Breast cancer treatment | Specialists & information

Types of breast cancer treatment

There are various treatment options that are used depending on the size and spread of the tumor in breast cancer (breast carcinoma). Personal circumstances, such as general health and the stage of the breast cancer, also play a role in the choice.

The Gynecological Oncology Working Group and the German Cancer Society regularly publish guidelines. Gynaecologists and oncologists can use these as a guide when compiling the therapy.

With around 67,300 new cases every year, breast canceris the most common cancer in women @ Sebastian Kaulitzki /AdobeStock

Important for the treatment of breast cancer:

• The size of the tumor in the breast
• Whether neighboring lymph nodes are affected
• Whether metastases have spread throughout the body

In principle, curative therapies are used in most stages of breast cancer with the aim of achieving a complete cure.

In advanced cases, doctors treat breast cancer more like a chronic disease. They control it to a certain extent, but can no longer cure it.

The starting point for breast cancer treatment is the gynecologist, who refers the patient to hospital. There she receives further diagnosis and treatment.

In general, there is no time pressure in the treatment of breast cancer. You can therefore take your time to find out about the various treatment options, their benefits and risks.

In addition to gynecologists, specialists in senology (the science of the mammary gland) are also involved in the diagnosis and treatment of breast cancer.

They can also perform mammography for breast cancer screening and early detection of microcalcifications and lumps in the breast.

Certified breast centers combine the expert knowledge of specialists from various medical fields.

Surgical removal of the tumor

The first step and core of most breast cancer treatments is the surgical removal of the tumor(breast cancer surgery). Depending on the size of the tumor, the affected breast may or may not be preserved.

In the case of advanced breast cancer or if there is a high risk, doctors may remove both breasts as a preventative measure. This is usually followed by breast reconstruction.In breast reconstruction with autologous tissue, doctors rebuild the breast using tissue from the back, abdomen, buttocks or groin @ Akarat Phasura /AdobeStock

In most cases today, the operation is performed as minimally as possible. This means that the surgeon removes the tumor itself as well as a small margin as a safety margin.

As a rule, they also remove the nearest lymph node to prevent the tumor cells from spreading. Examining the lymph node provides information about the spread of breast cancer in the body.

In three out of four cases, breast-conserving surgery is possible. Although removing the entire breast is safer, it does not reduce the risk of recurrence.

Additional measures (adjuvant therapies) are often used to kill any tumor cells that may remain in the breast after the operation.

Thanks to these advanced treatment methods, the prognosis for breast cancer patients is now very good. Around 9 out of 10 are still alive five years after diagnosis.

Non-surgical measures against breast cancer

If a tumor is too large, the breast cannot be preserved. Further therapeutic measures are used to shrink the tumor. These are called neoadjuvant therapy.

These include, among others

• Radiotherapy
• chemotherapy
• anti-hormone therapy
• antibody therapy
• Antiangiogenesis therapy

After the operation, further therapies are carried out to prevent a relapse. Also to combat existing metastases.

Chemotherapy has a non-specific effect throughout the body and is suitable for destroying non-localized tumour cells. Cytostatic drugs prevent the growth of cells, which is particularly damaging to rapidly dividing tumor cells.

However, all other body cells are also affected, which is why chemotherapy is usually accompanied by severe side effects.

Antiangiogenesis therapy also affects the whole body. Angiogenesis means the formation of new blood vessels. Over time, large tumors need more and more oxygen and nutrients, which is why they form new veins and blood vessels.

Certain drugs prevent this process. Tumor growth is therefore restricted. Doctors often use antiangiogenesis therapy in combination with chemotherapy.

Another type of adjuvant therapy is radiotherapy. It is used following surgery. However, it is limited to a specific area.

Radiotherapy damages the genetic material of the cells, causing them to die. Tumor cells are less able to regenerate than healthy tissue. The radiation therefore hits them particularly hard.

Nevertheless, radiotherapy also causes side effects due to the damage to healthy cells.

Targeted therapies with few side effects

Two thirds of all breast tumors react to the female hormones oestrogen and progesterone and grow. These hormone receptor-positive tumor cells can be effectively combated with anti-hormone therapy.

Specialists administer breast cancer medication in the form of tablets or injections. These prevent hormone production or block the docking sites on the cells. This slows down the growth of the tumor or stops it altogether.

Anti-hormone therapy is used either in combination with other drugs as the sole breast cancer treatment or after an operation.

It has a systemic effect and targets all tumor cells and metastases scattered throughout the body. In order to be fully effective, anti-hormone therapy is used over a period of several years.

The exact active substances depend on the type of tumor and the hormone status of the woman (before, during or after the menopause).

Another targeted breast cancer treatment is antibody therapy. Antibodies are molecules produced by the body to defend against pathogens.

They are also suitable for combating abnormal body cells, such as tumors. Antibodies always react to cells with certain characteristics. This makes it possible to administer drugs that specifically attack breast cancer cells and do not damage healthy tissue. They therefore have fewer side effects than chemotherapy or radiotherapy.

Treatment for advanced breast cancer

If many lymph nodes are affected by tumor cells and these are spread throughout the body, the prognosis for breast cancer patients is poor.

The patient's state of health is then usually poor. They usually no longer have the strength to endure the lengthy curative therapy.

Palliative therapy is used under such conditions. It is not aimed at curing the patient, but at enabling her to live without pain.