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 Women with breast cancer are often treated with a combination of surgery, chemotherapy or hormone therapy, and radiation therapy. The decision to use chemotherapy or hormone therapy is made with a medical oncologist, and addresses the risk of systemic (whole body) spread, or even involvement of the other breast, in addition to the tumor diagnosed. The decision to use surgery and potentially radiation therapy addresses the risk of local recurrence, in the breast or adjacent lymph nodes only.
Many women who present with early stage breast cancer have a choice of either breast conservation or mastectomy. Breast conservation involves the removal of the cancerous lump followed by external beam radiation to the breast. The most appropriate choice is a complex and personal decision which should be discussed with your doctor. Click to find further information regarding the use of breast conserving therapy
What is 3-D conformal therapy and why is it better?
Conformal therapy allows for the customized treatment of each individual. Every woman has a unique size and shape of breast, and this therapy allows the minimum amount of heart and or lung to be irradiated.
Most patients do very well during and after radiotherapy. There is some mild fatigue that occurs during the treatment, and resolves. Skin redness and irritation of the breast is expected, and usually occurs halfway through a typical 6 week course of radiotherapy, resolving completely a few weeks after finishing. The only common long-term side effect is a mild difference in the cosmetic appearance of the breast (firmness, swelling). There a few rare side effects that are minimized further by three dimensional conformal therapy.
Managing Side Effects of Radiation Therapy for Breast Cancer
Radiation treatment to the chest may cause several changes. You will notice some of these changes yourself, and your treatment team will keep an eye on these and others. For example, you may find that it is hard to swallow or that swallowing hurts. You may develop a cough. Or you may develop a fever, notice a change in the color or amount of mucus when you cough, or feel short of breath. It is important to let your treatment team know right away if you have any of these symptoms. Your doctor also may check your blood counts regularly, especially if the radiation treatment area on your body is large. Just keep in mind that your doctor and nurse will be alert for these changes and will help you deal with them.
If you are receiving radiation therapy after a lumpectomy or mastectomy, it's a good idea to go without wearing a bra whenever possible. If this is not possible, wear a soft cotton bra without underwires. This will help reduce the irritation to your skin in the treatment area. You may have several other side effects if you are receiving radiation therapy for breast cancer. For example, you may notice a lump in your throat or develop a dry cough. Or, your shoulder may feel stiff; if so, ask your doctor or nurse about exercises to keep your arm moving freely. Other side effects that may appear are breast soreness and swelling from fluid buildup in the treated area. These side effects, as well as skin reddening or tanning, most likely will disappear in 4 to 6 weeks. If fluid buildup continues to be a problem, your doctor will tell you what steps to take.
Women who have radiation therapy after a lumpectomy may notice other changes in the breast after the therapy. These long-term side effects may continue for a year or longer after treatment. The redness of the skin will fade, and you may notice that your skin is slightly darker, just as when a sunburn fades to a suntan. The pores may be enlarged and more noticeable. Some women report increased sensitivity of the skin on the breast; others have decreased feeling. The skin and the fatty tissue of the breast may feel thicker, and you may notice that your breast is firmer than it was before your radiation treatment. Sometimes the size of your breast changes-- it may become larger because of fluid buildup or smaller because of the development of fibrous tissue. Many women have little or no change in size.
After 10 to 12 months, no further changes are likely to be caused by the radiation therapy. If you see new changes in breast size, shape, appearance, or texture after this time, report them to your doctor at once.
Despite having had a mastectomy, some patients benefit from radiation to the chest wall region. The patients most likely to benefit are those with original tumors >4 cm in size, or with >3 axillary lymph nodes involved by tumor . However, newer data is implying that any women with positive lymph nodes after mastectomy should be considered for radiotherapy to prevent local/regional recurrence or even improve survival.
Most patients with locally advanced breast cancer are not candidates for breast conservation therapy. They usually are treated with a combined approach with chemotherapy, mastectomy and radiation to the chest wall. Some patients may be treated with chemotherapy first, to shrink the tumor, and possibly avoid mastectomy. There are early results to suggest this may be appropriate for certain women. Treatment is therefore highly tailored to each specific case and the sequence of how each modality is applied can vary.
This is a selective estrogen receptor modulator that can be used to prevent recurrence of breast cancer as well as prevention of formation of new breast cancers in many patients. A patient's age, tumor size, and estrogen receptor status all determine whether or not a patient might benefit from the use of tamoxifen. The benefits and risks of tamoxifen are usually discussed with a Medical Oncologist.
Chemotherapy is delivered by a medical oncologist as is a systemic treatment - meaning it is designed to treat cancer cells throughout the body. Recommendations regarding which women should receive chemotherapy, the specific agents and their duration of use are constantly being modified when new information becomes available.
A patient's age, tumor size, and cell characteristics determine whether she should receive chemotherapy. Side effects vary by which chemotherapy drugs are utilized. The role of chemotherapy and the potential side effects should therefore be discussed with a medical oncologist.
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