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Treatment

The breasts of a woman are a secondary sex characteristic. In addition to feeding children, breasts also have a sexual function. The breasts (mammary glands in Latin) consist of mammary tissue, fatty tissue and connective tissue. Both breasts also have an extension of the tissue of the breast that extends into the axilla, which is called Spense’s tail. Men also have breasts, although they have much less breast tissue than women. The breasts are divided into four quadrants: upper left, lower left, upper right and lower right of the nipple. During and immediately after pregnancy the breast glandular tissue produces milk that is transported through lactiferous ducts to the nipple, where the baby can drink. In women, the breasts overlay the musculus pectoralis major (the major pectoral muscle) and the musculus pectoralis minor (the minor pectoral muscle). These muscles are involved in the movement of the shoulders and arms.

Surgery

Depending on the type and the extension, breast cancer can be treated in several ways: Breast-conserving treatment: The tumour and a margin of healthy tissue is removed (lumpectomy). The surgeon tries to maintain as much healthy breast tissue as possible. Mastectomy: In a mastectomy, the entire breast is removed, preserving the pectoral muscle. For medical reasons, in some cases this is a better treatment than the breast-conserving treatment. If elsewhere in the body metastases are found, the physician may opt for a treatment irradiation alone. Lymph nodes: In both breast-conserving therapy and mastectomy there will be determined whether the lymph nodes contain tumour cells. Therefore, the so-called sentinel node is detected during surgery. This is done by preoperative injection of a radioactive substance into the tumour, which the lymphatic vessels uptake. The substance remains in the first lymph node. During the operation, the node can be found with the use of a so-called gamma probe. It is also possible to inject a blue liquid into the tumour. The dye remains in the lymph node and is hereby made visible for excision by the surgeon. If breast cancer spreads through the lymph nodes it is usually to the lymph nodes in the axilla or along the sternum. The so-called sentinel node is the first lymph node to which the cancer cells spread. If the sentinel lymph node contains tumour cells, all the axillar nodes will be removed in a second operation. The surgeon may choose to remove all axillar nodes immediately and examine whether there are tumour cells in it afterwards. After surgery and adjuvant radiation the breast may have a slightly different shape and can feel firmer.

Radiotherapy

The breast can be irradiated both internally and externally. In the case of external radiation, the radiation comes from a device from the outside to the inside. With an internal treatment, radioactive materials are administered via needles in or around the tumour (brachii therapy). This treatment is performed at only a few locations in the Netherlands. After surgery and adjuvant radiation the breast may have a slightly different shape and can feel firmer.

Chemotherapy

Infuus

Infusion

After or before surgery, often treatment with chemotherapy is used. This treatment addresses the breast cancer cells that are disseminated through the body. Hereby the chance of cure can be improved. Sometimes this treatment is used to reduce or inhibit the symptoms if the cancer is at a non-curable stadium (palliative treatment). Chemotherapy inhibits cell division. Side effects: Side effects of the chemotherapy are hair loss, nausea, vomiting, damage to the heart muscle, an increased risk of infections, fatigue and early menopause. After chemotherapy, many patients will continue to experience symptoms of fatigue and some patients will remain infertile.

Hormonal therapy

In hormonal therapy, the sensitivity of certain types of breast tumours for hormones is used. Normally, breast tissue needs hormones (oestrogen and progesterone) to grow, but some breast tumours also have this attribute. This makes it possible to temporarily stop the proliferation of cancer cells by giving anti-hormone preparations such as tamoxifen. New anti-hormone agents are the Aromotase-inhibitors, which inhibit the production of female hormones. Instead of treatment with medicines, sometimes the ovaries are being removed. When the tumour is susceptible to the substance Her2Neu, treatment with a specific inhibitor for Her2Neu (Herceptin) can be given.

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