Breast Cancer

Each type of cancer has unique characteristics and responds differently when treated. Our highly trained staff and physicians combine their skills with the latest equipment and techniques to treat all forms of cancer. The webpages below contain detailed information about specific types of cancer, related issues and the treatment options available.

Breast Cancer

RADIATION THERAPY

Typical Course

The usual situation is that the woman has undergone a lumpectomy and may or may not have received chemotherapy following her surgery before she is referred to the radiation therapy clinic. Following surgery, usually a few weeks are required in order to permit for adequate healing of the surgical scar. However, delay before starting radiation treatment should not be excessive, as delays of eight to 16 weeks after surgery have been found to correlate with decreased disease control within the breast. Following consultation with physical examination, the patient is set up for what is called a treatment simulation. This mainly consists of having the patient lie on a radiation treatment table in the exact position that she is to be treated on a daily basis thereafter. During treatment simulation, the radiation therapist makes temporary marks on the skin surrounding the breast to indicate the area that will be included within the field of radiation. X-rays are then taken of the breast from two separate angles. These angles are determined so that radiation may pass through the breast while minimizing exposure to the other breast as well as the underlying structures of the lung, heart, esophagus, and spinal cord. A radiation technologist obtains measurements of the breast and then calculations are performed in order to determine the appropriate amount of radiation to be given. Sometimes, a CT scan of the breast is obtained in order to assist with these treatment planning calculations. The entire process of treatment simulation may be expected to take between 30 and 45 minutes. Following treatment simulation, the patient is asked to return in approximately two days in order to begin her actual treatment. The position of the patient during treatment simulation is then repeated with each actual radiation treatment. Each actual radiation treatment session may be expected to take roughly five minutes. Treatment is performed on a daily basis from Monday through Friday with Saturdays and Sundays off. The total course of treatment may be expected to take approximately six weeks. During the course of treatment, the patient is evaluated by her radiation therapist on a weekly basis in order to discuss breast care during radiation treatment, as well as any other issues of interest to the patient.

Following completion of radiation treatment, the patient will need to be evaluated on a regular basis by all of her treating physicians. The typical course of follow-up will consist of evaluating the patient six weeks after completion of radiation therapy and then every six months for the first year. If an intact breast was treated with radiotherapy, then mammography is repeated every six months of that breast for the first year.

Side Effects

Side effects from radiation treatment include but are not limited to the following: redness and swelling of the breast, fatigue, mildly decreased blood counts, and mild arm swelling. Unlike chemotherapy, radiation therapy of the breast does not cause loss of hair or nausea and vomiting. The skin changes during radiation treatment are the predominant side effects of therapy. Typically, the breast begins to turn pinkish approximately two to three weeks after the start of treatment. For the rest of treatment, the breast becomes increasingly red in color and slightly sensitive, particularly around the nipple. In some women, most commonly among patients’ with larger sized breasts, the skin reaction might become quite uncomfortable. Some peeling of the very top layer of the skin may occur, revealing a raw area of the skin similar in appearance to that of a “popped” blister. This reaction is most commonly observed in areas where there is folding of the skin, such as directly underneath the breast and armpit. Fortunately, there are special lotions and medications that can be administered to help relieve the sensitivity of the skin, as well as promote its rapid healing. Following completion of radiation therapy, the breast begins to heal and will require approximately two to four weeks before the symptoms of radiation treatment have resolved.

Although not as prominent, there are also some long-term side effects of radiation treatment. Over the course of months to years of having completed radiation treatment to the breast, a woman may notice that the skin of the breast has become slightly darker in color, much like a light suntan. Alternatively, there may actually be a decrease in the pigmentation of the treated breast skin. Telangiectasias, which are very thin and superficial blood vessels, may appear as a small collection of very thin red lines on the skin of the breast with time. Most commonly, however, is that the breast becomes slightly firmer in texture and becomes a bit more uplifted than it was prior to treatment. There may be some slight decrease in breast size with treatment, but this rarely results in the change of cup size following treatment.

Please do not hesitate to discuss the radiotherapeutic management of breast cancer or its side effects with any of our radiation therapists at 21st Century Oncology. We are very happy to provide you with the information that you need in order to make your decision to receive radiation treatment an informed decision.