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 Women with breast cancer
are often treated with a combination of surgery, chemotherapy or hormone
therapy, and radiation therapy. The decision to use chemotherapy or
hormone therapy is made with a medical oncologist, and addresses the
risk of systemic (whole body) spread, or even involvement of the other
breast, in addition to the tumor diagnosed. The decision to use surgery
and potentially radiation therapy addresses the risk of local recurrence,
in the breast or adjacent lymph nodes only.
Many women who present with early stage breast cancer have a choice
of either breast conservation or mastectomy. Breast conservation
involves the removal of the cancerous lump followed by external beam
radiation to the breast. The most appropriate choice is a complex
and personal decision which should be discussed with your doctor. Click
to find further information regarding the use of breast conserving therapy
What is External Beam Radiation
Therapy?What is 3-D conformal
therapy and why is it Better?
Conformal therapy allows for the customized treatment of each individual.
Every woman has a unique size and shape of breast, and this therapy
allows the minimum amount of heart and or lung to be irradiated.
When breast cancer is found early, “breast conservation therapy “-lumpectomy rather than a mastectomy- may be possible. MammoSite is a Targeted Radiation Therapy that may be used following lumpectomy to help keep cancer from coming back. Instead of the usual 6 ½ weeks of daily radiation treatment, treatment is completed in only 5 treatment days.
MammoSite uses a small, soft balloon attached to a thin catheter (tube) that is placed inside the lumpectomy cavity in the breast. To deliver the radiation, a tiny source of radiation called a seed is placed within the MammoSite balloon by a computer controlled machine. After each treatment the seed is removed and the catheter remains for the next treatment. After 5 days of treatment, the catheter is removed and the area is closed with a small bandage. Most women say they feel little or no discomfort during or after the device is removed. Your doctor will carefully evaluate your cancer to determine if you are a candidate for this advanced treatment.
Most patients do very well during and after radiotherapy. There is
some mild fatigue that occurs during the treatment, and resolves. Skin
redness and irritation of the breast is expected, and usually occurs
halfway through a typical 6 week course of radiotherapy, resolving
completely a few weeks after finishing. The only common long-term side
effect is a mild difference in the cosmetic appearance of the
breast ( firmness, swelling). There a few rare side effects that are
minimized further by three dimensional conformal therapy. More info
Despite having had a mastectomy, some patients benefit from radiation
to the chest wall region. The patients most likely to benefit are those
with original tumors >4 cm in size, or with >3 axillary lymph
nodes involved by tumor . However, newer data is implying that any
women with positive lymph nodes after mastectomy should be considered
for radiotherapy to prevent local/regional recurrence or even improve
survival.Locally Advanced Breast Cancer
Most patients with locally advanced breast cancer are not candidates
for breast conservation therapy. They usually are treated with
a combined approach with chemotherapy, mastectomy and radiation to
the chest wall. Some patients may be treated with chemotherapy first,
to shrink the tumor, and possibly avoid mastectomy. There are
early results to suggest this may be appropriate for certain women. Treatment
is therefore highly tailored to each specific case and the sequence
of how each modality is applied can vary.
This is a selective estrogen receptor modulator that can be used
to prevent recurrence of breast cancer as well as prevention of formation
of new breast cancers in many patients. A patient's age, tumor
size, and estrogen receptor status all determine whether or not a patient might
benefit from the use of tamoxifen. The benefits and risks of tamoxifen
are usually discussed with a Medical Oncologist.
Chemotherapy is delivered by a medical oncologist as is a systemic
treatment - meaning it is designed to treat cancer cells throughout
the body. Recommendations regarding which women should receive
chemotherapy, the specific agents and their duration of use are constantly
being modified when new information becomes available.
A patient's age, tumor size, and cell characteristics determine whether
she should receive chemotherapy. Side effects vary by which chemotherapy
drugs are utilized. The role of chemotherapy and the potential
side effects should therefore be discussed with a medical oncologist.
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