1 www.klinikum-nuernberg.de/RU --- international@klinikum-nuernberg.de

Breast Center

Gynecology Department Paracelsus Medical University

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Dear Patient

You were diagnosed with breast cancer, or there is a suspicious lump

palpable in your breast. Being diagnosed with breast cancer can be a

devastating experience. Though some people don‘t openly express

how they feel, it is impossible to not be upset when told you have

breast cancer. The mere diagnosis of suspicion for breast cancer

causes tremendous anxiety.

The probability of healing breast cancer has been greatly improved

in recent decades through the introduction and optimization of

multi-modal therapies and interdisciplinary treatments. Early

detection of breast cancer is provided through mammogram

screening services and advanced diagnostic screening tools including

breast self-exams. Major treatment advances have been made in

recent years and patients’ prospects are much more promising than

they used to be.

Today, women with early detected breast cancer have an

approximately 90 percent survival rate. Survival time for breast

cancer in other patients was significantly extended, maintaining high

level of quality of life. We owe this to exciting advances which are

paving to better treatments in fighting cancer. Depending on the

type of cancer and tumor stage, our physicians dispose of much

wider and more differentiated treatment options than they did

twenty years ago.

All members of the multidisciplinary and certified Breast Center

team at Klinikum Nuernberg are committed to provid the highest

quality of care and attention. At our Breast Center, we have multiple

specialists in each discipline, so the recommendations for treatment

are based on the consensus opinions of the group of specialists, with

consultation from their colleagues in other specialty areas. Patient

cases that would benefit from a team review are reviewed by our

Tumor Board, which is a treatment planning approach where a

number of specialists review and discuss the condition and

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treatment options for a patient. Multiple scientific studies provide

evidence that the real benefit of multidisciplinary cooperation

approach and care is that the patient can get the opinion of a group

of specialists and can feel more confident that they have explored all

of their options.

Benign breast conditions in women and benign breast disorders in men

are treated the same with the highest quality of care and attention at

our Breast Center.

Prof. Dr. Cosima Brucker

Chief, Department of Gynaecology

and Director of the Multidisciplinary Breast Center

Certified Breast Center

The Breast Center at Klinikum Nürnberg is one among 255 designated comprehensive Cancer Centers in Germany and has held this designation since 2006. The Breast Center operates in full compliance with strict guidelines of the Deutsche Krebsgesellschaft (German Cancer Society [DKG]) and Deutsche Gesellschaft für Senologie (German Society of Senology [DGS]). The work-flow and quality-management processes employed at the Breast Center are certified to meet DIN EN ISO 9001:2008 Quality Management Standards. The Breast Center is participating in the Breast Cancer Disease Management Program (DMP) in Bavaria and has the additional specific designation “Brustzentrum (DMP)” (“Breast Center [DMP]).

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Our major services available, at a glance

Treatment in full compliance with the guidelines of national and

international standards

Our Breast Center is a comprehensive, multidisciplinary breast

care program, offering a full spectrum of clinical and support

services, from screening and diagnosis to treatment, all housed

within a serene, state-of-the-art facility (short distances to bridge,

short wait times).

We provide advanced medicine, based on high standards in

advanced training and latest medical technology

We provide innovative and high quality treatment techniques

Access to emerging therapies via clinical trial enrollments

We are committed to ensuring high-level safety and quality

standards

Patient cases that would benefit from a team review are reviewed

by our Tumor Board, which is a treatment planning approach

where a number of experts review and discuss the condition and

treatment options for a patient

We offer breast conservation surgery resp. reconstructive breast

surgery

We provide the most advanced treatment options, including

intraoperative radiotherapy with Intrabeam™ (IORT) for breast

cancer and sentinel lymph node technique

We provide complete patient care beginning with the initial visit

and ending with follow-up care programs

We are committed to liaise closely with supportive care and

support services

We provide psycho‐oncological care to every patient who needs it

Patient’s appointments are coordinated all in one place

We offer patients to participate in the Disease Management

Program DMP – for breast cancer

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The Breast Center offers a Full Spectrum of Clinical and

Support Services

At our Breast Center, you expect the newest medications, advanced

diagnostic procedures and innovative treatments. But what you will also

find is a compassionate, patient-focused team of state-of-the-art

technologists and highly skilled medical professionals who are

exclusively devoted to the prevention, early detection and treatment of

breast cancer ensuring a high level of quality. Complying with current

national and international standards, all members of the breast cancer

multidisciplinary teams are committed to providing patients the highest

quality of care and attention during their time with us. This applies as

much to diagnostics and treatment of breast cancer as to the treatment

of benign conditions and breast development disorders.

Our Breast Center offers a full spectrum of diagnostics and treatment of

all breast diseases:

Breast cancer (different types and stages, including second opinion)

Benign breast conditions, including - Benign breast tumors - Large breast (breast hypertrophy) - Small breast (breast hypoplasia)

Plastic and aesthetic surgery procedures - Breast reconstruction - Breast augmentation - Breast reduction

Coping with illness and regaining control - Professional counseling for the psychological needs - Couples counseling and sexual counseling

Counseling for individuals at high risk for breast cancer

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Mammary Carcinoma – diagnostics and therapy

Diagnostics

Diagnostic evaluation of breast cancer typically includes the newest

mammographic technology, breast ultrasound, MRI, minimal-invasive

automatic high-speed core-needle biopsy and stereotactic vacuum-

assisted breast biopsy.

The breast cancer staging workup and TNM classification is performed

complying with international standards in close cooperation with our in-

house Institute of Pathology. Having quick access to these expert

diagnosticians at Klinikum Nürnberg, Campus North, is a great benefit

to our patients. Histology analysis results are usually available after two

days.

Breast Cancer Treatment

Breast cancer treatments are delivered in compliance with national and

international guidelines and the current scientific standards.

Individually tailored optimal combination of modern treatments for

breast cancer are used, including:

Breast-preserving surgery

Sentinel lymph node surger

Radical mastectomy for breast cancer

Intraoperative radiotherapy (using Intrabeam®)

Antihormonal and bisphosphonate therapy

Adjuvant and neoadjuvant therapy

Chemotherapy (including treatment of possible side effects)

Modern test procedures can guide the decision for prognostic assessment and help make decisions to individualized treatment (for instance gene expression testing)

Radiotherapy (using radiotherapy treatment equipment of the latest generation, including radiotherapy planning systems)

Oncoplastic breast reconstruction procedures (using tissue flap surgery with autologous tissue or breast implant)

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Mammary Carcinoma – diagnostics and therapy

Generally, surgical removal of the tumor is the first step in treatment

for breast cancer. This may not always be the case, treatment options

may differ depending on the type of tumor and tumor stage.

Which procedures in which order recommended for treatment are

based on the consensus opinions of the multidisciplinary group of

specialists at the Tumor Board, with consultation from their colleagues

in other specialty areas. Every single step in the decision-making process

is shared with the patient. No decision is made over the heads of

patients, and patients will also not be pressured into a particular

treatment option.

Breast Preserving Surgery

In order for a patient to be a good candidate for lumpectomy, we should

be able to expect that lumpectomy will result in a breast with a good

cosmetic appearance. Almost 90 percent of eligible breast cancer

patients at our Breast Center have breast conservation surgery

conserving a natural looking breast. The lymph node system is

preserved as long as safety is ensured.

When breast preserving surgery is not the safest option, it is often

possible to use oncoplastic reconstructive techniques involving

autologous microvascular free flap options or breast implants, in order

to minimize the appearance of volume loss and to preserve a good

shape. Your breast surgeon at the Breast Center and the breast plastic

and reconstructive surgeon at the Department of Plastic and

Reconstructive Surgery will help you decide which option is best for you.

Radiation Therapy and Chemotherapy

Klinikum Nürnberg provides, both radiation therapy and chemotherapy,

“under one roof”. The Breast Care Nurse at the Breast Center

coordinates patient’s appointments, and she will navigate and support

patients as they take their journey through treatment cycles.

Intraoperative radiotherapy (using Intrabeam®) allows precise

irradiation and reduced postoperative treatment times.

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Mammary Carcinoma – diagnostics and therapy

Clinical Studies

The Breast Center participates in national and international clinical trials

to further advance clinical care and treatment for breast cancer, and

give their patients access to the latest cutting edge research that has

been published on breast cancer and its treatment. This way, our

patients are able to benefit from latest therapy approaches and

medications.

Both clinical trial participation and selection of eligible patients is

performed in full compliance with legal regulations and maintaining

high ethical standards. Patients which are eligible for a clinical trial are

fully informed about all aspects of the clinical trial. Participation in

clinical trials is optional. Speak with your Breast Center health care team

if you have questions about or interest in any of our current clinical

trials.

Outpatient and Inpatient Treatment

Diagnosis and most of treatments for breast cancer are performed in an

outpatient setting. Generally, lumpectomy only is performed on an

inpatient basis. For this purpose, you will be admitted to the

Department of Gynaecology for inpatient treatment.

A compassionate, patient-focused team of doctors, nurses and staff

welcome you on the wards, who are exclusively devoted to the

treatment of breast cancer and management of breast wound care. A

certified breast cancer nurse navigator provides one-on-one support.

The “hospital discharge package”, which you receive before discharge

from hospital, contains useful information covering all dimensions on

how to proceed the first few days following surgery, and the telephone

number of the Breast Center you can call if you have any questions.

Support and Survivorship

We offer different kind of support for our patients, including

psychooncological support.

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Mammary Carcinoma – diagnostics and therapy

Cancer Risk Assessment and Genetic Evaluation and Counseling

During special consultation hours on Breast Evaluation Consultation

Program we provide comprehensive counseling to our patients, we

discuss and offer genetic testing to evaluate inherited cancer

susceptibility, and perform relevant diagnostic tests. For women who

do decide to test, and find they have a genetic predisposition to breast

cancer, we carefully weigh pros and cons and offer a wide-range of

options.

Hospital Discharge and Aftercare

Following inpatient treatment, it is important that you visit your office-

based attending physician on a regular basis for aftercare. A hospital

discharge letter will be sent to your attending physician providing

detailed clinical information and recommendations.

Members of the Social Work Department and the survivorship program

at the Klinikum Nürnberg Breast Center is dedicated to providing

comprehensive and personalized follow-up care to patients who have

undergone breast cancer treatment and arrange for rehabilitation

specialized care services, including other outpatient and inpatient

treatment services. This includes nursing, social and psychosocial

components. They will work with you during your hospital stay to

answer questions; help identify any physical, social or emotional needs;

and arrange for appropriate services upon discharge.

Members of the medical and nursing team at the Breast Center serve a

critical role in guiding patients along the continuum of care including

aftercare, breast self-examination, lymphatic drainage and massage,

physiotherapy, nutrition, sports and exercise programs or psychological

support programs. The Breast Care Nurse provides one-on-one support,

and facilitates patient care throughout the treatment and recovery

processes, and also navigates you through the multispeciality program

developed to provide outpatient and inpatient rehabilitation services to

all survivors in need, whether you are newly diagnosed or long finished

with treatment.

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Cooperation Partners at Klinikum Nuernberg

At the breast cancer multidisciplinary clinic, we have multiple

specialists in each discipline, so the recommendations for diagnostic

evaluation and treatment are based on the consensus opinions of the

group of specialists, with consultation from their colleagues in other

specialty areas. The breast cancer multidisciplinary clinic is operated

under supervision of the Department of Gynecology.

Department of Gynaecology

Institute of Radiology and Nuclear Medicine, Campus North

Department of Radiooncology and Group Practice for

Radiotherapy

Institute of Pathology

Department of Psychosomatic Medicine and Psychotherapy

Department of Plastic, Reconstructive and Hand Surgery

Department and Institute of Physical and Rehabilitative

Medicine and Naturopathy,

Early Rehabilitation

Department of Anaesthesiology and Operative Intensive Care

Social Work Department and Patient Survivorship Program

Furthermore, Klinikum Nuernberg cooperates with a series of out-

patient partnes in and around the city of Nuernberg.

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Prof. Dr. Cosima Brucker, Dr. Zhorsten Koch and Doktor Simone Linsenbuehler

We Care For You!

We invite you to visit our Breast Center respectively the

Outpatient Treatment Center ABC, Department of

Gynaecological Oncology for diagnostic evaluation and therapy,

including inpatient treatment at Klinikum Nürnberg, Campus

North, to get a second opinion or for high risk assessment and

genetic testing.

At the Klinikum Nürnberg Breast Center, our team of breast

cancer experts specializes in the diagnosis and treatment of

breast cancer patients and offers you the most advanced

services in breast cancer prevention, diagnosis, and treatment.

They will discuss every step of an appropriate course of

treatment for you and answer all of your questions regarding

breast cancer.

When needed, we arrange for support care services. Please

contact us, and feel assured you are not alone in this battle.

Meet Your Team Of Dedicated Professionals:

Prof. Dr. Cosima Brucker, Chief

Dr. Thorsten Koch, Director, Breast Center

Dr. Simone Linsenbuehler, Coordinator, Breast Center

Dr. Frank Gisbert, Specialist in Oncoplastic Surgery

Dr. Christine Hoffmann, Breast Surgeon

Impressum: Herausgeber: Klinikum Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419 Nürnberg | V.i.S.d.P.: Bernd Siegler Redaktion: Doris Strahler | Fotos: Rudi Ott, fotolia.com | Gestaltung: Jo Meyer | Druck: diedruckerei.de 3. Auflage: 1.500, Juli 2018 | www.klinikum-nuernberg.de

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Contact details for patients from abroad

International Department of

Klinikum Nuernberg

Phone: +49 (0)911 398 7082 / 7071 Fax: +49 (0)911 398 7441

international@klinikum-nuernberg.de www.klinikum-nuernberg.de/EN