Breast cancer (mammary carcinoma): signs and treatment

Breast cancer is the most common form of cancer among women in Germany – around a third of all new cancer cases can be attributed to it. This diagnosis is made in around 70,000 women every year. The chances of recovery depend primarily on the type of cancer and the stage of the cancer. It is all the more important to recognize the signs early. What are the typical symptoms of breast cancer in women, how is the cancer treated, and what is the prognosis?

Breast cancer: forms of this cancer

In medicine, several forms of breast cancer contain different cells. They grow more or less aggressively and spread secondary tumours (metastases) to varying degrees – especially in the bones, lungs, liver and brain. The cancer either originates in the milk ducts (ductal breast carcinoma) or, less frequently, in the lobules of the gland (lobular breast carcinoma).

The other forms, such as cancer of the lymphatic system (inflammatory breast cancer) or the nipple, are much rarer but often more aggressive. There are also precancerous stages that have not yet grown into the surrounding tissue or formed metastases. They are, therefore, also called non-invasive tumours (“carcinoma in situ”, CIS).

Another form is cancer cells that do not have receptors for hormones or HER2 receptors on the cell surface. This type of tumour is known as triple-negative breast cancer. It is more likely to occur in younger women and is considered to be particularly aggressive. The subdivision into the different forms of breast cancer is essential for therapy and prognosis.

 

Causes and risk factors in breast cancer

It is still not clear how exactly breast cancer or mammary carcinoma develops. However, there are known risk factors for breast cancer that can contribute to cancer growth. What these are is explained below.

Hormonal causes

Many of these breast cancer-promoting factors are related to female sex hormones. These include early onset of menstrual bleeding, childlessness or older age at first pregnancy (over 30 years) and late onset of menopause. Conversely, multiple births or births at a younger age and more extended periods of breastfeeding are considered factors that reduce the risk of breast cancer.

Ovulation inhibitors such as the pill and hormone replacement therapy (HRT) with estrogen and progesterone during menopause, on the other hand, are said to increase the risk of breast cancer. However, once the hormones are stopped, the risk of developing breast cancer is said to decrease again.

Hormone replacement therapy, in particular, has long been considered a significant factor in the development of breast cancer. This assessment has been put into perspective somewhat, even if a connection remains. Over five years of use, there will be an additional 20 cases of breast cancer in women over 50 in 1,000 women who are taking combination therapy with estrogen and a progestogen. In the case of monotherapy with estrogens, there are five additional cases.

In addition, pronounced mastopathy (changes in the mammary glands) with cysts and movable nodules in the breast tissue can also promote the development of breast cancer (mammary carcinoma). However, this only applies to an atypically proliferating mastopathy.

 

Other possible causes

Other unfavourable factors for breast cancer, which can also be caused, are:

• obesity and lack of exercise
• Smoking
• more significant or regular amounts of alcohol

With a daily consumption of ten grams of alcohol, the risk of breast cancer already increases by ten per cent.

In addition, age probably also plays a role in the development of breast cancer: women who are over 50 years of age have a significantly higher risk of breast cancer because they are more likely to have errors in cell division.

According to the current state of research, however, nutrition does not seem to have any influence on the development of breast cancer.

influence of genes

The genetic influence on the development of breast cancer is specific: If diseases have occurred in close relatives (especially in the mother or sister), the risk of developing breast cancer is about two to three times higher than in a woman who does not have the disease close relatives. This applies even if the previously known “breast cancer genes” (including BRCA1, BRCA2, BARD1, and PALB2) are undetected.

If a woman already has breast cancer in one breast, the risk of developing the other breast increases. Exactly how much the risk increases depends, among other things, on the location, type of tumour, and kind of treatment.

Breast cancer: signs

Even without symptoms or signs, breast cancer or a preliminary stage of breast cancer can already have formed. The extensive range of complaints means they cannot be permanently assigned.

The following signs should always be checked out by a doctor, especially if these symptoms appear again:

• palpable hardening and knots
• Change in shape or size of a breast
• Change in the mobility of the chest when raising the arms
• Indentations of the nipple or skin (“orange peel”)
• Changes in appearance, colour or tenderness in certain areas of the breast
• Fluid discharge from a nipple
• enlarged and nodular axillary lymph nodes
• Drawing or burning in a chest
• other chest pains

In the best case, the symptoms have a harmless cause, such as hormone-related hardening or an infection. But even if breast cancer is present, acting quickly after the symptoms appear improves the chances of a cure for this type of cancer.

 

diagnosis of breast cancer

There are different methods to diagnose breast cancer. At home, regular breast palpation is the best form of self-monitoring. Older women should also take advantage of regular mammography services.

Palpation as self-examination

To recognize any symptoms at an early stage, every woman over the age of 30 should regularly examine her breasts. This self-examination is best done once a month, about a week after the start of your period. In this way, possible complaints or symptoms can be discovered.

Through regular inspection and palpation, the woman gets to know her breast tissue very well and notices changes early on, which can be a sign of breast cancer. As part of the gynaecological examination, the breasts are first looked at and palpated in a lateral comparison; this includes touching the lymph nodes in the armpits.

Mammography and ultrasound to examine the breast.

If breast cancer is suspected or if the changes cannot be assigned, mammography is initiated. This particular X-ray examination of the breast reveals tiny calcifications (microcalcifications) as signs of remodelling processes, lumps, thickening of the skin and other tissue changes in the breast.

Today, sonography is also part of the diagnosis of breast cancer: With the ultrasound examination, nodules and cysts can be distinguished, depending on the density of the tissue, and it provides better images than mammography. That is why it is used particularly frequently in women under 40. Magnetic resonance imaging (mammary MRI) is also used in rare cases and if there are still uncertainties.

 

Tissue biopsy brings security.

If the imaging procedures confirm the suspicion of cancer, a small piece of tissue from the affected area of ​​the breast can also be removed under local anaesthesia (biopsy). This tissue sample is then examined for abnormalities. These include deviations in the tissue structure (histology) and cells (cytology).

treatment of breast cancer

In principle, there are several methods available for the treatment of breast cancer – which can be used individually or in combination. Which methods are used depends primarily on the type of breast cancer, how far it has grown into the surrounding tissue and whether metastases have already formed. Age and previous illnesses also play a role in therapy.

The goal is healing (curative therapy); in some cases, however, intervention can only be made to alleviate the symptoms, and an attempt can be made to prevent or slow down the further spread of the tumour (palliative therapy). The treatment of breast cancer, in particular breast (cancer) centres, is particularly tried and tested.

Breast cancer: therapy in different ways

The following options are available for treating breast cancer:

• Operation
• chemotherapy
• radiotherapy
• Antihormontherapie
• targeted therapy

The different treatment options are explained in more detail below.

 

Surgery to treat breast cancer

Surgery is usually the first step in breast cancer therapy. If possible, an operation is attempted to save the breast – this is successful in around two-thirds of the cases. The cancer cells (possibly also metastases) and some surrounding tissue are removed. Axillary lymph nodes of the affected arm are only operated on if a sentinel lymph node is affected by cancer cells – otherwise, it is assumed that the cancer has not yet spread. Breast-conserving surgery always involves radiation therapy.

If the tumour is too large for breast-conserving surgery, if there are multiple tumour foci, or if the tumour is particularly aggressive, the entire breast is removed (mastectomy). The missing breast can be rebuilt by plastic surgery. Alternatively, breast prostheses can be fitted for the bra.

Breast reconstruction can be done with autologous tissue or with the help of silicone implants. The first method mentioned is more complex but rarely requires subsequent corrections. If radiation therapy is necessary, breast reconstruction should be performed before radiation if possible. This is particularly the case with silicone implants.

Radiation therapy: Irradiation of the tumour

Radiation can kill cancer cells that are left over after surgery, reducing the risk of the cancer coming back (recurrence). In addition, radiation therapy (sometimes with chemotherapy) is used to shrink large tumours before surgery (neoadjuvant therapy) or to treat metastases (especially in the bone). Radiation is rarely used as the sole therapy for breast cancer.

chemotherapy for breast cancer

Chemotherapy uses drugs ( cytostatics ) to kill cancer cells in various ways. However, healthy cells are also affected – which explains the side effects. These include hair loss, fatigue, a weakened immune system and damage to the oral mucosa.

For this reason, chemotherapy is carried out in several cycles – with rest periods in between. As a rule, those affected receive the cytostatics intravenously, i.e. via a drip. Tablet medications are only recommended if chemotherapy is scheduled for an extended period.

Chemotherapy should be considered as a treatment for breast cancer when there is a high likelihood of tumour recurrence, when the tumour is particularly aggressive, or when antihormonal therapy is not appropriate.

 

Antihormone therapy for hormone-dependent tumors

This treatment method is used for so-called hormone-dependent tumours, i.e. when breast cancer grows under the influence of corpus luteum hormones and under the influence of estrogen. This can be determined during the tissue examination after the operation. A typical representative of the drugs used is tamoxifen. This is a so-called antiestrogen known as SERM (“Selective Estrogen Receptor Modulator”).

Aromatase inhibitors and GnRH analogues are also used in antihormone therapy. The active ingredients either block binding sites (receptors) on the cancer cells or inhibit the formation of hormones in the body.

The exact amount of drug used depends on factors such as age and state of health, among other things. Whether a woman is already going through menopause can also influence the choice of the active ingredient.

Targeted therapy with biologicals

In what is known as “targeted therapy”, substances are used that only attack the tumour cells in contrast to chemotherapy. Examples are trastuzumab, which blocks cancer-promoting messenger substances, and bevacizumab, which cuts off the blood supply to the tumour. These active ingredients are referred to as “biologicals”.

Other measures in the treatment of breast cancer

In addition to the specific therapies, the pain, side effects – for example, ch, chemotherapy – and the after-effects of the operation are also treated; psychological support is also offered to those affected by breast cancer.

With bisphosphonates, which are otherwise used to protect bones in osteoporosis, the risk of breast cancer forming metastases in the bones should decrease.

 

chances of recovery from breast cancer

It can be said that the earlier the cancer is detected, the better the prognosis. There are many treatment options for breast cancer, and the chances of recovery are comparatively high if the tumour is detected early and has not yet formed metastases. Currently, 5-year survival rates – which can be equated to a cure in most cases – are around 87 per cent in these cases.

However, even after this period, local recurrence of the tumour or metastases is possible, so consistent follow-up care is critical.

breast cancer in men

Breast cancer can also occur in men but occurs much less frequently than in women, with around 600 to 700 cases per year.

Possible risk factors in men include obesity, smoking, regular alcohol consumption and family history. There are also diseases of the testicles, such as testicular inflammation or undescended testicles.

The symptoms of breast cancer in men are no different from those in women. This leads to lumps in the breast and armpit, skin changes on the breast or fluid discharge through the nipple.

Diagnosis, therapy, and prognosis also correspond to the procedures for women. However, surgical removal of breast cancer in men is often more complex. Since there is less breast tissue, the entire breast usually has to be removed.

Prevent breast cancer

As with many diseases, breast cancer has factors that cannot be influenced (e.g. age or genes) and other factors that can be used to specifically reduce the risk of developing breast cancer. These risk-reducing factors include:

• Reduce excess weight: Fat stimulates estrogen production and thus cell division in the mammary glands – the risk of degeneration increases. The often increased concentration of insulin in the blood when overweight also appears to increase the risk of breast cancer or a recurrence.
• Regular physical activity, especially after menopause: This reduces estrogen levels and promotes average weight.
• Rarely and rarely drink alcohol, do not smoke: alcohol increases the estrogen concentration and is, therefore, a proven risk factor for breast cancer (mammary carcinoma). Smoking also promotes the development of tumour cells.
• A healthy diet with lots of fruit and vegetables: Even if no specific effect on breast cancer has been proven, researchers assume that a low-fat diet with lots of antioxidants can prevent cancer.
• Balancing stress and relaxation phases: Again, no direct connection to breast cancer has been proven. But we know that a balanced lifestyle is fundamentally an essential prerequisite for staying healthy and thus being able to prevent breast cancer.

Incidentally, the above points also help to prevent the treated breast cancer from coming back. In addition, sports, as part of rehabilitation, can promote general well-being, strengthen shoulder joint mobility, and improve strength and endurance after therapy. Those affected should, however, pay attention to their general resilience rather than overstrain themselves. It makes more sense to increase physical activity gradually. Sports are often offered in special groups for (former) cancer patients.

Regular check-ups are also essential. Preventive check-ups can be crucial, especially since the tumour rarely causes symptoms typical of breast cancer, especially at the beginning.