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Why Radiation After Chemo For Breast Cancer

How Does Radiation Therapy Work / What Is Radiotherapy

Chemotherapy? Radiation? Surgery for Breast Cancer? When for each.

Radiation therapy, or radiotherapy, is the use of various forms of radiation to safely and effectively treat cancer and other diseases. Radiation oncologists may use radiation to cure cancer, to control the growth of the cancer or to relieve symptoms, such as pain. Radiation therapy works by damaging cells. Normal cells are able to repair themselves, whereas cancer cells cannot. New techniques also allow doctors to better target the radiation to protect healthy cells.

Sometimes radiation therapy is the only treatment a patient needs. At other times, it is only one part of a patients treatment. For example, prostate and larynx cancer are often treated with radiotherapy alone, while a woman with breast cancer may be treated with surgery, radiation therapy and chemotherapy.

Radiation may also be used to make your primary treatment more effective. For example, you can be treated with radiation therapy before surgery to help shrink the cancer and allow less extensive surgery than would otherwise be needed or you may be treated with radiation after surgery to destroy small amounts of cancer that may have been left behind. A radiation oncologist may choose to use radiation therapy in a number of different ways. Sometimes the goal is to cure the cancer. In this case, radiation therapy may be used to:

  • Shrink tumors that are interfering with your quality of life, such as a lung tumor that is causing shortness of breath.
  • Relieve pain by reducing the size of your tumor.

Starting With Neoadjuvant Therapy

Most often, these cancers are treated with neoadjuvant chemotherapy . For HER2-positive tumors, the targeted drug trastuzumab is given as well, sometimes along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.

Often, radiation therapy is needed after surgery. If breast reconstruction is done, it is usually delayed until after radiation is complete. In some cases, additional chemo is given after surgery as well.

After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. For people with hormone receptor-positive cancer in the lymph nodes who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral drug called neratinib for a year.

What Should I Expect On My First Visit

When radiation therapy might be of help, a family doctor, surgeon or medical oncologist will refer patients to a radiation oncologist.

The doctor will first review your medical records and X-rays. A physical exam will be done.

The doctors will then talk to you about his/her findings and decide how you should be treated. If radiation will help you, the staff will schedule the needed studies to develop a treatment plan. This is sometimes referred to as simulation.

During simulation, the therapist takes X-rays of the part of your body to be treated to help decide how the radiation will be given. Using the X-ray as a guide to the treatment site, the therapist uses a marker to outline the treatment area on your skin. This area is often called a treatment port or treatment field. These marks are very important. They act as a map of the treatment area and the therapist uses them each day to guide your treatment. Sometimes after a few treatments, tiny permanent dots can be used to replace the painted marks on your skin.

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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
  • Fatigue

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:

Physical Emotional And Social Effects Of Cancer

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In general, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

  • Music therapy, meditation, stress management, and yoga for reducing anxiety and stress.

  • Meditation, relaxation, yoga, massage, and music therapy for depression and to improve other mood problems.

  • Meditation and yoga to improve general quality of life.

  • Acupressure and acupuncture to help with nausea and vomiting from chemotherapy.

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What Are Late Effects

Most women have side effects during treatment for breast cancer and for a few weeks after treatment ends. Usually, these side effects get better slowly and then stop. But sometimes side effects do not go away. Or they can develop months or years after treatment.

There are two commonly used terms for these side effects:

  • Long-term effects Long-term effects begin during, or shortly after, treatment. They last for more than 6 months after treatment has finished. They may go away on their own, with symptoms getting better over 1 or 2 years after treatment. Or they may be permanent.
  • Late effects Late effects are a delayed reaction to treatment. They do not appear during treatment, but can happen months or even years later.

In this information, we use the term late effects to describe both long-term and late effects.

How Can I Make A Decision Between Mastectomy And Breast Conservation Therapy

Breast conservation therapy is often used for patients with early-stage invasive breast cancers . It is also used for patients with DCIS . Some of the reasons to not have breast conservation therapy include: personal preference increased risk of complications from radiation therapy in individuals with certain rare medical conditions such as certain autoimmune disorders surgery that would require removing a large amount of diseased breast tissue that would lead to a poor cosmetic result and tumors that are more likely than average to have a relapse in the breast with breast conservation therapy.

Most patients may choose a treatment based on other factors, such as convenience or personal preference . Most women prefer to keep their breast if this is possible to do safely, but there is no right answer that is best for everyone. This decision is one that is ideally made in partnership between a patient and her physician. In some cases a pre-surgical consultation with a radiation oncologist may be helpful in answering questions about breast-conserving therapy.

Nearly all physicians will recommend patients be treated with mastectomy instead of breast conservation therapy when the risk of recurrence in the breast is more than 20 percent. This is the case if the tumor is large or multifocal . This situation occurs for only a small number of women, however.

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Radiation For Breast Cancer

Radiation therapy is treatment with high-energy rays that destroy cancer cells. Some women with breast cancer will need radiation, in addition to other treatments. Radiation therapy is used in several situations:

  • After breast-conserving surgery , to help lower the chance that the cancer will come back in the same breast or nearby lymph nodes.
  • After a mastectomy, especially if the cancer was larger than 5 cm , if cancer is found in many lymph nodes, or if certain surgical margins have cancer such as the skin or muscle.
  • If cancer has spread to other parts of the body, such as the bones or brain.

The main types of radiation therapy that can be used to treat breast cancer are external beam radiation therapy and brachytherapy.

Working During Radiation Therapy

Radiation Duration After Neoadjuvant Chemotherapy & Mastectomy

Some people are able to work full-time during radiation therapy. Others can work only part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect from the treatment you will have.

You are likely to feel well enough to work when you first start your radiation treatments. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished treatment, it may take just a few weeks for you to feel betteror it could take months.

You may get to a point during your radiation therapy when you feel too sick to work. Talk with your employer to find out if you can go on medical leave. Check that your health insurance will pay for treatment while you are on medical leave.

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Other Ways Of Giving Radiotherapy

Intraoperative radiotherapy

Intraoperative radiotherapy uses low-energy x-rays given from a machine in the operating theatre during breast-conserving surgery.

Radiotherapy is given directly to the area inside the body where the cancer was, once it has been removed. Usually a single dose of radiation is given in one treatment, but it may be necessary to have a short course of external beam radiotherapy to the rest of the breast.

Intraoperative radiotherapy is not suitable for everyone and is not standard treatment.

Brachytherapy

Brachytherapy involves placing a radiation source inside the body in the area to be treated. Its usually only given as part of a clinical trial.

Narrow, hollow tubes or a small balloon are put in the body where the breast tissue has been removed. Radioactive wires are inserted through the tubes or into the balloon. The radioactive wires may be left in place for a few days or inserted for a short time each day.

Depending on the type of brachytherapy you have, you may need to have your treatment as an inpatient and be kept in a single room for a short time due to the radiation.

If brachytherapy is an option your specialist will discuss it fully with you.

What Are The Different Kinds Of Radiation

The goal of radiation therapy is to get enough radiation into the body to kill the cancer cells while preventing damage to healthy tissue. There are several ways to do this. Depending on the location, size and type of cancer, you may receive one or a combination of techniques. Your treatment team will help you to decide which treatments are best for you. Radiation therapy can be delivered in two ways, externally and internally. During external beam radiation therapy, the radiation oncology team uses a machine to direct high-energy X-rays at the cancer. Internal radiation therapy, or brachytherapy, involves placing radioactive sources inside your body.

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Radiotherapy To Part Of The Breast

Less commonly, some women are given radiotherapy to part of the breast instead of the whole breast. There are different ways of doing this.

Your cancer doctor or specialist nurse will explain if any of the following treatments are options for you. They will tell you what the possible side effects are and any risks involved.

It is important to have information about all your treatment options. They can explain how these treatments compare with external radiotherapy.

Local Recurrence After Mastectomy

Breast Cancer Radiation Therapy Burns

Even though the entire breast is removed in a mastectomy, breast cancer can still return to the chest area. If you notice any changes around the mastectomy scar, tell your health care provider.

The more lymph nodes with cancer at the time of the mastectomy, the higher the chances of breast cancer recurrence.

Local recurrence after a mastectomy is usually treated with surgery, and radiation therapy if radiation therapy wasnt part of the initial treatment.

Treatment may also include chemotherapy, hormone therapy and/or HER2-targeted therapy.

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Follow Up Care After Breast Cancer Treatment

Many women are relieved or excited to be finished with breast cancer treatment. But it can also be a time of worry, being concerned about the cancer coming back, or feeling lost without seeing their cancer care team as often.

For some women with advanced breast cancer, the cancer may never go away completely. These women may continue to get treatments such as chemotherapy, hormone therapy, or other treatments to help keep the breast cancer under control and to help relieve symptoms from it. Learning to live with breast cancer that doesnt go away can have its own type of uncertainty.

Even if you have completed breast cancer treatment, your doctors will want to watch you closely. Its very important to go to all of your follow-up appointments. During these visits, your doctors will ask if you are having any problems, and will probably examine you. Lab tests and imaging tests aren’t typically needed after treatment for most early stage breast cancers, but they might be done in some women to look for signs of cancer or treatment side effects.

Keeping Health Insurance And Copies Of Your Medical Records

Even after treatment, its very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

At some point after your treatment, you might find yourself seeing a new doctor who doesnt know about your medical history. Its important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.

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Why Are People Offered Chemotherapy

Chemotherapy is given to reduce the risk of breast cancer coming back in the future. It uses anti-cancer drugs to destroy cancer cells.

It is most commonly given after surgery.

Some people wonder why they need chemotherapy if theyve already had surgery to remove their cancer. Whether someone is offered chemotherapy depends on a number of features of their cancer. These include the size and grade of the cancer whether it has spread to any of the lymph nodes under the arm and whether the cancer is hormone receptor and HER2 positive or negative.

For some people the benefit is clear, but for others its less certain. This is why cancer specialists may use a test, like the one described above, to help estimate the benefit.

Because it affects cells throughout the body, chemotherapy can cause side effects including sickness, hair loss and an increased risk of infection.

What Are The Key Differences Between Chemotherapy And Radiation

TIMING OF CHEMOTHERAPY AND RADIATION FOR BREAST CANCER: How to Know Which Treatment Comes First

The major difference between chemo and radiation is the way theyre delivered.

Chemotherapy is a medication given to treat cancer thats designed to kill cancer cells. Its usually taken by mouth or given through an infusion into a vein or medication port.

There are many different types of chemotherapy drugs. Your doctor can prescribe the type thats most effective at treating your specific type of cancer.

Chemotherapy can have many side effects, depending on the type that youre getting.

Radiation therapy involves giving high doses of radiation beams directly into a tumor. The radiation beams change the DNA makeup of the tumor, causing it to shrink or die.

This type of cancer treatment has fewer side effects than chemotherapy since it only targets one area of the body.

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How Should I Care For Myself During Radiation Therapy

  • Get plenty of rest. Many patients experience fatigue during radiation therapy, so it is important to make sure you are well rested. If possible, ask friends and family to help out during treatment, by running errands and preparing meals. This will help you get the rest you need to focus on fighting your cancer.
  • Follow doctor’s orders. In many cases, your doctor will ask you to call if you develop a fever of 101° or higher. Be sure to read your instructions as far as caring for yourself during treatment.
  • Eat a balanced, nutritious diet. A dietitian, nurse or doctor may work with you to make sure you are eating the right foods to get the vitamins and minerals you need. With certain types of radiation, you may need to change your diet to minimize side effects. You should not attempt to lose weight during radiation therapy since you need more calories due to your cancer and treatment.
  • Treat the skin that is exposed to radiation with extra care. The skin in the area receiving treatment may become red and sensitive, similar to getting a sunburn. Your radiation oncology nurse will review specific instructions for caring for your skin with you. Some guidelines include:
  • Clean the skin daily with warm water and a mild soap recommended by your nurse.
  • Avoid using any lotions, perfumes, deodorants or powders in the treatment area unless approved by your doctor or nurse. Try not to use products containing alcohol and perfumes.
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