Follow Up To My Earlier Comments
Yesterday an older friend of mine was talking to me about radiation. Her daughter was one of my best friends, and she succumbed to cancer two years ago this past November. Anyhow, she said to me she has wondered why it was that radiation therapy was never an option suggested to her daughter when she first began her battle. Val had only one breast removed. She had chemo. That was it. A few years later, the cancer returned — initially to her bones.
I realize things change over the years, even as far as what DRs do and what they recommend. From what my surgeon was saying today when I mentioned the same thing to him, different DRs have different ideas as to what to do. My friend went to a different hospital, one with a reputable reputation in cancer treatments.
I say this to say that there are many good reasons to go through with the “complete” program, even if its purpose is preventative.
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Wishing you good luck too! Leeza |
Treating Stage Iii Breast Cancer
In stage III breast cancer, the tumor is large or growing into nearby tissues , or the cancer has spread to many nearby lymph nodes.
If you have inflammatory breast cancer: Stage III cancers also include some inflammatory breast cancers that have not spread beyond nearby lymph nodes. Treatment of these cancers can be slightly different from the treatment of other stage III breast cancers. You can find more details in our section about treatment for inflammatory breast cancer.
There are two main approaches to treating stage III breast cancer:
How Effective Is Radiation Therapy
If early-stage breast cancer hasnt spread, radiation therapy after a lumpectomy significantly reduces the risk of cancer coming back by approximately 50%. Studies show that a lumpectomy followed by radiation therapy is as effective as a mastectomy without radiation therapy.
People who undergo a lumpectomy have a 20% to 40% chance of the cancer coming back at 10 to 20 years. With the addition of postsurgical radiation therapy, that risk drops to 5% to 10%. However, there are some patients who derive less benefit from radiation including patients 65 years or older with small cancers.
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When Does Someone With Breast Cancer Get Radiation Therapy
The timing for radiation therapy depends on several factors. The treatment may take place:
- After a lumpectomy: A lumpectomy removes the cancerous tumor, leaving most of the breast. Radiation therapy lowers your risk of cancer coming back in the remaining breast tissue or nearby lymph nodes as well as reduces your chance of passing away of breast cancer.
- After a mastectomy: Most people dont get radiation therapy after a mastectomy . Your provider may recommend radiation if the tumor was larger than 5 cm ; if theres cancer in surrounding lymph nodes, skin tissue or muscle; or if all the cancer can’t be removed .
- Before surgery: Rarely, healthcare providers use radiation to shrink a tumor before surgery.
- Instead of surgery: Sometimes, providers use radiation therapy to shrink a tumor that they cant surgically remove . A tumor may be unresectable due to its size or location. Or you may not be a candidate for surgery because of concerns about your health.
- To treat cancer spread: Stage 4 breast cancer is cancer that spreads to other parts of the body. Your provider may use radiation therapy to treat cancer that spreads to other parts of the body.
If you had surgery, radiation therapy typically starts about one month after the incision heals if chemotherapy is not received. Some individuals receive chemotherapy after surgery, followed by radiation therapy. You may get the two treatments at the same time.
How Is Radiation Therapy For Breast Cancer Performed
Most people lie on their back during the treatment though some breast treatments are performed while lying on your stomach . You place your arm above your head .
During the treatment, your treatment team:
- Positions and secures your body in the immobilization device. If you had a mastectomy, your provider might place a bolus on top of the treatment area to increase the radiation dose to the surface.
- Lines up the machine with the first treatment field. To protect themselves from radiation exposure, providers leave the room. Your provider can still hear and see you.
- Turns on the machine. You will hear a whirring noise, but you wont see the radiation beams. You must remain still. Depending on the radiation type and dose, treatment can take 30 seconds to several minutes.
- Returns to the room to position the machine to treat a different treatment field. Most people get treatment on two to five fields each day.
- Takes daily/weekly X-rays of the treatment field to make sure the radiation is hitting the correct area.
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How Do I Prepare For My Treatments
Before your first radiation treatment, you will have a simulation appointment. This appointment will last approximately one to two hours. During this appointment, the doctor will identify the exact fields on your body to treat with radiation. This involves lying on a table while the radiation therapist marks the field with small dots made with permanent ink. Each dot is similar to a very small tattoo. You will not receive any radiation treatment during this appointment.
Does Everybody With Breast Cancer Have Radiotherapy
Not all women with breast cancer will be recommended to have radiotherapy. It is usually recommended, however, for women who have breast-conserving surgery . Radiotherapy is sometimes used following a mastectomy to target any cancer cells that may remain in the chest wall. If you are having chemotherapy as well as radiotherapy, you will usually have your chemotherapy treatment first.
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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.
How Long Can You Wait For Radiation After Lumpectomy
Radiation therapy usually begins three to eight weeks after surgery unless chemotherapy is planned. When chemotherapy is planned, radiation usually starts three to four weeks after chemotherapy is finished. You will likely get radiation therapy as an outpatient at a hospital or other treatment facility.
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Breast Cancer Radiation: The Routine
Expect daily weekday treatments for up to six weeks.In the intimidating trifecta of breast cancer treatmentsurgery, chemotherapy, and radiationmany women find radiation the easiest to deal with. The idea of having a strong dose of radiation beamed at your chest is no one’s idea of a good time, but as treatment goes, radiation is relatively painless and side effects are fewer and more manageable than ever before.
If external-beam radiation therapy is part of your breast cancer treatment, you’ll probably have a 20-minute session at a clinic or hospital every weekday for six or seven consecutive weeks. It will go something like this:
Day oneTo start off, you’ll be measured so that your radiation oncologist and his technicians will know exactly where to aim the radiation beam and how to calibrate the correct dosage. “We do a CAT scan of the breast, heart, and lungs just to see where the structures are,” says Jay L. Bosworth, MD, a radiation oncologist with the Nassau Radiologic Group in Manhasset, N.Y., and a Fellow of the American College of Radiology. “And we put tiny tattoo dotsthe size of a freckleon the breast” to ensure the radiation is delivered to the right spot every time.
Next Page: The treatment More about radiation
Do You Really Need Radiation Maybe Not
by Patient Expert
Way back in 2004, evidence surfaced that breast radiation after a lumpectomy wasn’t doing older women a whole lot of good. A decade later, nearly three-quarters of women over age 70 continue to receive radiation for early-stage breast cancer. Is this treatment really necessary?
Breast cancer is an older woman’s disease.
Despite the heavy media coverage of breast cancer battles fought by celebrities like Angelina Jolie, Christina Applegate, and Robin Roberts, the majority of women diagnosed with breast cancer are over age 60. Which isn’t surprising; the main risk factor for breast cancer, after being female, is growing older.
Thus it’s imperative that research news potentially affecting an enormous number of breast cancer survivors goes mainstream.
Sure, if there was a silver-bullet cure for cancer, we’d hear about it. A breast cancer vaccine? The media would be all over it. But how about data that could dramatically cut the cost of treatment, its risk, and its side effects, both temporary and permanent” wouldn’t you assume doctors would hear about the study, and use it to guide treatment decisions?
Apparently not. At least judging by the medical community’s response to a 2004 study showing that for women over 70 with early-stage breast cancer, radiation doesn’t increase either survival rate, nor decrease risk of cancer recurrence.
And that caution may be warranted. Who knows if those study results may change over the next 10 to 15 years?
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Preparing For External Beam Radiation Therapy
Before your treatment starts, the radiation team will carefully figure out the correct angles for aiming the radiation beams and the proper dose of radiation. They will make some ink marks or small tattoos on your skin to focus the radiation on the right area. Ask your health care team if the marks they use will be permanent.
External radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, but the setup timegetting you into place for treatmentusually takes longer.
Being Careful When Showering Or Bathing
A person should use warm rather than hot water, and avoid letting the spray from the showerhead directly hit the treatment area.
The National Cancer Institute notes that a person can shower daily. However, if they prefer bathing, they should do this every other day and avoid soaking for long periods of time.
They should avoid strong or fragranced soaps, and opt for gentle, fragrance-free, moisturizing soaps specifically for sensitive skin.
People should cleanse gently, and avoid scrubbing with loofahs or wash cloths, then, when done, use a soft towel to pat themselves dry..
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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.
Is Radiation Necessary For All Patients With Node Negative Disease
Researchers are evaluating whether eliminating radiation in several groups of women is ongoing but inconclusive at this time. For example doctors are trying to determine if women over 70 years who have hormone receptor-positive, HER2-positive disease or those with luminal A breast cancer can avoid radiation altogether.
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Treatment Of Breast Cancer Stages I
The stage of your breast cancer is an important factor in making decisions about your treatment.;
Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of drug therapy. In general, the more the breast cancer has spread, the more treatment you will likely need.;But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:
- If the cancer cells contain hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
- If the cancer cells have large amounts of the HER2 protein
- How fast the cancer is growing
- Your overall health
- If you have gone through menopause or not
Talk with your doctor about how these factors can affect your treatment options.
The Nitty Gritty Of Radiation
Do you know, technically speaking, what radiation therapy is? I didnt, until I started treatment. Radiation therapy uses high-energy rays to kill cancer cells. Unlike chemo, which affects your whole body, radiation affects cells only in the part of the body that is being treatedin this case, the breast or armpit area.
You might be wondering why you need radiation, if you already had chemo. Its basically used to destroy undetectable cancer cells and reduce the risk of cancer recurring. A radiation nurse explained it to me in this way: Think of chemo like using a sprinkler on your breast cancer. It treats everythingon the surface and inside, healthy and unhealthy tissue. Think of radiation like weed killer, targeting specific things below the surface that cant be seen.
Youll usually start radiation three to four weeks post-surgery. It is administered daily by a radiation oncologist at a radiation center for four to six weeks. Youll either get external beam radiation, where cancer-killing rays are delivered by a large machine, or internal radiation, a newer treatment that injects radioactive cancer-killing treatments into the affected area. I received the first one.
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How Physicians React To Findings
Have these findings changed the way physicians treat this subset of patients?
Not much.
There was some change, mainly in the oldest and sickest patients, but 60 percent of patients older than age 80 still receive radiation, said Shumway. My goal with this study was to investigate how physicians view the option of omitting radiotherapy, with the goal of understanding more about why practice patterns havent changed.
Until now, no one had asked them.
What If Cancer Is Detected In The Lymph Nodes
If you have lymph node positive breast cancer, it is likely you will be offered chemotherapy. Premenopausal women and those with multiple positive lymph nodes generally benefit from chemotherapy. If your breast surgeon detects cancer in your lymph nodes before surgery, there may be specific advantages to undergoing neoadjuvant chemotherapy.
If you have lymph node positive cancer and are elderly or not healthy enough to tolerate the side effects of chemotherapy, you may conclude that the risks of chemotherapy outweigh its benefits. These situations vary greatly from person to person. A detailed discussion with your medical oncologist is essential to make the best decision for yourself or a loved one.
Some women who have an early stage, lymph node positive breast cancer may meet the criteria to consider genomic testing of a sample of their tumor to see if they might be able to avoid chemotherapy. This is a rapidly evolving field in breast cancer. Ask your medical oncologist if a node positive genomic assay is appropriate for your unique cancer situation.
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Radiotherapy To The Lymph Nodes
Radiotherapy can be given to the lymph nodes under the arm to destroy any cancer cells that may be present there.
It may also be given to the lymph nodes in the lower part of the neck around the collarbone, or in the area near the breastbone .
If radiotherapy to the lymph nodes is recommended, your specialist will explain why.
Are Some Therapies More Effective Based On Stage
The type of radiation treatment you get depends on the stage of breast cancer. People with early to stage 3 breast cancer will benefit most from radiation treatment. Radiation can also help ease side effects in people with advanced breast cancer.
External whole breast radiation works best:
- for early stage to stage 3 breast cancer
- for tumors that are an inch or smaller
- if the cancer is in one spot
- if you had breast-saving surgery or a mastectomy
External beam radiation can also help treat side effects of advanced breast cancer.
Internal radiation works best:
- for early stage breast cancer
- if the cancer is in one spot
- if you had breast-saving surgery or a mastectomy
Sometimes, a person with advanced breast cancer will have internal radiation.
Intraoperative radiation works best:
- during early stage breast cancer
- when the tumor is too close to healthy tissue for external radiation to be possible
Not everyone can have intraoperative radiation or internal beam radiation. Whether you can have these procedures depends on:
- size and location of the tumor
- size of your breast
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