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Whole breast radiation therapy

Breast cancer - radiation therapy; Carcinoma of the breast - radiation therapy; External beam radiation - breast; Intensity-modulated radiation therapy - breast cancer; Radiation - whole breast; WBRT

Whole breast radiation therapy (WBRT) uses high-powered x-rays to kill breast cancer cells.

Cancer cells multiply faster than normal cells in the body. Because radiation is most harmful to quickly growing cells, radiation therapy damages cancer cells more than normal cells. This prevents the cancer cells from growing and dividing, and leads to cell death.

Description

This type of radiation is delivered by an x-ray machine that targets radiation either to the whole breast, or the chest wall (if done after mastectomy). Sometimes, radiation will also target the lymph nodes in the armpit or neck area or under the breast bone.

You may receive radiation treatment either in a hospital or in a private outpatient radiation center. You will go home after each treatment. A typical course of treatment is given 5 days a week for 3 to 6 weeks. Each treatment is scheduled the same time each day for your convenience.

Before you have any radiation treatment, you will meet with the radiation oncologist. This is a doctor who specializes in radiation therapy.

There are several ways the doctor and therapists may place little marks on your skin that can help make sure the radiation is pointed at the cancer but not at healthy tissue.

  • Some centers use ink tattoos. These marks are permanent but are most often smaller than a mole. These cannot be washed off and you can bathe and shower normally. After treatment, if you want the marks removed laser or surgery can be used.
  • Some centers use marks that can be washed off. You may be asked not to wash the area during treatment and the marks may need to be touched up before each treatment session.

During each treatment session:

  • You will lie on a special table, either on your back or your stomach.
  • The technicians will position you so the radiation targets the treatment area.
  • Sometimes alignment x-rays or scans are taken before treatment to make sure you are lined up in the right treatment position.
  • Some centers use a machine that delivers radiation at certain points of your breathing cycle. This can help limit radiation to the heart and lungs. You may be asked to hold your breath while the radiation is being delivered. You may have a mouthpiece to help regulate your breathing.
  • Most often, you will receive radiation treatment for between 1 and 5 minutes. Each day you will be in and out of the treatment center in less than 20 minutes on average.

Why the Procedure Is Performed

After surgery, cancer cells may remain in the breast tissue or lymph nodes. Radiation can help kill the remaining cancer cells. When radiation is delivered after surgery is performed, it is called adjuvant (additional) treatment.

WBRT may be given:

  • For ductal carcinoma (DCIS)
  • For stage I or II breast cancer, after lumpectomy or partial mastectomy (breast-conserving surgery)
  • For more advanced breast cancer, sometimes even after full mastectomy
  • For cancer that has spread to local lymph nodes (in the neck or armpit)
  • For widespread breast cancer, as a palliative treatment to relieve symptoms

Before the Procedure

Tell your health care provider what medicines you are taking.

Wear loose-fitting clothes to the treatments.

You are not radioactive after radiation treatments. It is safe to be around others, including babies or children. As soon as the machine stops, there is no more radiation in the room.

After the Procedure

Radiation therapy, like any cancer therapy, can also damage or kill healthy cells. The death of healthy cells can lead to side effects. These side effects depend on the dose of radiation and how often you have the therapy.

Side effects can develop early during treatment (within a few weeks) and be short-lived, or they may be more lasting long-term side effects. Late side effects can happen months or years later.

Early side effects 1 to 3 weeks after your first treatment may include:

  • You may develop some breast swelling, tenderness, and sensitivity.
  • Your skin over the treated area may turn red or darker in color, peel, or itch (much like a sunburn).

Most of these changes should go away about 4 to 6 weeks after the radiation treatment is over.

Your provider will explain care at home during and after radiation treatment.

Late (long-term) side effects may include:

  • Decreased breast size
  • Increased firmness of breast
  • Skin redness and discoloration
  • Swelling in the arm (lymphedema) in women who have had nearby lymph nodes removed
  • In rare cases, rib fractures, heart problems (more likely for left breast radiation)
  • Development of a second cancer in the treatment area (the breast, ribs, or muscles of the chest or arm)

Outlook (Prognosis)

WBRT following breast-conserving surgery reduces the risk of cancer coming back and of death from breast cancer.

References

Alluri P, Jagsi R. Postmastectomy radiotherapy. In: Bland KI, Copeland EM, Klimberg S, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 49.

National Cancer Institute website. Breast cancer treatment (Adult) (PDQ) - health professional version. www.cancer.gov/types/breast/hp/breast-treatment-pdq. Updated November 12, 2019. Accessed November 19, 2019.

National Cancer Institute website. Radiation therapy and you: support for people who have cancer. www.cancer.gov/publications/patient-education/radiation-therapy-and-you. Updated October 2016. Accessed August 2, 2018.

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    Breast cancer - Animation

    Of all the different types of cancers, breast cancer is one of the most talked about, and with good reason. One out of every eight women will develop breast cancer sometime in their life. That's why every woman should be thinking about how to protect herself from this disease. Breast cancer is cancer that forms in the breast. Usually, it begins in the tubes that transport milk from the breast to the nipple. If the cancer spreads to other parts of the breast or body, it's called invasive breast cancer. Some breast cancers are more aggressive, growing more quickly than others. Although women are 100 times more likely to develop breast cancer, men can also get the disease because they do have breast tissue. You're more likely to get breast cancer if you're over 50, you started your periods before age 12, or you have a close family member with the disease. Drinking more than a couple of glasses of alcohol a day and using hormone replacement therapy for several years also may increase your risk. The telltale sign of breast cancer is a lump in your breast or armpit. You may also notice a change in the shape, size, or texture of your breast, or have fluid coming from your nipple when you're not breastfeeding. If you notice any changes in your breasts, call your doctor. You'll probably need to have an imaging scan, such as a mammogram, MRI, or ultrasound. A piece of tissue may be removed from your breast, called a biopsy. With these tests, your doctor can tell whether you have breast cancer, and if so, determine whether or not it has spread. So, how do we treat breast cancer? That really depends on the type of cancer, and how quickly it's spreading. Your doctor may recommend that you have the cancer removed with surgery. Sometimes it's enough just to remove the lump. That's called a lumpectomy. In other cases, the doctor will need to remove the entire breast to get rid of all the cancer or prevent it from coming back. That's called a mastectomy. Other treatments for breast cancer include chemotherapy, medicines that kill cancer cells, and radiation therapy, which uses energy to destroy cancer. Women whose cancer is fueled by the hormone estrogen may receive hormone therapy to block the effects of estrogen on their cancer. Today's breast cancer treatments are better than ever. Many women who have breast cancer go on to live long, healthy lives. The outlook really depends on how fast the tumor is growing, and how far it has spread. That's why it's so important to report any changes in your breasts to your doctor as soon as you notice them. Women who are at an especially high risk for breast cancer because of their family history can talk to their doctor about taking medicine or even having surgery to reduce their risk.

  • Breast cancer

    Animation

  •  

    Breast cancer - Animation

    Of all the different types of cancers, breast cancer is one of the most talked about, and with good reason. One out of every eight women will develop breast cancer sometime in their life. That's why every woman should be thinking about how to protect herself from this disease. Breast cancer is cancer that forms in the breast. Usually, it begins in the tubes that transport milk from the breast to the nipple. If the cancer spreads to other parts of the breast or body, it's called invasive breast cancer. Some breast cancers are more aggressive, growing more quickly than others. Although women are 100 times more likely to develop breast cancer, men can also get the disease because they do have breast tissue. You're more likely to get breast cancer if you're over 50, you started your periods before age 12, or you have a close family member with the disease. Drinking more than a couple of glasses of alcohol a day and using hormone replacement therapy for several years also may increase your risk. The telltale sign of breast cancer is a lump in your breast or armpit. You may also notice a change in the shape, size, or texture of your breast, or have fluid coming from your nipple when you're not breastfeeding. If you notice any changes in your breasts, call your doctor. You'll probably need to have an imaging scan, such as a mammogram, MRI, or ultrasound. A piece of tissue may be removed from your breast, called a biopsy. With these tests, your doctor can tell whether you have breast cancer, and if so, determine whether or not it has spread. So, how do we treat breast cancer? That really depends on the type of cancer, and how quickly it's spreading. Your doctor may recommend that you have the cancer removed with surgery. Sometimes it's enough just to remove the lump. That's called a lumpectomy. In other cases, the doctor will need to remove the entire breast to get rid of all the cancer or prevent it from coming back. That's called a mastectomy. Other treatments for breast cancer include chemotherapy, medicines that kill cancer cells, and radiation therapy, which uses energy to destroy cancer. Women whose cancer is fueled by the hormone estrogen may receive hormone therapy to block the effects of estrogen on their cancer. Today's breast cancer treatments are better than ever. Many women who have breast cancer go on to live long, healthy lives. The outlook really depends on how fast the tumor is growing, and how far it has spread. That's why it's so important to report any changes in your breasts to your doctor as soon as you notice them. Women who are at an especially high risk for breast cancer because of their family history can talk to their doctor about taking medicine or even having surgery to reduce their risk.

    A Closer Look

     

     

    Review Date: 7/9/2018

    Reviewed By: David Herold, MD, Radiation Oncologist in West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 10/16/2019. Editorial update 11/19/2019.

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