Thanks to mammograms and careful breast exams, most women in South Dakota who are diagnosed with breast cancer have the option of treatment without undergoing a mastectomy (removal of the entire breast). For the majority of women who are treated with breast preservation, their treatment will involve both surgery and radiation therapy. While there are now different types of radiation treatment that can be used in the treatment of early breast cancer, in this blog post I will focus on the most commonly used type of radiation treatment for early breast cancer, which is external beam radiation therapy.
The process of deciding a treatment plan for a woman diagnosed early with breast cancer usually goes something like this:
- A woman decides, with the help of her breast surgeon, if she desires to preserve the breast the cancer was found in. If she does want to try to preserve this breast, the surgeon will normally recommend removal of the breast tumor along with a small rim of surrounding normal-appearing breast tissue.
- This procedure (lumpectomy) is normally done along with a sampling of the lymph nodes under the arm. This lymph node sampling is generally referred to as a sentinel lymph node biopsy.
- After the surgery is performed, the woman will again meet with her surgeon to discuss the results. If the removal of the tumor went well and no further surgery is recommended, the surgeon will normally make arrangements for the patient to see a medical oncologist and a radiation oncologist.
- The medical oncologist will tell the patient whether there are any medications that she should take in order to lower her risk of breast cancer recurrence.
- The woman will meet with a radiation oncologist to discuss the plan for radiation treatment. Radiation treatment is given to lower the risk of cancer recurrence in the breast. External beam radiation therapy is usually given over six to seven weeks, five days per week.
- Radiation therapy is started about a month after the last received dose of chemotherapy. If chemotherapy is not needed, then radiation therapy can be planned and started as soon as the woman has healed sufficiently from her surgery.
Treatment planning for radiation therapy is pretty easy for patients. Often a custom device is made to hold the patient’s arms above her head in the same position every day for treatment. The patient is then placed on an inclined board that is on the CT scan table with her arms above her head in the custom mold. CT images are then obtained of the entire breast to be treated as well as the entirety of the lungs. These images are then transferred to a special treatment planning computer. The radiation oncologist and a specially trained radiation treatment planner carefully plan the radiation beams’ sizes, shapes and intensities so that the right doses are delivered to the areas that the radiation oncologist wishes to treat. Normally, the initially treated area includes the entire breast. Additional radiation treatments are then delivered only to the part of the breast from which the tumor was removed. These are often called “boost” treatments and are usually given after the treatment to the whole breast is completed.
Once the treatment planning process has been completed, treatment can begin. Usually treatment for early breast cancer takes only a few minutes per day. The treatment is not painful. It is actually fairly easy for most patients. Patients are not radioactive as a result of this treatment. I tell many of my breast cancer patients that this type of treatment is actually one of the easiest forms of external beam radiation treatment to receive. Most women who are working at the time that their radiation treatment begins continue to work right through their radiation treatment. Some common side effects are tiredness, skin redness or peeling and mild discomfort. Most women will be seen weekly by their radiation oncologist and their radiation oncology nurse. At the time of these visits, treatment-related symptoms are discussed and care recommendations are made. Although there are some serious possible late side effects of radiation therapy that are important for patients to understand, most patients never experience any of these.
About once a month after the completion of radiation treatment, patients are seen by their radiation oncologists for a follow-up visit. The purpose of this visit is to discuss the management of any side effects that a woman may be experiencing and to educate her about the care for her breast cancer that she will need to receive after the completion of radiation therapy. I stress to women that they should get regular mammograms and do regular breast self-examinations. Often overall prognosis for most women with breast cancer is good when caught early. Our goal at Avera Sacred Heart Cancer Center is for our patients to return to all of the things that they were doing in their pre-diagnosis personal and professional lives as soon as possible.