Breast cancer or mammary carcinoma is the most common tumour disease in women, accounting for approximately 32.1 per cent of all cases. One in 8 to one in 10 women will develop breast cancer at one point in her life. Every year, in Germany around 70,000 women develop breast cancer for the first time. The risk increases with advanced age. Young women are only rarely affected. The risk rises in women older than 40 and in particular in those over 50. Men can also develop breast cancer but this is very rare: There is one man for every 100 women with breast cancer.
If the tumour is detected and treated in time, most of the cancers are curable. The number of deaths has been declining for a number of years now. 83 to 87 per cent of patients are still alive five years after the breast-cancer diagnosis.
Breast cancer can be treated more successfully today than in the past, using treatment methods that are more targeted and less toxic.
Invasive ductal carcinoma and invasive lobular carcinoma are particularly common (see illustration). Taken together, they account for around 85 per cent of all mammary carcinomas. Almost half of all tumours are located in the upper, outer quadrant of the breast.
(1) Lymph nodes and lymph vessels (2) Breast muscules (3) Fatty tissue (4) Arteries
(5) Veins (6) Lobules (7) Nipple
Patients may notice a hard knot in their breast themselves. Less often, it is tenderness or pain which leads to a diagnosis of breast cancer. Symptoms of advanced disease are reduced performance, tiredness, weight loss and bone pain.
Today, different risk factors are known that can favour the development of breast cancer:
- Hormonal imbalances or hormone therapy
- Bad diet
- Family history
- Increased body weightt
The following standard examinations are available:
- Breast MRI
Regular self breast exams and mammographies (in combination with ultrasound if applicable) are important tools in breast-cancer screening.
MRI, a radiation-free procedure, is also available for diagnostic purposes. Radiologists can use it to determine the location and size of the tumour.
Despite the use of mammography, ultrasound or MRI: Whether a change in the breast is benign or malignant can only be determined with any certainty once a tissue sample has been removed and examined histologically (biopsy).
The choice of treatment depends on whether the tumour needs oestrogen to grow, the size of the tumour and whether surrounding lymph nodes have already been affected.
In certain cases it may be advisable to administer chemotherapy (neoadjuvant chemotherapy) prior to surgery.
Chemotherapy is aimed at destroying cancer cells in the whole body with medicinal products that inhibit cell growth (cytostatics). Cytostatics are very effective against rapidly growing cells. Cancer cells are often particularly fast-growing.
Surgery on the breast without removing it is followed by radiation therapy.
A more recent, molecular biological approach is targeted therapy.
Your treating oncologist will discuss with you whether you are eligible for this and which substances are suitable in your individual situation.
The following factors are taken into consideration for an individual therapy:
- Tumour size
- Extent to which the cancer has spread to the lymph nodes in the armpit region
- Patient’s age
- Menopausal status
- Hormone receptor status
- Grade of the mutated cells (grading)
- HER2 (human epidermal growth factor receptor number 2)
- Invasion of blood and vessels
TNM is a widely used system to classify tumours. pTNM denotes definite pathological data made available after surgery. In pTNM classification, a “y” is put in front of the main classification if chemotherapy took place before surgery. The classification system ensures that all treating physicians and patients have the same information concerning the stage of the disease. In addition, treatment and prognosis can be inferred.
T for “tumour": size of the primary tumour (T0 to T4)
N for “nodes”: number of affected lymph nodes (N0 to N3)
M for "metastasis": Presence of metastasis; e.g. in the bones, liver, lungs or brain
T = tumour size
|T0||No evidence of a tumour|
|Tis||Carcinoma in situ (DCIS, LCIS), non-invasive|
|T1mic||Very small invasion (micro invasion), no more than 0.1 cm|
|T1||Tumour no larger than 2 cm|
|T2||Tumour larger than 2 cm and no more than 5 cm|
|T3||Tumour larger than 5 cm|
|T4||All tumours that have invaded the breast wall or the skin|
N = affected lymph nodes
|No evidence of lymph node involvement|
|N1||1 to 3 involved lymph nodes in the armpit|
|N2||4 to 9 involved lymph nodes in the armpit|
|N3||10 or more involved lymph nodes in the armpit or collarbone|
M = metastasis (bones, lung, liver, brain)
|Presence of metastasis|
X = no information available
Sometimes, test results are not available yet or the diagnosis is not yet certain. In those cases, the letter “X” is added. MX means that no information is available on the presence of metastasis.
C1 to C5 (C = certainty)
This letter is used by pathologists to denote the certainty of diagnosis. C1 equals uncertain, and C5 very certain.
R = residual tumour tissue after resection
R will be found on the pathology report after surgery. It denotes whether the tumour could be resected completely with a minimum distance to healthy tissue (with a visible edge of normal tissue).
R0 = no residual tumour
R1-2 = residual tumour of different extent (in this case, further resection needs to take place)
V = venous invasion
V0 = no venous invasion (no evidence of tumour cells in blood vessels)
V1 = venous invasion (evidence of tumour cells in blood vessels)
L = lymphovascular invasion L0 = no lymphovascular invasion (no evidence of tumour cells in lymphatic vessels) L1 = lymphovascular invasion (evidence of tumour cells in lymphatic vessels)