Breast Cancer Radiation Therapy and Chemotherapy

by National Cancer Institute

(Page 6 of 9)

Radiation Therapy

A lumpectomy usually is followed by radiation therapy. During radiation therapy, high-energy x-rays are used to destroy cancer cells that still may be present in the affected breast or in nearby lymph nodes. Radiation therapy is sometimes used to shrink tumors before surgery. Doctors sometimes use radiation therapy along with chemotherapy, before or instead of surgery, to destroy cancer cells and shrink tumors.

In radiation therapy after a lumpectomy 14, a machine delivers radiation to the affected breast and, in some cases, to the lymph nodes under the arm or at the collarbone (clavicle). The usual schedule for radiation therapy is 5 days a week for 5 to 6 weeks. The actual treatment, given by a radiation therapist, takes only a few minutes each day. Sometimes an additional "boost" or higher dose of radiation is given to the area where the cancer was found.

During your first visit for radiation treatment planning, your chest area will be marked with ink or with a few long-lasting tattoos. These marks must stay on your skin during the entire treatment period because they show exactly where the radiation will be given. Your radiation oncologist will plan your specific treatment based on a physical exam, mammograms, pathology and lab reports, and your medical history. Doctors carefully limit both the intensity of each treatment and the area being treated so that the least amount of normal tissue will be affected. Throughout your therapy, your radiation oncologist will check on the effects of your treatment, and you will have regular physical exams and blood tests to check your general health. To get the full benefit from radiation therapy, you need to complete all your treatments as scheduled.

POSSIBLE PROBLEMS: Feeling more tired than usual; skin problems such as itchiness, redness, soreness, peeling, darkening, or shininess of the skin; or decreased sensation in the breast. Radiation to the breast does not cause hair loss, vomiting, or diarrhea.

Long-term changes may include changes in the shape and color of the treated breast or a feeling of heaviness in the breast. Once a breast has been irradiated, it cannot be irradiated again. Any local recurrence or new tumor would have to be treated by mastectomy.

Radiation Therapy After Mastectomy

There are times when radiation therapy is used after a mastectomy. 15 It may be used if:

• The tumor is larger than 2 inches.
• Cancer is found in many lymph nodes under the arm.
• The tumor is close to the rib cage or chest wall muscles.

QUESTIONS TO ASK YOUR RADIATION ONCOLOGIST You will have time during your radiation treatment planning session and the daily treatments to ask questions and talk about your concerns. You may want to ask: What benefit will I get from radiation therapy? What are the side effects? What are the risks? When will my treatment begin? What is the schedule? When will treatment end? What should I do to prepare for each treatment? Who will give the actual radiation treatment? How long will each session take? What will happen during each treatment? Will I feel anything? How do I care for myself during the weeks of therapy? What side effects should I report to you? How will we know the treatment is working successfully? How will my breast look and feel when radiation therapy is completed? Will I be able to drive to and from the radiation center alone? Are there any restrictions to my normal activities? How long will I have to protect the irradiated skin from the sun? Will I need followup care? What if I don't have radiation therapy?

Chemotherapy

Research suggests that, even if a lump is small, cancer cells may have spread outside the breast. Doctors can use chemotherapy drugs to destroy cancer cells. Some chemotherapy drugs work better when combined with other chemotherapy drugs than when used alone.

The oncologist will recommend a treatment plan according to your individual case. The treatment will depend on your age, whether or not you still are having periods, the risk for spread or recurrence, and your general health. The drugs you take will depend on the type and stage of cancer, where it is located, how much or how fast it has grown, and how it is affecting you. Chemotherapy is used to:

• Decrease the chances that cancer will come back after breast cancer surgery.
• Shrink breast cancer before surgery, when the tumor is large or it is inflammatory cancer.
• Control the disease when breast cancer is found in the lungs, bones, liver, brain, or other parts of the body.

Chemotherapy drugs travel throughout the body to slow the growth of cancer cells or kill them. Often, the drugs are injected into the bloodstream through an intravenous (IV) needle needle that is inserted into a vein. Some drugs are given as pills. Treatment can be as short as a few months or as long as 2 years.

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