Breast Cancer Questions & Answers

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Why is radiation recommended after the tumor is surgically removed?

Surgery to remove the tumor and preserve the remaining breast tissue is called a lumpectomy. Radiation treatment is given to destroy any remaining microscopic deposits of cancer in and around the site of surgery. The combination of lumpectomy followed by radiation therapy is considered equal to total mastectomy (or removal of the entire breast) if the tumor meets certain criteria. If radiation is omitted following lumpectomy alone, there is a high likelihood of cancer recurrence in the breast.

What are the common side effects of radiation therapy to the breast?

Side effects can include fatigue, skin irritation similar to a moderate sunburn, and mild to moderate breast swelling. These changes are temporary and can be treated by skin creams and/or medications. Tell your radiation oncologist about any discomfort you may feel.

What is Accelerated Partial Breast Irradiation (APBI)?

Accelerated partial breast irradiation (or APBI) is the delivery of radiation to only part of the breast over four to five days. By treating a smaller area of the breast, treatment can be completed in just one week. While it is not yet considered standard practice, there is reason to believe that APBI may be equivalent to 5 to 7 weeks of external beam radiation therapy. Thousands of patients are being actively evaluated in national clinical trials—data on these patients must be collected over 10 to 20 years to see if APBI is as effective as the standard external beam treatment. Currently, it is used most often for patients who find it impossible to travel to and from the clinic for a standard radiation therapy course.

How is APBI performed?

Breast brachytherapy involves placing flexible plastic tubes called catheters or a balloon into the breast. During treatment, the catheters or the balloon are connected to a machine which sends out a small radioactive seed directly into the catheter or balloon which is placed where the tumor was removed. The radiation treatment takes several minutes, twice a day for five days. At the end of the entire treatment course the catheters or balloon are removed.

Who is a candidate for APBI?

Not everyone is a candidate for APBI. Patients must qualify based on the current guidelines which include but are not limited to:

  1. Age > 18
  2. Invasive ductal carcinoma or DCIS subtypes only
  3. Tumor size < 3cm
  4. Negative surgical margins

In addition, there are several technical factors which must be determined based on a planning CT scan such as placement of the catheter or balloon and adequate spacing between the catheter or balloon and skin surface. It is important that all patients understand between 20-30% of all catheters or balloons inserted must be removed due to technical factors. These patients are still candidates for external beam radiation.

Does choosing to have a mastectomy guarantee I will not need radiation?

No. Unfortunately, there are circumstances where radiation is recommended even after a mastectomy is performed. Whether or not radiation therapy should be used after removal of the breast depends on several factors. These factors include lymph node involvement, tumor size, and whether or not cancer cells were found near the edge of the tissue that was removed. You should see a radiation oncologist to discuss these possibilities before you decide which type of surgery to undergo.