Health
Breast Cancer Treatment: Mastectomy, Chemotherapy, and More
Radiation uses high-energy rays to kill cancer cells in the breast, chest wall, or underarm area after surgery. The aim is to keep the cancer from returning. In general, radiation only treats cells in the area of the body that is being treated.
It’s most commonly used if you’ve had a lumpectomy, but it is sometimes administered after a mastectomy if the tumor is larger than 5 centimeters (2 inches), or if the cancer has spread to several lymph nodes. It may be given to patients where the breast cancer is locally advanced and metastatic to ease symptoms and treat complications like bleeding.
You might be able to forgo radiation after a lumpectomy if you’re 65 or older, your tumor was small and hasn’t spread to the lymph nodes, and the cancer is hormone-sensitive (and hormone therapy will be given), according to the American Cancer Society.
There are two types of radiation therapy.
- External Beam Radiation Therapy This is the most common form of radiation, and there are two forms: whole breast and partial breast.
- Brachytherapy, or Internal Radiation A catheter is implanted in the area where the cancer was removed, and radiation is delivered through radioactive pellets that are inserted in the catheter. This procedure is used if the tumor is small, in an early stage, and shows no signs of having spread.
A newer type of external radiation therapy, called proton therapy, harnesses the energy of highly energized radiation particles to send a more precise dose of radiation to tumors. Because of its precision, it’s thought to result in fewer side effects and less harm to the areas surrounding the cancer, and while it is not yet the standard of care, it may be recommended if cancer is located close to the heart or lungs. Proton therapy can be used to treat most types of breast cancer, though not usually metastatic breast cancer, and may be used after a lumpectomy or a mastectomy.
Length of Treatment
Whole breast radiation is usually given five days a week for three to six weeks. Partial breast radiation can take one to two weeks. Increasingly, notes Mayo Clinic, doctors are recommending accelerated treatment schedules (known as hypofractionated treatment); this involves higher doses of radiation over a shorter time period. Whole-breast irradiation may take only one to four weeks, while partial-breast irradiation may be completed in five days or less. Sessions can take about 14 to 45 minutes, to allow your radiation therapist to position you correctly and ensure the radiation is properly delivered.
Brachytherapy, at low-doses, is slowly delivered over hours to days in the hospital. If high-dose radiation is used, it’s usually given twice a day for five days as an outpatient procedure.
Radiation Side Effects
Temporary side effects of external radiation include:
- Skin changes similar to sunburn (redness, peeling, irritation)
- Fatigue
- Swelling or soreness of the breast
Other side effects, which may appear later on, can include:
- Changes to the shape of the breast or the feel of the skin on the breast
- Lymphedema, or buildup of lymph fluid that causes swelling, usually in the arms or hand
Rare side effects and complications can include nerve damage in the arm, rib fracture, or additional cancers.
Side effects of brachytherapy can include:
- Pain
- Bruising
- Infection
- Damage to fatty tissue
- Fluid collecting in the breast
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