Breast Cancer: Anti-hormone therapies
Many forms of breast cancer are hormone-dependent and can therefore be treated with anti-hormonal therapies.
The removal of a breast changes the appearance. The weight difference and the often resulting tension in the neck, shoulders and back can also limit the quality of life of affected women. Breast reconstruction is still possible during the first operation or later after the wound has healed.
Immediate reconstruction is performed directly after tissue removal in the same surgical session.
Late reconstruction is performed after the wound has healed, approximately 3–6 months after surgery. If radiation therapy is carried out after the operation, the build-up can be started about a year after the end of the radiation. In the case of chemotherapy, the general condition of the patient is decisive for the timing of breast reconstruction.
Alternatives to breast reconstruction are silicone prostheses and special bras. For more information, including coverage by health insurance companies, see Breast cancer > Breast prostheses and special bras.
After the operation, the removed tissue is examined. Breast cancer can be divided into specific stages by histological examination. The size of the tumor, the number and location of the affected lymph nodes and the presence of secondary tumors in other parts of the body are taken into account (TNM classification). Depending on the result, either no follow-up treatment is necessary or local radiation, chemotherapy and/or hormone therapy is used. The aim is to kill any cancer cells that may still be present.
Since August 23, 2019, the costs for a so-called biomarker test have been covered by health insurance. This test is used in patients who have early-stage breast cancer (without metastasis) and who are uncertain about the risk of recurrence. Biomarker tests can be used to decide whether chemotherapy is required after the operation or whether radiotherapy is sufficient.
All therapies that affect the whole body and do not only have a local effect are referred to as “systemic”. In this way, even widely spread cancer cells can be reached.
Chemotherapy can be given before or after surgery. Drugs are used to prevent the division of the tumor cells, so-called cytostatics. The drugs act specifically on fast-growing cells. In addition to the tumor cells, these are also hair cells, blood-forming cells and cells in the digestive tract. Therefore, many patients suffer from the side effects of chemotherapy, e.g. hair loss or nausea.
The hair usually grows back about 4 weeks after the end of the chemotherapy, but the structure and color may have changed. Practical tips on wigs, headgear and cosmetics (eyelashes and eyebrows can also fall out) for hair loss in chemotherapy.
Many forms of breast cancer are hormone-dependent and can therefore be treated with anti-hormonal therapies. The side effects that can occur are similar to those associated with menopausal symptoms, such as hot flashes, weight gain and mood swings. Hormone therapy usually lasts 5–10 years.
The use of hormone therapy depends on the so-called receptor status, which indicates whether the examined tumor tissue is sensitive to the sex hormones estrogen and/or progesterone. The receptors are the “docking points” for hormones on the cell surface. They are responsible for the effects of the female hormones estrogen and progesterone in the body. Among other things, estrogen promotes the growth of the mammary glands. If the corresponding receptors are present on the tumor tissue, the hormone promotes cancer growth. So-called receptor blockers such as tamoxifen block access to the estrogen receptors so that the hormones cannot have any effect there. In the case of sensitive tumors, growth can be slowed down in this way.
A side effect of anti-hormone therapy can be the development of osteoporosis, especially in women before menopause. To monitor this, a doctor can take bone density measurements. In justified cases, the costs are covered by the health insurance company.
Molecular biological therapies
Molecular biological therapy, also known as targeted therapy, is a targeted treatment with drugs that interfere with biological processes that are important for tumor growth. With this therapy, only cancer cells should be attacked if possible. However, this therapy is only effective if certain structures can be detected. Molecular biological therapy often does not completely replace other forms of therapy, but can be used as a supplement. This treatment is also accompanied by side effects.
An example of this is immunotherapy. The corresponding drugs dock directly to receptors that are responsible for the growth of the tumors and thus slow down the tumor growth.
Radiation therapy (= radiotherapy, radiation) can be used before an operation, after an operation or instead of an operation. It only works locally in the radiation field, so that healthy tissue is largely spared.
The radiation damages the cells and the aim is to destroy the tumor cells. Healthy cells are also affected, but they have a functioning repair mechanism that they use to regenerate after exposure to radiation. Depending on the lymph node involvement, the type of tumor and its size, it may be necessary to also irradiate the armpit, mid-chest wall and subclavian fossa. If the tumor has already spread, radiation is also used, for example, to treat bone metastases.
The frequency and duration of radiation varies from woman to woman and can usually be carried out within 6 weeks on an outpatient basis. The risk of recurrence can be reduced by so-called boost radiation, i.e. a higher radiation dose in the area of the removed tumor. According to medical studies, women under the age of 50 and patients with an increased risk of recurrence benefit the most.
In patients with a low risk of recurrence, partial irradiation of the breast or irradiation during the operation may be sufficient or shorten the duration of radiotherapy.
New drugs and treatment strategies are tested in clinical trials. Patients who take part in studies have the opportunity to benefit from the latest medical findings.
However, since these therapies are not yet established, there can also be risks. In addition, not every study is suitable for every patient. As a rule, certain prerequisites, e.g. age or previous illnesses, must be met in order to be able to participate. For this reason, patients should seek detailed advice from their doctor before participating in a clinical study and, if necessary, obtain reports from a self-help group.
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