Surgery and radiation therapy are two of the most common treatments available to breast cancer patients today. Although both are highly effective and are often delivered in combination, they do come with side effects that you and your doctor should discuss before you undergo these treatments.
Surgery
The American Cancer Society reports that surgery is the most common treatment for breast cancer, used in nearly 95 percent of cancers caught in the earliest two stages and more than 70 percent of advanced stage breast cancers. Whether you’re undergoing a lumpectomy (sometimes called breast conserving surgery or BCS), a mastectomy (in which the affected breast is completely removed) or a bilateral mastectomy (in which both breasts are removed), surgery is a treatment approach with a long and largely successful history. “Fifty-eight percent of women diagnosed with early stage (1 or 2) breast cancer have BCS, 36 percent have mastectomy, 3 percent have radiation or chemotherapy without surgery and about 2 percent do not receive any treatment. In contrast, among women with more advanced breast cancer (stage 3 or 4), 14 percent undergo BCS, 58 percent have mastectomy, 17 percent receive radiation therapy and/or chemotherapy without surgery and 11 percent do not receive any of these treatments,” the ACS reports.
[See: A Tour of Mammographic Screenings During Your Life.]
Although surgery for breast cancer is a remarkably advanced and often very effective treatment, it still comes with some potential risks and side effects. Dr. Maryam Lustberg, breast medical oncologist at the Stefanie Spielman Comprehensive Breast Center at The Ohio State University and medical director of survivorship, says one of the most common side effects of surgery for breast cancer is a change in sensation in the breast. For some women, this can have negative implications for their sexual well-being. In addition, “there can be pain associated with surgery at the incisional area.” She says patients who experience these sensations often describe them as “zingers or zaps of discomfort,” but she says they’re not typically debilitating.
If lymph nodes have been removed as part of your surgery — and in many cases at least one lymph node is removed to check for the spread of cancerous cells — that can elevate your risk for lymphedema, a chronic, incurable swelling usually of the arm on the same side where the surgery was performed. After lymph nodes have been removed, in some patients the remaining nodes can’t drain the lymph fluid properly, creating a backup that results in swelling. It’s an uncomfortable and sometimes disfiguring side effect of surgery that can occur any time after surgery for the remainder of the patient’s life. When it does develop, it requires life-long maintenance. “Lymphedema can be challenging to manage and it can become a chronic issue that’s managed with lymphedema therapy and in the right candidate, lymphedema surgery,” Lustberg says.
The more lymph nodes are removed, the higher the probability of developing this condition, which is why many surgeons are now removing fewer lymph nodes than they once did in what’s called a sentinel node biopsy. In this procedure, typically one to three of the lymph nodes closest to the breast cancer tumor are removed to check for the spread of cancer, rather than removing all or nearly all of the lymph nodes as was more frequently done in the past during an axillary lymph node dissection. “It’s one of the greatest advances of the last decade,” Lustberg says. “Everybody used to have an axillary dissection,” but by removing only a few lymph nodes, the risk of lymphedema is reduced.
As with any surgery, lumpectomy and mastectomy procedures and the breast reconstruction surgeries that many women opt to undergo afterwards bring a risk of infection. Some patients also experience adverse reactions to anesthesia, which can be a serious health risk. Although these sorts of complications are rare, it’s important to speak with your doctor about any concerns you have about the surgery before you go under the knife.
[See: 7 Innovations in Cancer Therapy.]
Radiation
After concluding surgery for breast cancer, many patients will be prescribed radiation treatment to kill off any cancerous cells that may have been left behind. Breastcancer.org reports that “radiation therapy — also called radiotherapy — is a highly targeted and highly effective way to destroy cancer cells in the breast that may stick around after surgery.” In radiation therapy, the radiologist will direct a concentrated beam of high-energy rays from outside the body at the tumor.
Breastcancer.org also notes that “despite what many people fear, radiation therapy is relatively easy to tolerate and the side effects are limited to the treated area.” The National Cancer Institute reports that “radiation therapy can cause both early (acute) and late (chronic) side effects.” The acute side effects will show up during treatment while the chronic ones surface months or years later.
Acute side effects can include skin irritation or damage to the skin and tissue where the radiation beam is pointed. You may also experience swelling and pain in the breast or chest, hair loss in the armpit or chest, sore throat, fatigue and an increased risk of developing lymphedema. Nausea is a rare acute side effect, but may affect some patients, the Susan G. Komen organization reports.
Chronic side effects can include heart and lung problems, nerve problems and, rarely, rib fracture (radiation can weaken the ribs near the site of treatment). These problems all result from damage done by the radiation to healthy cells in the body — the radiation has killed some of the healthy cells these organs need to function properly.
In some patients who survive the initial cancer, secondary cancers may develop in other parts of the body as a result of exposure to radiation. The American Cancer Society reports that lung cancer, sarcomas of the blood vessels and other connective tissues and certain blood cancers are the most common forms of secondary cancers that breast cancer survivors develop after radiation therapy. These cancers may occur because radiation can cause some cells to mutate; cellular mutations can give rise to cancer.
Because of these concerns, radiation works better — and the risk of secondary cancers or recurrences are reduced — when the therapy is highly targeted at the site of the tumor. It’s often necessary to break up the delivery of the treatment into several smaller doses over the span of a few weeks to spare the healthy tissue, but some doctors are now delivering highly targeted radiation therapy at the time of surgery with a procedure called intraoperative radiation therapy.
Dr. Olga Ivanov, assistant professor of surgery, University of Central Florida and medical director of the Breast Health Center at Florida Hospital Celebration Health in Celebration, Florida, says that using traditional radiation therapy after a lumpectomy brings the recurrence rate “down to two percent. So that’s a no-brainer” to use radiotherapy. However, “traditional radiation is a big commitment,” she says, noting that the typical patient receives treatment “every day Monday through Friday for six weeks. Now there’s newer and more advanced protocols, so you may be able to get that down to three weeks sometimes, but if the woman lives 100 miles away [from the hospital] or even five miles away on a busy highway or doesn’t drive, it’s a big commitment for her and her family or social network,” to get the treatment as prescribed.
[See: Breast Pain? Stop Worrying About Cancer.]
In an effort to reduce this burden, Ivanov has been using the IORT approach for the past eight years with certain women with early stage breast cancers who are undergoing a lumpectomy procedure. During this process the radiation (a slightly different type as is used in traditional radiotherapy) is delivered at the time of the lumpectomy before the patient’s incision has been sutured. With this one-time delivery of radiation, Ivanov says “we can substitute the six- or eight-week process [of traditional radiation therapy] with an eight-minute process” that happens just once during the lumpectomy surgery. Although this condensed process isn’t meant for everyone, the results are on par with traditional radiation treatments in this subset of patients, and Ivanov says only one of her patients has had a recurrence.
In addition to reducing the burden of receiving treatment, there’s some indication that the IORT could reduce the occurrence of certain side effects. Ivanov says that studies of the technique have shown that patients had reduced rates of heart attacks later, because “we shield the rest of the body. We’re protecting the heart more. And people have less secondary cancers because they’re less exposed to radiation,” which shows, Ivanov says, that in some patients “less radiation can work just as well.”
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What Are the Side Effects of Surgery and Radiation Therapy for Breast Cancer? originally appeared on usnews.com
