Breast cancer treatment in Germany

Breast cancer is the most common malignant tumor in women. It can be detected even at a young age. If the diagnosis is confirmed on time, then the disease can be cured completely. Nevertheless, curing cancer is not enough. It is also important to do it with minimal risk of complications, while maintaining an active lifestyle and an attractive appearance. To ensure that cancer treatment is not only effective, but also safe and as sparing as possible, you can undergo therapy at one of the German hospitals.

Content

1. Surgical treatment of breast cancer in Germany
2. Sentinel lymph node biopsy
3. Breast reconstruction
4. Radiation therapy in Germany
5. Chemotherapy in Germany
6. Advantages of undergoing treatment in Germany
7. Diagnostics and treatment in Germany with Booking Health

Surgical treatment of breast cancer in Germany

Surgery is the main treatment option for breast cancer. The aim of the intervention is to remove the primary tumor completely. An additional stage of surgical intervention can include the excision of the axillary lymph nodes.

In Germany, organ-preserving operations for breast cancer are performed in most cases. The doctor removes only the tumor and 1-2 cm of healthy tissues. Such approach has many benefits:

• The psychological state of the woman is better, as breast loss is difficult for many patients, regardless of age.
• Minimally traumatic surgery that is often performed on an outpatient basis, so a woman does not even need to stay in the hospital overnight.
• The ability to restore the aesthetics of the breast quickly. In many German clinics, oncoplastic surgery is performed – it includes the removal of the tumor and flap breast reconstruction.

The widespread introduction of organ-preserving surgeries has become possible due to the high quality of breast cancer diagnosis making. Today, more than 40% of tumors are revealed before reaching a size of 2 cm. They are detected using mammography, which women undergo annually.

Clinical situations when organ-preserving surgery is suitable:

• Single tumor up to 5 cm in diameter
• Being newly diagnosed with breast cancer (not relapse)

Most women with stage 1-2 breast cancer are the candidates for breast-preserving surgery. Radiation therapy is performed after it in order to reduce the risk of relapse.

Mastectomy is the main operation in countries with backward medicine. In Germany, whole breast removal is used rarely. Indications for mastectomy include:

• Large tumors more than 5 cm in diameter
• Spreading of a neoplasm into the chest wall
• Inability to conduct radiation therapy after surgery (contraindications to irradiation or refusal from it)
• Mutations in genes that increase the risk of breast cancer recurrence (bilateral mastectomy is recommended)
• Inflammatory breast cancer
• Multiple tumors
• History of radiation therapy

Even if the breast is removed completely, German doctors rarely perform radical mastectomy, as this operation is very traumatic. They mostly perform simple or modified radical mastectomy. If the tumor does not spread to the pectoral muscles, such surgeries demonstrate the similar survival rate.

Sentinel lymph node biopsy

The sentinel lymph node biopsy is performed in most hospitals in Germany, but is not performed in many countries with a low level of medicine. This is an important part of breast surgery as it avoids lymph node dissection in women with early stage breast cancer.

The standard surgical approach includes removing the tumor or breast and at least 10 lymph nodes to be examined for cancer cells. But the problem is that complications may develop after the lymph node dissection. The most unfavorable one is lymphedema – lymphatic edema of the hand, which can lead to a complete loss of its function.

In Germany, doctors try to make the surgery as safe as possible. For German specialists, it is important not only to cure breast cancer, but also to maintain a high quality of life and work capacity after the surgery.

The essence of sentinel lymph node biopsy is as follows:

1. The doctor finds the first nodes into which the lymph flows from the cancer site.
2. He removes 2-3 sentinel lymph nodes.
3. The nodes are examined in the laboratory, under the microscope.
4. If there are no cancer cells in them, this means that there are no metastases in the lymph nodes located further from the tumor. It makes no sense for such women to undergo lymphadenectomy.
5. If cancer cells are found in sentinel lymph nodes, the doctor removes more lymph nodes in order to determine the stage of breast cancer.

To locate the sentinel lymph nodes, a radionuclide method is used. It can be combined with the introduction of a blue dye. The doctor injects a radiopharmaceutical at several points along the perimeter of the tumor. Radiopharmaceutical enters the lymph, and with it reaches the sentinel lymph nodes. After the distribution of the radiopharmaceutical, lymph nodes become visible on the images made with the help of a gamma scanner or tomograph.

Sentinel lymph node biopsy is performed not only during breast-conserving surgery, but sometimes during a simple mastectomy. It is performed in women with early stage breast cancer. If metastases are found, the intervention is converted into a modified radical mastectomy with removal of the axillary lymph nodes.

Breast reconstruction

Although the mammary gland is not a vital organ, breasts are an important part of female physical attractiveness. Therefore, most patients want to restore it after complete or partial removal.

Postoperative breast reconstruction is possible and very common in developed countries. There are many techniques of restoring the mammary gland. After a sectoral resection, plastic intervention is usually performed using a patient’s own tissues. After a mastectomy, it is possible to use both patient’s own tissues and implants.

Breast reconstruction options, depending on the time of performing:

• Immediate – during the surgical tumor removal
• Delayed – 6-12 months after the surgery

Each approach has advantages and disadvantages. Immediate plastic surgery excludes psychological problems. A woman does not need to undergo two consequent operations. On the other hand, subsequent radiotherapy may worsen the results of breast reconstruction. In addition, with delayed plastic surgery there is less risk of complications that worsen the aesthetic results of plastic surgery.

Thus, many factors influence the choice of the method of breast reconstruction and the timing of this surgery. The main of them are the initial size of the mammary glands, the type of surgery (mastectomy or sectoral resection), the need for subsequent radiotherapy. The patient's wishes regarding her appearance after surgery are also considered. Some women want to enlarge or reduce the breast, as well as perform mastopexy (lift).

All women without exception undergo radiotherapy after breast-conserving surgery. The risk of complications after plastic surgery with a patient's own tissues is lower than after the implantation. For breast reconstruction, doctors take flaps from different parts of the body: abdomen, buttocks and thighs, and back. In German clinics, a microsurgical technique is used, which ensures good blood supply to the transferred flap and minimizes the risk of its necrosis (death).

The use of implants is preferable for those women with completely removed breasts who do not need additional radiation therapy. The plastic intervention can be performed directly during the operation to remove the malignant breast tumor. If radiation therapy is required, it is better to install implants in a few months, during a second surgery, since radiation therapy increases the risk of capsular contracture (formation of dense tissue around the endoprosthesis).

Radiation therapy in Germany

Radiation therapy is equally effective in any country of the world. At the same time, in Germany it is safer. In addition, in some cases the radiation therapy can be carried out according to an accelerated protocol, during only 5 days instead of 6 weeks.

In the vast majority of cases, radiation therapy is performed after surgery. The main situations when it is recommended:

• After the breast-conserving surgery; recommended for all women without exception
• After mastectomy; only with positive margins of resection, in tumor growth into the chest wall, in tumor size more than 5 cm, as well as in presence of more than 4 metastases in the lymph nodes

In countries with a low level of medicine, irradiation is still carried out on outdated gamma devices. They successfully prevent the recurrence of breast cancer, but can cause serious complications, such as heart problems, pathological changes in the lungs, rib fractures, etc. In addition, another malignant tumor, angiosarcoma, may develop 8-10 years after exposure.

In Germany, the latest linear accelerators are used for irradiation. Planning and direction of rays occur in 3D mode. Beam intensity modulation is also possible. Beams are directed to the target area from different angles in order to minimize damage to healthy tissues. Since modern equipment is used in German clinics, serious complications after radiation therapy develop rarely here.

Some hospitals use programs of the accelerated partial breast irradiation. They are only used in the treatment of early stages of breast cancer. Instead of 30 sessions of radiation therapy, a woman undergoes only 10 ones. Irradiation is performed 2 times a day, so the whole course takes only 5 days instead of the usual 6 weeks.

Chemotherapy in Germany

In Germany, a woman can undergo chemotherapy. German doctors use only original drugs for pharmacological therapy. This increases the cost of treatment, but makes its effect more predictable and safe, as most of the clinical investigations were carried out with original drugs, and not their cheaper counterparts.

Chemotherapy after surgery is recommended to many women. It is aimed at reducing the risk of relapse. In non-aggressive types of breast cancer, chemotherapy is performed only after removal of large tumors (over 5 cm), or in the presence of metastases in the lymph nodes. In fast-growing tumors, chemotherapy is prescribed for tumors with a diameter from 0.5 cm, even if metastases are absent.

Usually, a course of chemotherapy takes from 3 to 6 months. It can be combined with other treatment options, except for radiation therapy. If the patient requires chemotherapy, then the radiation therapy is carried out no earlier than 3-4 weeks after the drug withdrawal.

In stage 3 breast cancer, chemotherapy is often prescribed as the first-line treatment. After tumor shrinkage and suppression of metastatic foci, a surgery is performed.

Along with other systemic methods of breast cancer treatment, chemotherapy is the main treatment option in patients with advanced stages of the disease. In the presence of metastases, drugs are able to penetrate into all organs and tissues, destroying cancer cells everywhere (even if they have not been detected by doctors yet). Chemotherapy does not cure breast cancer completely, but it can lead to the long-term remission of the disease, increasing a woman's life expectancy by several years.

Advantages of undergoing treatment in Germany

If you undergo treatment in Germany, you have a better chance of curing breast cancer completely. You can get rid of a deadly diagnosis with minimal trauma of healthy tissues, without serious health consequences, as well as with a good aesthetic result – German plastic surgeons will restore your breasts after defeating cancer.

Main benefits of breast cancer treatment in Germany include the following.

• Precise diagnostics. This includes not only mammography, CT scan or MRI, but also molecular genetic tests, laboratory tests for individual selection of chemotherapy, sentinel lymph node biopsy, PET scan to detect distant metastases, etc.
• Organ-preserving surgeries. In most cases, breast cancer can be cured without removing the whole breast.
• Avoiding lymphadenectomy. While in countries with a low level of medicine doctors remove at least 10 lymph nodes, which often leads to the development of complications, German specialists remove only 2-3 sentinel lymph nodes. Only if sentinel lymph nodes have metastases, a lymphadenectomy is performed at standard volume.
• Breast reconstruction. It is often performed simultaneously, during an operation to remove a tumor. After a sectoral resection, doctors usually reconstruct the breast with the woman's own tissues. After mastectomy, both flap plastics and the use of implants are possible.
• New types of radiation therapy. They are much safer, do not cause heart problems, do not deform the mammary gland and do not worsen the aesthetic results of previous reconstructive surgery.
• Individual chemotherapy regimens. German doctors select a treatment regimen based on laboratory and genetic tests. In case of insufficient effect or poor therapy tolerance, the scheme is adjusted.
• Affordable prices. The ratio of quality and cost of treatment in Germany is one of the best in the world. Medical services here are cheaper than in other developed countries with a comparable level of medicine (USA, Japan).

Diagnostics and treatment in Germany with Booking Health

You can undergo treatment in one of the best German clinics. The reliable information about hospitals, doctors, breast cancer treatments and prices is presented on the Booking Health website. Here you can compare the cost of treatment in different clinics and book a medical program at a favorable price. Average prices for the certain medical procedures are as follows:

1. Sectoral resection in breast cancer with flap plastic – 12,400 EUR
2. DIEP flap plastic breast reconstruction with own tissues – 39,200 EUR
3. Treatment of breast cancer with embolization or chemoembolization – 29,900 EUR
4. Brachytherapy in breast cancer – 9,800 EUR

The average price of rehabilitation after breast cancer treatment is 1,190 EUR per day, the minimum price is 1,041 EUR per day, and the maximum price is 1,553 EUR per day.

Booking Health specialists will arrange a trip to Germany. Services and benefits of the company include:

• Choosing a hospital that specializes in breast cancer treatment and demonstrates the best results
• Direct communication with the selected oncologist
• Short waiting period for breast cancer treatment in Germany; making an appointment at a convenient date
• Reducing the cost of treatment in Germany; prices are lower due to avoiding additional coefficients for foreign patients
• Full information about your expenses, the cost of medical procedures, funds remaining in the account
• Elaboration of the medical program without repeating previous examinations
• Communication with the hospital after completing breast cancer treatment in Germany
• Purchase and shipping of drugs
• Organization of additional diagnostics or treatment in Germany

Booking Health specialists provide quality services. We will book a hotel and airline tickets for you, organize a transfer from the airport to the hospital and back.

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.

Sources:

Centers for Disease Control and Prevention

National Cancer Institute

Breastcancer.org