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A life with

breast cancer

After diagnosis: defeat the breast cancer!

Modern breast cancer treatment
rests on many pillars –

Chances of healing have never been better!

The safe and accurate diagnosis of your breast cancer is the first treatment step. Important questions should be
answered: where and how is the tumour growing? What stage of growth has it reached? What are the genetic
characteristics of cancer cells? The subsequent treatment options depend on the exact description of the tumour.
However, the question is usually no longer: surgery, radiation or chemotherapy? This is because multimodal treatment usually promises the best success. This is the combination of surgery, radiation therapy and the administration of different
cancer drugs (systemic treatment). One positive effect of this combination treatment: in many cases, breast amputation can be avoided in favour of breast-preserving surgery.

The basis for the treatment options available today is medical knowledge about breast cancer, which has grown
enormously over the past few decades. Some important facts and figures about breast cancer will certainly help you better
understand the disease and better assess the risks and opportunities of different treatment options.

After diagnosis: defeat the breast cancer!

Numbers that are also encouraging

The diagnosis of “cancer” is undoubtedly a stroke of fate that completely changes
your everyday routine and your life planning from now on. But there are many good reasons to take an optimistic approach to the fight against cancer. The
possibilities of modern medicine to cure cancer have never been better than they
are today.

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If breast cancer is detected in time and treatment is carried out according to medical guidelines, nearly nine out of ten patients will be treated successfully (i.e. they will still be alive 5 years after being
diagnosed). Another indication of the effectiveness of modern treatment methods: the number of deaths is steadily decreasing, although more women are suffering from breast cancer than in the past. (Source: the German Cancer Society)

The treatment options in Germany are very good: There are about 280 breast centres. These are clinics that have been certified by the German Cancer Society (DKG) and the German Society for Senology (DSG). They offer breast cancer treatments that meet the latest standards (97% of all first-diagnosed breast cancer patients are treadted there).

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Breast cancer is well researched: Breast cancer is the world’s most common cancer among women (about one in four women with cancer has breast cancer). On average, one in eight women will develop breast cancer over the course of their lives. In Germany, approximately 70,000 women are diagnosed with breast cancer each year. (Source: Robert Koch Institute).

Cancer risk depends on age: younger women are less likely to fall ill. It increases from the age of 40, and
especially from the age of 50. The risk decreases after the age of 70. In Germany, women are 64 years old
on average at the time of diagnosis. (Source: Robert Koch Institute)

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Breast cancer basics

Only: how and where does breast
cancer originate?

All cancer is caused by genetic changes. The genes are the body´s building
instructions and guidelines. They are stored in each cell in the form of the genetic molecule DNA. With each cell division, the DNA is doubled and distributed to the
daughter cells. This happens continuously in our bodies. If errors sneak in, they are
usually corrected. Many of the mistakes that persist have no consequences at all.
However, if a defect affects genes that are important for controlling cell growth or
cell division, a normal body cell can become a cancer cell that grows unchecked and
constantly divides.

The anatomy of the “female breast”: glands and lymphatic vessels

In anatomy, only the milk-producing mammary gland is referred to as a “female breast” in the narrower sense. The glandular tissue is arranged in the shape of a star around the nipple. It consists of the glandular lobules and the mammary ducts. Milk is produced in the glandular
lobules. The mammary ducts lead them to the nipple. There they flow outwards. The
glandular lobules and mammary ducts are embedded in fat and connective tissue that gives the breast its shape. Nerves, blood vessels and lymphatic vessels also pass through the breast´s fatty and connective tissue.
Lymphatic vessels play a role in breast cancer. This is because individual cancer cells from
malignant tumours can reach other parts of the body via the lymphatic vessels – and
blood vessels – and form metastases. The lymph nodes near the chest – i.e. in the armpits
and towards the chest and collarbone – are usually the first to be affected.

Carcinoma in situ or invasive tumour?

Breast cancer usually starts in the surface cells (epithelial cells) of the mammary
ducts, but occasionally also in the glandular lobules. If the cancer cells have not yet
broken through the basal membrane of the surrounding glandular tissue, this is
referred to as “carcinoma in situ”. The tumour is still limited to its place of origin.
The chances of eliminating all cancer cells by surgery alone at this early stage are good. If the tumour cells have already broken through the basal membrane and grow into the surrounding connective and fatty tissue, this is referred to as an invasive tumour. In this case, surgery alone is no longer enough.
Such invasive breast tumours are also referred to as “mamma carcinomas”. This is because the medical term for the female breast is “mamma”.

Important warning signs: the risk factors

Although no one can predict with certainty whether a woman will develop breast cancer or not, there are factors that indicate an increased risk of breast cancer: If one of the following risk factors applies to you, you should talk to your gynaecologist about sensible early detection measures:

An exact diagnosis sets the course for treatment

Before starting cancer treatment, many questions need to be clarified: where exactly is the tumour located? How big is it? Is it growing rapidly and aggressively? Has it already begun to scatter cells that form metastases in lymph nodes or distant organs? What weaknesses does it have that might be exploited with certain
medications? Some of these questions can be answered using modern imaging techniques such as computer tomography (CT), magnetic
resonance imaging (MRI) or sonography (ultrasound).

To answer other questions, it is absolutely necessary to take a tissue sample of the tumour (biopsy) which can be processed in the pathology laboratory. There, the genetic profile of cancer cells – their “character” – is also examined. In breast cancer, for example, the four genetic subtypes “luminal A,” “luminal B,” “HER2/neu” and “triple negative” are of particular interest. The names refer to certain characteristics of a tumour. They provide information as to whether chemotherapy with cytostatics is useful or which additional active ingredients may be particularly helpful. The “hormone receptor status” of the tumour is also examined in the laboratory. Tumours that are stimulated to grow by the female sex hormone oestrogen are treated differently from those whose cancer cells have only a few hormone receptors on the surface and hardly react to oestrogen.

Surgical options – better than ever

Surgery today is usually gentle and preserves the breast

This remains true even though modern breast cancer treatment consists of several
components: surgery is still the best way to completely cure people with cancer, provided that it succeeds in removing all cancer cells. How successful an operation can be depends on the type, size and exact location of the tumour. In the case of breast cancer, surgery is almost always part of the treatment, no matter how big
or small the tumour is. However, its size and stage of development determine the
type – and extent – of the surgical procedure.

After surgery: prevent scars, keep the, shape

Immediately after a breast operation, it is important to support the healing of the scar and to secure the shape of the breast that has been operated on or reconstructed in order to maintain the breast. For both purposes, the magic word is “medical compression”, and the right dosage prevents the uncontrolled growth of scar tissue – and possibly subsequent impairment of the range of motion of the arms. And pressure, i.e. targeted compression, also maintains the shape of the breast and helps alleviate postoperative swelling.

THUASNE’s extensive portfolio of compression products, bras and epitheses, which can be
combined in a variety of ways, always offers the right solution for these medical challenges – at any stage of treatment following breast surgery.

Established treatment modules:

Radiation and medication

Radiotherapy

In breast cancer, irradiation of cancer cells after surgery is an integral part of
breast-preserving treatment (postoperative radiotherapy). Radiotherapy is also often used before the operation (preoperative). Before surgery, the radiation should stop the growth of the tumour and reduce it in size so that it is possible to operate better. After surgery, the radiation should kill any cancer cells still present in the breast or in the scar area.
Radiotherapy has long been the standard treatment for breast cancer. The concept of radiation therapy works because cancer cells are more susceptible to high-energy ionising radiation than healthy body cells: the cancer cells die as a result of the radiation, the cells of the body recover from it and continue to live.
And thanks to state-of-the-art radiotherapy equipment, radiation therapy is now
much more gentle than it used to be: the area to be irradiated is recorded using imaging techniques such as computed tomography. The radiation dose required for each area of the body is then calculated. In this way, possible side effects such as burns are reduced. Nevertheless, the affected area of the skin is extremely sensitive during the course of radiation therapy – usually for five to six weeks.

Systemic treatment

Surgery and radiotherapy only work “locally”, i.e. in a certain place. Medicines, on the other hand, are distributed throughout the entire body system. They have an effect “everywhere”. Their use is therefore also referred to as “systemic therapy”. This includes classic chemotherapy with cytostatics, but also the administration of modern antibody active ingredients and hormone therapy. For large tumours, systemic therapy is often used before surgery (neoadjuvant therapy). The aim is to shrink the tumour so that it can be operated on more easily and in a way that preserves the breast as much as possible. Adjuvant therapy is a systemic treatment that is used after surgery. It is intended to fight cancer cells that still live somewhere in the body after surgery.

Today, the rule is: breast-preserving surgeries

Thanks to the combination of different therapeutic components, breast cancer
surgery is now more gentle than it usually was decades ago. In other words: in most
cases, breast amputation can be avoided in favour of breast-preserving surgery!
Surgery scars and lymphoedema – a common secondary disease following breast cancer surgery – can also be prevented today with appropriate follow-up care. An important factor in whether or not breast-preserving surgery is possible is the ratio of tumour size to the entire mammary gland tissue. In order to indicate the location of a change in the mammary gland, the breast is roughly divided into four quadrants.

Most malignant tumours occur in the outer upper quadrant, i.e. between the collarbone and the armpit. In what is known as a quadrantectomy (also: quadrant resection), both the tumour and the tissue in the quadrant are removed for safety. However, the cosmetic result of this form of surgery is not always ideal. In case of breast-preserving surgery, some lymph nodes are usually removed from the armpit for an exact diagnosis. Only small, barely visible scars remain from the procedure.

Breast removal: radical form of breast surgery

Only a few women with breast cancer are unable to undergo breast-preserving surgery. This may be the case, for example, if the tumour is very large compared to the breast tissue. In the case of “radical” breast
amputation (also: mastectomy, ablatio), the entire body of the mammary gland and the associated lymph nodes in the armpit are removed. Nowadays, the pectoral muscles are only removed if they are also affected by tumours. In a “simple” mastectomy, on the other hand, only the entire glandular tissue is removed and the lymph nodes are not touched.

Options for breast reconstruction
Even if the breast is removed, this does not necessarily have to be visible. Surgical reconstruction of the breast is often started during the operation. There are different procedures and techniques for reconstructing the breast. In principle, foreign implants made of silicone or sodium chloride or the body’s own tissue are considered. This is then taken either from the latissimus dorsi muscle or from the lower abdominal tissue.