the ins and outs of breast cancer and radiation oncology

Is it Right for You?

Radiation therapy (or radiotherapy) often follows surgery, like a lumpectomy or mastectomy. The process is meant to target cancer cells that may be left after the surgery. Radiation is very safe and very effective, which is why it is used often. However, it is never appropriate for a woman who is pregnant. Radiation is also not typically used if you have already had radiation in that area previously, if you have a connective tissue disease (for example, scleroderma or vasculitis), or if the daily commitment is too much.

Typically, the radiation treatment following a lumpectomy (tumor removal) will target the whole breast. A lumpectomy and radiation is usually recommended to patients with cancer in its early stages, a tumor that is 4 centimeters or smaller, located just on one side, and is removed with clear margins.

Mastectomies remove the entire breast, though it’s difficult to remove every cell of breast tissue. Therefore, many doctors will recommend radiation after the mastectomy to be sure there’s a smaller chance of recurrence. A mastectomy and radiation is usually recommended to patients with cancer equating 5 centimeters or larger (including one large lump or several smaller lumps), cancer invading lymph channels or blood vessels, removed tissue with a positive margin or resection, infected lymph nodes or skin. Breast cancer statistics show that radiation can help reduce the risk of recurrence by 70%.

How Does it Work?

Radiation therapy finds and kills invasive breast cancer cells, typically found near the breast and armpit area. The treatment is used to target and destroy undetectable cancer cells and reduce the risk of recurrence. There are two kinds of radiation: External Beam Breast Cancer Radiation and Internal Breast Cancer Radiation.

The external beam is the traditional way involving a large machine, similar to an x-ray. The beam targets cancer cells for 2-3 minutes and involves multiple appointments in an outpatient center.

The internal radiation is a newer treatment that injects the radiation into the affected area, so only part of the breast, typically. The doctor may use needles, wires, or a catheter to inject the radiation.

What Are the Side Effects?

According to Susan G. Komen, there are a number of radiation effects to be aware of.

In the short term, you should give your body a chance to get used to the radiation. Many patients report having subsiding symptoms as treatment goes on for a few weeks. However, in the beginning, you should be prepared for breast soreness, redness (like a sunburn), and swelling. The skin may also peel (again, like a sunburn), so talk to your doctor about a cream you can use.

While fatigue is also common, other symptoms usually associated with radiation (like nausea and hair loss) are not common with breast cancer radiation. Hair loss may occur, however, near the underarm. In breast cancer for men, hair loss may also occur on the chest.

In the long term, women may experience firmness or shrinkage to their breasts. Lymphedema (swelling due to fluid collection) is also a concern in patients who received radiation therapy to their lymph nodes.

More extreme (and unlikely) side effects include rib fractures, heart problems (which may still occur years after treatment finishes, so stay up to date with your cardiologist), radiation pneumonitis (lung inflammation), and brachial plexopathy (nerve damage in the upper chest).

Make sure you stay open and honest with your doctor about how you’re feeling and what your next steps should be. You don’t want to come off “too tough” for something that ends up growing into a bigger problem. Most of these side effects are easily managed, so let your doctor help you.

Written by: Joanna Hynes

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