Breast cancer treatment

 Medical statistics show that the effectiveness of breast cancer treatment in post-Soviet countries is far from ideal. The main reason lies in the late detection of the disease and somewhat superficial examination of patients. Successful breast cancer treatment in Germany is based on modern methods of tumor research, selection of the most effective targeted therapy, and use of progressive surgical approaches.

Breast cancer diagnosis

Medical statistics of the last decades show a steady tendency of increasing incidence of malignant tumors of the mammary glands.  A negative impact is caused by low oncological caution of general practitioners, because of which many malignant breast tumors are detected at advanced stages, and the cost of treatment, accordingly, increases.

The situation is somewhat different in European countries. For example, in German clinics the recommendations of the European Society of Mastology (EUSOMA), concerning the complete diagnosis of breast pathology. The focus is on such methods and tests:

• Low-dose digital mammography (radiologic study option).
• Ultrasound examination in sonography and Doppler modes.
• Computed tomography with positron emission tomography (CT-PET)
• Magnetic resonance imaging.
• Scintigraphy.
• Biopsy of the suspicious focus and «sentinel» lymph nodes.

The instrumental techniques from the beginning of the list (ultrasound, CT and MRI) are used to clarify the local extent of the process. Doppler ultrasound and contrast-enhanced CT provide a characterization of the tumor blood supply. CT with PET provides valuable data on node size and the presence of regional or distant metastases.

A key diagnostic role is played biopsy. The puncture needle is precisely positioned under real-time ultrasound or MRI monitoring. A biopsy specimen is taken from the breast tissue or lymph node site. The tissue samples obtained are used for pathomorphologic analysis. Established:

• tumor histological characterization — type, maturity;
• immunohistochemical analysis estrogen and progesterone receptors on cancer cells;
• receptor expression HER2.

Such data are crucial for predicting the effect of different chemotherapeutic techniques and allow treatment to avoid the use of obviously useless drugs.

The diagnostic algorithm is made individually for each patient (malignant breast tumors in men are rare, but not nonsense). It is not necessary to undergo all examinations very often: the absence of signs of metastases allows you to refuse CT-PET, other options are also possible. Everything depends on how early the process was detected.

Signs of breast cancer

Primary breast tumors develop from two sources: parenchyma cells and ductal epithelium of the gland. Rarely, secondary nodules occur when malignant cells are brought in from other organs (have a metastatic origin).

The early symptoms of the different forms of breast cancer are fairly well known:

• breast asymmetry — one breast becomes larger or smaller than the other;
• displacement of the breast from its «usual» place, usually one pulled up or to the side;
• breast configuration disorder — the appearance of visual or tactile detectable swelling, stretching area;
• changes in the nipple or areola — deformation, retraction, ulceration;
• discharge, have a different appearance — serous, with an admixture of blood (greenish-brown), similar to colostrum or thick, like ointment;
• skin symptoms, localized or widespread hyperemia, dense swelling «lemon peel», nodules, ulcers, bleeding and wetting surfaces.

These changes usually occur to one breast, and are often (but not always) painless. The appearance of any of the described symptoms means the need for urgent consultation with a qualified oncologist. Otherwise, it cannot be excluded that under one of the types of mastopathy will be missed the initial stage of edematous-infiltrative breast cancer.

Stages of breast cancer

The staging of breast tumors is based on the internationally recognized TNM, but with its own peculiarities. On the one hand, this makes the classification somewhat cumbersome and complicated. On the other hand, it allows oncologists to give the most detailed characteristics of the tumor process individually for each patient.

By category T (tumor) the main options are as follows:

• TIS — cancer in place, prefix DCIS means the ductal source of the tumor, and LCIS — lobular, Paget — Paget’s disease;
• T1 a, b, c — node size from 0.1 mm to 2 cm in the largest dimension;
• T2 – tumor 2-5 cm;
• T3 — node more than 5 cm in diameter;
• T4 a, b, c, d — any size tumor, when the skin of the chest and breast is involved, inflammatory form of the malignant process.

By category N (nodulus), the basic criteria are as follows:

• NX — no evidence of lymph node involvement;
• N0 — lymph nodes are not reliably affected;
• N1 — metastases to regional axillary lymph nodes on the affected side, l/u mobility is preserved;
• N2 a, b — lymph nodes are fused, there are signs of lesions of the intrathoracic group of l/u;
• N3 a, b, c — lesion of two or more groups of lymph nodes, involvement of supraclavicular l/u.

In total, more than 20 variants of lymph node involvement in the area of the affected breast are coded under different indices. There is no point in listing them here, as the main value of such data is for treating physicians.

To determine the stage of tumor development, these parameters are also taken into account:

• microinvasion — the malignant process grows beyond the basal membrane of its locus into adjacent tissues to a depth of no more than 0.1 cm;
• multicentricity of growth — if there are several nodes in one gland, the criterion is T is set by the largest of them all;
• bilateral (bilateral) cancer is staged as two different processes;
• inflammatory form (edematous-infiltrative) is considered as a stage of T4 b, d.

Due to the multifaceted nature of the disease, there are many details and nuances for each case. Understanding them means choosing the most effective method of tumor control.

Breast cancer treatment methods in Germany

The German medical school has traditionally relied on progressive and promising methods, without abandoning the most effective and studied early developments.

German oncology clinics use all effective treatment options for patients with breast tumors:

1. Surgical approach. The most studied, quite effective.
2. Radiation therapy. Irradiation of malignant tumors with X-rays is practiced in all branches of oncology.
3. Local hyperthermia. In combination with radiation and chemopreventive agents, it inhibits tumor progression.
4. Chemotherapy. Classic scheme — cytostatics, antitumor antibiotics.
5. Targeted therapy. Drugs selected based on the results of tests of cell sensitivity to estrogen, progesterone, and receptor expression HER2.
6. Adoptive immunotherapy is the most modern and reassuring treatment for breast cancer.

The modern surgical option for solving the problem is based on a balance between organ-preserving and radically effective intervention. When operated on in Germany, 60-80% of women manage to save their breasts. Complete removal of the breast proved necessary in the management of women who had previously been treated with less effective methods.

Adequate radiation therapy regimens and techniques are used in Germany as preparatory and final stages of surgical treatment. A postoperative course of radiation reduces the risk of recurrence even T3-Tstage 4 is at least 50%.

The European guidelines, also adopted in Germany, allow local heating of the tumor node. However, a persistent positive result is only observed as part of complex therapy. Tumor masses are heated up to 43.6˚C using focal ultrasoundC, the standard regimen includes 3-8 courses of tumor hyperthermia.

Chemotherapy in Germany is selected individually, based on immunohistochemical study of the cells of the neoplasm and the history of the current disease. The standardized scheme provides for 4-8 cycles of treatment with a combination of 2-3 drugs from different groups. This approach allows you to safely reduce the volume of breast removal or refuse surgery.

Immunotherapy is still in its infancy, but clinics in Germany already use four different immunotherapy approaches. The optimal one is selected individually, and the course is made up only of drugs approved for use by the European Medical Association (EMA).

How much does it cost to treat breast cancer in Germany

It starts with a preliminary examination. First, the patient is interviewed by a qualified, experienced oncologist. The initial consultation is of a typical nature, which minimizes its cost.

The price of a consultation with a leading oncologist is 250 Euros.

Then, based on the results of the medical examination, an individualized plan for additional examination is drawn up. At this stage, the most informative instrumental methods are used, the hardware part of which is most often produced in Germany. The price of the diagnostic complex is formed based on the list of necessary methods. The advantages of oncological clinics in Germany in specialization. That is, each case of breast cancer is examined in a specialized institution, the results are analyzed by highly qualified specialists. This significantly increases the informativeness and value of diagnostic data.

From the moment the treatment is prescribed to the completion of the course, each patient can be assured of its completeness and effectiveness.

Modern targeted gamma therapy machines minimize the negative effects of radiation on healthy tissue adjacent to the breast.

Minor invasive breast cancer surgeries are performed using high-tech medical equipment.

In some cases, it is necessary to have the breast removed.

As for conservative treatment: Germany is one of the countries in Europe where drugs for targeted chemotherapy and immunotherapy are not only widely used, but also produced. German drug manufacturers guarantee the quality of medicines. The cost of the course, of course, is also individual, and depends on the type of tumor, its prevalence. On average from 1500 Euros per course.

Prices for breast cancer treatment in Germany

Name of service	Price, €	Optional
Positron emission tomography combined with computerized tomography (PET/CT)	3000	—
Gamma Knife averages	800-1700	1 session
Standard radical mastectomy	7000	5 days inpatient
Extended axillary-chest radical mastectomy	10800	7 days inpatient
Modified radical mastectomy	9800	5 days inpatient
Simple mastectomy (breast amputation)	7000	5 days inpatient
Radical sectoral resection	8500	5 days inpatient
Sectoral resection	8400	5 days inpatient
Reconstructive surgeries	5000	3 days inpatient
Minimally invasive surgery	from 5000	—

With early detection of the tumor, timely full diagnosis and complete treatment of breast cancer, recovery is achieved by 93% of patients in Germany.

All this is thanks to the widespread introduction of innovative techniques that were considered experimental just a few years ago. The experience and modern knowledge of doctors, digital technology and guaranteed German quality save health and often preserve breasts.

The assistance of qualified expert doctors will help to reduce costs and save time. The consultants at Klinikum Germany specialize in the selection of oncology centers in Munich for patients of different profiles.

We collect, store and analyze a lot of information about clinics from open and closed sources and therefore always give only reasoned advice regarding breast cancer treatment.

There is no need to waste precious time. Contact specialists who will help each patient to find a German clinic specializing in breast cancer in a short period of time. At the same time we will organize interpreter services, hospitalization, examination, treatment and round-trip flights.

breast cancer