Breast Cancer Radiation | Radiation Treatment For Breast Cancer

About Breast Cancer

If you have been diagnosed, you may be wondering…what is breast cancer? It is the most common cancer diagnosed in women, affecting nearly one in eight women during their lifetimes. Breast Cancer forms when normal cells that make up different parts of the breast tissue become malignant. Early detection in the last few decades has shifted the stage that breast cancer is typically diagnosed into a much earlier one, and advances in treatments such as surgery, radiation and chemotherapy have made great strides in improving survival rates.

The physicians at Advanced Radiation Centers of New York are experts in the radiation treatment for breast cancer with radiotherapy. They are pioneers in the New York Metropolitan area in using advanced technologies such as Intensity Modulated Radiation Therapy, or IMRT, and partial breast balloon brachytherapy (PBI) to attain improved outcomes with decreased side effects for their patients.

What is Breast Cancer?

Breast cancer is an abnormal growth of cells that were once normal breast tissue cells. If these cells stay within the duct itself, the cancer is called a Ductal Carcinoma In-Situ, or DCIS. If the malignant cells poke through to the outside of the duct, into the surrounding breast tissue, this is called an Invasive or Infiltrating Ductal Carcinoma. When abnormal cells of the lobules invade into the breast tissue, it is called an Invasive or Infiltrating Lobular Carcinoma.

Signs & Symptoms

There are many different ways that a woman can present with breast cancer. What is the most typical subjective sign is a palpable mass that is either felt by the woman herself through a monthly breast self-exam (BSE), or during a routine clinical breast exam (CBE). The most common medical sign is during a mammography, where an abnormal exam can often mean that a cancer has been detected.

Other presentations or symptoms that a woman might notice may be a change in the shape or contour of one breast, persistent redness, retraction of the nipple or skin of the breast, nipple discharge or skin thickening. Breast cancer in men usually presents as a palpable mass or nipple thickening or discharge.

If one of these signs or symptoms is noted, the next step is usually a mammogram either with or without ultrasound, which is also referred to as a sonogram. If the mammogram was the original detecting test, or if there is a palpable lesion, the next step could then be a biopsy, to assess whether the mass is or is not a cancer. To determine if breast cancer treatment is required, biopsies are performed by either an interventional radiologist under ultrasound, mammographic or MRI guidance, or by a breast surgeon.

If a cancer is detected, referral to a breast surgeon is then warranted. Depending on the diagnosis, breast cancer treatment, such as radiation therapy for breast cancer, generally begins.

What Happens After Diagnosis?

Your doctors will perform many additional tests to determine more information about the type of breast cancer you have. The most critical test results for your treatment and your long-term health will show whether your cancer is invasive or non-invasive and whether lymph nodes are involved and if so, how many. Your medical team will also investigate the size of your tumor, tumor grade, hormone receptor status, HER2/neu oncogene overexpression and the margins of resection.

Based on the results of these tests, your cancer will be staged. Based on the stage, together with your medical team, you will decide which course of treatment will be most appropriate for you.

Risk Factors

There are many risk factors that increase a woman’s risk of developing breast cancer.  It is important to realize that these are risk factors only and having a risk factor does not mean someone will develop breast cancer, it just means that the risk may be higher than if a person did not have that risk factor, all other things being equal.

As women get older, their risk of developing breast cancer increases; age is a risk factor of breast cancer. Also well known is that a family history of breast cancer does play a prominent role in one’s risk of developing breast cancer. This family history can be a mother, sister, grandmother or any other first or second degree relative. It is important to point out though that nearly 75% of women who are diagnosed with breast cancer have no family history at all. If in the past, a woman has had a breast cancer, she is at increased risk of developing a subsequent one, in the other breast.  A woman’s personal history is a strong risk factor.

In about 5% of women with breast cancer, there is a strong familial history, which is likely, genetic. There are now several genetic tests that can be done to determine whether a woman has a genetic mutation that can increase her chance of developing breast cancer. These tests can also help assess her family’s risk since this is passed down to children of women and men with this mutation. The gene mutations are termed BRCA1 and BRCA2. Family members who harbor mutations in these genes have a 60% to 80% risk of developing breast cancer in their lifetimes, as well as possible increased risks of other associated malignancies, such as ovarian or pancreatic cancers. These tests are typically performed on women with a diagnosis of breast cancer. Knowing he/she has the BRCA1 or BRCA2 gene can help a person make decisions regarding their own treatment and to help guide their daughters or other family members who may also have the mutation.

A genetic counselor can help to get the test performed and more importantly discuss the importance of this testing and its implications. The physicians at ARC routinely refer patients to genetic counselors in the area if the circumstances make sense to do so.

Other physical factors can put a woman at increased risk of developing breast cancer, including race and ethnicity. Women who had their first period at an earlier age or gave birth to their first child at a later age or have had no children are also at an increased risk for developing breast cancer.

There are also some environmental factors that are associated with an increased risk of developing breast cancer. They include the use of certain oral contraceptives and hormone replacement therapies, alcohol intake, smoking, being overweight, and having a previous history of radiation therapy.

How is Breast Cancer Treated? Radiation Therapy Options

The physicians at Advanced Radiation Centers of New York are leaders in the treatment of breast cancer using the latest technologies in the fight against breast cancer. These technologies include 3D-conformal radiation therapy and intensity modulated radiation therapy (IMRT).

Radiation Therapy is used in conjunction with surgery and sometimes chemotherapy or hormone therapy to treat breast cancer. Radiation is used to treat the breast followinga lumpectomy. Radiation is given to “mop-up” any stray cells that may be left behind.

Surgical Options

Surgery is the standard treatment for nearly all breast cancers. Surgery is usually either a lumpectomy, which removes the tumor from the breast, or a mastectomy which involves the removal of the entire breast itself.

Lumpectomy involves the removal of the mass and usually a rim of normal tissue around it to ensure that any adjacent ‘rootlets’ of tumor are also removed. Lumpectomy is typically followed by radiation therapy.

Since the surgeon knows that radiation will be used to aid in sterilizing the tissue after surgery, he/she is able to offer a less disfiguring surgery, which allows a woman to retain her breast without sacrificing curability. The most important thing to remember about lumpectomy and radiation is that it allows an equivilent survival to mastectomy.

Mastectomy is performed in certain situations, including in women who prefer this option over lumpectomy + radiation. One of the more common reasons that a mastectomy may be recommended is when women are found to have more than one lesion in the breast, especially if these lesions are in separate quadrants or regions, making a lumpectomy a more disfiguring procedure.

Balloon Brachytherapy for Breast Cancer - What is it?

Another method of giving radiation shortens the treatment time to just one week, with treatment given twice a day. Radiation is delivered internally to the part of the breast where the tumor had been located prior to surgery.

ARC was the first in Nassau County to use the Contura breast balloon brachytherapy device, which provides better radiation shaping to reduce doses to the skin, heart and chest wall.

Side Effects of Breast Cancer Radiation

Side-effects of radiation are due to damage or irritation to the normal, healthy tissues. Using technologies such as Intensity Modulated Radiation Therapy (IMRT) and Breast Balloon Brachytherapy will significantly reduce the radiation dose to these normal, non-cancerous tissues.

Side-Effects Can Include:

– skin discoloration, including redness
– skin irritation causing a rash, itching, or peeling
– tiredness or fatigue
– slight breast heaviness or swelling

Acute side effects (i.e. the ones that can occur during a course of treatment), will begin to go away after treatment is completed and are expected to fully resolve. Side effects from Balloon Brachytherapy are similar to those of external beam radiation, but on average there is less skin sensitivity, redness and peeling.

Chemotherapy or Hormone Therapy for Breast Cancer

A medical oncologist is a physician who uses systemic therapies, like chemotherapy or hormone therapy, to treat breast cancer and other cancers. Chemotherapy can be given either orally or intravenously, depending on the agent or type of regimen that is being used. It can be given on a weekly basis or more often for one or two days every two to four weeks. Each of these episodes of chemotherapy is called a cycle, and a full course of chemotherapy may involve 3-6 or more cycles.

Hormone therapy is a form of systemic therapy that takes advantage of the fact that normal breast cells, as well as many breast cancer cells, are tissues that respond to hormonal manipulation. Certain types of medications have been developed that have been shown to turn-off or even slow-down or prevent cancer cells from growing, since normally circulating hormones, like estrogen can tell a cancer cell to grow. There are several different types of hormonal therapies: Tamoxifen, Tamoxifen/Nolvadex, Raloxfine/Evista, Arimidex/anastrozole, Aromasin / exemestane and Femara / letrozole.

The Radiation Treatment Process

The Treatment Process: Today, radiation is delivered using highly sophisticated technologies that require a significant amount of preparation and planning, involving the physician, physicist and entire Radiation Oncology Team.