Breast Cancer Treatment | Specialists & Information

There are various treatment options available for breast cancer (mammary carcinoma), depending on the size and extent of the tumor. Personal circumstances, such as overall health and the stage of the breast cancer, are also taken into account when making a decision.

The Working Group on Gynecologic Oncology and the German Cancer Society regularly publish guidelines. Gynecologists and oncologists can use these guidelines as a reference when developing a treatment plan.

With approximately 67,300 new cases annually, breast cancer is the most common cancer among women @ Sebastian Kaulitzki /AdobeStock

Important factors in the treatment of breast cancer include:

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

In principle, curative therapies aimed at a complete cure are used in most stages of breast cancer.

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

The first step in breast cancer treatment is a consultation with a gynecologist, who refers the patient to a hospital. There, she undergoes further diagnostic tests and receives treatment.

Generally, there is no time pressure when it comes to treating breast cancer. Therefore, you can take your time to learn about the various treatment options, their benefits, and their 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 mammograms for breast cancer screening and the early detection of microcalcifications and lumps in the breast.

Certified breast centers bring together the expertise of specialists from various medical fields.

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 cases of advanced breast cancer or when there is a high risk, doctors may remove both breasts as a preventive measure. Breast reconstruction usually follows.In breast reconstruction using the patient’s own tissue, doctors reconstruct the breast using tissue from the back, abdomen, buttocks, or groin @ Akarat Phasura /AdobeStock

In most cases today, the surgery is as minimally invasive as possible. This means that the surgeon removes the tumor itself along with a small margin of surrounding tissue as a safety precaution.

They also usually remove the nearest lymph node to prevent the spread of tumor cells. Examining the lymph node provides information about how far the breast cancer has spread throughout the body.

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

To kill any tumor cells that may remain in the breast after surgery, additional measures (adjuvant therapies) are often used.

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

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

These include, among others:

• Radiation therapy
• Chemotherapy
• Anti-hormone therapy
• Antibody therapy
• Anti-angiogenic therapy

After surgery, further treatments are administered to prevent a recurrence and to combat any existing metastases.

Chemotherapy acts non-specifically throughout the entire body and is effective at destroying tumor cells that have not been localized. Cytostatic drugs inhibit cell growth, which is particularly harmful to rapidly dividing tumor cells.

However, all other cells in the body are also affected, which is why chemotherapy is usually associated with severe side effects.

Antiangiogenic therapy also affects the entire body. Angiogenesis refers to the formation of new blood vessels. Over time, large tumors require increasing amounts of oxygen and nutrients, so they form new arteries and veins.

Certain medications prevent this process, thereby limiting tumor growth. Doctors often use antiangiogenic therapy in combination with chemotherapy.

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

Radiation therapy damages the genetic material of cells, causing them to die. Tumor cells are less able to regenerate than healthy tissue. Therefore, the radiation affects them particularly severely.

Nevertheless, side effects also occur with radiation therapy due to damage to healthy cells. 

Two-thirds of all breast tumors respond to the female hormones estrogen and progesterone and grow as a result. These hormone receptor-positive tumor cells can be effectively treated with anti-hormone therapy. 

Specialists administer breast cancer medications in the form of tablets or injections. These medications inhibit hormone production or block the hormone binding sites on the cells. This slows the growth of the tumor or stops it entirely.

Anti-hormone therapy is used either in combination with other medications as the sole treatment for breast cancer or following surgery. 

It acts systemically and targets all tumor cells and metastases scattered throughout the body. To achieve full effectiveness, anti-hormone therapy is administered over a period of several years. 

The specific active ingredients depend on the type of tumor and the woman’s hormonal status (before, during, or after menopause).

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

They are also effective against abnormal cells in the body, such as tumors. Antibodies always react to cells with specific characteristics. This makes it possible to administer drugs that specifically target breast cancer cells without damaging healthy tissue. As a result, they have fewer side effects than chemotherapy or radiation therapy.

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

The patients’ health is usually poor at this stage. They often no longer have the strength to endure lengthy curative therapy.

Under such conditions, palliative care is used. It is not aimed at curing the patient, but rather at enabling her to live a pain-free life.