Breast Cancer

Breast cancer is the most common cancer affecting women in the United States. Each year, over 200,000 American women are diagnosed with this disease. As a result, thousands of women in Central California will be diagnosed with breast cancer each year. Breast cancer is a type of cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is much more rare.

At Rio Bravo Cancer Center, our team of oncologists provides only the most innovative and proven cancer fighting radiation therapies as one part of an overall comprehensive breast cancer treatment program. Indeed, our only objective is the successful treatment of your cancer.

Many breast cancers will require surgery, and nearly all will necessitate cancer fighting radiation therapy to destroy any remaining cancer cells in the breast and beyond. Yet, when it comes to effective radiation treatment for breast cancer, older radiation delivery methods fall short, because they can expose nearby, healthy tissue to unwarranted radiation.

However, cutting-edge radiation therapies such as Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) enable Rio Bravo Cancer Center’s team of specialized oncologists to deliver higher doses of radiation with acute precision to cancerous tumors.

Signs and Symptoms of Breast Cancer

Symptoms of breast cancer may include: a lump or thickening in or near the breast or in the armpit area, nipple tenderness, a change in how the breast or nipple appears, a change in the size or shape of the breast, a change in the skin of the breast or nipple, and nipple discharge (fluid).

Early breast cancer usually does not cause pain. However, a woman should see her health care provider about breast pain or any other symptom that does not go away after a few weeks. Any woman with these symptoms should be evaluated by a physician as soon as possible.

Helpful Terms

  • BB’s – Small markers that are placed on the skin for localization purposes during radiation therapy.
  • Blocks – Used for some patients’ treatments to block out unnecessary structures within the treatment field (heart, lung, etc.).
  • Dry desquamation – Dryness, itching, scaling, flaking and peeling of the skin.
  • Ecchymosis – A bruise or contusion.
  • Erythema – Abnormal redness and inflammation of the skin
  • Fat necrosis – Necrosis of adipose tissue, characterized by the formation of small quantities of calcium soaps when fat is hydrolyzed into glycerol and fatty acids. Also known as steatonecrosis.
  • Gantry – The C-arm part of the machine that rotates around you to deliver radiation from different angles.
  • Induration – Hardening and swelling of a part of the body.
  • Lasers – Red lasers in the treatment room that the therapists will use to align you in the correct treatment position.
  • Linear Accelerator – The machine that delivers the radiation treatment.
  • Lumpectomy  Surgical removal of the breast tumor alone.
  • Lymph node dissection – Surgical removal of lymph nodes, in breast cancer the lymph nodes in the armpit (axilla) are dissected. Often times a sentinel lymph node biopsy is done first.
  • Lymphedema – The accumulation of fluid in soft tissues of the body with accompanying swelling, often of the extremities: sometimes caused by inflammation, obstruction or removal of lymph channels.
  • MammoSite/Savi/Contura – Brand names of breast implants/balloons, which are inserted into the lumpectomy bed for targeted radiation therapy for breast cancer.
  • Mastectomy – Surgical removal of the all breast tissue in the affected breast.
  • Metastasis – The spread of malignant or cancerous cells to other parts of the body by way of blood or lymphatic vessels or membranous surfaces.
  • Moist desquamation – Moist peeling of the skin which sometimes can be associated with blistering.
  • Port films – X-ray films that confirm the treatment area and patient positioning (taken on a weekly basis for treatment quality assurance purposes).
  • Pruritus – Itching
  • Sentinel Lymph node biopsy – A tracer or dye that is injected into the breast where the tumor originates, it then drains into the axilla (armpit) to help guide the surgeon to which lymph nodes need to be sampled. This procedure reduces the risk of lymphedema in comparison to a lymph node dissection.
  • Seroma – A mass or swelling caused by the localized accumulation of serum (fluid) within a tissue or organ. These normally absorb on their own, however it sometimes may require surgical drainage.
  • Stage 0 is carcinoma in situ
  • Lobular carcinoma in situ: Abnormal cells in the lining of a lobule which is considered non-invasive disease. However, LCIS does indicate an increased risk of invasive breast cancer
  • Ductal carcinoma in situ (DCIS): Abnormal cells are in the lining of a duct, which is considered non-invasive disease. The abnormal cells have not spread outside the duct or invaded the nearby breast tissue. DCIS can become invasive cancer if not properly treated.
  • Stage I is the earliest stage of invasive breast cancer.
    • The tumor is no more than 2 centimeters (three-quarters of an inch) across. Cancer cells have not spread beyond the breast.
  • Stage II is one of the following:
    • The tumor is no more than 2 centimeters (three-quarters of an inch) across. The cancer has spread to the lymph nodes under the arm.
    • The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has not spread to the lymph nodes under the arm.
    • The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches).
    • The cancer has spread to the lymph nodes under the arm.
    • The tumor is larger than 5 centimeters (2 inches).
    • The cancer has not spread to the lymph nodes under the arm.
  • Stage III is locally advanced cancer. It is divided into Stage IIIA, IIIB, and IIIC.
  • Stage IIIA is one of the following:
    • The tumor is no more than 5 centimeters (2 inches) across. The cancer has spread to underarm lymph nodes that are attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone.
    • The tumor is more than 5 centimeters across. The cancer has spread to underarm lymph nodes that are either alone or attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone.
  • Stage IIIB is a tumor of any size that has grown into the chest wall or the skin of the breast. It may be associated with swelling of the breast or with nodules (lumps) in the breast skin.
    • The cancer may have spread to lymph nodes under the arm.
    • The cancer may have spread to underarm lymph nodes that are attached to each other or other structures. Or the cancer may have spread to lymph nodes behind the breastbone.
    • Inflammatory breast cancer is a rare type of breast cancer. The breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast. When a doctor diagnoses inflammatory breast cancer, it is at least Stage IIIB, but it could be more advanced.
  • Stage IIIC is a tumor of any size. It has spread in one of the following ways:
    • The cancer has spread to the lymph nodes behind the breastbone and under the arm.
    • The cancer has spread to the lymph nodes above or below the collarbone.
  • Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body.

Recurrent cancer is cancer that has come back (recurred) after it has been treated. It may recur locally in the breast or chest wall. However, it may also recur distantly in any other part of the body, such as the bone, liver, or lungs.

Treatment of Breast Cancer

To plan your treatment, your doctor needs to know the extent (stage) of the disease. The stage is based on the size of the tumor and whether the cancer has spread. When breast cancer spreads, cancer cells are often found in lymph nodes in the axilla (armpit). The stage often is not known until after surgery to remove the tumor in your breast and the lymph nodes in your axilla. . Staging may also involve imaging tests and lab tests. These tests can show whether the cancer has spread and, if so, to what parts of your body.

Breast cancer treatment often requires both local and systemic therapy:

Local Therapy
Surgery is always required for definitive local treatment. This removes the bulk of the tumor which can then be analyzed by a pathologist.

Radiation is added after lumpectomy to prevent any cancer relapse in the breast. Sometimes after mastectomy, radiation is recommended if high-risk features are found.

Systemic Therapy
Some women with higher risk disease may need systemic therapy after local therapy to prevent the cancer from coming back in the body. Chemotherapy, hormonal therapy, and biological therapy are systemic treatments. They enter the bloodstream and destroy or control cancer throughout the body. Some women with breast cancer have systemic therapy to shrink the tumor before surgery or radiation.

Surgery

Therapeutic Surgery
Both breast-sparing (lumpectomy) and mastectomy surgeries are options for patients with breast cancer. Surgery is often followed with radiation and chemotherapy treatments to prevent any future relapse.

Reconstructive Surgery
We work closely with skilled plastic surgeons who can evaluate you for breast reconstruction if necessary. This multi-disciplinary approach ensures the best cosmetic outcome and chance for curing your breast cancer.

Radiation Therapy

External beam radiation delivers radiation via a source outside or external to the body, in this case through a linear accelerator machine. This complex machine uses electricity to produce high-energy x-rays, targeted and delivered to the affected breast. These x-rays deposit the prescribed dose of radiation deep within the body while sparing surrounding structures.

The actual radiation treatment is invisible, tasteless, odorless, and painless. External beam radiation is a completely non-invasive technique. It works by damaging cancer cells and slowing their ability to grow and divide. Healthy cells can repair the effects of radiation fairly quickly while cancer cells have a difficult time recovering. By delivering radiation over a pre-determined amount of time (approximately 6-8 weeks), we allow the healthy tissues to repair while repeatedly damaging the cancer cells.

LINAC External Beam Radiation Treatment

Delivered by our state-of-the-art linear accelerator machine, beams of radiation are carefully aimed directly at the affected breast. The linear accelerator machine uses on board imaging to monitor the position and movement of the breast, ensuring that the surrounding healthy tissue is not affected.

External Radiation FAQ

Q: What are the common side effects of breast irradiation and when shall I expect them to appear?

A: The actual radiation treatments are painless, however the side effects may bother you. Common side effects are redness and irritation of the skin in the area being treated. Some patients may experience skin dryness, tingling, throbbing, peeling, and discoloration in the treated area. Skin reactions may appear within 2 weeks of treatments. However, each patient’s reactions are unique. Side effects are reversible and usually subside in 2-3 months after treatment.

Q: What can I do to alleviate skin irritation?

A: We recommend that during the course of radiation the patient apply alcohol-free 100% aloe vera gel and/or Nivea cream. If there is moist peeling some patients may need a special antibiotic cream.

Q: What are tattoos and why are they needed?

A: The tattoos are small permanent marks placed on the skin surface with a needle and India ink. The therapists refer to these tattoos for treatment positioning and radiation field alignment.

Q: Can I shave my underarm?

A: Do not shave the underarm of the area being treated. Skin is sensitive in that area during the radiation treatments and shaving will irritate that area.

Q: What will I feel during the treatment?

A: You will not feel or see anything during treatment. However, you will hear a buzzing noise while the radiation beam is on.

Q: Why am I feeling tired?

A: Fatigue is a common side effect of radiation, usually experienced two weeks into treatment. However, every patient is different and fatigue levels will
vary. The fatigue is reversible and usually subsides 3-4 weeks after finishing radiation treatment.

Q: What if I need to miss a day of treatment?

A: Missing a day of treatment is permissible, however, all absences should be cleared with the doctor or radiation therapist first. The missed treatment will
be made up with an additional treatment at the end.

Q: What diet should I be on during radiation treatments?

A: In general, there are no diet restrictions with radiation to the breast.