Therapy and aftercare

Individual therapy recommendation

Every week, the breast center at the English Garden (BzaEG) holds a so-called "tumor conference" in the women's clinic Dr. Geisenhofer. The center doctors from the various disciplines take part. They discuss an individual therapy plan for each patient, which follows the current guidelines of the German Society for Senology. An essential part of our quality standards in therapy is - if possible - breast preservation instead of removal.

The therapy recommendation is discussed with the patient in a timely manner and the further necessary procedure is planned and organised. All examination and operation results are presented and discussed at the weekly tumor conference.

This happens both before an operation that may be necessary (preoperative tumor conference) and after the operation (postoperative tumor conference).

Therapy

Basicly, there are three different therapies possible for the treatment of breast cancer:

the operation
radiotherapy and
treatment with drugs (chemotherapy, anti-hormone therapy, antibody therapy)

Sentinel lymph nodes procedure

Lymph nodes are endogenous filters which capture harmful substances from the lymphatic pathways, including toxins, pathogens, cell fragments, and possibly even cancer cells.

Sentinel lymph nodes, also known simply as "sentinel nodes", refer to any lymph node to which the lymph first flows from a tumour area. Only then does this reach other lymph nodes in the area of the armpit. This lymph node, so to speak, watches over the other lymph nodes. It is also highly likely to be the first lymph nodes to find tumour cells.

In the sentinel lymph nodes procedure, the first node in the lymphatic pathway is identified, surgically removed and examined for cancer cells. The sentinel lymph node is tracked by marking it with a dye or a low-level radioactive protein.

If the pathologist finds no cancer cells in the sentinel lymph node preparation, it will not be necessary to remove further lymph nodes.

Only when the sentinel lymph node contains cancer cells, the remaining, up to 15 lymph nodes in the armpit area, will be removed as a precautionary measure.

Surgery

Breast conservation surgery

During this operation, only the tumor-bearing segment is removed from the mammary gland, the breast itself is preserved. The success of these procedures is not inferior to that of a complete breast removal, but certain prerequisites are important, which your doctor will discuss with you individually.

Ablative breast surgery (mastectomy)

If the entire breast has to be removed, this is referred to as a mastectomy or ablation. Under certain conditions, it is possible to preserve the nipple even with a mastectomy. The surgeon will explain the various procedures in detail.

Breast reconstruction

The reconstruction of the female breast is intended to restore the shape and aesthetic of the breast. In recent years, breast reconstruction following the removal of a breast has increasingly reached attention. Different procedures are available for reconstructing the female breast, which must be individually adapted to each patient.

Under favorable circumstances, reconstruction can be carried out together with tumor removal in one operation (primary reconstruction of the breast). Under certain circumstances, however, it is reasonable to only carry out the breast augmentation procedure after the therapy has been completed. This is called secondary or subsequent reconstruction. Breast reconstruction is possible at any time afterwards. In any case, the plastic surgeon will weigh the options and discuss them with the patient.

Selecting a procedure for breast reconstruction

On the basis of careful preliminary investigation and individual consultancy, we offer the following procedures:

Reconstruction using foreign body tissue (expander/implant), possibly with so-called cellular matrices (ADM)
Reconstruction of the breast using the body’s own tissue

Reconstruction using tissue from the back (latissimus muscle or TDAP flap plastic)
Reconstruction using tissue from the belly (DIEP flap plastic, formerly TRAM flap plastic, and SIEA flap plastic)
Reconstruction of the breast using tissue from the thigh and gluteal fold (TMG, PAP- flap plastic)

External breast prostheses

Should you not wish to undergo or have doubts about breast reconstruction, suitable external breast prostheses are also available. These usually consist of a cushion on the operated side, which is sewn into a bra or swimsuit. Because of its perfect fit, it is not possible to see the difference from the outside.

More recently, gel prostheses have also become available, which do not have to be sewn into the underwear and are worn directly on the skin.

The cost of a breast prosthetic is covered by statutory health insurance.

After the operation

To prevent re-bleeding in the wound or the accumulation of tissue fluid, suction tubes are placed under the breast skin during the operation. These will be removed in the clinic before you are discharged.

Threads are removed 8-10 days after the operation. The wound itself usually heals within 3-4 weeks.

Chemotherapy

Chemotherapy involves the administration of cytotoxic drugs. These are particularly effective on the rapidly multiplying cancer cells and kill these off.

According to current recommendations, chemotherapy is recommended for patients with affected armpit lymph nodes as well as for patients who carry an increased risk.

Constant research and large-scale studies have ensured that chemotherapy can be tailored very individually. Depending on the tumor biology, the drugs are used in a targeted manner.

How does chemotherapy work?

Cytotoxic drugs are primarily effective on cells which divide rapidly and constantly, such as cancer cells.

Cells in the cell subdivision phase are particularly susceptible. The drugs intervene in this cell division process, by deliberately preventing their multiplication.

Chemotherapy is administered based on a schedule with fixed intervals, in order to combat the cancer cells during their division phases. Multiple treatments also allow attacks on cancer cells which were in a rest phase and did not divide during a previous treatment. The drugs are administered individually or in combination, usually as an infusion or injection, but sometimes also in tablet format. A single portion of the treatment is called a “cycle”. A treatment normally comprises six cycles, with a pause of between one to three weeks between each cycle.

Potential side-effects of chemotherapy

Cytotoxic drugs act on cells which divide rapidly. These include not only cancer cells, but also cells in the blood, the digestive tract, the ovaries and the hair roots. Side-effects of cytotoxic drugs can include hair loss, nausea, fever, vomiting, diarrhoea and irritation of the skin and mucous membranes. These side-effects can be avoided and resolve on their own following the end of treatment.

Radiotherapy

What is the radiation used for?

Radiotherapy is an integral part of the treatment of breast tumours. It is used to any individual tumour cells which may still be present at the site of the original tumour after surgery.

How does radiotherapy work?

The rays used in radiotherapy are almost always wave rays (photons). The radiation which passes through the irradiated tissue is only generated in the radiation unit for the short exposure period.

This damages the tumour cells. These are unable to recover from the radiation damage and die off. Healthy cells recover very rapidly.

The patient retains none of the radiation in her body, and never herself emits radiation.

The radiotherapy process

Radiotherapy is initiated after surgery, once the internal and external scars have healed sufficiently, normally after 4-6 weeks. Where chemotherapy is used, radiotherapy only begins once the former has been completed.

Before the start of radiotherapy, the area to be irradiated is measured using a special planning computer tomography and entered into the radiation planning system.

Physicians, together with their medicine physicists, use this radiation planning system to draw up an individual radiation plan for each patient. This is how the physicians determine the daily dose and the overall dose for the treatment series. This then determines the number of sessions (fractions).

A radiation session normally lasts between 3 to 7 weeks from Monday to Friday, i.e. a total of 15-35 times. The irradiation itself only lasts a few minutes, and the entire session, with its preparations (storage and field controls) last between 10-20 minutes.

Tolerability of radiotherapy

Most patients tolerate radiotherapy and the localised side-effects well.

Towards the end of the series of the radiations, there is almost always slight, sometimes marked reddening of the skin in the irradiated area, and sometimes a slight swelling of the breast. Patients may also feel fatigued. Other side-effects such as mild nausea are very rare.

The symptoms normally subside around 3 weeks after the completion of the radiotherapy.

Due to the highly sensitive radiation devices, no serious consequences are to be expected nowadays.

Hormone therapy

How does hormone therapy work?

Hormone therapy blocks the growth of cancer triggered by female hormones. However, the therapy is only effective if the relevant tumour cells react to the hormone. This requires specific docking points, called hormone receptors, to be present on the tumour cells.

These docking points can be found in tumour preparations in approximately 40% of premenopausal women and 60% of postmenopausal women.

Whether the so-called anti-hormone treatment is administered to the female patient is strongly dependent on whether she is in the menopause or not. It has however been shown that therapy efficacy increases significantly, particularly when a new disease is involved.

Potential side-effects of hormone therapy

Hormone therapy has relatively few side-effects when compared to chemotherapy. The side-effects are mainly related to the triggered hormone deficiency and may manifest as hot flashes or dryness of the mucous membrane.

Aftercare

During the follow-up visit, your physician will perform a physical examination, paying particular attention to symptoms which may indicate a recurrence of the tumour. He or she will also ask you about your well-being, your physical fitness, as well as any abnormalities, complaints and physical changes. You can ask your physician any questions you may have relating to your mental, social, family, physical and professional rehabilitation.

Normally, these examinations are performed every three months for the three years following the treatment. These intervals are extended to 6 to 12 months in subsequent years. The operated breast undergoes a mammography every six months for the first three years, and the healthy breast undergoes an annual mammography.

A so-called follow-up calendar is recommended in order to document the follow-up visits. This will be issued to you upon discharge from the Clinic by the general practitioner who is treating you.

Rehabilitation

Patients with - or who have suffered from - cancer are legally entitled to rehabilitation services, which help them to cope with the consequences of the illness and treatment, as well as their re-entry into everyday life.

These can include inpatient rehabilitation/follow-up treatment measures, the issue of a disabled person’s pass as well as assistance with professional reintegration.

The oncological care concept

Patients with cancer require not only medical treatment, but also special nursing care. Nurses make a significant contribution to the oncological treatment team with their specific specialist knowledge and their expertise, so that the patients and their relatives are better able to manage the effects of the disease and treatment.

In addition to sound basic training, comprehensive specialist knowledge is essential, and insured by advanced oncological training. The two-year part-time course for oncological specialist nurses complies with European standards and is performed in accordance with the guidelines of the German Hospital Association (DKG).

Oncological specialist nurses in our Breast Centre have the necessary competence and continuity of care and play a key role as the interface between the physician, patient and relatives.

Oncological specialist nurses are responsible for the following duties:

Quality assurance / quality development
Compliance with hygiene and accident prevention regulations and specifications issued by the MPG, as well as with internal clinic requirements
Advice and training for non-oncological specialist members of the treatment team
Participation in the induction of new members and guidance of participants in the "care in oncology" continuing education course, with particular consideration for oncological specifics
Participation in internal training
Participation in internal and external oncology-specific training for their own continuous and further education
Participation in quality assurance processes (e.g. certification processes)
Ensuring and verifying care quality on the ward, taking oncology-specific aspects into account