Radiation and medicines

Radiation therapy after breast surgery

Radiation therapy uses focused X-rays to destroy any cancer cells that may be left in or around the breast, or in nearby lymph nodes, after surgery. The point of it is to lower the chance of the cancer coming back in that area.

It is given after a lumpectomy as a matter of course, and after a mastectomy in some situations.

What radiation treatment is actually like

There is a planning session first, where the team maps exactly where the beams should go and marks your skin. After that, each treatment takes only a few minutes. You lie still, the machine moves around you, and you feel nothing at the time. You are not radioactive afterward and you are safe to be around children and pregnant women.

A course usually runs on weekdays for somewhere between one and six weeks depending on the schedule you are given. The daily trip is often the hardest part of it, which is why the drive matters when choosing between operations.

Side effects of radiation

• Fatigue is the common one. It builds through the course and lifts gradually afterward.
• The skin over the treated area can become pink or red, dry, itchy, and tender, rather like sunburn. The breast may feel swollen and sore.
• Ask the radiation team which moisturizer to use and when, because the wrong product at the wrong time makes skin reactions worse.

The four families of breast cancer medicine

Drug treatment is given based on the characteristics of the tumor, not on which operation you had. There are four broad families, and many people get more than one.

Chemotherapy

Chemotherapy travels through the bloodstream, which is what lets it reach cells that may have left the breast. It is given over roughly three to six months, in cycles, with days or weeks off in between so the body can recover.

Short-term side effects of chemotherapy

• Hair loss
• Nausea and vomiting
• Weak fingernails and toenails
• Mouth sores
• Fatigue
• A drop in red or white blood cells, which raises the risk of infection

Longer-term side effects of chemotherapy

• Early menopause
• Weight gain
• Problems with memory and concentration, widely known as chemo brain

Tell your team about side effects as they happen rather than saving them for the next appointment. Most can be managed or reduced, and the plan can be adjusted.

Endocrine therapy

Also called hormone therapy, though it is not remotely the same thing as hormone replacement. Endocrine therapy slows or stops the growth of hormone receptor positive cancers by blocking estrogen from reaching them or by lowering how much estrogen your body makes.

It is usually a pill taken every day for five to ten years. That length is the part people find hardest, and it is also where the benefit comes from.

What endocrine therapy buys you

Taking tamoxifen or an aromatase inhibitor lowers the risk of the cancer coming back, lowers the risk of a new cancer in the other breast, and lowers the risk of dying from breast cancer. Those are three separate benefits and all three are real.

What endocrine therapy costs you

• Menopausal symptoms, particularly hot flashes and night sweats
• Joint and muscle aches, which are more associated with aromatase inhibitors
• Loss of bone density with aromatase inhibitors, which is why bone health gets monitored

Side effects are the main reason people stop taking these pills early, and stopping early gives up the benefit. If you are struggling, say so. Switching from one drug to another often helps, and there are ways to manage the symptoms. Quietly stopping is the worst of the available options.

HER2-targeted therapy

Around 10 to 20 percent of newly diagnosed breast cancers make too much of the HER2 protein. Targeted therapies aimed at HER2 treat only those cancers, and they changed the outlook for them substantially.

Trastuzumab, sold as Herceptin, and pertuzumab, sold as Perjeta, are the two best known. They are given into a vein or by injection under the skin.

The side effect that gets watched most closely is on the heart. Your heart function is checked before treatment and at intervals during it. Fatigue and other side effects are also common.

Immunotherapy and newer drugs

• Immunotherapy helps your own immune system recognize and attack cancer cells. In breast cancer it is used mainly for certain triple negative cancers.
• CDK4/6 inhibitors block a signal that cancer cells use to divide. They are used with endocrine therapy, particularly for advanced hormone receptor positive disease.
• PARP inhibitors are used for some people who carry an inherited BRCA1 or BRCA2 change.
• Antibody-drug conjugates attach a chemotherapy drug to an antibody that seeks out a particular marker on the cancer cell, so the drug is delivered more precisely.

Do I actually need chemotherapy?

For some people with small, early, hormone receptor positive cancers, this is a genuinely open question rather than a foregone conclusion. There are tests that help answer it.

Oncotype DX is run on tumor tissue already removed at surgery. It examines a set of genes inside the cancer and produces a score that helps predict whether chemotherapy would add benefit on top of endocrine therapy. A low score can mean endocrine therapy alone is enough. A high score points toward adding chemotherapy.

Ask whether you are a candidate. Avoiding months of chemotherapy that would not have helped you is worth a conversation.

Clinical trials for breast cancer

A clinical trial is a carefully run study testing whether a new approach works better than the current standard. Taking part can give access to a treatment that is not otherwise available. It is always voluntary, and you can leave at any point without affecting the rest of your care.

Ask your oncologist whether there is one you are eligible for. BreastCancerTrials.org also lets you search, and Susan G. Komen’s helpline on 1-877-465-6636 can help you look.

Where this comes from

Drug treatment for breast cancer changes faster than any other part of this site. Anything here that matters to your own decisions should be checked against what your oncologist tells you today.