Breast cancer: radiation treatment
After a breast-conserving surgery and sometimes also after a mastectomy (mastectomy), the patients receive an (adjuvant) radiotherapy : Breast cancer remnants that may have remained in the body are so severely damaged by the high-energy rays that they die. As a rule, the entire thoracic area affected by the disease is irradiated (rarely partial breast irradiation is sufficient). Often lymph nodes below the collarbone and armpit also receive radiation.
Breast cancer patients should start radiotherapy as soon as possible – as soon as the surgical wound is completely healed. Mostly the irradiation is done on several days a week. About how many weeks radiotherapy extends and which radiation dose is administered at each session, the doctor determines individually for each patient.
Note: In certain cases, neoadjuvant radiotherapy is also useful – that is, the irradiation of the tumor before surgery. If a breast cancer can not be operated on or the patient refuses the surgery, a single radiotherapy can be performed.
Side effects of radiation
Nowadays, it is possible to target the rays in a targeted manner only to the desired tissue area and thus protect healthy cells or organs to a great extent. Nevertheless, side effects can not be completely ruled out. The skin in the irradiated district is indeed very stressed. It can respond to it (like a severe sunburn ) with painful redness to blistering. Also, hair loss can occur.
Radiation of lymph nodes can cause lymphatic stasis with edema (lymphedema) in the chest or arm.
Breast cancer: chemo
Breast cancer (and other cancers) is often treated with chemotherapy. The patients receive so-called cytostatics (usually as an infusion , sometimes as a tablet): The active ingredients are distributed throughout the body and reach even the smallest, previously undiscovered tumor nests and individual cancer cells in the blood and lymphatic system. These are so severely damaged by the cytostatics that they die. Chemotherapy can be performed before (neoadjuvant) or after surgery (adjuvant). It is also used as a palliative therapy. In the case of breast cancer that can no longer be cured, cytostatics can at least slow down tumor growth.
Chemotherapy: different schemes
For breast cancer chemotherapy (and other forms of cancer), several cytotoxic drugs are usually combined and then administered in multiple cycles. Between the individual cycles, a treatment break is maintained in order to minimize the side effects of chemotherapy. The type and amount of cytostatics administered and the number of treatment cycles are determined individually.
Port for chemotherapy
The cytostatics are often given as an infusion. In order not to have to re-enter the venous line at the beginning of each treatment cycle, a port is often placed under the skin (usually below the clavicle): a small metal or plastic chamber with a catheter leading into a large, cardiac vein , So the toxic substances are better diluted in a stronger bloodstream. The cytostatics are introduced via a special needle through the port into the venous system.
The port can stay in the body for a longer period of time (even a few years). The patient is not limited by the implanted small chamber in their movement and may – in consultation with the doctor – also bathe, shower or do sports.
Side effects of chemotherapy
Cytostatic drugs can not differentiate between healthy and cancerous cells. Therefore, the treatment may have undesirable effects. Especially damaged cells are those that divide quickly. In addition to cancer cells, these include the blood-forming cells in the bone marrow. As a result, a shortage of red and white blood cells and platelets may develop. This leads to anemia , an increased susceptibility to infection and increased bleeding tendency.
Chemotherapy often damages the hair root cells, causing hair loss. Other common side effects include nausea and vomiting , diarrhea , loss of appetite, and prolonged fatigue and tiredness .
Read more about the adverse effects of cytotoxic drugs in the article Chemotherapy: Side Effects .
Breast cancer: anti-hormone therapy
About two thirds of all breast cancers have many estrogen and / or progesterone receptors because they need the female sex hormones to grow. In such tumors, an (anti) hormone therapy (endocrine therapy) is in question: The patients receive drugs that stop or at least slow down hormone-dependent tumor growth. Depending on the exact mechanism of action, these are antiestrogens, aromatase inhibitors or GnRH analogues.
An (anti) hormone therapy for breast cancer extends over several years. Possible side effects of the treatment include menopausal symptoms such as hot flashes and mood swings . They can also occur in patients who have already passed their menopause.
Antiestrogens inhibit the action of the female sex hormone estrogen by occupying its binding sites on the cancer cells. Thus, estrogen can no longer dock itself and stimulate cell division. The most important antiestrogen is tamoxifen . It can be used before and after menopause and is taken once a day as a tablet.
Aromatase inhibitors block the body’s own estrogen production in muscle and adipose tissue, but not in the ovaries. Thus, they are only suitable for patients after menopause (when the ovaries have already stopped their hormone production). Aromatase inhibitors are taken once a day as a tablet.
GnRH analogs (such as goserelin) are artificial hormones that inhibit estrogen production in the ovaries. They are therefore suitable for the treatment of breast cancer before menopause. Patients are artificially induced by menopausal GnRH analogues. The drugs are injected every few weeks or months under the skin.
Note: The different groups of active ingredients of (anti) hormone therapy can also be combined with each other. Thus, GnRH analogues are usually administered together with tamoxifen or aromatase inhibitors.