Each year around 44,000 people in the UK and 192,370 in the USA are diagnosed with breast cancer. According to the American Cancer Society (ACS), a women in the United States is diagnosed with breast cancer every 3 minutes.
Breast cancer does also affect men, but on a much smaller scale, with around 1 in every 200 cases being diagnosed in males. The treatment options used in male and female breast cancer are the same so the following information will be relevant to all sufferers.
What is Breast Cancer...
All cells in the human body have a life cycle. They are programmed to reproduce and then die, after a certain time, when they are replaced by new cells. A cancer cell is a 'normal' cell that has been damaged in some way and "forgets" it should die. It then goes on to replicate itself, producing more cells that have the same genetic fault, meaning they also do not know they should die. As this process of replication continues, a tumour is formed.
Cells from this tumour have the potential to break away and these break off cells can then be transported around the body in the blood or lymphatic (lymph) systems. If they get stopped, for example, in a thin capillary they can start the whole process again and form another tumour. The medical world calls this metastatic spread and the subsequent secondary tumour that is formed is called a metastases. If you have breast cancer, and they find that some of your lymph glands (in the axilla or scf region) test positive for cancer cells, it is important to note that this is not classified as a secondary tumour. This is because it is the lymph node's job as part of your bodies immune system, to catch these cancer cells, to reduce the likelihood of spread to other areas of the body.
The size and type of your breast cancer, along with any diagnosed areas of spread, help the clinical oncologist decide what treatment option is best for you.
TYPES OF BREAST CANCER...
There are many different types of breast cancer, your specific type will determine the most appropriate treatment option for you.
THE NON INVASIVE BREAST CANCERS
These breast cancers have not spread outside of the lobes or ducts into the surrounding breast tissue.
LCIS - Lobular Carcinoma In-Situ
This is not yet an actual cancer, but a collection of cells in the lobes of the breast. If you are diagnosed with LCIS, it means you have a higher risk of developing breast cancer at a later stage.
DCIS - Ductal Carcinoma In-Situ
DCIS cells look like cancer cells as they have over multiplied, however they are still contained within the ducts, and have not yet spread into the surrounding breast tissue. DCIS can also be known as pre-cancerous, or pre-invasive breast cancer.
THE INVASIVE BREAST CANCERS
Invasive cancers are those that have spread beyond the lining of the ducts or lobes into the surrounding breast tissue.
Invasive Ductal Breast Cancer
This is the most common type of breast cancer, making up 70 - 80% of cases diagnosed. It occurs when the cells lining the duct have become cancerous and spread into the surrounding breast tissue.
Invasive Lobular Breast Cancer
Around 10% of breast cancers diagnosed are this type. They occur when the cells lining the lobes have become cancerous and spread into the surrounding breast tissue.
Inflammatory Breast Cancer
This is a less common type of breast cancer - only accounting for 1- 2% of all breast cancers diagnosed. In this type of cancer, the cells do not usually form a lump, instead they multiply throughout the breast tissue. These cells then block the vessels in the skin of the breast, causing a red, inflamed, sore and swollen appearance.
There are several other, rarer types of breast cancer including : -
- Paget's Disease of the Breast
The most appropriate and effective treatment for you depends on many factors including : - the cancer type, stage and grade, the cancers hormone status e.g. estrogen/ oestrogen positive or negative, the cancers protein status e.g. HER2 positive or negative, your age, your fitness level and your menopausal status.
Most breast cancers will be treated with some form of surgery, to try to remove all the tumour cells. Either all (mastectomy) or part (lumpectomy) of the breast will be removed.
Chemotherapy is a whole body (systemic) treatment option. This means it will be recommended if there is an increased risk of the cancer spreading or returning.
Radiotherapy is a very effective and commonly used way to treat breast cancer. It is normally given after surgery and / or chemotherapy but can be given before if the tumour is especially large, or located in a harder to operate place. Radiotherapy can be given after surgery to any remaining breast tissue, or to the chest wall alone following a mastectomy. The aim of radiotherapy is to destroy any microscopic cancer cells left in the area following surgery.
HOW IS IT GIVEN?
Radiotherapy treatment using photons is normally given to the whole breast area and may also include the lymph nodal regions in the underarm (axilla), collarbone (supraclavicular - SCF), or breastbone (inter-mammory chain - IMC). Many women will also have a final weeks booster treatment using electrons, to the tumour bed site alone. Radiotherapy to the breast can be given in 15 - 30 treatments, depending on the factors listed above. It is normally given once per day, monday to friday.
For the Radiotherapy treatment you will need to lie on a breastboard, this is set at a specific incline height for you, to ensure your sternum lies horizontal to the treatment couch. The breastboard is hard, and some patients find it slightly uncomfortable, but please tell the radiographers at your planing session if they can do anything to assist you. Depending on your specific type of treatment, you will either need to raise one or both arms above your head, so that the radiotherapy treatment can be both planned and treated effectively. Sometimes after surgery your arm / shoulder muscles may feel tight and stiff making this position more difficult. This is why it is so important to regularly practice your arm exercises, given to you by your medical team, to ease your flexability and degree of movement.
Please read the pages titled "My first CT planning session" and "My first day of treatment", for detailed information on what to expect during your first appointments at the radiotherapy department.
COMMON SIDE EFFECTS OF RADIOTHERAPY TO THE BREAST
The most commonly experienced side effects of radiotherapy, to the breast area are skin reactions and fatigue. If you look at the side effects section of this website, you will learn the best methods for coping with these.
Below is some additional specific advice to help you manage/ reduce the severity of a radiotherapy skin reaction to the breast area.
** Your skin will feel most sensitive and sore around the nipple and underneath the breast fold area (especially if you are wear a bra size C Cup or above). This is because here the skin is naturally more sensitive, and the radiation is able to act in a bouncing type motion in the skin fold creating a greater reaction. To help with this, it is important that you do not wear an underwired bra during and for a few weeks after your radiotherapy treatment, as the wire acts as a rubber against your skin - thus in turn making it more sensitive and irritated. If you are able to go without wearing a bra, then please do so, as this will be best for your skin. However, if you are unable to manage without a bra, opt for one that is soft, loose and comfortable.
** Do not shave under your affected arm, during and for a few weeks after your radiotherapy treatment. Shaving will only make the area more irritated and sore, and if you were to cut yourself, it may take longer than normal to heal.
** Avoid using any fragranced, chemical or metallic containing deodorants under the affected arm, during and for a few weeks after finishing your radiotherapy. They will be too harsh for your skin, and they normally contain aluminium particles or zinc oxide, which will not react well with the radiotherapy treatment. Also, avoid using talcum powder products, even baby powder, in the treatment area/ under the affected arm. These contain metallic particles, which will cause a more severe skin reaction. If you do wish to use a deodorant in the area, only use one that is made from natural ingredients. We here at MyRadiotherapy.com, particularly like the Crystal Rock Body Deodorant and the Pit Rock Natural Deodorant ranges. These both can be found in the form of a roll-on or spray, and they both contain only natural ingredients, and are totally fragrance, metal and alcohol free, so are totally safe to use during your course of radiotherapy treatment.
** Radiotherapy can cause a change in the look or feel of the breast tissue itself, although for most women this change is very slight. Radiotherapy can make your breast tissue, and this can cause the skin to feel a little tight. It can also cause the breast area to swell slightly during, or shortly after the treatment has finished. This is known as oedema, and should settle down within a couple of months of completing radiotherapy treatment.
** As your breast region heals following surgery, you may experience some shooting pains or tingling in the area, which can be aggravated by radiotherapy. This should settle in the months after finishing radiotherapy treatment.
** Please read our page on Lymphoedema, which can be another side effect of radiotherapy treatment to the breast, for more information and advice.