Breast cancer and invasive ductal carcinoma with Prof. Dr. Fitzal

1. What are the less common symptoms of invasive ductal carcinoma?

In this disease, one of the not so common symptoms is, for example, redness of the skin in the breast area. Other such can be the formation of bumps on the skin, and also the appearance of unilateral lymphedema in the patient's arm. The condition in which skin tissues begin to die due to the lack of blood supply to them (skin necrosis) is also one of the less common symptoms of invasive ductal carcinoma.

2. What are the necessary methods to detect the disease in time?

In patients with this disease, palpation is not a reliable enough method for its diagnosis. As the most effective option for diagnosis, the use of ultrasound of the axillary lymph nodes to examine the health of these nodes combined with breast mammography is recommended.

3. What are the main causes that can contribute to the development of this disease?

At the moment, there is still no clear idea what the underlying cause of breast cancer is. One of the risk factors is thought to be familial burden, which can be identified through blood tests of the patient. Mast cells accumulated in the body tissues (adiposities), as well as previous breast surgeries in a woman, can also lead to the development of breast cancer.

4. Which is the most effective method in the fight against breast cancer?

In 96% of cases, the most effective treatment for this disease is undergoing surgery to remove the tumor. In cases of metastases to visceral organs or those to bone, the patient is not advised to undergo surgery.

5. In which cases is axillary lymphadenectomy necessary?

According to data, about 10-15% of women suffering from breast cancer have to undergo surgery to remove lymph nodes from the axillary region in the body. In patients undergoing chemotherapy in the period before surgery, removal of axillary lymph tissue is required if metastases are found in the lymph nodes. Resection of this tissue is necessary in patients without prior treatment if more than 2 metastases are present in the lymph nodes.

6. What are the advantages of intensity modulated radiotherapy? What are the main differences between treatment with chemotherapy and radiotherapy?

The use of intensity modulated radiotherapy (IMRT) aims to protect healthy tissues by reducing the radiation dose to them. This also reduces the possible side effects of the treatment. The procedure itself is a type of radiotherapy and is most commonly used to treat cancer. MILT uses advanced technology to manipulate proton and photon beams, adapting to the shape of the tumor. For more precise irradiation of the malignancy, the beams used are of varied intensity. The shape of the beam changes during each treatment, depending on the size and shape of the tumor at the time of the specific procedure.

When radiotherapy is used in the fight against cancer, it only has an impact on the local tissue. In chemotherapy treatment, the patient's entire body is treated.

7. Can tamoxifen be taken by women of any age during hormone therapy?

The drug tamoxifen is not recommended for postmenopausal women, especially if used as an initial intervention in the fight against breast cancer. Except in such cases, the drug is allowed for use by women at any age.

8. In which cases is treatment with medication recommended?

Several different types of the disease are known, so a different treatment is recommended for each of them. It should also be tailored to the type and size of the malignancy, whether there are any accompanying diseases, and the stage of the woman's cancer. In HER2-positive breast cancer, the patient undergoes treatment that includes immunotherapy through the use of antibodies and chemotherapy. In patients who have developed metastases due to breast cancer, immunotherapy treatment using antibody-drug conjugates is necessary.

9. How can a patient undergo immunotherapy and would it be effective in fighting breast cancer?

In patients with breast cancer characterized by the absence of all three receptors - estrogen, HER2 and progesterone, treatment with immunotherapy is administered directly into the patient's circulatory system. Antibodies are also used to combat the PD-1 and PD-L1 receptors. In cases where metastases are detected in the body, this type of treatment can only be applied if the patient has a mutation in the gene coding for PD-L1. When the patient does not have metastases spreading to surrounding tissues, immunotherapy treatment limits the risk of the cancer spreading by about 20%.

10. When does breast cancer come back after successful initial treatment?

There are currently no clearly identified causes that may be responsible for the return of breast cancer. The condition of single wing resistance, where the cancer is single wing positive, is thought to be one of the likely causes. Treatment with new more effective drugs is needed to overcome this resistance. Research on this topic is ongoing. An example is the POLAR study.

11. What is the prognosis for recurrence with different breast cancer treatments?

Each patient's prognosis is different as it depends on what type of breast cancer they had. For example, in HER-2 positive breast cancer, which develops the fastest compared to other types of the disease, the prognosis becomes more optimised as antibodies are used in treatment, as is the case with luminal breast cancer. Patients suffering from luminal types of this disease have an 80% probability of maintaining their health in the 10 years after cancer detection. In luminal breast cancer, the prognosis is better in contrast to that of triple negative breast cancer. It has about a 60% chance of a woman's good health after diagnosis