Cancer of the breast

cancer of the breast (synonym: Mammakarzinom) is a malicious tumor outgoing from (epithelium -) the cells of the gland small cloths or the milk courses.
With animals one speaks of the Gesäugekarzinom.

From the Mali gnomes escape the woman approx. 25% on the Mammakarzinom, it are thus the most frequent cancer illness with women. It concerns each 8. to 10. Woman in the course of their life. The probability to get sick with cancer of the breast rises with increasing age, it is however increasingly also young women concerned. Per year step approx. 110New illnesses per 100.000 woman up, that are in Germany about 47,000 cases.
With women between that 30. and 60. Lebensjahr is cancer of the breast the most frequent cause of death in the western world. Altogether die annually approx. 19,000 women at cancer of the breast (source: Institute for Robert cook).

Also with men cancer of the breast can occur; here the illness is however very rare.

Table of contents

early recognition and Screening

the preventive medical examination of the chest by a physician is a component of the legal Cancer early investigation program starting from that 30. Lebensjahr.

On the other hand the self investigation of the chest is not suitable to recognize cancer of the breast in the early stage; missing palpation findings do not exclude a tumor illness. The self investigation of the chest does not carry contrary to the Screening Mammografie also for loweringthe number of deaths at cancer of the breast with (scientific proof here:Regularly self examination or clinical examination for early detection OF breast CAN cerium.).

The Mammografie is the substantial component of the early recognition and basis of the population-referred cancer of the breast Screening. In Germany at present a quality-secured mammography Screening program becomesconstructed, on the basis „of the European guidelines for the quality assurance of the mammography Screenings “. Altogether 89 of these units is planned to at the end of of 2007 in completely Germany. In some regions a mammography Screening already becomes for the target group (women between 50 and69 years) offered.

Additionally to the investigation of the chest and to the Mammografie with younger women an ultrasonic investigation of the chest is in particular accomplished, since there are tumors, which are not noticeable in the Mammografie. About 10-15% of the Karzinome are not in the Mammografievisibly, can be possibly discovered however during the ultrasonic investigation.

causes and factors of risk

the etiology (a cause) of the Mammakarzinoms is not well-known.
Genetic factors seem to play likewise a cause like external influences (life habits, nutrition etc.). The mutation thatTumorsuppressorgene BRCA-1 on Chromosom 17q and BRCA-2 on Chromosom 13q accompanies with a increased illness risk. With 80% of the familiar left illnesses are mutations of BRCA-1. Mutations of this gene accompany additionally with a increased risk of a Ovarialkarzinoms. Oneaccording to recent data also mutations of at gene (responsible for the Ataxia teleangiectasia) seem to play smaller role.
The risk with the income of the contraceptive pill is clarified not completely, however the Nurses' Health Study and other large prospektive shows andretrospective studies a moderate increase of the risk with an income of more than five years (relative risk from 1,2 to 1.4).
Geographical differences are possibly due to life habits (nutrition among other things), there itself the risk of Migranten after few generations thatadapted to the population of homeland.
Mammography - investigations lead to no significant risk increase.

The table is to give an overview of the factors of risk:
(after: Gynäkologie and birth assistance (Stauber and Weyerstahl), Thieme/MLP 2005)

factor of risk increase of the relative risk around the factor
genetic arrangement (BRCA-1, BRCA-2,
family load: Nut/mother, sister concerned)
2-9
adiposity (fat craze) 2-3
alcohol - consumption > 20 g per day 2-3
childlessness 1.5-2.3
Mastopathie ~2
cancer of the breast of the other chest 2-10
age > 30 ~3 Menarche and
late early with Erstschwangerschaft Menopause 1.0-2
oral Kontrazeptiva („pill “) 1,2-1,5?
Smoke
high meat consumption
ionizing radiation
higher age
ethnical factors
asymmetrical chests (see: [1])

symptoms

a physician attendance is recommended urgently, if one notices the following symptoms:

  • again more arisen, in a diffuse waylimited knot
  • hardening or crude place of the chest
  • newly arisen size and outlining changes of the chests (side comparison!),
  • a different behavior of the chests with lifting the arms, that for you is not new
  • to Vorwölbung or a suddenly not arising
  • any more Verdickung of a chest,fading away turning red of a chest
  • skin collections or orange peel (skin with drawn in places) collection
  • or skin changes of the nipple isolations
  • from the nipple knot
  • in the shoulder cave Ekzemartige
  • change of the nipple with bloody secretion achievement break
  • bone pain
  • very

good explanation in picture thickened andClay/tone under: [2]

diagnosis

if one changes in your chest noticed, strikes the physician (depending upon age) a Mammasonographie i.e. an ultrasonic investigation of the chest or a mammography forwards. The Sonographie is used particularly with younger women,since with them the portion of gland fabrics is higher. With older women the increase of the fatty tissue and the ultrasonic representation rise become inaccurate. Therefore a mammography is made here. This is a special x-ray examination of the chest, which can uncover also tumors,to ore branches are too small. If you have a knot in your chest, your physician must a small fabric sample with you possibly take and under the microscope on cancer cells examine. This procedure is called Biopsie. Sometimes this Biopsie becomesalso accomplished, as a needle is inserted into the appropriate chest fabric and something fabrics are punched out. If this Biopsie shows the fact that cancer is present must be accomplished absolutely determined tests (one calls OS trough and Progesteronrezeptorentest it) at the cancer cells.

Stage organization

Mammographie eines Mammakarzinoms des Stadiums T1b
mammography of a Mammakarzinoms of the stage T1b

the stage organization of the Mammakarzinoms takes place as with other tumors after the TNM classification. That happens on the basis of the picture-giving procedures and the taken samples/lymph node/the OI preparation. For the cancer of the breast the organization sees as followsoff:

  • T (tumor size)
    • T0: no tumor demonstrably
    • Tis: Carcinoma in situ, not invasiv
    • T1: The tumor is not larger than 2 cm
      • T1a: 0,1 to 0.5 cm
      • T1b: > 0,5 to 1 cm
      • T1c: > 1 to 2 cm
    • T2: Tumor with a diameter of > 2 to 5 cm
    • T3: The tumor is larger than 5 cm
    • T4: Tumor of each size with expansion on the chest wall or skin
  • N (Nodes = stricken lymph nodes)
  • M (far from Metastasen)
    • M0: no Metastasierung into other organs
    • M1: Far from Metastasen available, usuallysometimes in bones, lung, liver or

brain one groups the TNM findings:

Stage I

T1, N0, M0

stage II

IIA: T0-1, N1, M0 or T2, N0, M0

IIb: T2, N1, M0 or T3, N0, M0

stage III

IIIA: T3, N1, M0 or T0-3, N2, M0

IIIB: T4, each N-stage, M0

IIIc: each T-stage, N3, M0

stage IV

each T-stage, each N-stage, M1

certified chest centers

the German cancer company wants to provide treated with the assignment of the quality seal „certified chest center “for it that patients can be safe, in the certified center according to the current conditions of the science toobecome. With the certification procedure the German cancer company wants to ensure that the supplying situation for patients, who are gotten sick with cancer of the breast improves clearly. The term „chest center “is not protected and each hospital can it use, without it explanation about thoseQuality of the offer gives.

The German cancer company has for it in co-operation with the German society for Senologie (Senologie: Theory of the chest illnesses) a requirement catalog for chest centers developed, European guidelines also includes („EUSOMA “- criteria for chest centers) and beyond that the documentationthe treatment results demands. These contentwise requirements were summarized in a catalog „technical requirements for chest centers “and examined in rehearsing and pilot certifying at four chest centers in Germany.

Additionally the cancer company that the chest center introduced a recognized quality management system, demands i.e. thatChest center has itself optimally on the basis of internationally recognized guidelines (e.g. DIN ISO 9001) organized, works continuously to improvements and the organisational structure becomes annually external by a nationally certified society (e.g. TÜV, DEKRA, NIS Zert) examines among other things.

Only if the chest centeran externally recognized quality management system introduced and „the technical requirements for chest centers “is fulfilled, the quality seal „certified chest center “is assigned.

A rough orientation, whether a center fulfills qualitative of minimum standard, you can infer from the following questions. They issue an excerpt„the technical requirements for chest centers “.

  • Checkliste für den Patienten
    • Hat das Brustzentrum ein Qualitäts-Zertifikat (Qualitätsmanagementsystem z.B. according to ISO DIN 9001) acquired?
    • Do regularly interdisciplinary conferences of tumor take place, on which representatives of the fields of activity involved specify the therapy strategy together? Participant: Chest operating surgeons (Gynäkologe,Surgeon), Röntgendiagnostiker, internal Onkologe (= cancer specialist), onkologisch experienced Gynäkologe, Strahlentherapeut, pathologist
    • being used the treatment guidelines of the specialized companies?
    • Becomes a date in the chest consulting hour within max. two weeks assigned, the waiting period in the chest consulting hour under max. amounts to. 60 minutesand the final result of a fabric sample becomes within max. one week by the physician personally communicated?
    • Are the operations made by chest operating surgeons, who accomplish at least 50 chest operations per year?
    • At least 50 per cent of the operations chest-receiving are accomplished and existsEntrance to chest-developing operation procedures?
    • Per year are at least 150 new illnesses at cancer of the breast in the center treated?
    • Does one specialist with sufficient experience for the chest center work at least in the fields of activity involved? Pathologist: , Strahlentherapeut can show at least 300 feingewebliche cancer of the breast findings: Proof more regularlycertified advanced training, internal Onkologe and gynäkologischer Onkologe: Internalist with subsection designation „Hämatologie/Onkologie “, Gynäkologe: with proof of at least. 400 accomplished chemotherapies, radiologist: participates in the Brustkrebsscreening and befundet at least. 3000 Mammografien per year.
    • Become the treatment results (event-free survival period, number of Rezidive, life span,Quality of life etc.) completely documents?
    • Is the entrance to a psychological support, and to groups of self-helps given to a social worker? To the diagnostic position is the therapy plan specified together with the female patient and given to opportunity for catching up a secondary opinion?

Left the German cancer companyregistered association. over chest centers in Germany [3]

therapy

with approx. 70-80% of the female patients are possible a chest-receiving therapy, with which the tumor with a safety margin under leaving the remaining chest gland body is removed. A radiotherapy of the entire becomes subsequently,Chest accomplished. If a chest-receiving therapy is not possible (tumor in relation to the chest very largely, several knots, patient desire), the entire chest gland body is removed (Mastektomie, i.e. Brustamputation). Then can be done without following irradiation.

For the subsequent treatment andfor the evaluation of the prognosis on the side concerned mostly the shoulder lymph nodes is removed and examined. In order to avoid here unnecessary lymph node distances, can - if the tumor does not exceed a certain size - also first only individually (so-called. Sentinel orGuard lymph node) to be removed and examined. In addition around the tumor coloring material or a radionuclide is injected and so the Lymphabfluss and concomitantly the first lymph node station are represented. So aimed this first station of the Lymphabflusses can be removed from the tumor. Should these by cancer cells stricken its, the remaining lymph nodes are only then removed.

At present a chemotherapy is necessary with over 90% of all female patients. It often concerns a treatment with FEC or TEC. The treatment becomes in severalCycles accomplished.

With hormone-positive tumors takes place additionally an anti-hormone treatment with Tamoxifen or Arimidex, which should begin however only after the chemotherapy. Because of the high costs of Arimidex (30-mal of expensive) and the clearly shorter clinical experience with this medicine is at present Tamoxifen the gold standard. Arimidex seems to show newest studies to consequence somewhat better results in view to illness-free surviving with however easily increased side effects (Osteoporose with the consequence of fractures). A simultaneous treatment with both means is not meaningfully.

Unfortunately frequently Rezidive ( same chest) or Metastasen arises . While Rezidive are well therapierbar, it usually comes with Metastasen to no healing. Lung and Lebermetastasen have a clearly worse prognosis than bone and Hautmetastasen.

For a uniform qualitywith (post) the therapy the legal health insurance companies offer Disease management programs (DMP) since 2003. The participating physicians orient themselves with the therapy at the current in each case guidelines for the treatment and aftercare of the cancer of the breast. A participation is possible with all physicians, itselfthese quality-assurance programs attached. Information about participating physicians and/or attached hospitals is to be received with each legal health insurance company. For the female patients the participation in this program means a restriction of the free choice of doctor.

In the year 1998 the active substance became Trastuzumab (Trade name Herceptin ®) in the USA and 2000 in the European union for female patients with metastasiertem cancer of the breast certified. It is a therapeutic monoclonal anti-body against the growth receptor HER2 /neu on the cell surface of cancer cells and is for the treatment ofFemale patients with cancer of the breast certified, if HER2/neu on its cell surface increases the tumor cells trains (exprimieren), which with approximately each fourth breast cancer patient the case is. Studies resulted in that with this soganannten Targeted Therapy substance the risk of a relapse around approximately 50% are reducedcould. Since 2005 suggest itself in clinical studies that also women without Metastasen profit, if they suffer from HER2-positivem cancer of the breast.

prognosis

established prognosis factors are the so-called. Pc. Gallen criteria for the estimate of a tumor. The lymph node infestation becomes,the tumor size, the differentiation degree, which and the age of the female patient considers hormone receptor status.

With nodalnegativem cancer of the breast (i.e. of cancer of the breast cells struck lymph node) does not amount to the long-term healing chances approx. 85%.

literature

cancer of the breast with Mrs.

  • Lilo mountain: Cancer of the breastKnowledge against fear the manual. Goldmann publishing house, ISBN 3-442-15168-6
  • Ursula Goldmann Posch: The knot over my heart. Goldmann publishing house, ISBN 3-442-15128-7
  • P. Jungmayr: Information and consultation with cancer of the breast. German pharmacists newspaper, Stuttgart 2004, 114 (49), S. 80-87, ISSN 0011-9857
  • Klaus Giersiepen, Ulf Haatje, Stefan Hentschel, Alexander Katalinic, Joachim Kieschke:Cancer of the breast registration in Germany. Tumor stage distribution in the target group for the mammography Screening. German physician sheet, Cologne 2004, 101 (30), S. A2117-A2122
  • Rainer shorten: Evidence-based misunderstandings with the Mammakarzinom. Illness risk and mortality reduction. German physician sheet,Cologne, 101 (36), S. A2387-A2390, ISSN 0012-1207
  • Franz Fischl, Andreas's holiday restaurant economics cancer of the breast, Springer, Vienna - ISBN 3211235949

cancer of the breast with men

  • Jael cheek: Cancer of the breast with the man. German physician sheet, Cologne, 99 (17), S. A1168-A1172 (2002), ISSN 0012-1207
work on []

Web on the left of

general one on the left of

of on-line offers of universities and specialized companies

of information offers of the Pharmaindustrie

see also

Duktales Karzinom insitu - early recognition of diseases - cancer registers - Onkologie - Nurses' Health Study

please consider you the reference to health topics!

 

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