Causes of colon cancer

The main cause of malnutrition is adopted.

As causes of colon cancer is considered part of the diet. It is assumed that high-fat meat and rich, and thereby increasing the risk of diet low in fiber. Although this hypothesis has not been definitively proved, the indication of their accuracy but quite clear. Other risk factors are also counted and alcohol addiction, asbestos, and the frequent consumption of nitrosamines, for example in the form of cured one assumes that about 80 to 90 percent of colorectal diseases on nutritional and environmental factors are due. The risk of cancer increases from the 45th Year of life.

Adenomas or colon polyps can become malignant.

People who have benign tumors of the colon (called adenomas), one also speaks of intestinal polyps, there have a certain risk that convert it into a malignant tumor and thus into a cancer. If such a benign tumor, for example during a colonoscopy, found, we recommend the removal of the adenoma or during the investigation, e.g using a small loop.

Ulcerative colitis increases the risk of bowel cancer.

Patients who have chronic inflammatory bowel disease, the so-called ulcerative colitis suffer, also are at increased risk for colon cancer. Ulcerative colitis is known as a precancerous condition. This term describes diseases that are considered as potential "preliminary stage" for the development of cancer. For this reason, needed regular check-ups in ulcerative colitis by colonoscopy.

The risk increases with family pressures already at a young age.
For certain family obligations, or inherited diseases, there is an increased risk of getting colon cancer:

• People who have a particular gene, as evidenced so-called HNPCC gene, cancer to 80 - 90 percent of colon cancer. Conversely, at 10 to 15 percent of all cancer patients found that gene.

• In some families, this often leads to benign tumors of the colon (adenomas), one speaks of "familial adenomatous polyposis coli. At the risk of colorectal cancer is affected by the transformation of benign tumors to malignant tumors in 70 percent. However, less than 1 percent of patients with colon cancer, such polyposis coli.

• There are also some hereditary diseases in which occur particularly in the large intestine to the formation of benign adenomas. These can turn into cancer. These genetic diseases include Gardner's syndrome, in which the risk of malignancy is 85 percent, Turcot syndrome (about 70 per cent risk of malignancy), and the Peutz-Jeghers syndrome with only a low risk of malignancy.

Regular inspections are necessary.

Must be based on these family-related risks from the fact that the disease affected much earlier to cancer. Therefore, risk groups should have from 25 years of age once a year to an ultrasound examination every two years and perform an endoscopy.

Treatment for colorectal cancer

More on the gastro-intestinal disorders can be found here.

For the treatment of colon cancer are essentially 3 eligible therapies:

• Operation
• Radiotherapy
• Chemotherapy
  

Some of these therapeutic possibilities are also applied in combination.

The operation is paramount.

If the tumor is confined to the intestinal wall, it can be removed surgically good. However, it is necessary to remove the affected bowel, including associated lymph nodes and the connective tissue that attaches the intestines to the rear wall of the abdomen (mesentery), too. The resulting "gap" in the intestine can be bridged by the two resulting tails are linked. In colon cancers, is directly operated by an abdominal incision, in tumors of the rectum is also possible to access the tumor through the anus. Sometimes it is necessary to create the defecation a colostomy (artificial anus) to the newly operated to relieve bowel. To the end of a loop of intestine is sewn into the abdominal wall, where the stool is discharged into a glued-on bag. Depending on the individual situation, such artificial anus can be created as a bridging or a permanent solution.

Metastases can also be operated on.

Surgery is also useful if they have formed individual metastases in the liver and / or in the lungs. These can be removed with a surrounding rim of healthy tissue surgery as well.

Radiation therapy can be applied before and after surgery.

Radiotherapy is mainly performed for tumors in the rectum and that for larger tumors (stage T3 and T4, see "Staging". In general, the irradiation is performed before surgery to shrink the tumor already. Will the radiation therapy applied after surgery, the goal is to kill, and possibly some residual tumor cells. The duration of radiation therapy is highly individual. It depends on the tumor size and the nature and extent of planned or carried out the operation.

Conditions of chemotherapy:

Chemotherapy may be complementary especially if:

• Metastases
• A rapidly growing tumor or
• There are strong tumor-related symptoms.
  

The duration of treatment varies depending on the individual used drugs (cytostatics, cf "General Treatment") and the overall treatment approach.

A regular follow-up is necessary.

After completion of treatment of a regular follow-up examinations must be performed to detect any recurrence (recurrence of the disease) or metastatic disease early enough and effectively treated. In the event that an artificial anus was constructed, whose condition is monitored in the follow-up as well. Possibly, according to a major intestinal surgery, or after installation of an artificial anus a change in diet necessary. Such counseling is also often included in the follow-up. Follow-up examinations are usually during the first 2 years after completion of therapy in 3-month intervals is required. After that for another 3 years every 6 months. The investigations include a colonoscopy to exclude a relapse and an ultrasound examination of the liver and a chest X-ray to rule out metastases


For early detection of the tumor, the chances of recovery are good.

The chances of a cure for colon cancer depends mainly on the extent of tumor growth within the intestinal wall and the presence of metastases in the lymph nodes. It was found that after surgery, patients without metastases in the lymph nodes, and limited to the inner bowel wall tumor growth 5 years after the operation to 70 - 80 percent (stage I, 95 percent living, 80 percent stage II, stage III 30 - 60 percent). In patients with involvement of lymph nodes, this share is 30 - 50 percent.

Colon cancer staging

The TNM system is crucial in the choice of individual therapy.

After the TNM system of cancer according to the size of the tumor (T), the appearance of" daughter tumors (metastases) in lymph nodes (N, Latin for "nodus = knot and the occurrence of metastases in other organs (M) divided. This has consequences for the individual therapy in individual patients. For colorectal cancer, there is the following TNM classification:

T = size of the tumor
T stage

• Tx: No tumor assessment possible.
• T0: No evidence of a tumor.
• Tis: Non-invasive (not) in the surrounding tissue ingrown tumor.
• T1: tumor grows within the intestinal wall into the layer beneath the mucosal tissue.
• T2: tumor to grow into the muscle of the intestinal wall.
• T3: tumor grows beyond the bowel wall.
• T4: Tumor extends to adjacent organs or the peritoneum.
  

N = involvement of lymph nodes
N stage

• Nx: lymph nodes can not be assessed.
• N0: Lymph nodes are not affected.
• N1: Metastasis in 1 to 3 nearby lymph nodes.
• N2: Metastasis in 4 or more nearby lymph nodes.
  

M = Metastases
M stage

• M0: no organ metastases detected.
• M1: metastases in other organs present (eg, liver).
  

Stages:

Specifically for the colon cancer is the classification according to the TNM system also classified into 5 stages, which, however, is based on the TNM system:

• Stage 0: TisN0M0
• Stage I: T1N0M0 or T2N0M0
• Stage II: T3N0M0 or T4N0M0
• Stage III: Any T stage, as well N1M0 and N2M0
• Stage IV: Any T stage, and each N stage, as well as M1

Risk factor of colorectal cancer

The main cause of malnutrition is adopted.

As causes of colon cancer is considered part of the diet. It is assumed that high-fat meat thereby increasing the risk of diet low in fiber. Although this hypothesis has not been definitively proved, the indication of their accuracy but quite clear. Other risk factors are also counted and alcohol addiction, asbestos, and the frequent consumption of nitrosamines, for example in the form of cured one assumes that about 80 to 90 percent of colorectal diseases are due to nutritional and environmental factors. The risk of cancer increases from the 45th year of life.

Adenomas or colon polyps can become malignant.

People who have benign tumors of the colon (called adenomas), one also speaks of intestinal polyps, there have a certain risk that cast them as a malignant tumor and thus into a cancer. If such a benign tumor, for example during a colonoscopy, found, we recommend the removal of the adenoma or during the investigation, e.g using a small loop.

Ulcerative colitis increases the risk of bowel cancer.

Patients who have chronic inflammatory bowel disease, the so-called ulcerative colitis suffer, also are at increased risk for colon cancer. Ulcerative colitis is known as a precancerous condition. This term describes diseases that are considered as potential "preliminary stage" for the development of cancer. For this reason, needed regular check-ups in ulcerative colitis by colonoscopy.

The risk increases with family pressures already at a young age.

For certain family obligations, or inherited diseases, there is an increased risk of getting colon cancer:

• People who have a particular gene, as evidenced so-called Hereditary Non-polyposes Colorectal Cancer (HNPCC gene), cancer to 80 - 90 percent of colon cancer. Conversely, at 10 to 15 percent of all cancer patients found that gene.

• In some families, this often leads to benign tumors of the colon (adenomas), one speaks of "familial adenomatous polyposis coli. At the risk of colorectal cancer is affected by the transformation of benign tumors to malignant tumors in 70 percent. However, less than 1 percent of patients with colon cancer, such polyposis coli.

• There are also some hereditary diseases in which occur particularly in the large intestine to the formation of benign adenomas. These can turn into cancer. These genetic diseases include Gardner's syndrome, in which the risk of malignancy is 85 percent, Turcot syndrome (about 70 per cent risk of malignancy), and the Peutz-Jeghers syndrome with only a low risk of malignancy.

Regular inspections are necessary.

Must be based on these family-related risks from the fact that the disease affected much earlier to cancer. Therefore, risk groups should have from 25 years of age once a year to an ultrasound examination every two years and perform an endoscopy.

Disease and progression in colon cancer

More on the gastro-intestinal disorders can be found here.

At the start of colon cancer symptoms do not occur. Only late show general symptoms such as bloating or general, occasional indigestion. Because these complaints, however, are very commonplace, they hardly disturb anyone. That is why cancer is often discovered late, when the tumor growth leads to more serious complaints.

Frequent diarrhea and constipation occur in alternation.

With the increasing size of the tumor reduces the intestine, thus reducing its permeability. Then, the bolus can not freely pass through the gut, constipation is the result. If the bowel is narrowed by the tumor growth over a longer distance, it can be a very thin form result of the deposed stool. Conversely, the tumor growth can affect the large intestine but also in its function of avoiding the pre-digested chyme fluid. In this case, diarrhea symptoms are the result. Often these symptoms appear constipation and diarrhea but on the exchange.

You may experience severe abdominal pain.

If the tumor during its growth, which restricts the intestine and thereby threatened the regular onward movement of chyme. By strong contraction of the underlying muscles in the intestinal wall of the intestine tries to squeeze the stool against the obstacle or to get past. These strong muscle contractions are perceived by those affected can be very painful in the form of cramping abdominal pain.

The chair can be mixed with blood or mucus.

Some symptoms are noticeable to the chair. Changes in appearance can be caused by both the tumor itself, but they can also reactions of the intestinal mucosa at the tumor to be. Occasionally, blood or mucus can be observed on the chair. In particular, blood occurs occasionally from the tumor itself. The mucus produced is amplified by the irritated bowel wall. The blood outlet may be so small that it can not be detected by the naked eye, but only through a special test (occult blood test, cf "preventive measures"). Due to increased blood loss in turn can lead to a general anemia occur (anemia), which manifests itself in the form of pallor, fatigue, weakness, and diminished performance. For many sufferers, it also comes to weight loss.

Weight loss and weakness are often very stressful.

In particular, this "constitutional symptoms" such as weakness and declining performance, are often a great burden, since they participate in the hitherto exercised severely limit daily activities. In addition to the targeted cancer therapy for example can Blood transfusions are administered to compensate for the anemia and thus increase the well-being. Physiotherapy exercises are another helpful measure.

An artificial anus may be necessary.

Some stakeholders must be created as part of the operative tumor removal, an artificial anus. Many patients, this is unpleasant, and they limit their social contacts. Specialist inform individuals about proper care and detailed advice on how to deal with a colostomy. As a rule, then normal social contact problem. In partnership, family and friends open discussions are helpful to familiarize yourself with the new situation.

Diagnosis of colorectal cancer

As a first simple analysis measures the faecal occult (hidden) blood in the stool, and a sampling of the rectum are carried out, as they are performed as screening measures or as part of preparedness.

Occult blood in the stool.

To test for faecal occult blood test, the patient receives 3 cards, which he takes home. For 3 consecutive days, will now chair a small amount applied to these test cards, which are then released back to the doctor. With the help of a test fluid that is instilled into the doctor's office on the cards can also be seen blood in the stool, if it is not visible to the naked eye. If the test is positive, further examinations should be performed to rule out any disease or colon cancer as early as possible to determine.

By scanning only a limited area of the intestine is reached.

The scanning of the rectum is the search for tumors located in this area, but even this limited part of the intestine is recordable. If the test positive for occult blood, which means it can be shown blood, this indicates a source of bleeding in the gut. This may be a tumor, but also another, eg inflammatory disease.

Endoscopic examinations are necessary for bowel cancer suspicion.

In concrete suspicion of cancer, but further measures are necessary. Here are a primary rectal and call colonoscopy (Rectosigmoidoscopy and colonoscopy) to. In preparation for these investigations, a cleansing of the bowel is necessary to achieve a "good view" for the physician and thus the best possible study conditions. For cleaning, it is necessary to take a few days before the examination only liquid food, and take immediately before the date is a laxative.

With a small forceps, tissue samples can be taken.

During the investigation itself is first introduced some air into the bowel to distend it. Subsequently, a flexible tube is advanced with the endoscope into the intestine, the rectum mirror up to the beginning of this section of the intestine, where colonoscopy up to the beginning of the entire large intestine. The actual reflection, that is the consideration of the intestinal mucosa through the lens, is only given the slow withdrawal of the instrument. If abnormal areas are found in the intestinal mucosa can be removed via a small built-in clamp directly to the small tissue histological examination. Even benign colon tumors (adenomas, see "tumors") may be directly removed through a small loop. Because the mirror examination Dilate is perceived by the necessities of the intestine affected by many to be unpleasant, may advance and / or be given during the investigation of pain and mild sedative.

Here is a brief overview of possible endoscopic examinations of the colon:

• Proctoscopy: Is the study of the bowel disease. A proctoscope is a device with which you can view the rectum. It is a simple, tubular instrument. It may be with handle 8 to 15 inches long. The opening in front is beveled. Sometimes in the middle of the side a little window. Through the cavity in the middle of a lighting or other devices can be pushed. Thus it is possible to sample tissue or even obliterated hemorrhoids. By proctoscope the doctor can only reach the front areas of the anus.

• Rectoscopy: The rectoscope proctoscope which is very similar, but it is much longer with up to 30 centimeters. The rectoscope can be rigid or flexible. Thus, the entire rectum may be considered. Often, so the view is better, pumped some air into the rectum, which later without any problems re-entering the outside world.

• Sigmoidoscopy: The name of this investigation is derived from the sigmoid colon, which means nothing other than S-shaped colon. In the lower region of the colon is examined using a flexible endoscope. This study is one of the colonoscopy and is performed only if it has been found with proctoscopy and rectoscopy no cause for complaints. About miniature instruments, it is possible to sample tissue or remove, for example, to diverticula.

• Colonoscopy: With the help of this study mirrored the entire large intestine to the transition into the small intestine.

X-ray with contrast may be necessary as a supplement.

In addition to the reflection of the large intestine x-ray examination can be performed with contrast material. Again, a preliminary bowel cleansing is necessary. For the investigation of liquid contrast agent itself opens into the intestine. To ensure that this is good from the inside walls of the intestine port, then after the contrast agent has not opened a little air, then the contrast slightly pressed against the intestinal walls. On the x-rays then prepared striking shape changes of the intestinal wall are visible, which may indicate a tumor.

Further investigation should determine the extent of the disease.

If the diagnosis of colorectal cancer found, further investigations are recommended to determine the extent of the disease:

• Blood test to determine one (by the tumor-related anemia, anemia) (see "clinical picture and course").

• Ultrasound examination of the liver to find any seed off "daughter tumors (metastases) to.

• Renal ultrasound examination to rule out a urinary. A hydronephrosis can occur when a growing tumor on the intestine pushes the ureter and the urine from the kidney can not drain properly.

• For tumors of the rectum with an ultrasound scan ultrasound probe introduced into the intestine to assess the thickness of the tumor.

• Chest X-ray to exclude lung metastases.

• Computed display to the size of the tumor and its spatial relationship to adjacent organs.

Complaints and Therapy of Pancreatic cancer

Complaints not become effective until late on

As with many other types of cancer even when symptoms of pancreatic cancer at a later stage. Therefore, it is usually detected very late. Pancreatic cancers are on the rise. Today every third to fourth with cancer which is affected.

In most cases, in 75 percent of all cases, the head of the pancreas is affected.

Carcinomas in the pancreatic head cause the following symptoms:

• Nausea
• Loss of appetite
• Weight Loss
• Painless jaundice
  

Carcinoma of the pancreas body - Carcinoma of the pancreas in the body cause the following symptoms:

• Severe abdominal pain in the upper abdomen, radiating to the back. You become stronger after eating and lying down.

Aetiologies

Smokers are at greater risk
The causes are unclear. Favoring contribute off:

• Chronic pancreatitis
• Alcohol
• Nicotine
• Carcinogenic food components, peroxides, for example, during the heating of polyunsaturated fatty acids are formed, or nitrosamines, nitrates and nitrites, which are contained in cured and smoked.
  

Therapy

Operation only in the early stages

Only in the early stages of pancreatic cancer, with about 20 percent of all cases, removal of the pancreas possible. Thus, life expectancy is increased. Those affected will be the removal of the pancreas and diabetes need to inject insulin. In all other cases, only the recurrent tumor symptoms are treated. Affected and / or relatives should be informed early on about the possibilities of home care.


Intra-arterial chemotherapy and chemoembolization

One form of non-drug therapy, which is also used in liver cancer, is the Intra-arterial chemotherapy and chemoembolization.

These types of chemotherapy have the advantage of fewer side effects compared to intravenous or oral. If a cytostatic drug on the vein (intravenously) or in the form of tablets orally introduced into the body, it acts more systemic, it will affect the whole organism, because the drug enters the bloodstream. The risk of side effects, here is higher. If the chemotherapy drug injected directly into the tumor, however, reached only a small fraction of drug in the bloodstream. Therefore, the concentration in the cancerous tissue itself is high.

Systemic side effects are less

For this type of therapy, the cytotoxic Fluorodeoxyuridine (FUDR, Floxuridine) is preferably used. About 90 percent of this substance be chemically altered in the liver and thus inactivated. This process is called "first-pass effect or presystemic elimination", i.e a medicinal product may lose some of its effectiveness if it is metabolized to a large extent by the liver before it reaches the bloodstream. In the case of FUDR, which is directly administered in liver cancer, does this high "first pass effect" that the possible occurrence of systemic side effects is very low.

The flow rate of blood is reduced in the tumor

The intensity of the effect of locally administered cytostatic drugs can be further increased if the flow velocity of arterial blood in the tumor vessels is lowered. This provides for a longer residence time of the drug in diseased tissue, because it is not by the slowing of blood flow can be taken away so quickly. Combined to reduce the flow to be the cytostatic drug with fat droplets are injected into the tumor vessel. This process is called chemoembolization. ) A embolus (grch Embolos = wedge is a stopper, which is located in the bloodstream. This can for example a blood clot, or foreign objects like his in this case a fat droplets.

A cure is obtained with this process. It is used to relieve the symptoms and thus preserving the quality of life of those affected. In addition, the tumor can be reduced with this method so that the possibility of an operation and it can be safely removed.

Pain

In addition to a change in diet, the implementation of a pain therapy is recommended. Because of the severe pain are often used early on opiates.

Cervical cancer Treatment and prognosis

Early detection and close monitoring

The treatment for cervical cancer depends on the stage of disease. Preliminary stages of cancer development that can be found on the early detection, can be treated with medication and even regress. Here, however, careful monitoring is necessary.

Surgical removal is in the foreground

In a unique development of cancer, the tumor is surgically removed. Here, different surgical techniques can be applied. For small tumors, and if the person has another child, the tumor tissue within a cone cut out of the cervix. It's called too conization. For larger tumors, the entire uterus is removed. In the neighboring lymph nodes are removed. For very large tumors may also be required under certain circumstances, the bladder and / or rectum to remove if the tumor has already penetrated into these organs. But it's often possible to combine the remaining bowel segments together so that no artificial anus is required. Also the urine in a natural way is still in control despite the removal of the bladder possible.

Radiotherapy

In some patients it may be useful to conduct after the surgery nor radiotherapy. In this way, may be remaining in the body kill tumor cells. Less commonly, chemotherapy can be recommended.

Prognosis

The prognosis of patients with cervical cancer depends on the disease stage at time of diagnosis. For example, live 5 years after diagnosis yet 87 percent of women with a tumor in stage I and about 70 percent of those with stage II cancer.

Preventive vaccination against infectious types of the HPV virus

Since 2006, there is a vaccination against the highly infectious HPV virus types that are responsible for the development of cervical cancer. Vaccination against HPV virus spreading from the Permanent Vaccination Commission (STIKO) for girls aged 12 to 17 years and is recommended since February 2007 as the official vaccination calendar. Vaccination should be completed with 3 doses before the first sexual intercourse. How long will the vaccination leads to immunity is not yet known. Importantly, however, in this context that, despite the vaccination continue regular cancer screening should be performed. Only thus can be other causes and forms of developing cancer early detection and treatment. The vaccine also offers no protection against other types of the HPV virus and the diseases caused by them.

Cervical cancer Symptoms and Diagnosis

Investigate complaints immediately leave

In most cases occur at an early stage of disease, no complaints. Any complaints can often be misdiagnosed, because similar symptoms may also occur in gynecological inflammations and benign tumors. Therefore, it is always important to be examined by a doctor and even mild symptoms to clarify.

Discharge, bleeding, pain

The following signs and symptoms may occur:

• Discharge that is persistent and possibly offensive
• Bleeding after intercourse
• Unusual bleeding between periods, for example, outside the cycle, bleeding after menopause
• Pain in the pelvic and / or lumbar
• Pain during urination or defecation
• One-sided swollen legs indicate a change in the lymph nodes
  

Early detection and treatment are lifesaving

The fear of cancer, many women can often go late to the doctor. But just for cervical cancer may be of regular use of screening tests (since the age of 20 lifetime), detected 80 to 90 percent of the early tissue changes and effectively treated. Early detection and treatment are lifesaving.

Physical Exam

With the appropriate complaints can often be easily ascertained, what cause underlies them. In the history, physical examination and by examination of the smear can already perceive clearly many of the typical symptoms.

Further investigation

To confirm the diagnosis and to determine the disease stage and extent of the tumor, however, further investigations are necessary:

• Taking a tissue sample for histological examination
• Ultrasound examination of the pelvis and abdominal organs
• X-ray with contrast medium for the representation of the ureters
• Cystoscopy
• Reflection of the rectum
• X-ray examination of the chest
• Any computer and / or magnetic resonance imaging of individual organs or body regions

Preventive vaccination of Cervical cancer

Preventive vaccination against infectious HPV virus

Since 2006, there is a vaccination against the highly infectious HPV virus types. Vaccination against HPV virus spreading from the Permanent Vaccination Commission for girls aged 12 to 17 years and is recommended since February 2007 as the official vaccination calendar.

Vaccination should be completed with 3 doses before the first sexual intercourse. How long will the vaccination leads to immunity is not yet known. Importantly, however, in this context that, despite the vaccination continue regular cancer screening should be performed. Only thus can be other causes and forms of developing cancer early detection and treatment. The vaccine also offers no protection against other types of the HPV virus and the diseases caused by them.

Staging of Cervical cancer

Early scattering is typically

A characteristic of cervical tumors is that they form very early during progression of disease spread to the lymph nodes of the pelvis. This is often already at a tumor diameter of 1 to 2 cm of the case.

Staging

Depending on the extent of the disease, different stages can be distinguished:

• Stage 0: very small tumor that affects only the most superficial layer of mucous

• Stage I: tumor that is strictly limited to the cervix

• Stage II: tumor grows beyond the area of the cervix, but not to enter into the vagina and not to the pelvic bone

• Stage III: The spread of cancer to the pelvic bone and / or to the upper third of the vagina with or without clamping of the ureter lying adjacent to, the latter leads to urinary obstruction, and injury to the kidney

• Stage IV: Tumor growth in addition to the mucosa of the bladder and / or rectum and / or tumor growth beyond the area of the basin

Origin and Abundance of Cervical cancer

The cervix (cervix or a short cervix) is the narrow lower foothills of the womb (uterus), which protrudes into the vagina. In the analysis of the visible portion of the cervix, vagina, cervix uteri is called, is seen in the middle of the opening of the cervix to. By this point, in the context of gynecological cancer screening swabs prepared for microscopic examination.

Position 10 of the most common cancer of women

Each year, in Germany, about 6500 women from cervical cancer. The precursors are included in this figure. Before the introduction of screening (1971) had cervical cancer, the commonest cancer in women. Today, it lies in 10th place, as for regular check-ups are often curable stages of the disease are detected early.

Age-related development

There are two age sections in which the disease occurs more frequently:

• A peak incidence is in women, at the 35th year of life. Since younger women are more frequent and often go to a regular gynecologist, who are here frequently detected cancers at an early stage.

• From age 60 Age are also found increased cervical cancers. Since older women are less regularly go to the gynecologist, they are generally of advanced cancer disease.

HPV viruses are the trigger for abnormal cell development

As a reliable cause of cervical cancer today is the infection with human papillomavirus (HPV). There are about 80 subtypes of the virus causing the disease can be different, or even for humans are quite harmless. Some causes such as genital warts. Especially HPV types 16 and 18 you have to stimulate the ability to uncontrolled cell growth. With more than 70 percent of all cervical cancers, these two virus types are detected.

Additional conditions are necessary for infection

However, certain conditions are necessary so that the result is an infection with these types of HPV to the development of cervical cancer. The virus must survive in the form of a chronic infection, on average, over 15 years in the cells. Only then it comes to cell degeneration. That is despite infection rates of 50 to 80 percent only a few women in the case. Typically, a fully intact immune system can fend off a viral infection. Due to the slow development of the tumor, it is also possible to detect early stages of cervical cancer and treat.

Risk Factors

There are several factors that favor the development of cervical cancer:

• Immune deficiency diseases such as AIDS and immunosuppressive drugs (eg, after organ transplantation), cause an HPV infection, the immune system can not adequately fight.

• If there is already infected with HPV, it can facilitate an additional infection with other sexually transmitted pathogens such as herpes simplex and chlamydia in colon cancer. Condoms reduce the possibility of infection with these pathogens.

• Smoking and passive smoking: degradation products of tobacco smoke can increase detected in the mucosa of the cervix. This increases the risk for cervical cancer by up to 60 percent compared to nonsmokers.

• Women with many births, four times more likely to suffer cervical cancer than women who have no children. What brings about this increased risk is not assured. Both pregnancy related tissue changes are discussed, as well as lower living standards and poverty-related risk factors.

Enabling conditions

Other factors that promote the general infection with HPV:

• Start of sexual intercourse at a young age
• Frequent change of sexual partners
• Poor hygiene in the genital area

Treatment and prognosis of Uterine cancer - endometrial cancer

Operation

Basis of therapy is surgical removal of the tumor. In the uterus and is often also remove the ovaries, because there are most likely to settle metastases. Also, the adjacent lymph nodes are removed with this reason.

Radiotherapy

Frequently closes after the operation to radiotherapy. This will apply even if an operation is not possible, for example, if the tumor is already advanced.

Hormones

Occasionally, the administration of certain hormones (progesterone) may be useful. Chemotherapy is rarely used.

Forecast

The chances of recovery are very different, depending on how the tumor is advanced. Averages are:

• Tumor confined to the endometrium:

- If surgery and radiation therapy 60 - 97 percent tumor free after 5 years
- When irradiation without surgery 60 - 80 percent

• Tumor penetrates all layers of the wall of the uterus, but still no contamination of adjacent organs:

- If surgery and radiation therapy 40 - 60 percent
- When irradiation without surgery 30 - 40 percent

• Tumor penetrates all layers of the wall of the womb, contamination of adjacent organs, distant metastases:

- To achieve greater freedom o no tumor
- Relief of the symptoms by exposure
- Pain

Disease risk of Uterine cancer - endometrial cancer

Malignant change in the mucous membrane of the uterus

Among the malignant tumors of the uterus, the endometrial cancer is of particular importance. This is a malignant change in the endometrium. It affects the uterine of the body. We therefore also speak of uterine cancer, or uterine corpus carcinoma. Cancer of the uterus must be differentiated from cervical cancer.

The endometrial cancer is the third most common cancer in women. In Germany, about 9600 new cases registered each year, most commonly in women between the ages of 70 and 80 years. Particularly at risk are also female with the following characteristics:

• Infertility
• Start of menstrual bleeding in young
• Late onset of menopause
• Obesity
• Diabetes (diabetes mellitus)
• Use of anti-birth control
• Taking the hormones for menopausal symptoms
• Smoking

Diagnostics of Ovarian Cancer

Initial investigations confirm the suspicion

Case of a suspected ovarian cancer begin with a thorough gynecological palpation. Subsequently, an ultrasound examination can be performed, allowing an assessment of the ovaries and adjacent pelvic organs.

Imaging techniques show the extent of the tumor

Further studies are used to estimate the disease stage:

• CT scan of the pelvis
• X-ray examination of the chest
• X-ray of the breast (mammography to rule out that breast cancer is what led to the resettlement of metastases in the ovaries (this would directly against ovarian cancer in the ovaries arisen)
• Blood test to the so-called tumor marker CA 12-5, its concentration in the blood is less important for the diagnosis rather than for therapy monitoring.
  

Histological examination only during the surgical

A histological examination is usually carried out only during the operation (so-called frozen section, where the surgical team is still reported as a result of the surgery). A biopsy before surgery, for example through a puncture is not recommended, it could lead to a slight violation of the tumor and thus to the spread of tumor cells.

Staging and Prognosis of Ovarian cancer

Stage I

For the assessment of disease severity following stages are used:

• The tumor is confined to the ovary (or ovaries), where tumor cells can enter the peritoneal cavity.

Stage II

• Spread of the tumor in the pelvic region

Stage III

• Formation of secondary tumors (metastases) in lymph nodes and / or the peritoneum outside the pelvic region and / or the capsule of the liver

Stage IV

Formation of metastases in other organs, such as:

• Colon (in approximately 50 percent of cases)
• Liver (48 percent)
• Lung (34 percent)
• Lymph nodes adjacent to the large main artery (aorta, 58 per cent), pelvic (48 percent), chest (28 percent) and neck (14 percent)
• Stomach (20 percent)
• Adrenals (20 percent)
• Spleen (19 percent)
• Renal (15 percent)
• Thyroid gland (15 percent)
  
• Pancreas (12 percent)
• Bone (12 percent)
• The brain and meninges (3 percent)
  

Treatment planning and prognosis

The staging is both important for treatment planning, on the other can be estimated in this way the forecast. For example, the statistical probability of survival at 5 years, depending on tumor stage. It amounts to:

• About 92 percent of stage I
• Stage II, about 64 percent
• Stage III approximately 35 percent
• About 17 percent in stage IV

Therapy of Ovarian cancer

Surgical stage I and II

The treatment of ovarian cancer depends on the stage of disease. In stages I and II, both ovaries and both fallopian tubes and the uterus to be removed to remove the tumor safely as a whole. Also, the adjacent lymph nodes are examined in general, with distance and the presence of metastases out. A histological examination is usually carried out only during the operation (so-called frozen section, where the surgical team is still reported as a result of the surgery). A biopsy before surgery, for example through a puncture is not recommended, it could lead to a slight violation of the tumor and thus to the spread of tumor cells.

Operation stages III and IV

Even in the stages III and IV, a complete removal of the ovarian tumor is possible in principle. However, it may be the extra distance of the peritoneum, the infected portions of the intestine and possibly the spleen is required, depending on the tumor extent and delocalization of metastases. As often the appendix of tumor cells is infected, it is generally removed with as a precautionary measure, if it still exists.

Reduce the tumor mass

Complete tumor removal is not possible, the surgeon seeks to reduce the tumor mass as much as possible. This reduces the one hand, the pressure on neighboring organs such as ureters and intestine, other better conditions for subsequent chemotherapy to be created.

Prognosis correlated with the intensity of tumor reduction

Moreover, the statistical probability of survival depends on the extent of tumor reduction. To live by the affected patients with total tumor removal after 5 years on average about 50 - 60 percent, with a residual tumor less than 2 cm approximately 30 - 40 percent and a residual tumor> 2 cm less than 10 percent. In this context it is particularly important that it succeeds in experienced hospitals or university clinics focus on how often a better tumor shrinkage, which has a correspondingly favorable impact on prognosis. Therefore, no patient should be afraid to ask for a suitably experienced hospital and another hospital where the surgery.

Chemotherapy

After the surgery closes normally containing chemotherapy. This serves to complete removal of the tumor by killing the body of residual, microscopic tumor cells. If not completely removed tumor, chemotherapy can lead to downsizing of the tumor remains. Even after re-occurrence of ovarian cancer after initial successful treatment (relapse) is usually chemotherapy is used.

Radiotherapy is useful only in individual cases.

Symptoms of Ovarian cancer

No complaints in the early stages

In the early stages of disease ovarian cancer often causes no symptoms. Therefore, it is often diagnosed only in advanced stages. An effective method of early detection, such as of cervical cancer, not previously exist.

Depending on the extent of the tumor varied and often non-specific symptoms are possible
Among the complaints that may arise in a further tumor growth, including:

• Feeling bloated or swollen
• General abdominal discomfort
• Loss of appetite, bloating
• Flatulence, indigestion
• Diarrhea
• Constipation
• Frequent urination
• Nausea
• Weight Loss Rare vaginal bleeding
• Ascites with swelling of the abdomen
• Shortness of breath
  

Targeted Diagnostics necessary

Since these symptoms are often not only ovarian cancer but also occur separately or as a symptom of other diseases, is a specific diagnosis of need for a doctor to rule out a malignancy or confirm such.

Ovarian cancer: Disease risk

Fourth leading cause of death among women

When ovarian cancer is a malignant tumor of the ovary (ovaries). In Germany are diagnosed each year about 8,000 women in it. This is the sixth most malignant tumor of women. However, the ovarian cancer is the fourth leading cause of death in women. This means that it leads to a relatively high incidence of death.

Risk Factors

The risk of developing ovarian cancer increases with age. The median age of onset is 58 years.

Other risk factors include:

• Infertility
• Genetic predisposition (presence of BRCA1 and BRCA2 genes, which also play in the development of breast cancer an important role)
• Belonging to the population of western and northern Europe or North America
  

Conversely, the prolonged administration may involve the anti-birth control some protection.

At 25 - 35 percent of the women involved both ovaries are affected by cancer. Often) it comes to ovarian cancer by ascites.

Therapy for breast cancer

1. Operation
2. Breast development
   
3. Radiotherapy
   
4. Hormone Therapy
5. Chemotherapy
6. Follow-up and prognosis
   

1. Operation

With a single engagement tumor and lymph nodes are removed. When the diagnosis of a breast cancer and will be available at all major research findings must be carefully planned how to make the therapy. In many cases it is possible with a single surgical procedure the tumor (or remove the affected breast) and the lymph nodes in the axilla. The lymph nodes removed at will to examine them for any existing metastases. In this case we speak of a one-stage approach. This one-stage approach is used in eligible women,

• Where the tumor is to be distinguished very well,
• During the previous investigations no metastases were found and
• The doctor recommends surgery alone without any additional therapy as the best option.

In several tumors should be operated on twice. In contrast to the single stage is also the possibility of the so-called two-stage approach. It is removed during an initial operation, only the tumor and the histological examined under the microscope. According to this histological examination can then be made for a focused second operation to remove any remaining tumor tissue, the affected breast and / or the lymph nodes in the axilla. Such a two-stage procedure is recommended for those women of whom there is suspicion of multiple tumor foci in the chest and / or the node can not be seen on X-ray very well.

If an operation is planned, physician and patient must consult together before, which is the best intervention. Basically, there are the following possibilities:

• Breast-conserving surgery, in which only the tumor tissue from the breast and lymph nodes are removed in the armpit
• The so-called mastectomy, which removes the entire breast with the tumor contained
  

Radiotherapy after surgery.

The breast-conserving approach for small tumors is questioned. The lymph nodes in the armpit are also removed in order to examine them for the presence of metastases. After breast conserving surgery always includes a radiation treatment. This is to prevent a recurrence of individual tumor cells in breast tissue remaining pose a disease.

The breast must be removed only if the tumor is large or has multiple foci.
The removal of the entire breast along with the tumor (mastectomy is performed at parties, whose tumor is relatively large. Other reasons for the removal of the breast are, for example the existence of multiple tumor foci in one breast or the impossibility of carrying out of post operative radiotherapy (this was after breast-conserving surgery) imperative. There is always a possibility, the chest by a plastic surgery to rebuild. The reconstruction of the breast during the same operation as the mastectomy or possible under a second surgery.

2. Breast development

Tissue expanders to stretch the preserved breast tissue slowly. Basically there are 2 different ways to reconstruct the breast with exogenous or endogenous material. As a foreign material such as silicone cushions can be used. These are inserted under the skin or the chest muscles and then simulate the curvature of the breast. Fears of toxic effects or allergic reactions are rather unfounded. Even so-called tissue expanders can be used. These are empty silicone cushions that are then filled slowly over weeks and months at regular intervals through the skin via a syringe with fluid. This allows the skin to stretch over the tissue expander slowly. After expansion, the expander is exchanged for a silicone cushion.

"Transplant" of its own muscle tissue can build up the chest. During the recovery of the body's tissues are used in such a flap called transplants. These are muscle tissue from the body with the overlying skin. This flap is removed from its original position to form a new breast from this tissue from the patients own tissue.

Also, the nipple is modeled. In order to restore not only the shape of the breast, but also the nipple, it is also reproduced. This is usually a small piece of skin taken from the inner thigh, then use the slightly darker skin coloration. From this skin is formed now a new nipple and fit them accordingly. If the skin from the thigh is not dark enough, the color using a tattoo to be adjusted.

3. Radiotherapy

Radiation therapy is required after surgery. In the event that radiation therapy is being considered, are in favor of schedule 4 to 6 weeks. After the start of irradiation in the hospital outpatient radiation therapy can be continued frequently. Radiotherapy as sole treatment is performed only rarely, because they can be treated for up to 90 percent of all breast cancer tumors with surgery much better. Often, however, is the additional radiation therapy after surgery, which has especially positive effects on the recurrence of breast cancer.

4. Hormone Therapy

A decision must be taken after careful individual consideration. Basically it should in any woman with breast cancer, the possibility of chemo and/or hormone therapy should be considered. Radiation therapy also is a candidate. As a decision support involves:

• Size of the tumor
• Art and hormone sensitivity of the tumor after histologic examination
• Tendency to growth of the tumor
• Presence of metastases in lymph nodes or other organs
• General health and age of the patient
• The request of the woman concerned
  

A hormone blockade therapy can also be used to shrink the tumor to such an extent that instead of a mastectomy for breast conserving surgery is possible.

Hormone-dependent tumors respond to hormone therapy. In about 30 percent of breast cancers are hormone-cases. This means that they can be brought about by hormonal therapy to regress. Hormone therapy may also come into question when other therapies are no longer useful, for example, in advanced disease with daughter ulcers in various body regions. In such a case, hormone therapy to relieve symptoms and may also affect survival benefit. A cure is in this case, however, not possible. Hormone therapy is usually performed as a continuous treatment over 5 years.

5. Chemotherapy

Chemotherapy added to the primary therapies. Chemotherapy is usually performed after surgery and radiotherapy. The aim is to destroy even the smallest remnants of a tumor or to treat tumors that are so small that surgery or radiation is not possible. Chemotherapy is a so-called adjuvant (additional) therapy. The advantage of this treatment is that can be prevented by the recurrence of cancer. Also, the survival time prolonged.

There may be massive side effects. However, chemotherapy can also have significant side effects. These side effects can often not be avoided but can be treated well and are usually transient. Benefits and risks should be weighed individually. Chemotherapy is usually a total of 6 times at intervals of 4 weeks.

6. Follow-up and prognosis

Regular inspections are followed for life. After completion of therapy, the phase following the aftercare. ) In addition to a possible rehabilitation treatment are important to regular medical appointments. In the treated and examined the healthy breast and a mammogram once a year.

Furthermore, the woman concerned should regularly examine their breasts themselves. These activities are designed to detect early recurrences may arise (new outbreaks) in order to initiate an effective therapy.

The prognosis depends on the size and behavior of the tumor. It turns out that the chances of recovery depend decisively on termination of breast cancer therapy on the size of the tumor and the presence of metastases in the lymph nodes of the armpit. Thus, in one study occurred in women with small tumor (T stage 1) within 10 years to nearly 80 percent of any new cases. In women with large tumor (T-stages 2 a.m. to 3 p.m.) and metastases in the lymph nodes of the armpit, but it was reversed in 80 percent of those affected of the disease.

Risk factors for breast cancer

Any woman can get breast cancer.

A breast cancer arises "spontaneously", ie without any apparent external cause. Breast cancer is not caused by a specific behavior. This also means, conversely, it can not be prevented by, for example, a particularly health-conscious lifestyle. Basically, any woman can fall ill.

Occur also at increased risk do not automatically have a disease. But there are some important factors that influence the probability of the occurrence of breast cancer:

• Higher life expectancy: A 65-year-old woman has become ill as compared to a 45-year-old a 3-times as high risk in their next year of life breast cancer.

• Family history: If a first-degree relatives (mother or sister) who is ill, the risk to the 3 - to 4-fold, especially if the affected relatives had the disease when younger than 50 years.

• Mutation: Are certain genes that increase the so-called BRCA 1 and BRCA-2 genes, altered the risk by a factor of 7 to 8 At 2 to 5 percent of women with breast cancer and these genes can be detected even in 30 to 60 percent of cases where there is a family history of this disease.

• Births: When infertility is an increased risk of breast cancer by a factor of 1.5 to 4

• Age at first birth: the first child was brought from the age of 35 years to the world, is the increased risk of breast cancer 3 times. By contrast, the risk is lower if the first birth before 20 age took place.

• Breastfeeding: A lasting longer than 4 weeks lactation reduces breast cancer risk.

• Date of first menstrual period: an onset of menstruation before 12 year of life increases the risk by a factor of 2 A menstrual period beginning after 16 Age lowers the risk.

• Suspension of menstruation: Set the menstrual bleeding after the 55th Years off, doubled the risk. If this date is before the 45th year of life, is to reduce the risk.

• Previous illness: If an illness has been through breast cancer, the risk of another breast cancer 5-fold higher than that of a non-affected women.

Some other risk factors have less influence, but may still be important. These include obesity and the intake of hormones for menopausal symptoms.

Regular studies provide security.

These risk factors are statistically calculated. The specified risk increases are statistical averages. This means that it is unlikely for a presence of one or more risk factors automatically with the occurrence of breast cancer. However, in women who have multiple risk factors combine to provide detailed advice and regular examinations by the gynecologist is necessary. In this way a possible breast cancer can often be detected early. At an early stage of the disease can be effectively treated, as an already more advanced illness.

Diagnosis of suspected breast cancer

A guide to breast self-examination here.

When striking the breast self-examination or the examination by the gynecologist in the breast lump or hardening, must be clarified what it is. There are several options available:

• Physical exam
• Mammography (radiography of the chest)
• Microscopic examination
  

If it turns out that it was actually a breast cancer that have diagnostic procedure is still another meaning: they seek to determine how far the disease has progressed, and the treatment planning.

Medical history and physical examination:

As a first diagnostic step, the physician's medical history rises, to obtain information about symptoms and possible risk factors. After collecting the medical history is usually the physical examination. In both breasts and the region around the breasts and armpits carefully palpated and examined for nodules or lumps. If it finds a node that is sure how big it is, whether it hurts and whether he can move. The skin is thoroughly considered, and also took care whether fluid can be squeezed from the breast.

Ultrasound:
Sometimes, after the physical examination, an ultrasound scan of the chest to give further information. With the help of ultrasound, structures within the body including hardened tissue, cysts or lumps in the breast represent.

Mammography:
The next diagnostic step is followed by a rule called a mammogram. This is an X-ray examination of the breast. In addition, the breast between 2 plates and is positioned relatively firmly clamped. Through this rather unpleasant procedure for the chest radiograph can be somewhat spread out ", thus resulting better pictures, then allow a more accurate assessment. A good picture quality for the correct interpretation of great importance. It will be made once per breast 2 shots, one from the side and once from above. Therefore, it is necessary to position each breast, each with 2 times for the X-ray between the plates. The inclusion of healthy breast serves as a reference recording for improved assessment of the affected side. In addition, a lump in one breast does not exclude that the other side is possibly affected as well. Exposure to X-rays is now limited by the use of modern X-ray machines.

Tissue:
However, it is possible that it may be decided according to this diagnosis is not yet sure whether this is a palpable node is a benign or malignant findings. This distinction has important consequences. Thus, a benign node can remain untreated in many cases, however, therapy needs to be a malicious immediately. Next, comes the possibility of diagnostic investigation of a tissue sample into question. This is using a thin needle from the district suspects obtained the chest and then examined under a microscope.

Puncture under ultrasound guidance

To obtain the tissue sample, there are several options: If a node is easily palpable, because it lies close to the surface, for example, it is the physician palpated with one hand and run with the other hand the needle into the nodule. This approach is very small or difficult in the deep lying nodes. In these cases, a so-called "puncture under ultrasound guidance can be performed. This means that the doctor initially by ultrasound for the nodes in the chest and it looks then "reserves in the picture. Now he can with the other hand, so to speak, "lead under direct vision, the needle safely into the node. There are also ultrasonic devices are available that are directly provided with a needle. In this way, the node can be represented with the ultrasound device and simultaneously targeted with the needle out, will be. Another way of "puncture under direct vision" is to puncture based on an X-ray examination. In this case, be made from several directions, x-rays of the node. A computer then calculates the exact path of the needle into the nodule, so that they reach their destination safely.

And fine-needle aspiration biopsy

For the 2 different tissue sampling methods can be used to come, the fine-needle aspiration and biopsy. In fine-needle aspiration of a very thin needle will be guided in the nodes and a small amount of tissue, "sucked". Because the needle is very thin (comparable to the injection) in a blood sample, no anesthesia is necessary. This method is particularly suitable for very small knots that could not be accurately achieved with a larger needle. For larger nodes, however it is possible to gain some more tissue for the investigation, here's the punch biopsy is used. It is run by a local anesthetic, a slightly larger needle into the nodule. This cuts out a small piece of tissue from the node, which can be removed after removing the needle from its interior. With injuries of the chest or bleeding in both procedures is not likely. The risk of kidnap by the puncture of cancer cells, is negligible.

The stage must be determined.

The removed tissue is used for histological examination under a microscope. In this way, it may be established from which the breast tissue (mammary glands and milk ducts), the tumor starts and whether it is hormone sensitive. Moreover, can the grading stage to determine (see section "Staging, Grading"). These results are important in order to plan subsequent treatment as accurately as possible.

Investigation for metastases.

Must be further investigated whether the breast cancer may be "daughter tumors (metastases have formed). Various regions of the body (liver, lung, bone, brain) are using such X-rays, computed tomography, magnetic resonance imaging, ultrasound or scintigraphy.

Clinical picture and course of breast cancer

Often the first sign of a node.

A breast cancer is noticed very often through a palpable node. It may be surprising in the breast self-examination, or at the screening by the doctor. But there are also other symptoms that can occur in breast cancer. These include:

• Hardening of the breast or the breast skin
• Pain, pressure or tightness in the chest
• Recovery of the breast skin
• Inflammation of the breast and / or breast skin
• Changes in the nipple
• Fluid discharge from the nipple
• General symptoms (eg, general feelings of weakness, weight loss)

Not always the symptoms are caused by a tumor.

Not go out at one or more such complaints, but you have to automatically assume that there is definitely a breast cancer disease. It can also cause other illnesses on these complaints. Feelings of tension in the chest as can also indicate a mastodynia. Even nodes are not automatically mean cancer. By normal remodeling processes in the breast can lead to fibrocystic changes that occur in the nodes and also pain. But it is better in every case, to investigate the complaints quickly and thoroughly by a doctor to find out the actual cause. At the same time is also a relief if it is found that a harmless illness is behind the complaints.

Various symptoms indicative of metastasis.

In rare cases, breast cancer is only noticed if they have already formed "daughter tumors (metastases) in the lymph nodes or other organs. Then are the associated discomfort that interfere with the normal functions of affected lymph nodes or organs. This can for example be:

• Palpable thickened and / or hardened lymph nodes in the armpit with involvement of one or more axillary lymph nodes

• Shortness of breath or other breathing problems, chronic cough, bloody sputum and / or pain in the chest where the lungs and / or the pleura is affected

• Bone pain and / or bone fractures in the presence of bone metastases

• Paralysis, sensory disturbances and / or pain in bone metastases in the spine that press on the spinal cord or nerve roots springing from the spinal cord

• Ascites (ascites) and / or jaundice during infection of the liver

• Headache, disturbances of consciousness, paralysis, numbness, speech difficulties, impaired memory and / or personality changes when metastases have formed in the brain

Only an investigation creates security.

But again, that these complaints are not a sure indication of a cancer. Such symptoms can sometimes also occur with other diseases or in healthy people as a "mood disorder". Time should be prolonged existence of such complaints, or on specific cancers suspected a thorough investigation.

Very rarely, a breast cancer disease first manifests itself by so-called general symptoms that may occur in the context of many cancers.

Illness, treatment and life circumstances cause considerable suffering for the soul.

Apart from the purely physical complaints and the "accompanying" charges should not be ignored. Thus, by the by the disease or therapy associated disorders, such as declining performance, or general weakness, limitations arise in everyday life. For many stakeholders, it is very stressful when their usual activities at work or leisure, you can pursue any more. You may develop feelings of inferiority or anxiety within the fellow's fault. In addition, a disease is a typical female body part such as the breast for many women, the female self-image into question. Just after the surgical removal of the breast may face obstacles in sexual intercourse with the partner.

Psychologists and psycho-oncologists to help.

A panacea for these complaints or charges do not exist. However, no woman should be afraid, with family and friends and of course with the doctor or speak to a psychologist or a psycho-oncologist about this serious situation. This results in often quite practical help and understanding of the disease is encouraged. In addition, physiotherapy exercises to help overcome physical weaknesses. A big help to restore the "female self-image" offer methods of breast structure or when simpler measures, externally, or with the clothes to wear breast prostheses.

Staging of breast cancer

According to the TMN system cancers are the size of the tumor (T) after the appearance of "daughter of tumors (metastases) in lymph nodes (N; Latin" nodus = knot and divided the occurrence of metastases in other organs (M) . It derived from each of consequences for individual therapy.

T = size of the tumor
For breast cancer the following classifications are distinguished:

• T stage
• Tx: no assessment of possible tumor
• T0: No evidence of a tumor
• Tis: non-invasive (not in the surrounding tissue ingrown) tumor
• T1: tumor in greatest dimension no greater than 2 cm
• T2: Tumor size 2-5 cm in greatest diameter
• T3: Tumor larger than 5 cm in greatest dimension
• T4: tumor extends into neighboring tissues (eg, chest muscles, skin or fins)
  

N = involvement of lymph nodes:
N stage

• Nx: lymph nodes can not be assessed
• N0: Lymph nodes are not affected
• N1: metastasis in the axillary lymph nodes on the same side as the affected breast, the lymph nodes can move during the examination by the doctor
• N2: metastasis in the axillary lymph nodes on the same side as the affected breast, the lymph nodes can be moved during the examination by the doctor, since they are fused together or with the surrounding tissue
• N3: metastasis along the internal thoracic artery on the same side as the affected breast
  

M = metastases:
M stage:

• Mx: presence of organ metastases not assessable
• M0: no organ metastases detected
• M1: metastases in other organs, there
  

Grading:
Furthermore, the biological behavior of tumor tissue in the histological examination will be further explored ( "Grading"). This can for example inferences about the rate of growth of the tumor, or a tendency to metastasize. It distinguishes the grading stages G1, G2 and G3.