Tuesday, October 27, 2009

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.

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