Breast Cancer

Invasive breast carcinoma

Breast cancer is a malignant disease of the mammary gland and the most common cancer in women. Men can also be affected, but very rarely. If breast cancer is detected and treated in time, most cases are curable. Early detection and increasingly targeted treatment methods (surgery, radiotherapy and medication) have further improved the chances of curing breast cancer in recent years, despite the rising number of cases. Five years after diagnosis, about 87% of the women are still alive.

Causes and risk factors of breast cancer

The actual causes of breast cancer, as with most other types of cancer, are not known. However, risk factors that increase the risk of developing breast cancer are known:

Overweight and high-fat diet, low physical activity
Long-term use of female sex hormones (pill and hormone replacement therapy during the menopause for longer than 5 years)
The early onset of periods and the late onset of the menopause
Smoking
Alcohol consumption
Strong family history
Childlessness and late pregnancies after the age of 30, no or only short breastfeeding of the children
High mammographic density of the mammary gland

Does breast cancer cause symptoms?

At an early stage, breast cancer generally does not cause pain or discomfort. Signs that may nevertheless indicate a possible tumour are as follows:

A lump in the breast is palpable; they are usually noticed from a size of 1-2 cm and are usually not painful. Not every lump means breast cancer, as there are also benign lumps - nevertheless, every palpable finding should be clarified.
Skin changes in the sense of puckering, protrusions, conspicuous large pores in the skin ("orange peel skin"), a reddening or inflammation of the breast that does not subside are further possible indications of a carcinoma.
Changes in the nipple such as secretions, especially if they are bloody or clear and only occur on one side, in-drawing of the nipple, inflammation or skin changes of the nipple.
Newly appeared change in the size of the breast (both increase and decrease in size) as well as an altered behaviour of the breasts when lifting the arms.
Swelling of the lymph nodes in the armpit - this can indicate a tumour in the armpit, but can also occur in the context of inflammation.

If you have noticed one or more symptoms, you should see your gynaecologist as soon as possible to investigate the change. In the late stage, in addition to increasing changes in the breast area, you may also experience pain in the area of the bones, difficulty breathing or unwanted weight loss - these could be signs of metastases (daughter tumours of the cancer).

How is breast cancer diagnosed?

Changes in the breast or abnormalities in the mammography screening should be examined more closely by a gynaecological specialist. In addition to a palpation and inspection of the breast, the next step is usually a breast ultrasound. If there is an abnormal finding here, the mammography is usually supplemented by a fine tissue examination of the findings and an ultrasound-guided punch biopsy is performed. The tissue obtained is sent to the pathologist for histological (fine tissue) examination, who can then provide more detailed information about the change in the breast, in particular whether it is a benign or malignant tumour.

In the case of malignant breast tumours (invasive breast carcinomas), a distinction is made between ductal breast carcinomas (affecting the mammary ducts), lobular breast carcinomas (affecting the mammary glands) and some rarer variants.

How is breast cancer treated?

The diagnostic results obtained are discussed at our multi-disciplinary tumour meeting, which takes place once a week. All attending specialists - gynaecologists, oncologists, radiologists, nuclear medicine specialists, surgeons - and therapists discuss the findings and work out a targeted therapy proposal on this basis. This is precisely tailored to the characteristics of the tumour and accordingly offers the greatest possible prospects of success.

In most cases, we advise surgery. Until the 1980s, a breast cancer diagnosis was usually accompanied by radical removal of the breast. Today, we can usually operate more gently and preserve the breast. The characteristics of the tumour are key here. Thanks to improved diagnostic and therapeutic methods, breast-conserving surgery does not carry a higher risk of recurrence for patients than radical breast removal.

The aim of the operation is to remove all tumour cells from the breast. To ensure this, some of the surrounding healthy tissue is also removed, the so-called safety margin. After the operation, the pathologist examines the removed tissue and assesses whether the cut edges still contain tumour cells or whether everything in the healthy tissue has been removed.

Following breast-conserving surgery, the breast should be irradiated. Removal of the breast, a so-called mastectomy or ablation, is necessary if the breast cancer has already progressed locally, i.e. if it has spread further in the breast. Another indication for a mastectomy is specific tumour characteristics that stand in the way of breast conservation. In this case, we will also be happy to inform you about the possibilities of reconstructing the breast before the planned operation and establish contact with our plastic surgery team.

In some cases, the tumour meeting suggests not to operate immediately, but to first use chemotherapy, anti-hormone therapy or antibody therapy. This is especially the case with more aggressive tumours with a high growth rate and has the advantage that tumours may shrink, allowing breast-conserving surgery to be performed.

In breast cancer, the sentinel lymph nodes should also always be removed. The sentinel lymph nodes are the first lymph nodes located on the lymphatic pathway between the breast and the armpit. Removing them is a gentle method that can preserve the subsequent lymph nodes in most cases. However, if there is a suspicion of lymph node involvement in the ultrasound or mammography before the operation, we cannot use this method. In this case, the abnormal and neighbouring lymph nodes (at least ten in total) should be removed. This procedure is called an axillary dissection.

What are the advantages of integrative therapy for breast cancer?

During your inpatient stay at Havelhöhe, we combine conventional medical therapies from the start with integrative of anthroposophic treatments that help you to strengthen your self-healing powers, activate the immune system and mobilise your strengths. In breast carcinoma, therapy with mistletoe extracts in particular has been proven to be additionally helpful.

In many cases, integrative therapies can also significantly reduce the side effects of cancer therapy. These include movement and body therapies, e.g. eurythmy therapy and rhythmical massage therapy, as well as painting and music therapy. Additional support is provided by our anthroposophic care therapies, which promote regeneration.

You also have the option of taking advantage of psycho-oncological counselling. You can discuss possible fears there as well as the effects of the disease on your family situation or prospects for the time after treatment.

The healing power of movement

Current studies show that the course of breast cancer can be positively influenced by exercise. Regular physical activity has been shown to reduce the risk of recurrence and increase the chances of complete recovery. The side effects of chemotherapy or anti-hormonal therapy often decrease, and symptoms of fatigue syndrome (chronic fatigue syndrome) also occur less frequently. With the increased performance, self-confidence also increases, the quality of life improves and depression can be avoided.

In all cases, it is important to coordinate your exercise programme with the doctors treating you. To find the right measure for you, they will take into account your individual constitution as well as the specific situation. If your blood count is low, if you have a fever or if you have lost a lot of weight, you should temporarily reduce more intensive activities.