There are several types of breast cancer treatment options available today thanks to years of ongoing breast cancer research. Here are some of the most common treatments.
A breast cancer treatment plan is created for each patient, specific to their type, stage and overall health condition. Your medical oncologist will work closely with the surgeon and radiation oncologists who will also be a part of many patients’ treatment program.
Most patients with breast cancer have surgery to remove the cancer. Types of surgery include the following:
Breast-sparing surgery: An operation to remove the cancer and some normal tissue around it, but not the breast itself. Part of the chest wall lining may also be removed if the cancer is near it. This type of surgery may also be called lumpectomy, partial mastectomy, segmental mastectomy, quadrantectomy, or breast-conserving surgery.
Mastectomy: Surgery to remove the whole breast that has cancer. Some of the lymph nodes under the arm may be removed and checked for cancer as well. In some cases, a skin-sparing mastectomy may be an option. For this approach, your surgeon removes as little skin as possible. Some women may also get a double mastectomy in which both breasts are removed.
Some patients may receive some treatment before surgery such as chemotherapy to help shrink the tumor before it’s removed.
After surgery for breast cancer, some women may choose breast reconstruction. It may be done at the same time as the cancer removal surgery or later.
Patients are often referred to receive radiation therapy at some point during their care, quite often right after surgery to be sure any left over breast cancer cells in the area are killed. You have a choice as to where you go. Talk to your medical oncologist about where you’d like to receive state of the art radiation therapy that’s also conveniently located near your home in the greater Atlanta region and surrounding areas including Athens and Augusta.
There are two types of radiation therapy used to treat breast cancer:
External radiation therapy
Internal radiation therapy
With external beam radiation, the radiation comes from an x-ray machine called a linear accelerator. To begin the treatment process, you will go through a planning session called a simulation. Those CT images are used to identify areas where treatment is needed and also areas that need to be protected, like the heart and lung. Your radiation oncologist will design and calculate a treatment plan tailored to your anatomy and the specifics of your breast cancer.
The radiation oncologist may use various planning techniques including IMRT (Intensity Modulated Radiation Therapy), 3D (three dimensional) or DIBH (Deep Inspiratory Breath Hold) to protect your organs. Once the plan is ready, you will undergo a practice session called a verification simulation to confirm your daily treatment setup.
Once the treatment begins your setup will be verified daily to ensure that the radiation is delivered to precisely the right place every time. IGRT (image-guided radiotherapy) may be utilized for the daily verification process. Treatments are delivered 5 days a week for 4 to 6 weeks. The treated area typically includes the whole breast and possibly the draining lymph nodes followed by treatment targeted to the lumpectomy cavity or mastectomy scar.
Hypofractionated radiation is external beam radiation that delivers the total dose of radiation in a shorter period of time. Clinical trials have proven hypofractionation to be just as safe and effective as conventional radiation therapy. Slightly larger doses are given during each treatment session so that the total number of days required to complete the course of treatment is shorter.
Hypofractionated radiation for breast cancer is delivered daily for 3-4 weeks. The standard treatment includes 42.5 Gray(Gy) over 16 daily fractions, the dosage may vary for each patient. The average daily treatment takes 30 minutes which includes time for check-in and out. Ask your radiation oncologist if you are a candidate for hypofractionated breast radiation therapy.
Side effects from radiation treatment can vary, but there are some common side effects to watch for and talk to your oncologist and radiation technician who you will see often. They can often help you with treating the side effects and minimizing their effects. Since radiation is a targeted therapy side effects are limited to the treatment areas and not the entire body.
Common side effects of external radiation for breast cancer include:
Tenderness to the touch, especially in the area where the radiation beam is pointed
Red, dry, tender, or itchy skin similar to a sunburn. Your health care team may advise you to avoid exposing the treated skin to the sun since it could make the skin changes worse
Swelling, which may feel like breast “heaviness”
General fatigue, even after your treatments are complete
Accelerated partial breast irradiation (APBI) is a high-dose internal radiation therapy which may be an option for patients with early-stage breast cancer.
APBI involves the surgeon implanting a thin, hollow tube called a catheter into the breast. This surgery is typically the second one, scheduled after the lumpectomy and confirming that the margins around the lumpectomy are clear of cancer cells.
At the end of the catheter, a balloon or multiple smaller catheters are expanded to fill the lumpectomy cavity. Once the catheter has been placed, there is a treatment planning session called a CT simulation. The CT images collected during the planning process are used to identify where the treatment is needed and areas that will need to be protected, like your chest wall and skin. Your radiation oncologist will design and calculate a treatment plan tailored to your anatomy and the catheter placement.
Treatments are given twice a day for five days for a total of ten treatments. The catheter treatment device remains in place for the duration of the treatment course requiring daily dressing changes by your care team. During treatment, a radioactive seed is inserted into the catheter tube so that it can deliver radiation to the lumpectomy cavity. It’s only left in place for about 5-10 minutes each time the treatment is administered. Once complete the radiation oncologist will deflate the catheter and remove the device in the office.
