Breast cancer - the 25 most common questions

Every year, 50, 000 women and their families in Germany are confronted with the frightening diagnosis of "breast cancer". When the first shock is over, the affected women face an insurmountable "mountain" of open questions: "What happens now? Does every minute count or is there enough time to choose a clinic? What treatment options are there? Can my breast be preserved? ? " Many women affected by breast cancer are confused and insecure.

What are the causes of breast cancer?

The exact causes for the development of breast cancer are not yet known. For most women with breast cancer, no specific risk factor can be proven to be a safe trigger for the cancer. Breast cancer is a malignant tumor of the mammary gland. A tumor usually starts from a single degenerate cell. What this cell changes, you do not know until today.

Are there risk factors?

Several issues are likely to play a role in the development of breast cancer. Hereditary and hormonal components, for example, are considered general risk factors. If a mother or sister has breast cancer, the risk of developing breast cancer increases by 2 to 3 times.

In addition, an early first menstruation (before the age of 12 years) and a late menopause (after the age of 55) as well as a late (from the age of 30) or no pregnancy are considered as possible risk factors. The personal lifestyle (alcohol, smoking, overweight) can also play a role.

Do I have an increased breast cancer risk?

However, the potential presence of several of these factors does not need to unsettle you. Careful monitoring of one's own body as well as regular check-ups are the best way to detect changes in the breast early and clarify or treat if necessary.

What can I do to prevent?

Once a month (preferably right after menstruation, when the breast tissue is soft), every woman should carefully examine her breast herself. You stand in front of a mirror and look at your chest from all sides, even with raised arms. Pay attention to any changes.

Thereafter, both breasts are scanned clockwise with the fingers of the flat hand. Then gently squeeze both nipples between your thumb and forefinger to see if any fluid is leaking. Thereafter, the breast is again scanned while lying down as described above.

Finally, the underarms should also be examined for possibly swollen lymph nodes. It is important that you take the offer of the regular gynecological check-up. Also, the doctor will undergo a palpation of your breast and may recommend a supplementary mammography.

What symptoms are there?

The following symptoms may indicate breast cancer:

  • a keyed blurred node
  • Hardening or a rough spot on the chest
  • one breast is suddenly larger or differently shaped than the other
  • a sudden redness that does not subside
  • Skin retractions or "orange peel"
  • Knot in the armpit
  • Secretions from the nipple

If you notice one or more of these changes, you should consult your gynecologist.

How does the diagnosis work? What is a mammogram?

First, the gynecologist will carefully scan the breast. If a node is palpated, so-called mammography usually follows. This is an X-ray examination of the breast, in which the breast is gently compressed for better fluoroscopy. This is often perceived as unpleasant, but it is crucial for the quality of the X-ray, on which an experienced doctor can detect even the smallest changes.

What kind of examinations are there?

In addition to mammography, an ultrasound examination can be performed. However, this does not replace mammography. Rarely, an MRI scan is performed if breast cancer is suspected.

For final confirmation of diagnosis, a tissue sample is taken from the hospital. Various methods are available for this purpose.

Can breast cancer be cured today?

Yes, breast cancer can then be cured if it is detected in time before it metastasizes, that is, translocated tumor cells get into other parts of the body.

What happens after the diagnosis? What is the usual procedure? Does every minute count?

After the diagnosis has been confirmed, the doctor will send his patient to a hospital, usually to start the operation as the first treatment step. In most cases, the operation is carried out promptly for the diagnosis.

But: If you feel that everything is going too fast, take your time. Get a second opinion if you are unsure. Even if there are a few weeks between the diagnosis and the beginning of the therapy, this is not decisive for the further course.

How do I find the right clinic? What do I have to pay attention to when choosing a clinic?

Of course it is nice to be a patient at a nearby hospital. It is more important, however, to pay attention to the qualifications of the clinic and the doctors. In general, university hospitals, tumor centers or breast centers are considered the best addresses. Here, the doctors specialize in breast cancer and participate in current therapy studies.

Are there different forms of therapy?

The state of the art today makes it possible to provide a "tailor-made therapy" for every patient. The first step in therapy is usually the surgery to remove the tumor tissue from the breast. The lymph nodes under the armpit are also removed and then examined for the presence of cancer cells. After the so-called lymph node status then the further therapy.

What happens after the operation?

The surgery is followed by radiation of the affected breast. In patients whose lymph nodes were tumor-free, either no further therapy is given or hormone or chemotherapy is recommended.

If the lymph nodes have cancer cells and can be detected in the tumor tissue hormone receptors (hormone dependence), is recommended to a combination of chemo- and hormone therapy. Without the presence of hormone receptors, only chemotherapy is recommended.

What is a therapy study?

Studies on new treatment options for breast cancer are very important for medical progress. At so-called study centers different therapies are compared. The patients are often divided into two groups, one of which receives the most effective standard therapy, the other a new, promising therapy.

Does taking a study benefit me?

Definitely! Studies are carried out at specialized clinics and offer those affected improved healing and survival opportunities. It is checked in advance whether the study therapy is suitable for the patient. New drugs already approved by clinical trials will be compared to proven standard therapies.

Thus, it can be assumed that each patient receives one of the currently best available treatments. In other words, patients receive the highest quality of care and treatment in their studies - convincing reasons for participating in the study.

How do you go about the operation today? Can the breast be preserved?

The surgery usually takes place directly after the diagnosis and is carried out as gently as possible. The entire tumor and a "safety margin" of about one centimeter around the affected tissue are removed. Frequently, the surgery is also possible breast conserving. This depends, among other things, on the type and extent of the tumor and on the size of the breast.

What is chemotherapy? When is it used?

In chemotherapy drugs are used, which inhibit cell division (so-called cytostatics). It is a systemic treatment, one that affects the entire body. Whether chemotherapy makes sense depends on the type and stage of the tumor and the general condition of the patient.

The therapy is carried out at certain intervals, so-called cycles. Each treatment phase is followed by a break. The earliest possible use of chemotherapy is the so-called primary systemic use (formerly also referred to as "neoadjuvant"). It serves to reduce the size of the node even before the operation in order to make a breast-conserving operation possible. In addition, you can check in this early use, if the therapy strikes and the tumor shrinks. The goal is the cure of breast cancer.

What does adjuvant chemotherapy mean?

In Germany, so-called adjuvant, ie preventive relapse, chemotherapy has been carried out as standard for many years. There are several medications available. Adjuvant chemotherapy should prevent metastases from forming or relieving the patient. The aim of this therapy is also healing.

A recent study has shown that women treated with the modern cancer drug Taxotere (docetaxel) suffered 32% fewer relapses than those receiving standard therapy with conventional drugs. In women who had only minor lymph node involvement, the chance of survival increased by more than 50 percent.

What is a palliative chemotherapy?

When the disease is already advanced, that is, the tumor has already metastasized, a so-called palliative chemotherapy is used to stop further progression of the disease and to rapidly alleviate possible symptoms. The quality of life of the patient is at the forefront of this therapy.

What is hormone therapy?

A large proportion of all breast cancers contain hormone receptors, which means that the growth of the tumor can be additionally stimulated via female sex hormones. In these cases, tumor growth can be halted or slowed down by interfering with the woman's hormonal balance.

In hormone therapy, there are various options available: So far, the standard therapy consists of the administration of tamoxifen. It is a so-called antiestrogen, which occupies the hormone receptors and thus displaces the body's estrogen that would stimulate tumor growth. Tamoxifen is usually taken for five years.

As a treatment option for menopausal women, so-called GnRH analogues are available. These are hormones that inhibit the body's own hormone production in the ovaries. Removal of the ovaries is thus unnecessary.

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