help in the early detection of breast cancer. Any suspicion should immediately be checked with a gynecologist. This is done first by recording the medical history, then by palpation of the breasts, the armpits and the pits of the collarbone. A mammogram and additional tests such as ultrasound are used for screening and further diagnostics, increasing the reliability of a breast cancer diagnosis. With mammography, benign and malignant mutations can be distinguished, and their size and extent determined. Final confirmation of the diagnosis is made following a biopsy (punch biopsy, vacuum biopsy, fine needle biopsy or excisional biopsy, as applicable). In isolated cases, magnetic resonance imaging (MRI) is performed.

Breast cancer: Treatment

The choice of treatment depends on a number of individual factors, among others the size of the tumor, the metastasis and tissue characteristics of the tumor; the hormone receptor and menopausal status are also important. In addition to surgical procedures, in which in the early stages the breast is preserved or in radical surgery (mastectomy) is completely removed, radiation therapy and adjuvant or neoadjuvant chemotherapy may be employed. Adjuvant treatment is carried out after the (surgical) primary treatment, while neoadjuvant treatment is performed before the pending operation in order to minimize the tumor.

Additionally, radiation therapy is performed after breast-conserving surgery, which may last several weeks.

A new method for breast-conserving treatment of breast cancer has been available for several years: intraoperative radiation therapy (IORT). Here the tumor area is irradiated selectively with a high dose of radiation, because after removal of the tumor in the mammary gland, the area affected has the highest potential risk of recurrence. The new irradiation device uses weak X-rays at short range. The radiosensitive healthy organs and structures are thus protected during the procedure, making high-dose irradiation possible.

Chemotherapy is carried out with the addition of so-called cytostatics, which contain the growth of cancer cells, and is administered in the form of infusions or tablets. Chemotherapy involves a cyclic treatment with therapy-free periods (1 to 3 weeks) during which the patient can largely recover from the side effects. Hormone therapy can be connected to the chemotherapy as required, if the tumor responds to hormones.

In addition, immunotherapy with monoclonal antibodies and other targeted treatments are possible.

Breast cancer: Course and Prognosis

Early diagnosis of the disease increases the chances of recovery significantly. The risk of recurrence after breast-conserving surgery, although higher than after a mastectomy, can however be significantly reduced via subsequent irradiation.

Following radical surgery it is possible to undergo breast reconstruction, which depending on the patient's wishes and medical indications or post-operative care, can be carried out either in the course of the operation or at some later time.

Breast cancer prevention is possible only to a limited extent. One can simply avoid certain risk factors (e.g. alcohol) and contribute to general wellness with a healthy diet (e.g. fruits and vegetables) and physical activity (e.g. sport).

Breast cancer: Miscellaneous/Other comments

One of the priorities of the Department of Obstetrics and Gynecology at the Medical Center - University of Freiburg is cancer research. The interdisciplinary Breast Center of the Medical Center - University of Freiburg, under the medical direction of Prof. Dr. med. Elmar Stickeler, offers patients comprehensive, individual, capable treatment of breast diseases, as well as a wide range of preventive measures, early detection, diagnosis and treatment right through to post-operative care.