Breast cancer - HirslandenGoesPink

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Chemotherapy

Chemotherapeutic substances are drugs which interfere in the metabolism of the cancerous cells. They kill cancer cells directly or inhibit their growth. Such drugs are called cytostatic drugs. There are more than a hundred different cytostatic drugs that are used individually based on the type of cancer and stage of the disease.

Several types of cancer such as leukaemia or lymphoma are primarily treated with chemotherapeutics. In the case of other cancers such as lung cancer, breast cancer or bowel cancer, chemotherapy is used after an operation or irradiation. In this case, we refer to adjuvant chemotherapy. Chemotherapeutics can cause side effects like nausea and vomiting. For this reason, patients undergoing chemotherapy are often given a drug at the same time as chemotherapy to combat nausea.

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Antihormonal therapy

The growth of breast cancer is often stimulated by the female hormone(s) oestrogen and/or progesterone. This happens via hormone receptors on the tumours to which the hormones attach themselves. A tissue examination can determine whether a tumour has these receptors and is therefore "hormone receptor-positive". Antihormonal therapy (also known as endocrine therapy) takes advantage of the hormone dependence of many breast tumours by either blocking the hormone receptors on the tumour or suppressing the body's own production of female hormones.

Antihormonal therapy is usually used as a complementary treatment after surgery and, if necessary, further treatments such as chemotherapy. The goal of antihormonal therapy is to reduce the risk of relapse. It is usually done by taking one tablet daily over a period of several years. Possible side effects include hot flashes and bone, muscle and joint pain. The alleviation of such side effects is part of breast cancer aftercare.

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Antibody therapy

Antibody therapy (immunotherapy)

Antibody therapy is a relatively new treatment and is usually combined with chemotherapy. It is considered a target therapy because it only fights tumour cells and spares healthy tissue. Such therapies combat the properties of a tumour that promote its growth. In one type of breast cancer, this trait manifests in a high incidence of the growth receptor HER2 on the tumour cells. Growth signals are transmitted into the cell via the HER2 growth receptor.

A high HER2 density affects around 20 per cent of breast tumours and is associated with aggressive progression of the disease. Antibodies that attach to and block the HER2 receptor have been developed to treat this type of breast cancer. As a result, the growth signals are no longer passed on, which slows down the growth of the tumour. At the same time, the antibodies strengthen the effect of the chemotherapy and activate the body's own immune response against the tumour cells. For this reason, antibody therapy is also considered to be an immunotherapy. It is administered via a monthly infusion and lasts 12 months.

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Surgical

The central pillar of breast cancer treatment is usually surgery. The primary goal is the complete removal of the tumour. Until the 1990s, the typical procedure was the complete removal of the breast (mastectomy). This has changed fundamentally since then.

Today, around two out of three operations can be performed with breast-conserving surgery. However, depending on the size and location of the tumour as well as the size of the breast, complete breast removal may still be necessary today. Such surgery is also carried out if a patient expressly requests it. Of course, this also applies to plastic surgery reconstruction of the breast – either directly after the breast removal or at a later date. The options range from silicone prostheses to breast reconstruction with the patient's own tissue. Breast cancer surgery also includes the removal of lymph nodes in the armpit because tumour cells metastasise there first. However, today, is not usually necessary to remove all of the lymph nodes.

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Radiotherapy

Even after the complete surgical removal of a malignant breast tumour, microscopic tumour cells may still be present which are invisible to the surgeon's naked eye. They are able to induce a new outbreak of the disease, either locally or at another location in the body.

For this reason, radiotherapy is often recommended as a further treatment step after surgery. Today, linear accelerators are used almost exclusively to bombard cancer cells with the smallest particles. The treatment usually lasts five to six weeks. During this time, the patient comes to the hospital several times a week for radiotherapy of the entire breast. This is sometimes followed by additional radiotherapy of the former tumour area with an increased dose (boost) because this is where the greatest risk of relapse exists. Radiotherapy is planned and carried out by radio-oncologists, who are specialists in this field.

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Complementary therapies

In recent years, major advances have been made in the treatment of breast cancer. Nevertheless, in many cases, it remains a lengthy process. In addition to the symptoms of the disease, patients often suffer side effects from the therapies – such as fatigue, changes in body image, eating difficulties and psychological problems. For this reason, breast cancer patients have access to a wide range of complementary medical therapies and non-medical services. The goal is to improve the quality of life of the women affected by alleviating the complaints caused by their illness and treatment and by strengthening their resilience.

The range of services includes pain therapy, physiotherapy, complementary medicine, nutritional advice, psycho-oncology, social counselling, integrative care and sexual therapy. This can be complemented by integrative measures such as yoga and mindfulness therapy or music and dance therapy. Breast cancer patients are advised by experienced specialists in the design of a programme tailored to their individual needs.