STANDARD TREATMENT OF BREAST CANCER

Breast cancer is the most widespread type of cancer among women. If breast cancer detected during the early stage of breast cancer, this type of cancer can successfully be treated.


The stage of the disease at the time of diagnosis is one of the most important factors, which influence the choice of treatment options and the future prognosis. Correct staging is made via comprehensive examination.

With our DNA testing we provide crucial additional information and allow more precise and individual prognosis.


Specific examination for reliable and exact determining of the stage of breast cancer:


  • Mammography.
  • Ultrasound examination of the breasts.
  • MRI
  • Biopsy. 


Standard or general examinations are also carried out to get the correct data:


  • Complete blood count (to reveal anaemia)
  • Biochemical blood test (to estimate liver and kidney function which is important before chemotherapy for breast cancer)
  • Inflammation markers test
  • Electrocardiogram (to estimate state of the heart)

Book Your Breast Cancer Standard Treatment Here

STANDARD PROCEDURES IN EUROPE AND IN THE UNITED KINGDOM

SURGERY

Surgery for breast cancer can include:


  • removing only the area of your breast with cancer in it (sometimes called breast-conserving surgery)
  • removing the whole breast (mastectomy)
  • removing lymph nodes in your armpit – these are small glands that are part of the body's immune system
  • If you've had a mastectomy you may choose to have breast reconstruction, where the surgeon makes a new breast.


This can sometimes be done at the same time as the mastectomy, or you can have another surgery.

RADIOTHERAPY

Radiotherapy uses high-energy beams, such as X-rays or protons, to target and kill cancer cells. This treatment can be used post-surgery to eliminate any remaining cancer cells or as a primary treatment when surgery is not an option.

Radiotherapy uses radiation to kill cancer cells.

You may have radiotherapy for breast cancer:


  • after surgery to lower the chance of the cancer coming back
  • if you have secondary breast cancer to help control your symptoms-therapy.

CHEMOTHERAPY

Chemotherapy uses medicines to kill cancer cells.

You may have chemotherapy for breast cancer:


  • before surgery to help make the cancer smaller
  • after surgery if the cancer has spread to your lymph nodes or is growing quickly
  • either before or after surgery if you have certain types of breast cancer
  • if you have secondary breast cancer to help make the cancer smaller and control your symptoms.

HORMONE THERAPY

Some breast cancers are affected by different hormones in the body, which can make them grow faster.


Hormone therapy uses medicines to either:


  • lower the amount of certain hormones in the body
  • block certain hormones from getting to breast cancer cells
  • Hormone therapy may be used:

  • before surgery to help make the cancer smaller
  • after surgery to lower the chance of the cancer coming back
  • if you have secondary breast cancer to help control your symptoms
  • if you are not able to have surgery

TARGETED MEDICINES AND IMMUNOTHERAPY

Targeted medicines kill cancer cells.


Immunotherapy is where medicines are used to help your immune system kill cancer.


Targeted medicines and immunotherapy may be used:


  • before surgery to help make the cancer smaller
  • after surgery to lower the chance of the cancer coming back
  • if you have secondary breast cancer to help control your symptoms
  • if you are not able to have surgery


STAGE of BREAST CANCER ACCORDING TNM STAGING SYSTEM - STAGES 0-4

The TNM staging system is widely used in oncology. This tool is normally used to classify each type of cancer, except for blood cancer. Principles of the TNM system are common worldwide. TNM staging system give as answers on numerous questions:


  • Where is the primary tumour located?
  • What is the size of the primary tumour?
  • Is it localized?
  • Has the oncologic process affected lymphatic nodes and if they did, how many of them and where are they located?
  • Is this metastatic breast cancer?
  • Has the oncologic process metastasized to remote organs and tissues, where and to which extent?


In principle, there are two types of TNM staging when it comes to breast cancer.


  • The first one is the clinical stage:

The clinical stage of breast cancer is based on the primary results of the non-invasive investigations and biopsy before the surgery.

  • The second one is the pathologic stage:

The pathologic stage takes into consideration pathology reports after examination of the surgically removed breast tissue and lymphatic nodes. Pathologic stage of breast cancer is more precise, as oncologic changes may be invisible to the naked eye, but not to the microscope.


"T" in the TNM staging system stands for "tumour". This point describes the size of the initial tumour and its interrelation with nearby tissues and organs.


"T" may be assessed in the following ways:


  • TX – size of the primary tumour cannot be determined due to objective reasons.
  • T0 – there are no signs of the primary tumour.
  • Tis – this is usually carcinoma in situ or Paget disease; carcinoma in situ is small and superficial. Chemoembolization for breast cancer may substitute surgery at this stage.
  • T1 the primary tumour is under 2 cm in maximum size; this stage of breast cancer may be divided into stages T1a, T1b and T1c if a doctor needs more precise information. At this stage doctors also use both surgery and chemoembolization for breast cancer.
  • T2 the primary tumour is more than 2 cm, but less than 5 cm in size. Chemoembolization for breast cancer can still be carried out as the safer and more sparing surgery alternative.
  • T3 the primary tumour is more than 5 cm in size. At this stage surgery comes to the fore, as chemoembolization for breast cancer may be ineffective. However, in certain women chemoembolization for breast cancer can reduce tumour size and stop its growth.
  • T4 – the primary tumour may have any size, but it affects skin or chest wall. Symbol T4a means spreading on the chest wall, symbol T4b – spreading on the skin and oedema of the involved breast, symbol T4c – affecting both chest wall and skin, symbol T4d – inflammatory oncologic process with oedema, pain and redness of the skin.


"N" in the TNM staging system stands for "nodes". This point describes spreading of the oncologic process on the nearby or remote lymphatic nodes. Earlier removed lymphatic nodes were investigated under the light microscope, but improvement of technical basis gradually gave the possibility to find out the tiniest changes in the tissues. As it is not actually clear, whether such changes are clinically significant or not, doctors take into consideration only focuses of 200 and more oncologic cells or 0.2 and more mm in size. When such focuses are less than 2 mm in size, they are called micro-metastases.


"N" may be assessed in the following ways:


  • Nx – it is impossible to assess nearby lymphatic nodes.
  • N0 – there are no signs of oncologic process in the nearby lymphatic nodes. To be more precise, stage N0(i+) is distinguished in case of revealing focuses consisting of less than 200 cells or less than 0.2 mm in size and stage N0(mol+) is distinguished in case of revealing cancer cells only with the help of molecular tests (RT-PCR).
  • N1 – cancer process has spread to 1-3 lymphatic nodes in the underarm region (axillary lymphatic nodes) and / or near the breast bone (internal mammary lymphatic nodes). To estimate the process more accurate, stage N1mi means presence of micro-metastases in the axillary lymphatic nodes, stage N1a – involving into the process 1-3 lymphatic nodes with presence of at least one macro-metastasis, stage N1b – involving into the process internal mammary lymphatic nodes on the same side (without their enlargement), stage N1c – presence of stages N1a and N1b signs.
  • N2 – cancer process has spread to 4-9 axillary lymphatic nodes or has led to the enlargement of internal mammary lymphatic nodes. Stage N2 is divided into stage N2a – 4-9 axillary lymphatic nodes are involved into the process with presence of at least one macro-metastasis, and stage N2b – cancer has spread to internal mammary lymphatic nodes and they are visually enlarged.
  • N3 is divided into stage N3a, when oncologic signs are present in more than 10 axillary lymphatic nodes or other lymphatic nodes below the clavicle; stage N3b, when both axillary and internal mammary lymphatic nodes are affected with macro-metastases; stage N3c, when lymphatic nodes above the clavicle are involved into oncologic process.


"M" in the TNM staging system stands for "metastases". This point describes the metastatic breast cancer with spreading of the process to the distant organs – brain, bones, bone marrow, lungs, liver.


"M" has the following meanings:


  • Mx – it is impossible to assess the presence of metastatic breast cancer.
  • M0 – metastases are absent according to physical examination or imaging investigations (X-ray, CT, MRI). Stage M0(i+) is distinguished when oncologic focuses of less than 200 cells or less than 0.2 mm in size are revealed.
  • M1 – implies presence of metastatic breast cancer with lesions in any of distant organs. M1 stage requires systemic treatments, e.g. chemotherapy for breast cancer

PRICES FOR PROCEDURES for Stage 4

Breast cancer Standard and Improved Therapy Price List:


  • Diagnostic test for breast cancer £6,000
  • Stage 4 with Radical Mastectomy £8,000
  • Stage 4 with Chemotherapy £8,000
  • Stage 4 with Radiotherapy £15,600
  • Stage 4 with Proton therapy £48,800
  • Oncological rehabilitation £0.00 if booked and admitted by The Zdenko Kos Foundation.


The above figures represent ¼ of original costs because The Zdenko Kos Foundation contribute and cover the balance of ¾ of the real price.

MAMMOGRAPHY

Mammography is a kind of X-ray examination, which reveals tumours and other pathological conditions of breasts (like cysts or mastopathy). Depending on the level of healthcare institution, mammography might be traditional (with film screens) or digital (with receiving images of better quality and recording the data on the computer).

ULTRASOUND EXAMINATION

Ultrasound examination allows more intricate estimation of the breast tissue state, distinguishing between solid tumours, which may be both benign and malignant, and cysts, which are always benign, but need surveillance.

BREASTS MRI

MRI is mainly used for revealing the extent of the invasion by the tumor, presence of oncologic process in the other breast and nearby organs, and development of metastatic breast cancer. Under certain circumstances a mammography may be substituted with MRI, as the last one is more precise and gives more diagnostic information in women with metastatic breast cancer. MRI is always performed before planning, surgery, chemotherapy or radiotherapy for breast cancer, chemoembolization for breast cancer.

BIOPSY

Biopsy is the "usual standard" in breast cancer diagnosis. This investigation involves the taking of a sample of tumour or suspicious tissue in metastatic breast cancer and examining it under the microscope or with the help of chemical agents. Biopsy may be performed by thin (it is called "fine needle aspiration", FNA) or wide (it is called "core needle biopsy") needle. Needle biopsy is guided with the help of mammography, ultrasound or MRI. In case a greater amount of tissue is required for the diagnostic purposes, surgical biopsy is performed. Usually surgical biopsy means total removal of the neoplasm, regardless of its origin, and may be complemented with chemotherapy or radiotherapy for breast cancer.

YOUR QUESTIONS ANSWERED

  • Can I choose the hospital for my treatment?

    Yes, you can select the hospital you would like to be during your treatment, however, keep in mind that that particular hospital must have a department and wards for the kind of profile of your medical issue. When the patients identify where they would like to have their treatment, they must have in mind the remoteness from the airports, main road and main railways in cases of any emergencies. 

    We’ll give our recommendation which is based on a long experience and a profound analysis of all criteria necessary for the quality of medical the patients are looking for.

  • How much does treatment cost?

    When you book your treatment with us you will get fix figure of which you are paying just ¼ of original cost only, the balance of ¾ contributed and paid by Zdenko Kos Foundation.

    Costs for hospitals are also fixed for entire year, therefore, if you are having treatment over one year, the hospital costs might changed. Once you make the payment for the hospital (eg. for one year) you have hospital free of any charges doesn't matter how many times and days per year you spent in the hospital, doesn't matter how many times you are booked and discharged from the hospital.

  • What is the cost of your services

    Depending on the duration of the medical program the cost in every hospital doesn't matter, the country may vary -  but not when you are booking with us. Our prices are fixed doesn't matter what we may find once eg. surgery or treatment start. All the costs of our services are significantly lower, up to 80% (depending on  treatment) that you will have to pay either through your health system in your country or when organizing the program on your own. There are several reasons for it: The hospitals provided by us have special contract agreements to have fixed rates with discounts for the entire year. There are no overstated rates. You and the hospital you will be having treatment are insured specially from unforeseen expenses eg. possible complications.

  • With whom will I conclude the contract?

    You must book with us, and you will complete the contract with us - The Zdenko Kos Foundation. It is a contract on the organization of a medical trip and provision of services. The protocol is very clear: 

    [1] You have to make the booking with us online on this web site (see the page with the booking box) for the treatment you are after where we are strongly suggest to give us as much data and images of your medical condition to date that we can contact you directly with our doctors, consultants and other medical staff for the treatment you would like to have. 

    [2] Once booking is completed, you will receive automated mail for the payment to be made. You have to make the payment in full for the treatment you would like to have in maximum 24 hours after the booking. With making the payment you start ball rolling. 

    [3] Being admitted to the hospital, you will conclude a direct contract with us for the provision of medical services.

    {4} Once payment made you will get direct link to the doctor and counsaltant to discuss your case face-to-face via What's Up or other such service provider available to both parties depend on your locatition.

  • Why should I pay you, but not the hospital?

    Firstly, unlike many intermediary firms and portals, we do not take from hospitals a percentage of the medical service cost because we have contract agreement not just with hospitals but also with doctors, consultants and other medical professional in each hospital we are working with. 

    Secondly, we are covering ¾ of costs for your procedure not to mention that your procedure-treatment will be fully insured up to £250,000 (for one year treatment) and automatically up to £500,000 (for 2-5 years treatment). The Zdenko Kos Foundation cover the hospital insurance seperately during your treatment if there may come to unforseen complication during the treatment.

    Finally, as we are registered as charity, we remain independent in choosing a medical facility and work exclusively for the benefit of the patient. Any type of payment for sending a patient to the hospital is prohibited by law, since it contradicts medical ethics.

  • At what point do the services become paid?

    The services for the organization of treatment become paid from the moment you made your medical treatment booking online and make the payment in full. Once this done, pre-treatment consultation will take the place following the initial examination (hospitalization).

  • Can I contact the hospital directly?

    Yes, of course, you can also contact the hospital on your own. You should choose the hospital and the attending doctor, write an email to the chief doctor with a description of your case in English, ask him/her about the possibility of undergoing treatment in the hospital and the approximate cost of staying there. If you have received the consent of the hospital and you are satisfied with the price for the hospital (please specify that it must be the price for one year doesn’t matter on number of admissions and discharges and transfer an advance payment to us on our account. Once full payment is received, we will negotiate special terms with the hospital you select on your own that they will be aware of what and how many procedures they have to have in mind and secure at any time free bad in ward. If you are coming from a non-EU country write an email to the secretary of the hospital with a request to send an invitation for a visa. Please note that the invitation should come from the chief doctor, but not from the hospital's international department. After that you should on your own get a visa for medical treatment abroad, agree with the secretary of the chief physician on the date of the initial examination (hospitalization), translate medical records of local physicians into German or English (depending on the chosen country for treatment), book a hotel, prepare a transfer from the airport and find for yourself an interpreter for communication with the medical staff.

    All these activities are not needed in case you are booking with us and you are choosing a hospital we would recommend. If you book with us, we will deal with your visa (if you are coming from a non-EU country), we will book you a hotel, and do all that is necessary to get you started with your treatment.

  • Shall I pay for a consultation?

    A consultation before the treatment as well as long-distance consultation (if you are not from EU countries) is provided free except when you are returning to your home address and it is necessary to study CT or MRI images as the specialist gives an official consultation with a written opinion.

    If you are not from EU countries it is imperative to translate epicurises and medical records from domestic doctors into English.

    If you opt for our services for the organization of treatment with us, there is no need to translate the medical records. This will be done by qualified specialists.


  • What happens, if I refuse from the treatment?

    If you refuse from the treatment you will get a refund of the advance payment. 

    The expenses for all what has been done to that moment will be deducted acordingly. 

  • Is it possible to postpone the treatment?

    Yes, it is. In case of an advance postponement (more than 48 hours before the start of the treatment), the treatment cost will not be changed, and will be deleyed till as per your request. If you intend to postpone the treatment, you must do so on written only. There may be some additional cost for consultation or pre-treatment appointment, depend on the lenght from the initial day of treatment till the day you want to be.

  • What security and guarantees do I have?

    When booking the treatment with us all medical treatment are fully insured against possible complications and unforeseen contingencies. The additional treatment costs will be covered by the insurance covered and paid by The Zdenko Kos Foundation.

  • How is my personal data managed?

    The Kos Foundation is a Data Controller therefore rest assured that your personal data and all material you submit over our link along with all medical history with us will be protected according to current regulations and legislation, using advanced security technologies. Medical history will not be disclosed to any 3rd party even to your GP without your special written permission.

  • Check list for inpatient and outpatient

    When you pack your bag for your hospital stay, the following things should not be missing:

    For your record

    - Referral certificate from the general practitioner or specialist

    - Health insurance card

    For your treatment

    - Medicines in original packaging that you take at home

    - Current preliminary findings, such as X-rays, CT/MRI, ECG or EEG, blood tests, etc.

    - Doctor's Letters

    - If available, living will and power of attorney

    - If available: allergy passport, vaccination certificate, X-ray passport, diabetic card, blood group card


    For your stay

    - Your aids (e.g. wheelchair, walker, walking stick, glasses, hearing aid)

    - Comfortable clothing

    - Towels

    - Cosmetics and personal care products

    - To pass the time: books, magazines, MP3 player with headphones

    - Contact details of relatives and friends


    Please be aware:

    When you get your inpatient admission appointment, please clarify whether you have to appear fasting on the day of admission.


    Valuables

    If possible, please do not bring any valuables with you, as you are liable for losses. For indispensable valuables, e.g. Your watch or wallet, you will find a small safe deposit box in the closet of your patient room in the Surgery I Dermatology and in the Psychosomatics department. In internal medicine, there is a dispensing point.


  • How are the visiting hours regulated?

    Visitors are not only welcome to us but are also of huge importance for our patients!

    Doesn’t matter with which hospital we are working with you are booking there are variable visiting hours, as well as special visiting hours which are not for regular patients visits. Once you are admitted the care team will give you all the details about visiting hours. There are also alternative that your partner (husband/wife) stay with you during the treatment. Such accommodation is available nearly in all hospitals we are working with. For such accommodation additional charges applies. 

    There are separate visiting hours for intensive care units while parents of young patients in the children's area have unlimited visiting hours.

    Visitors are asked to be considerate of patients and fellow patients. If necessary, the nursing staff of that hospital where you are staying, will point out the necessary rest periods for patients who have just undergone surgery

  • Where can I reach pastoral care?

    All hospitals we are working with offer pastoral care for at the Protestant and Catholic hospital chaplaincy for patients and relatives. For all other religions you will be informed by the care team at that particular hospital on the day of your admission.

  • What help and counselling services are available?

    Doesn’t matter which hospital we are working with you choose, you will be given supports with various counselling services and support services, such as the Social Counselling Service, Psychosomatic consultation service, Special offers for cancer patients, Clinic chaplaincy, Services of other religious communities, Art therapy, Self-help, Hospice and much more.

  • How can I contact social services?

    The Social Counselling Service can advise you on topics such as rehabilitation, post-discharge care, social law, psychosocial care and many other matters. You will get special overview with information and contact details from consultant and care team in the hospital where you start your treatment.

  • Inpatient stay: How is admission made?

    Registration and admission for an inpatient stay

    If you have made an appointment for an inpatient stay in cooperation with The Zdenko Kos Foundation, you will first be "admitted" to hospital of your choice upon arrival. This means that we record your data and inform you about your hospital stay.

    Please ask exactly where you should travel when making an appointment. The Zdenko Kos Foundation has several locations and consists of many individual clinics.

    An overview of the parking facilities at the clinic locations will be provided once you identify the hospital you would like to be admitted to.

    When you get your inpatient admission appointment, please clarify whether you have to appear fasting on the day of admission.

  • What should be considered when discharging?

    Your attending physician has decided that you will be discharged from the hospital. This means that you will either be discharged directly to your home or still need follow-up treatment, which will be carried out on an outpatient or inpatient basis in another clinic or rehabilitation facility. For both situations, you will get full information before discharged date.

  • What do the General Terms and Conditions of Contract regulate?

    Accepting services of The Zdenko Kos Foundation, you are not accepting just our Terms & Conditions but also for the period of your entire treatment or stay doesn’t matter which hospital we are working with, the hospital GTCs and the house rules of that hospital in their respective valid versions which you can see and read on hospital websites directly.