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Diagnostics and treatment of breast cancer in Germany

The increase in the breast cancer incidence and mortality from this disease in a number of countries makes this problem one of the most important ones, requiring close attention of a number of doctors. However, a significant proportion of women are not aware of the basic facts regarding this disease: how often and why it occurs, what are the early signs and symptoms of the tumor, what treatment methods are used and how effective they are.

Breast cancer risk factors

According to the mechanism of development, breast cancer is divided into 3 groups:

  1. Random or sporadic cancer (about 65% of all tumors), the leading role in the etiology of which is given to the prolonged and/or intense exposure to estrogens.
  2. Family cancer (about 25% of tumors). In the presence of breast cancer in mothers, sisters and daughters, the risk of the disease increases by 9 times.
  3. Genetic cancer (about 10% of all tumors), which is characterized by an autosomal dominant type of inheritance, an early age of onset, vertical transmission from both the maternal and paternal sides. The mutations of the BRCA1, BRCA2, p53, pTEN, and CHEK2 genes are connected with the pathology onset.

Сlinical forms and symptoms of breast cancer

There are several clinical forms of breast cancer, including nodular, diffuse (edematous-infiltrative, erysipelas, mastitis-like and armor infiltration), as well as Paget's nipple cancer.

Nodular forms of cancer are the most common and are diagnosed in 75-80% of cases. The main clinical manifestation of this form is the presence of nodular formation in the breast tissue. It should be noted that in approximately 80% of cases, women reveal changes in the mammary gland by themselves.

Symptoms that are characteristic of more common forms of the tumor include:

  1. Deformation of the mammary gland skin over the tumor that is noticeable by the naked eye (especially when arms are raised up).
  2. A pronounced symptom of "umbilical" (retraction) of the skin over the tumor.
  3. The phenomena of lymphostasis, which is presence of "lemon peel" above the tumor.
  4. Tumor spreading in the skin and/or tumor ulceration.
  5. Pronounced thickening of the nipple and areola folds (symptom of Krause).
  6. Retraction and fixation of the nipple.
  7. Deformation of the mammary gland, a decrease or increase in its size, pulling up, fixing to the chest wall.
  8. Multiple dense lymph nodes in the axillary region on the side of the tumor; sometimes they are merging into conglomerates.
  9. Dense supraclavicular lymph nodes on the affected side.

Diagnostics of breast cancer

German specialists use the following diagnostic tests for the breast cancer detection:

  1. X-ray mammography should be carried out in all women older than 40 years, but can be performed at an earlier age in case of suspicious ultrasound picture. Mammography can show changes in the mammary glands 1.5-2 years before the onset of clinical manifestations of the tumor procession.
  2. In the presence of bloody discharge from the nipple, ductography is used widely. During the procedure a blunt needle is inserted into the secreting duct, through which a contrast medium is introduced, followed by an X-ray examination.
  3. According to a number of authors, MRI is currently the most informative method for examining mammary glands. However, it is possible to confirm or deny the diagnosis of the mammary glands malignancy only by morphological examination of the cellular or tissue composition of the neoplasm.
  4. Biopsy (pistol biopsy, trepanobiopsy) is the most advanced and informative method of the breast cancer morphological diagnosis. The advantages of CORE biopsy include speed of its performing and minimal discomfort. It does not require a surgical incision, suturing, and usually does not leave a scar. CORE biopsy allows you to harvest a larger sample compared to fine-needle aspiration, which leads to a higher diagnosis accuracy.
  5. Immunohistochemical examination. If according to the biopsy results the diagnosis of breast cancer is confirmed, it is possible to determine the degree of tumor malignancy, receptor status, HER2/neu gene expression, and the degree of tumor proliferative activity.

Thanks to the experience of doctors in the best clinics of Germany, the diagnostics and treatment of breast cancer are as comfortable for the patient as possible. If you want to undergo breast cancer treatment in Germany, the most appropriate option is using help of Booking Health. Booking Health is the medical tourism provider with international ISO certification that offers mammological check-ups in the leading German hospitals.

Treatment of breast cancer

The choice of breast cancer treatment option is made taking into account the main prognostic factors. The clinical ones include age, ovarian-menstrual function state, size and localization of the primary tumor, the degree of tumor dissemination. The morphological ones include histological and immunohistochemical tumor type, the amount of metastases in the regional lymph nodes, degree of tumor malignancy, receptor status, expression of HER2/neu gene, proliferative activity of the tumor.

1. Surgical treatment. Operations of choice in breast cancer are radical mastectomy in various modifications, radical resection (sectoral resection with axillary lymph node dissection), lumpectomy, tumorectomy. Widespread breast cancer treatment in Germany in recent years includes organ-sparing interventions.

Cosmetic defects after radical surgery may lead to significant psycho-emotional trauma. That is why simultaneous or delayed reconstructive plastic surgeries are often carried out. The tissue defect is replaced by either patient’s own body tissues (autoplasty) or silicone implants or expanders (alloplasty).

2. Radiation therapy. Its main aims are the destruction of low-grade tumor cells and suppressing the growth of metastases in the lymph nodes. The postoperative radiation therapy is performed after breast-preserving surgery as well as in patients after mastectomy.

3. Chemotherapy is used for the secondary prevention and treatment of metastatic breast cancer. It also may serve as the neoadjuvant option for making the large tumors operable. Breast tumors are sensitive to the majority of modern anticancer drugs.

4. Hormone treatment. Breast cancer is a hormone-dependent and hormone-sensitive tumor. In 50-70% of patients, the tumor has the specific proteins on its surface. In these patients, hormone therapy demonstrates a pronounced effect. Currently, two types of hormonal drugs are used: antiestrogens (tamoxifen and its analogues), which block hormonal receptors, and aromatase inhibitors, which prevent the formation of estrogens due to the conversion of androgens to estrogens blockage (arimidex, letrozole, aromatazine, etc.).

This article does not necessarily reflect the opinions of the editors or management of EconoTimes.

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