What Happens Before During And After Treatment
Once the diagnosis has been made, you will probably talk with your primary care physician along with several cancer specialists, such as a surgeon, a medical oncologist and a radiation oncologist, to discuss your treatment choices. These specialists will work together to help recommend the best treatment for you. In some cases, your cancer will need to be treated by using more than one type of treatment. For example, if you have breast cancer, you might have surgery to remove the tumor , then have radiation therapy to destroy any remaining cancer cells in or near your breast . You also might receive chemotherapy to destroy cancer cells that have traveled to other parts of the body.
Accelerated Partial Breast Irradiation
In select women, some doctors are using accelerated partial breast irradiation to give larger doses over a shorter time to only one part of the breast compared to the entire breast. Since more research is needed to know if these newer methods will have the same long-term results as standard radiation, not all doctors use them. There are several different types of accelerated partial breast irradiation:
- Intraoperative radiation therapy : In this approach, a single large dose of radiation is given to the area where the tumor was removed ;in the operating room right after BCS . IORT requires special equipment and is not widely available.
- 3D-conformal radiotherapy : In this technique, the radiation is given with special machines so that it is better aimed at the tumor bed. This spares more of the healthy breast. Treatments are given twice a day for 5 days.
- Intensity-modulated radiotherapy : IMRT is like 3D-CRT, but it also changes the strength of some of the beams in certain areas. This gets stronger doses to certain parts of the tumor bed and helps lessen damage to nearby normal body tissues.
- Brachytherapy: See brachytherapy below.
Women who are interested in these approaches may want to ask their doctor about taking part in clinical trials of accelerated partial breast irradiation.
What Are The Different Kinds Of Radiation Therapy
Most radiation therapy is administered by a radiation oncologist at a radiation center and usually begins three to four weeks after surgery. The radiation is used to destroy undetectable cancer cells and reduce the risk of cancer recurring in the affected breast.
There are two main kinds of radiation therapy that may be considered,;and some people have both.
- External Beam Breast Cancer Radiation;
- Internal Breast Cancer Radiation;
Keep in mind that the course of treatment you decide is something you should discuss with your radiation oncologist in order to ensure that it is as effective as possible.
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Nerve Damage Around The Treatment Area
Scaring from radiotherapy may cause nerve damage in the arm on the treated side. This can develop many years after your treatment. Symptoms include tingling, numbness, pain, and weakness. In some people, it may cause some loss of movement in the arm and shoulder.
Speak to your doctor if you notice any of these symptoms.;
Myths About Radiation Therapy For Breast Cancer
Every breast cancer treatment has its downfalls and its scary moments. But in general, people are more scared of radiation therapy than they should be. The manner in which this treatment is delivered has been improved over the years, and most patients find that their side effects are fairly mild, especially compared to more rigorous or invasive treatments, such as chemotherapy or a mastectomy.
Radiation therapy, also known as radiotherapy, is underused and undervalued, at least in part because people dont know enough about it and are afraid of it. Some people even confuse radiation therapy with chemotherapy. The lack of education on the subject leads to the development of myths. Here, well dispel some of those myths for you so you can make a more informed decision about whether radiation is right for you.
Here are 7 myths many people still believe about radiation therapy.
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Radiotherapy After Breast Conserving Surgery
You usually have radiotherapy to the whole breast after having breast conserving surgery . You generally start it about 4 to 6 weeks after surgery.
If you need to have chemotherapy you have this before your radiotherapy.;
People with a very low risk of the cancer coming back may only have part of the breast treated with radiotherapy. Or they may not have radiotherapy at all.
Radiation Boost After Lumpectomy
Research has shown that women who undergo a radiation boost have fewer local breast cancer recurrences than women who do not undergo a boost, with a reduction in recurrence most likely among women 50 or younger who are diagnosed with ductal carcinoma in situ .
That said, even though a radiation boost significantly reduces the risk of breast cancer recurrence, it does not appear to have any effect on overall survival up to 20 years out after treatment.;
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Possible Side Effects Of External Radiation
The main short-term side effects of external beam radiation therapy to the breast are:
- Swelling in the breast
- Skin changes in the treated area;similar to a sunburn
Your health care team may advise you to avoid exposing the treated skin to the sun because it could make the skin changes worse. Most skin changes get better within a few months. Changes to the breast tissue usually go away in 6 to 12 months, but it can take longer.
External beam radiation therapy can also cause side effects later on:
What Are Clinical Trials
Cancer specialists regularly conduct studies to test new treatments. These studies are called clinical trials. Clinical trials are available through cancer doctors everywhere- not just in major cities or in large hospitals.
Some clinical studies try to determine if a therapeutic approach is safe and potentially effective. Many large clinical trials compare the more commonly used treatment with a treatment that cancer experts think might be better. Patients who participate in clinical trials help doctors and future cancer patients find out whether a promising treatment is safe and effective. All patients who participate in clinical trials are carefully monitored to make sure they are getting quality care. It is important to remember that clinical trials are completely voluntary. Patients can leave a trial at any time. Clinical trials testing new treatments are carried out in phases:
Only you can make the decision about whether or not to participate in a clinical trial. Before making your decision, it is important to learn as much as possible about your cancer and the clinical trials that may be available to you. Your radiation oncologist can answer many of your questions if you are considering taking part in a trial or contact the National Cancer Institute at 1-800-4-CANCER or www.cancer.gov.
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What Are Some Of The Possible Risks Or Complications
Minor complications include:
- Slight swelling of the breast during radiotherapy. This usually goes away within six to 12 months.
- The skin becomes darker during the course of radiotherapy, similar to tanning from the sun. In most cases, this also fades gradually over six to 12 months.
- Most women will have aches or pains from time to time in the treated breast or the muscles surrounding the breast, even years after treatment. The reason why this happens is not clear; however, these pains are harmless, although annoying. They are NOT a sign that the cancer is reappearing.
- Rarely, patients may develop a rib fracture years following treatment. This occurs in less than one percent of patients treated by modern approaches. These heal slowly by themselves.
More serious complications include:
Chemotherapy Vs Radiation: 10 Questions Every Patient Should Ask
Receiving a cancer diagnosis is life-changing. It can trigger feelings of anxiety, depression, and fear. Many patients feel overwhelmed by the many available treatment options and are afraid to make the wrong decision. While some rely solely on their oncologists recommendations, patients must be involved in choosing their course of treatment. This is especially true when youre comparing chemotherapy vs. radiation treatments.
Depending on the form of cancer you have and how aggressive it is, both treatment options may not be available to you. But because all cancers involve rapidly dividing cells, both treatments share the same objective: to cure, control, and reduce cancer as well as its symptoms. If youre not sure whether chemotherapy or radiation is right for you, here are 10 questions every patient should ask before embarking on a treatment plan.
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How Long Does Radiation Therapy Typically Last
With breast cancer, radiation therapy usually begins about 3 to 4 weeks after breast-conserving therapy or a mastectomy, according to the National Breast Cancer Foundation.
External beam radiation is typically given once a day, 5 days a week, for anywhere from 2 to 10 weeks on an outpatient basis. This means you can go home after the treatment.
Sometimes the schedule for external radiation can differ from the standard schedule. Some examples of this include the following:
- Accelerated fractionation. Treatment is given in larger daily or weekly doses, reducing the duration of the treatment.
- Hyperfractionation. Smaller doses of radiation are given more than once a day.
- Hypofractionation. Larger doses of radiation are given once daily to reduce the number of treatments.
For brachytherapy , treatments are usually given twice a day for 5 days in a row as outpatient procedures. Your specific treatment schedule will depend on what your oncologist has ordered.
A less common treatment option is to leave the radiation in your body for hours or days. With this type of treatment, youll stay in the hospital to protect others from the radiation.
Common side effects of external beam radiation therapy for breast cancer include:
- sunburn-like skin irritation in the treatment area
- dry, itchy, tender skin
- swelling or heaviness in your breast
Skin changes and changes to your breast tissue usually go away within a few months to a year.
This Consequence Can Affect The Breast And Other Parts Of The Body
Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.
In breast cancer treatment, radiation fibrosisscar tissue that forms as a result of damage caused by radiation therapycan occur in the breast and chest wall. It can also strike the lungs and bones. It often begins with inflammation during radiation therapy and is most common in the first two years post-treatment, though it can occur up to 10 years after therapy is completed.
Fibrosis is a potentially painful, life-long condition, as the tissue changes are permanent. However, you have a lot of options for treating it, including medications, physical therapy, and more.
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When Is Radiation Usually Used To Treat Stage 2 Breast Cancer
According to the American Cancer Society, radiation therapy may be used after a breast-conserving surgery, or lumpectomy, to mitigate the risk of cancer cells recurring in the same breast or nearby lymph nodes. After a mastectomy, an oncologist may determine that radiation is necessary if the tumor was larger than 5 cm, if there was lymph node involvement, or if cancer was found outside of surgical margins.
Planning Your Radiotherapy Treatment
You will have a hospital appointment to plan your treatment. You will usually have a CT scan;of the area to be treated. During the scan, you need to lie in the position that you will be in for your radiotherapy treatment.
Your radiotherapy team use information from this scan to plan:
- the dose of radiotherapy
- the area to be treated.
You may have some small, permanent markings made on your skin. The marks are about the size of a pinpoint. They help the radiographer make sure you are in the correct position for each session of radiotherapy.
These marks will only be made with your permission. If you are worried about them, talk to your radiographer.
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Radiation Therapy Is Painful
Radiotherapy patients should not experience any pain during the procedure, although some report a sense of warmth or tingling. Because the treatment affects fast-reproducing cells, both healthy and cancerous, it can cause some pain later on, generally due to skin irritation in the treated area. For most patients, this is fairly mild. For other patients, radiation therapy can be paused for a few days to allow the skin and other healthy cells to recover before continuing.
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Treat Breast Cancer Protect The Heart
Future heart risks should not be the reason to abandon this important component of treatment. I dont think by any means it should make anyone forego radiation for breast cancer therapy, says Dr. Javid Moslehi, instructor in the department of medicine at Harvard Medical School, and co-director of the cardio-oncology program at Brigham and Womens Hospital.
The ultimate goal is to minimize the exposure to the heart as much as possible, Dr. Taghian says.
In the JAMA study, researchers found that having a woman lie on her stomach during radiation treatment reduced her exposure. Dr. Taghian uses a technique called the breath-hold with his patients. Holding a breath expands the lungs, which pushes the heart out of the radiations path. This technique can cut radiation exposure to different structures of the heart by 54% to 96%.
Protecting women from the side effects of radiation is not a one-size-fits-all approach. I dont think there is one method to fit all patients, he says. The bottom line is we have to try the optimal method for each patient to avoid exposing the heart.
Proton therapya relatively new radiation treatment that uses particles instead of traditional x-rayscan also lower a womans exposure, but very few centers currently offer this treatment. In the future, this will probably be the dominant way to spare the heart, Dr. Taghian says.
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What Kind Of Treatment Follow
The major goal of follow-up is, if possible, to detect and treat recurrences in the irradiated breast or lymph nodes and new cancers developing later in either breast before they can spread to other parts of the body. Theroutine use of bone scans, chest x-rays, blood tests and other tests to detect the possible spread to other organs in patients without symptoms does not appear to be useful. Your physician will determine a follow-upschedule for you. This may include a physical exam every few months for the first several years after treatment and then every six to 12 months or so after that. Annual follow-up mammograms;are an important part of your care. If symptoms or clinical circumstances suggest a recurrence, diagnostic tests such as blood tests, ultrasound,computed tomography , magnetic resonance imaging;, chest x-ray , or bone scan may be needed.
Cancers Linked To Radiation Treatment
Lung cancer:;The risk of lung cancer is higher in women who had radiation therapy after a mastectomy as part of their treatment. The risk is even higher in women who smoke. The risk does not seem to be increased in women who have radiation therapy to the breast after a lumpectomy.
Sarcoma: Radiation therapy to the breast also increases the risk of sarcomas of blood vessels , bone , and other connective tissues in areas that were treated. Overall, this risk is low.
Certain blood cancers: Breast radiation is linked to a higher risk of leukemia and myelodysplastic syndrome . Overall, though, this risk is low.
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What Is Radiation Recall
Radiation recall is a rash that looks like a severe sunburn. It is rare and happens when certain types of chemotherapy are given during or soon after external-beam radiation therapy.
The rash appears on the part of the body that received radiation. Symptoms may include redness, tenderness, swelling, wet sores, and peeling skin.
Typically, these side effects start within days or weeks of radiation therapy. But they can also appear months or years later. Doctors treat radiation recall with medications called corticosteroids. Rarely, it may be necessary to wait until the skin heals before continuing chemotherapy.
Questions To Ask The Health Care Team
What physical side effects are likely based on my specific radiation therapy treatment plan? When will they likely begin?
How can these side effects be prevented or managed?
How can I take care of the affected skin during my treatment period?
Who should I tell when a side effect appears or gets worse?
Are there specific side effects I should tell the doctor about right away?
Who can I talk with if I’m feeling anxious or upset about having this treatment?
If I’m having side effects that affect my nutrition, can you recommend an oncology dietitian?
What are other ways I can take care of myself during the treatment period?
Are there any restrictions on exercising or other physical activity during this treatment?
Could this treatment affect my sex life? If so, how and for how long?
Could this treatment affect my ability to become pregnant or have a child? If so, should I talk with a fertility specialist before cancer treatment begins?
What are the potential long-term effects of this type of radiation therapy?
If I’m worried about managing the financial costs of cancer care, who can help me?
Will special precautions be needed to protect my family and others from radiation exposure during my treatment period?
After radiation therapy is completed, what will my follow-up care plan be?
Why is follow-up care important for managing side effects of treatment?
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