Breast Cancer

The Hospitals of Athens Medical Group (AMG) have specialised Breast Centers offering modern and personalized treatment of breast cancer. Our Breast Centers cover a wide range of medical services, from prevention and early diagnosis to treatment and rehabilitation, in accordance to the latest international therapeutic and diagnostic protocols.

Athens Medical Group Breast Centers adhere to the strict EUSOMA (European Society of Breast Cancer Specialists) standards and guidelines.

Our breast cancer specialists are leaders in their field. They work closely as a team to provide comprehensive services for patients with all types of breast cancer and in any form, including triple negative and metastatic disease, breast cancer during pregnancy. We also provide services for breast cancer genetics whereas we are also experts for breast cancer in men:

• Triple-negative breast cancer: Representing almost one fifth of cases, triple-negative breast cancer can be very aggressive with increased likelihood of recurring when compared to other types of breast cancer. Our specialists are monitoring closely pioneering programs and clinical trials for the development of new treatments for triple-negative breast cancer. Thanks to the latest therapeutic approaches treating triple-negative breast cancer has became much more effective.
• Metastatic breast cancer: At AMG, we specialize in the treatment of metastatic breast cancer. Our dedicated personnel of doctors, nurses and various cancer experts work closely as a team to provide you with personalized care and support of the highest quality, making sure you get those treatment options that are best suited to your needs and goals.

Our Breast Centers offer the expertise, medical technology, information, care and support patients and their families require in order to make the right choices about their condition.

Through the application of the “one stop clinic” process, we ensure faster diagnosis as well as avoiding the discomfort of repeat visits.

AMG care team

At AMG we are committed to providing early diagnosis and management of breast cancer, offering holistic treatment through the collective wisdom of our cancer experts. A multidisciplinary team of specialists, such as breast surgeons, medical oncologists, radiation oncologists, radiologists, and pathologists, work closely with each other to produce treatment strategies that are tailored to each patients particular needs and condition.

The team discusses thoroughly your treatment options, and collaboratively makes a recommendation for the best course of action.

Depending on the particularities of each case, the team may include specialists in genetics, and plastic surgery, as well as dietitians, psychotherapists, gynaecologists, cardiologists and other health expert.

At Athens Medical Group you have a most skilled and dedicated team on your side. Your personal team focuses on you and your needs in order to offer not only advanced treatments but also extensive support and guidance throughout the whole process.

More specifically:

You will review all available treatment options with and guidance of various specialists who will help you understand the pros and cons of each course of action.

You will be offered various supportive services with respect to your rehabilitation, your proper nutrition, your psychological support, etc.

Your treatment will be personalized according to your genetic makeup.

Our Breast Centers are constantly incorporating the latest technological and scientific advances in the prevention, diagnosis and treatment of breast cancer aiming for the best medical outcome for each patient, as well as the highest satisfaction with their appearance and sense of self after surgery.

Your overall treatment plan may include:

• Chemotherapy
• Hormone therapy
• Radiation therapy
• Immunotherapy for triple negative breast cancer
• Targeted therapy and
• Surgery, including lumpectomy, mastectomy and breast reconstruction

Based on your condition and personal preferences, you may be eligible for immediate breast reconstruction. In that case, your surgeons will begin reconstructing your breast during the same surgery as your mastectomy.

Departments that treat this condition

General Surgery

Medical Oncology

Plastic and Reconstructive Surgery

Radiation Oncology

Radiology

The diagnosis of breast cancer usually comes after the discovery of a lump in the breast or a suspicious finding in screening mammography. Your doctor will ask you about possible symptoms and may accordingly perform or recommend the following examinations:

Clinical examination

It involves physical examination and the bimanual palpation of the breasts and locoregional lymph nodes, as well as assessment for distant metastases (bones, liver and lungs).

Imaging

Imaging includes bilateral mammography and ultrasound of the breast and regional lymph nodes.

An MRI of the breast should be considered in cases of familial breast cancer associated with BRCA mutations, breast implants, lobular cancers, suspicion of multifocality/multicentricity (particularly in lobular breast cancer), or large discrepancies between conventional imaging and clinical examination.

MRI may also be recommended before neoadjuvant chemotherapy, when evaluating the response to therapy or the findings of conventional imaging are inconclusive.

• Laboratory investigations.
• Routine blood tests.
• Tumor markers. These are substances produced by tumors or by other cells in response to cancer. They are found in the blood and are identifying with a blood test. A high level of tumor markers suggests the presence of cancer in the body, but is not itself a definite indication. That is why, tumor markers examination may be combined with other tests, such as imaging or biopsies, for an accurate diagnosis.
• Histopathological examination. It involves the laboratory investigation of a core needle biopsy, obtained by ultrasound or stereotactic guidance, as well as histological type, grade, immunohistochemical evaluation of estrogen receptor status and, in the case of invasive cancer, IHC evaluation of progesterone receptor (PgR) and human epidermal growth factor 2 receptor (HER2) gene expression. A histopathological examination may be also carried out on resected lymph nodes and organs, as well as metastases. Histopathological examination is very important for the accurate staging of the cancer.

Staging

After the diagnosis of breast cancer, follows the process called staging, that is determining the extent of the disease in the breasts and elsewhere in the body.

Staging involves various imaging tests including mammograms, CT scans, bone scan, and preferably PET-CT scans.

It may also require examination of the breasts and other parts of the body with magnetic resonance imaging on specific indications.

The staging process is of great value for two reasons. Firstly, it determines the type of treatment that should be applied, and secondly, it is the only safe way to assess the prognosis of each patient.

Your doctor will select the tests you need with respect to your case.

Based on the findings, the stage of the cancer is determined. The stages of breast cancer range from 0 to IV. The lower the stage, the less the development and spreading of thse disease.

Stage 0 is when the cancer is noninvasive or contained within the milk ducts. On the other hand, Stage IV refers to breast cancer that has spread to other areas of the body.

Breast cancer is frequent and concerns a large part of the population.

The implementation of prevention programs, early diagnosis and correct and scientifically documented treatment have now led to a spectacular increase in the survival of breast cancer patients, improving their quality of life and, in many cases to its cure.

Once diagnosed with breast cancer, you will begin to develop a treatment plan with your medical team.

The optimal approach to the management of patients with breast cancer requires the expertise of specialists from various medical specialties.

Surgery

Treatment options for breast cancer include various therapeutic approaches. However, surgery plays a prominent role, since malignant tumors must be removed along with a part or entirely one or both breasts, as well as neighboring lymph nodes that might be affected.

There are various type of surgery performed for breast cancer, such as:

Removal of the breast cancer (lumpectomy)

Lumpectomy is considered an operation that conserves the breast and is recommended for the removal of smaller tumors.

During the operation, the surgeon removes the tumor and an amount of healthy tissue around it.

In some cases of larger tumors chemotherapy helps reduce their size and allow for lumpectomy as a treatment option.

Removal of the entire breast (mastectomy)

Mastectomy is the surgical removal of the entire breast, sometimes along with some parts of the skin, the nipple and the areola. Nowadays, extensive surgery is rare, and breast conservation is the choice for most breast cancer surgeries. But even if mastectomy is necessary, techniques such as mastectomy with skin retention, as well as the conservation of the nipple and areola are gaining ground.

Removal of a limited number of lymph nodes (sentinel node biopsy)

The sentinel node is the one that first one the cancerous cells from the breast spread to. Removing the sentinel node instead of a number of lymph nodes constitutes allows for a rapid biopsy during the surgery. If the biopsy shows that the lymph node is clear of cancer cells, then the surgeon does not remove any more nodes. With this practice, many patients avoid a rather difficult operation, which is sometimes accompanied by serious side effects.

Removal of several lymph nodes (axillary lymph node dissection)

If the biopsy from the sentinel nod reveals cancerous cells cancer then, the surgeon removes more nodes often to the point of complete lymph node cleansing.

Reconstruction of the breast after mastectomy and lumpectomy

Breast reconstruction is a normal procedure after mastectomy, and in some cases, lumpectomy. Usually, it is carried our soon after the operation for the removal of the tumor, but it may also be performed months or even years after surgery.

During the procedure, a plastic surgeon reconstructs the breast using implants, flaps of tissue from another part of the body, or both.

Breast cancer surgeons are now able to incorporate plastic surgical techniques that reconstruct the breast after removing the tumor and optimize the aesthetic effect.

Chemotherapy

Chemotherapy is the use of anti-cancer (or cytotoxic) drugs to destroy cancer cells. Your personal care team will devise a chemotherapy plan (type of drugs, doses, schedule) tailored to your particular needs. You may also receive other treatments to alleviate potential side effects.

Chemotherapy is carried out in order to achieve:

• Shrinkage of a large tumor before surgery (neoadjuvant chemotherapy)
• Destruction of cancer cells that may have remained after surgery, in order to reduce the risk of recurrence (adjuvant chemotherapy)
• Treatment of recurring cancer
• Treatment of advanced breast cancer (palliative chemotherapy)

Targeted drug therapy

Breast cancer targeted therapies involve the use of special drugs which block the growth of cancer by targeting particular functions of specific molecules that allow the cancer cells to develop. It damages cancer cells without hurting the healthy ones. However, not all patients benefit from it.

Targeted drug therapy may be used after surgery, with the aim of reducing the risk of a return of the cancer or to slow down the growth of the tumor in cases of advanced cancer.

Radiation therapy

Also called radiotherapy, radiation therapy is a highly targeted and highly effective method of killing cancer cells in the breast. As a therapeutic approach, radiation therapy is not hard for a patient to tolerate and its side effects are limited to area of the body is treated.

Usually, it is applied before surgery as a means to shrink tumors or after the operation for the destruction of cancer cells that may have remained.  Also, radiation therapy is carried out in order to relieve symptoms of cancer that has spread in other areas and organs of the body.

It may be performed through aiming energy beams to the breast (external beam radiation) or by placing radioactive material inside it (brachytherapy).

External beam radiation of the whole breast is commonly used after a lumpectomy. Brachytherapy can be an option in cases of low risk of cancer recurrence.

The duration of radiation therapy for breast cancer varies from three days to six weeks. Radiation oncologists determine the best suitable treatment for each patient, taking into account the type of the cancer, the location of the tumor and the conditions of the patient.

Hormone therapy

It is used in the cases of breast cancers that are sensitive to hormones, such as estrogen receptor positive cancers and progesterone receptor positive cancers. Hormone therapy involves the use of medication to either block hormones from affecting cancer cells or stopping the body from producing them.

It may be used both before and after surgery.

Some of the most frequent questions asked to our doctors include:

• Where is the location of the cancer in my breast?
• What is the type and stage of my breast cancer?
• Has my breast cancer metastasized?
• What kind of tests will I need?
• Will treatment cause menopause?
• What are my treatment options?
• Can my breast cancer be cured? What are the chances?
• How much does each treatment increase my chances for cure of my breast cancer?
• What are the potential side effects of each treatment?
• How will my daily life be affected by each treatment?
• Which treatment do you believe is best for me?
• How soon must I decide about the type of my treatment?
• Would it help to seek a second opinion?
• Would it help to see a specialist? What will be the cost of that? Will my insurance cover it?
• Is there any printed material that I can take with me? Where can I find more information online?
• Do my siblings or my children have an increased risk of breast cancer? What do you advise me about that?