BreastCentre Zurich

Every breast cancer is individual. So is every treatment. Your doctor will explain all the options to you in detail. Each individual treatment method affects different aspects of the disease. Most types of breast cancer are removed by surgery. You will receive personalised care throughout your treatment, from the initial examination to aftercare . We will assign you your own so-called Breast Care Nurse, a specialised nursing expert.

Surgery

Surgery for breast cancer is one of the mainstays of treatment. It is designed to remove the tumour with the greatest possible safety. Most operations for breast cancer are performed as breast-conserving surgery. This means that only the tumour is removed. The aim of an operation is to remove the tumour completely while at the same time preserving as much healthy breast tissue as possible in order to achieve a visually favourable result. However, some patients still have to have the affected breast removed for oncological reasons. Additional treatments are often added to the operation. We determine these at interdisciplinary tumour board meetings. Naturally, we involve you closely in these consultations. These additional therapies complete the treatment and improve your chances of recovery.

Breast surgeon in discussion with patient

Breast cancer and reconstruction

Fortunately, it is now possible to reconstruct the breast in the same operation in which it is removed. This is done using your own tissue or implants. This means that you will not wake up without the feeling of having no breast. The simultaneous reconstruction of the breast has no negative influence on the course of the cancer or further chemotherapy. On the contrary: it improves your quality of life and therefore your sense of well-being. Reconstruction can also take place at a later date following breast amputation. If we have to carry out radiotherapy, it is better if the breast is reconstructed using the patient's own tissue. With microsurgical procedures in reconstruction, we can achieve better aesthetic results and significantly reduce possible adverse effects in the area where the autologous tissue was removed. We will discuss the best surgical procedure with you on an individual basis. You can find out more about breast reconstruction at Plastic Surgery.

Radiotherapy

In radiotherapy, we irradiate tumours or any microscopic tumour remnants still present after an operation. This prevents or slows down the growth of a tumour. Radiotherapy is usually used after an operation to eliminate any tumour remnants. Its aim is to reduce the risk of the disease recurring (locoregional recurrence) in the breast and armpit. Radiotherapy can also be used if breast cancer recurs in the breast or another area.

Drug therapy: Chemotherapy

The best-known drug therapy is chemotherapy. It is directed against the growth of cancer cells - often only after an operation (adjuvant therapy). You will be given so-called cystotics, usually by infusion, to prevent a relapse. In certain cases, however, chemotherapy is sometimes also used before an operation (neo-adjuvant therapy). The aim of this is to shrink the cancer. There are breaks between the individual cycles of chemotherapy during which you can recover. You can find out more about chemotherapy here.

Chemotherapy is also known as cytostatic therapy. The active substances inhibit the proliferation of tumour cells, hence the name cytostatics or "cell stoppers". Chemotherapy has different aims in breast cancer. Depending on the stage of breast cancer, we distinguish between three different applications:

Adjuvant chemotherapy: Chemotherapy is used after the first or second operation if the tumour is confined to the breast and possibly to the axillary lymph nodes. The aim of chemotherapy is to destroy any tumour cells that may still be present in the body (so-called micrometastases or a small amount of tumour cell seeding). Studies have shown that this additional treatment is worthwhile for certain types of tumour: the risk of recurrence and mortality is reduced in both the short and long term with supportive chemotherapy compared to surgery alone. However, not all women need chemotherapy after breast cancer surgery. Chemotherapy is preferably used for young women or women with biologically unfavourable or advanced tumours. Older women can also benefit from chemotherapy. However, the prerequisite here is the absence of additional serious concomitant diseases.
Primary or neoadjuvant chemotherapy: Chemotherapy is given before surgery. The aim is to shrink the breast cancer. This can make breast-conserving surgery possible and destroy existing tumour cells in the body. It is therefore used for large, rapidly growing or inflammatory tumours. The advantage of this method is that we can observe how the tumour responds to chemotherapy. This gives us an idea of the tumour's sensitivity to specific chemotherapies. More aggressive breast tumours in particular often respond very well to primary chemotherapy as they grow quickly. Unfortunately, the use of chemotherapy before surgery cannot yet completely destroy micrometastases. If tumour remnants are still found in the surgical specimen after primary chemotherapy, further chemotherapy or immunotherapy is now recommended after the operation, depending on the nature of the tumour. This further improves the prognosis.
Palliative chemotherapy: The main aim is to reduce the size of visible metastases that have already settled in the body and to reduce the symptoms caused by the tumour. This can include symptoms such as pain, breathlessness, loss of appetite and others. In this way, we maintain your quality of life and try to prolong your life and alleviate possible pain.

With all types of chemotherapy, you will receive active substances that inhibit the proliferation of tumour cells. These are primarily substances that prevent normal cell division. The affected cells die as a result. The faster the tumour cells multiply, the more effective they are. As breast cancer cells often have a high multiplication rate, i.e. they divide quickly, they are more sensitive to chemotherapy.

Unfortunately, chemotherapy also attacks healthy cells. Its effect on healthy, rapidly dividing body tissue such as bone marrow (blood cell formation), hair roots, mucous membranes of the mouth and gastrointestinal tract explains frequently encountered side effects such as increased susceptibility to infections, hair loss, inflammation of the oral mucosa, fatigue and diarrhoea. Therefore, not every form of breast cancer can and must be treated with chemotherapy. There are also certain tumours that are insensitive (resistant) to chemotherapy.

There are different groups of cytostatic drugs that intervene in different phases of the cell cycle. The combination of different active substances and mechanisms of action increases the chance of destroying many tumour cells. The following drug classes are mainly used for breast cancer:

Alkylants: Cyclophosphamide is one of the alkylating agents used in breast cancer. It attaches itself to the human genetic material (DNA) in the cell nucleus and either causes the DNA strands to break apart or to become closely linked. This prevents the genetic material from being passed on during cell division. Cyclophosphamide is used in breast cancer exclusively in combination with other active substances.
Anthracyclines: Anthracyclines belong to the group of antibiotics and inhibit the synthesis of the human genome (DNA and RNA). The anthracyclines doxorubicin and epirubicin are mainly used in combination with taxanes, fluorouracil (5-FU) and/or cyclophosphamide.
Antimetabolites: The class of antimetabolites includes fluorouracil (5-FU), one of the oldest cytostatics, capecitabine, methotrexate (MTX) and gemcitabine. They resemble the building blocks of the tumour. When building up the genetic material, these incorrect building blocks then lead to the disruption of cell proliferation. Antimetabolites are often combined with other cytostatic drugs (especially anthracyclines and cyclophosphamide).
Taxanes: The taxanes paclitaxel and docetaxel are extracted from the yew tree and are among the most effective chemotherapeutic agents against breast cancer. Patients with involvement of the axillary lymph nodes or particularly aggressive tumours without involvement of the axillary lymph nodes benefit most in the adjuvant therapy situation. Taxanes are usually administered in combination with anthracyclines. They affect the so-called spindle apparatus, which is responsible for the exact division of the cancer cell. They also damage the genetic material and the cell wall of the cancer cell.
Vinca alkaloids: Vinca alkaloids such as vinorelbine or vincristine are derived from the plant species pink catharanthus (periwinkle). They prevent cell division and affect rapidly dividing cancer cells in particular.

Cytostatic drugs can be administered in different ways. There are the following types:

Monotherapies with the use of only one substance
Polychemotherapies with the use of several substances
Sequential therapies with the use of different substances one after the other
Dose-dense therapies with administration of chemotherapy at shortened intervals

In the case of polychemotherapies, the combinations are usually named with the abbreviations of the first letters of the cytostatic agents used.

The chemotherapy regimens have different strengths and are selected in the adjuvant therapy situation depending on the underlying risk of relapse.

Most chemotherapies are now administered on an outpatient basis. The treatment is administered via an infusion. We usually use a vein on the side of the arm not affected by the breast cancer. Before the chemotherapy is administered, you will usually be given modern medication against nausea and vomiting.

In the case of chemotherapy that irritates the arm veins or if the veins are tender, the chemotherapy can also be administered via a so-called Port-a-Cath. This is a chamber system implanted under the skin of the chest or on the arm with a connection to a large internal body vein, which can be pierced from the outside using special needles. Piercing and administering the therapy is not painful at the port. Oral cytostatic drugs, i.e. taken as tablets, play a subordinate role.

Chemotherapies have become much better tolerated in recent decades thanks to greater knowledge and supportive medication. Nevertheless, side effects are still common. These include

Nausea and vomiting
diarrhoea
Loss of appetite
Inflammation of the oral mucosa
Pain when swallowing
Hair loss
Blood formation disorders with anaemia
Increased susceptibility to infections (immunodeficiency)
Sensory disorders in the hands and feet (so-called polyneuropathy)
Persistent exhaustion and tiredness
Temporary impairment of mental functions, for example poor concentration and impaired memory
Cardiac insufficiency due to anthracyclines (mainly doxorubicin, less frequently with epirubicin). The disorder is dose-dependent, which is why a fixed total dose of anthracyclines should not be exceeded.

The side effects occur in different sequences after therapy, sometimes rapidly, sometimes with long delays. They are usually only temporary. They are treated as well as possible, for example with medication for nausea or constipation, wig adjustments, possibly. Transfusions of red blood cells or injections to speed up the recovery of white blood cells. If the side effects are severe, chemotherapy is paused until recovery or the dose of medication administered is reduced.

Drug therapy: anti-hormonal therapies

Drug therapies also include anti-hormonal therapies. They suppress the effect and/or the production of sex hormones - and thus inhibit the growth of tumours. Around two thirds of breast cancers are hormone-receptor positive, which means that they grow under the influence of sex hormones. Anti-hormone therapy, also known as "anti-hormonal" or "endocrine" therapy, aims to prevent the tumour from growing or recurring after an operation by preventing hormone production or the effect of hormones in the body. You can find out more about anti-hormonal therapy here.

Anti-hormonal therapy is an essential pillar in the treatment plan for breast cancer, just like surgery or radiotherapy. For one of the first drugs (tamoxifen), it was proven that patients with hormone receptor-positive breast cancer were able to significantly improve their cure rate with this therapy. The risk of death in the specific case was reduced by around a third within 15 years of the initial diagnosis. Anti-hormonal therapy also reduces the risk of recurrence (so-called "relapse") - or the occurrence of cancer in the other breast.

Symptoms similar to those of the menopause can occur. This is because the oestrogen effect is blocked or oestrogen withdrawal occurs. Examples of symptoms are hot flushes, sweating, but mood swings or concentration problems, joint stiffness and pain as well as reduced bone density can also occur as side effects. In rare cases, blood clots or uterine cancer can also occur. As we now have various anti-hormone therapies at our disposal, the treatment can be customised. Of course, we will inform you in detail about the symptoms that may occur during therapy so that you can switch to a different preparation.

Drug therapy: immunotherapies

Immunotherapies are also among the drug therapies. These drugs stimulate the body's defence system so that it can take targeted action against cancer cells. There are also drugs that act on cancer cells at a precisely defined point of attack and are therefore known as targeted therapies.

Breast-conserving therapy (BET)

Whenever possible, we favour breast-conserving therapy (BET), also known as segmentectomy, in the treatment of breast cancer. In BET, we only remove the part of the breast affected by the tumour. After removal, we reshape the breast. For this operation, the tumour should not be too large and the breast should not be too small so that the result looks good cosmetically. As a rule, we make the affected breast slightly smaller than the healthy breast, but the differences are usually small. The important thing with BET is that we remove the tumour "R0". This means that no tumour remains in the breast and the margins are healthy. The latter are assessed under the microscope by the pathologist (histology). In most cases, the breast should be irradiated after BET surgery. This reduces the likelihood of recurrence in the breast. You can find out more about BET here.

During BET, the tumour in the breast is removed. However, breast cancer can also spread to the lymph vessels and lymph nodes. In the past, all lymph nodes were removed from the armpit. Today, the lymph node that first drains the lymphatic fluid from the breast (sentinel lymph node) is sought if there is no suspicion of metastasis in the armpit before the examination.

If the sentinel is affected by cancer, other lymph nodes can be removed from the armpit, depending on the type of tumour, or the armpit is later irradiated together with the breast. In order to find the sentinel, a special medication is injected under the skin of the breast before the operation. This travels along the lymph vessels into the sentinel lymph node, which we find during the operation using a special device. If the sentinel contains cancer cells, we usually have to extend the therapy. Sentinel removal and examination is therefore very important to improve the chances of recovery.

With BET, the tumour should not be too large and should only be located in one area of the breast. If the tumour is too large, spread across the breast or accompanied by a large precursor (DCIS), it may be better to choose a different procedure (mastectomy and reconstruction). Even very aggressive tumours or tumours of genetic origin can sometimes be better operated on with other oncological procedures. Lymph nodes are usually removed during the same operation.

The operation is performed under general anaesthetic. The skin incisions are discussed in advance and depend on the location of the tumour in the breast. If the tumour is not palpable, it is marked with a wire through the skin beforehand so that we can find it more easily and only remove the tumour and the adjacent tissue. This increases precision. The pathologist then examines the tumour under the microscope (histology). We usually receive the results a few days later.

After the operation, the breast is reshaped so that no "hole" remains. We sometimes insert drainage tubes to drain wound fluid. The removal of the sentinel or, if necessary, several lymph nodes from the armpit is usually carried out via a separate incision. If the breast tumour is located near the armpit, this is usually possible through the same incision.

As with all operations, you should not smoke afterwards in order to minimise the risk of wound healing disorders. You can stand up after the operation. We recommend a light (sports) bra as a bandage and to relieve pressure on the breast. You will stay in hospital for about two days. Initially, the breast will look swollen and possibly "dimpled". This is normal and will normalise over the next few weeks.

If we only remove the sentinel lymph node from the armpit, you will usually not notice much in the armpit or arm. However, if we have to remove several lymph nodes, you may experience temporary numbness in the armpit or on the inside of the upper arm.

Approximately four to six weeks after the operation, the breast and, if necessary, the armpit can then be irradiated.

Acute complications are extremely rare. However, as with any surgical procedure, there are certain risks such as bleeding, infection or wound healing disorders. The swelling and sutures in the breast can cause asymmetries and irregularities, which usually even out later. Sometimes we have to puncture excess wound fluid (seroma). You can minimise the risks by not smoking and eating a protein-rich diet.

In rare cases, the removal of lymph nodes in the armpit can lead to temporary or permanent lymph congestion (oedema) in the arm and, in very rare cases, in the breast. This can usually be treated well with lymphatic drainage. We will discuss the exact risks in detail during your consultation.

Finding the right path together

There are many different types of breast cancer. It is therefore important that we create the right treatment concept for you individually and in close consultation with you.

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Contact / Registration

Monday to Friday:
8.00 - 16.00
Standort Spital Zollikerberg
Fachärztezentrum Prisma
Trichtenhauserstrasse 12
8125 Zollikerberg
Tel
+41 44 397 24 88
Mail
brustcentrum@spitalzollikerberg.ch
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