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Radiation Therapy For Breast Cancers

Facts About Breast Cancer

Breast cancer is the most common type of cancer in American women, according to the American Cancer Society.

  • Each year, nearly 216,000 women and 1,500 men learn they have breast cancer.
  • Another 59,000 women learn they have in situ or noninvasive breast cancer.
  • Nearly 40,000 women will die from breast cancer each year.

Risk Factors for Breast Cancer

Most women who develop breast cancer do not have known risk factors, but some factors may increase the chance of developing this disease. One of these risk factors is age — more than 75 percent of women diagnosed with breast cancer are over age 50. Other factors include:

  • Early onset of menstruation.
  • Family history of breast cancer in your mother or sister.
  • Hormone replacement therapy with estrogen and progesterone.
  • Alcohol consumption.
  • A personal history of breast cancer or prior breast biopsy for benign disease.

Diagnosing Breast Cancer

Breast tumors are typically, but not always, painless, so it is important to have any breast or underarm lump checked. Swelling, discoloration, thickening of the skin or nipple discharge also should be checked immediately.

  • In some cases, a biopsy to determine if you have breast cancer will be done in an office setting using a needle to remove cells from the lump.
  • A stereotactic biopsy uses mammography targeting to pinpoint smaller tumors and permit a small amount of tissue to be removed by a needle for diagnosis.
  • Your surgeon may suggest removing the lump to see if you have cancer.

Types of Breast Cancer

The breast is made up of ducts and lobules surrounded by fatty tissue.

  • Cancer confined within a duct is called ductal carcinoma in situ (DCIS). Lobular carcinoma in situ (LCIS) is cells confined to a lobule.
  • Tumors that break through the wall of the duct or lobule are called infiltrating ductal or infiltrating lobular carcinomas.
  • Inflammatory breast cancer may involve the entire breast with specific skin changes and swelling.

Breast-conserving Surgery

Studies have shown that women with early-stage breast cancer who have a lumpectomy to remove the cancer followed by radiation live just as long as women who have a mastectomy and may be preferred by many women. The standard of care after breast-conserving surgery is external beam radiation therapy. Often, this follows chemotherapy.

  • Your surgeon will perform an operation called a lumpectomy, also called a partial mastectomy, excisional biopsy or tylectomy, to remove the tumor. In some cases, a second operation called a re-excision may be needed if microscopic examination finds tumor cells at or near the edge of the tissue that was removed (called a positive or close margin).
  • To see if your cancer has spread, your doctor may remove several lymph nodes from under your arm (axilla). If any of these nodes contain cancer cells, more nodes may be removed.
  • Breast-conserving surgery is not suitable for all breast cancer patients. Talk with your surgeon to see if this is the best procedure for you.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast.

  • Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks.
  • The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.
  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.
  • Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of the radiation beams. It is currently being studied for treating breast cancer.
  • Side effects might include skin irritation, like a mild to moderate sunburn, mild to moderate breast swelling and fatigue.

Brachytherapy, also called internal radiation or seed implants, is the placement of radioactive sources in or just next to a tumor. The radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used. Because the radiation sources are placed so close to the tumor, your doctors can deliver a large dose of radiation directly to the cancer cells with minimal exposure to normal tissue.

The radioactive sources used in brachytherapy, such as thin wires, ribbons, capsules or seeds, come in small sealed containers. Some sources are placed permanently and are referred to as implants. These radioactive sources remain in the body after their radiation has been expended and the source is no longer radioactive. Other sources are placed temporarily inside the body, and the radioactive sources are removed after the prescribed dose of radiation has been delivered.

There are two main types of brachytherapy: intracavity treatment and interstitial treatment. With intracavity treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.

Often these procedures require anesthesia and brief hospitalization. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities. Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will need to take special precautions to limit their exposure to radiation.

Devices called high dose rate (HDR) remote afterloading machines allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You may be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.

Most patients feel little discomfort during brachytherapy. If the radioactive source is held in place with an applicator, you may feel discomfort from the applicator. There are medications that can help this. If you feel weak or queasy from the anesthesia, your radiation oncologist can give you medication to make you feel better.