Breast Cancer (cont.)

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated. Radiation therapy may be used after surgery to destroy breast cancer cells that remain in the area.

Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:

  • External radiation therapy: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for 4 to 6 weeks. External radiation is the most common type used for breast cancer.


  • Internal radiation therapy (implant radiation therapy or brachytherapy): The doctor places one or more thin tubes inside the breast through a tiny incision. A radioactive substance is loaded into the tube. The treatment session may last for a few minutes, and the substance is removed. When it's removed, no radioactivity remains in your body. Internal radiation therapy may be repeated every day for a week.

Side effects depend mainly on the dose and type of radiation. It's common for the skin in the treated area to become red, dry, tender, and itchy. Your breast may feel heavy and tight. Internal radiation therapy may make your breast look red or bruised. These problems usually go away over time.

Bras and tight clothes may rub your skin and cause soreness. You may want to wear loose-fitting cotton clothes during this time.

Gentle skin care also is important. You should check with your doctor before using any deodorants, lotions, or creams on the treated area. Toward the end of treatment, your skin may become moist and "weepy." Exposing this area to air as much as possible can help the skin heal. After treatment is over, the skin will slowly heal. However, there may be a lasting change in the color of your skin.

You're likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay active, unless it leads to pain or other problems.

You may wish to discuss with your doctor the possible long-term effects of radiation therapy. For example, radiation therapy to the chest may harm the lung or heart. Also, it can change the size of your breast and the way it looks. If any of these problems occur, your health care team can tell you how to manage them.

You may want to ask your doctor these questions before having radiation therapy:
  • Which type of radiation therapy can I consider? Are both types an option for me?
  • When will treatment start? When will it end? How often will I have treatments?
  • How will I feel during treatment? Will I need to stay in the hospital? Will I be able to drive myself to and from treatment?
  • What can I do to take care of myself before, during, and after treatment?
  • How will we know the treatment is working?
  • Will treatment harm my skin?
  • How will my chest look afterward?
  • Are there any lasting effects?
  • What is the chance that the cancer will come back in my breast?
  • How often will I need checkups?

Hormone therapy

Hormone therapy may also be called anti-hormone treatment. If lab tests show that the tumor in your breast has hormone receptors, then hormone therapy may be an option. Hormone therapy keeps cancer cells from getting or using the natural hormones (estrogen and progesterone) they need to grow.

Options before menopause

If you have not gone through menopause, the options include:

  • Tamoxifen: This drug can prevent the original breast cancer from returning and also helps prevent the development of new cancers in the other breast. As treatment for metastatic breast cancer, tamoxifen slows or stops the growth of cancer cells that are in the body. It's a pill that you take every day for 5 years.


  • In general, the side effects of tamoxifen are similar to some of the symptoms of menopause. The most common are hot flashes and vaginal discharge. Others are irregular menstrual periods, thinning bones, headaches, fatigue, nausea, vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash. Serious side effects are rare, but they include blood clots, strokes, uterine cancer, and cataracts.

  • LH-RH agonist: This type of drug can prevent the ovaries from making estrogen. The estrogen level falls slowly. Examples are leuprolide and goserelin. This type of drug may be given by injection under the skin in the stomach area. Side effects include hot flashes, headaches, weight gain, thinning bones, and bone pain.


  • Surgery to remove your ovaries: Until you go through menopause, your ovaries are your body's main source of estrogen. When the surgeon removes your ovaries, this source of estrogen is also removed. (A woman who has gone through menopause wouldn't benefit from this kind of surgery because her ovaries produce much less estrogen.) When the ovaries are removed, menopause occurs right away. The side effects are often more severe than those caused by natural menopause. Your health care team can suggest ways to cope with these side effects.

Options after menopause

If you have gone through menopause, the options include:

  • Aromatase inhibitor: This type of drug prevents the body from making a form of estrogen (estradiol). Examples are anastrazole, exemestane, and letrozole. Common side effects include hot flashes, nausea, vomiting, and painful bones or joints. Serious side effects include thinning bones and an increase in cholesterol.


  • Tamoxifen: Hormone therapy is given for at least 5 years. Women who have gone through menopause receive tamoxifen for 2 to 5 years. If tamoxifen is given for less than 5 years, then an aromatase inhibitor often is given to complete the 5 years. Some women have hormone therapy for more than 5 years. See above for more information about tamoxifen and its possible side effects.


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