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.