Want to know if you'll need radiation after your breast cancer surgery? We will
teach you all about it.
Breast cancer radiation plays a very important role in breast cancer
treatment. Unfortunately, when you're diagnosed
you're already dealing with so many other things such as getting a breast
MRI, preparing for surgery or maybe even preparing for chemotherapy. What can
be lost in this fast-paced, very stressful time are discussions about the
indications for breast radiation because your surgical choices and even if you
choose chemotherapy up front before surgery can sometimes affect whether or
not you will need breast radiation. In this lesson I'm going to teach you when
breast radiation is needed after a lumpectomy you will also learn when
radiation is needed after a mastectomy called post mastectomy radiation
therapy (PMRT). it's sometimes important to see a radiation oncologist before surgery
and I'm going to teach you when you need to do them because most of the time you
see them after surgery and I'm also going to share with you a few situations
where you might be able to avoid breast radiation so let's get started. So will I
meet radiation after my breast lumpectomy? Well in the vast majority of
cases the answer is yes when you and your breast surgeon are talking early on
about maybe pursuing a lumpectomy well it's important to note that a lumpectomy
followed by radiation is just as effective as a mastectomy with no
radiation for early-stage breast cancer so sometimes the term breast radiation has not
really brought up in the discussion or discussed at length. The way to think
about it is that when you take out a cancer
out of the breast and you keep the breast there could be a couple of cancer
cells left behind that we don't know about it even though we tell you we got
a well around the cancer and radiation reduces the chance that one of those
cells will grow and the cancer goes back in the breast radiation after lumpectomy
It is invariably needed for younger women it is needed just as equally for
invasive breast cancer and a precancerous condition called DCIS so
when you're planning a lumpectomy you're sort of committing to breast radiation
therapy so it's important to talk to your surgeon so you understand what
radiation is ahead for you. So when is radiation needed after a mastectomy.Well
the short answer is not that often. Post mastectomy radiation therapy (PMRT) is when
radiation is needed after a mastectomy surgery and you could have had
reconstruction or no reconstruction and it's generally performed to lessen the
chance of something growing back on the chest wall and in the reconstruction
when you're at a higher risk for having a recurrence. So most of the time it's
applied to women that have a more advanced cancer when their tumor is very
large or you have inflammatory breast cancer which it's invariably needed. Also
if you're found to have a lot of lymph nodes involved with cancer certainly an
indication but post mastectomy radiation therapy is also helpful in women with
early-stage breast cancer in a few situations. Let's say your surgeon removes
the breast tissue, you do a reconstruction or not but they find under the microscope
after surgery that the cancer is at the edge of the tissue that they removed
well sometimes you need radiation after
surgery to make sure nothing grows back. The take-home point is
that these are very complicated decisions that you must make with your
surgeon and radiation oncologist and sometimes a medical oncologist is involved.
Next I'll tell you how to best make these decisions and I'll also reassure
you that most of the time you will not need post mastectomy radiation therapy.
So when should you consult with a radiation oncologist before surgery
rather than after? Well there's a simple principle that applies to almost
anything. The more someone knows about you the more they can help you. So there
are a few situations where it's a good idea to visit with a radiation
oncologist before surgery, meaning the tumor is taken out, or chemotherapy if
they're gonna have it before surgery, because the tumor shrinks away. A couple
of situations: Inflammatory breast cancer, it is essential for your radiation
oncologist to see the extent of the tumor in your breast, the involvement of
the skin, the size of the lump and evidence of cancer in your lymph nodes. The same
applies for a large tumor in your breast. A big one that you can feel that you're
probably going to have a surgery and there's some concerns that it might
spread to other areas in the area of the chest wall if you have a lot of lymph
nodes involved. That might be a good situation to visit with the radiation
oncologist. So think about it, your radiation oncologist will examine you
look at the size of the tumor look at the skin, look at your imaging,
examine and find out whether you have lymph nodes and also and even more
importantly educate you about radiation and assess your health status to see if
it's something that you can tolerate. If you're unsure that you're interested in
undergoing them a lumpectomy for an early stage breast cancer because you're
worried about radiation and you're trying to decide whether you're gonna
have a mastectomy and avoid radiation or have a lumpectomy followed by radiation
and you're struggling with that decision, make sure to ask your breast surgeon to
make an appointment to visit with their breast radiation oncologist because you
can sit down have a discussion with them to learn more about radiation
and what it means. It may reassure you that radiation is something you want or
it may guide you away from radiation because you will conclude that it's
something that you do not want. So how can I avoid radiation therapy for my
breast cancer? Well your surgical choice most of all affects whether or not you
get radiation therapy. So if you have early stage breast cancer and most
patients do, and you undergo a lumpectomy that's generally followed by radiation
therapy but you can also choose to have a mastectomy it doesn't particularly
make you live longer, or cure cancer more but if you have a mastectomy
in this situation you generally do not need radiation after a mastectomy. So
your surgical choice really brings radiation into your discussions.If you are older, have an advanced age or have a lot of health
issues a lot of times we feel radiation is not needed or does not benefit you
and we can avoid radiation after it if you have a very small favorable
breast cancer or pre-cancer called DCIS then there's some situations where we
can remove the cancer with good margins and avoid radiation, but it is somewhat
controversial and it's worth asking your surgeon if there's a way to avoid
radiation after a lumpectomy. Neoadjuvant chemotherapy, where you get
chemotherapy up front to shrink your tumor and maybe the cancer in the lymph
nodes underneath your arm before surgery sometimes that can take someone that if
they had surgery initially they would need radiation after a mastectomy but if
all the cancer is gone after chemo has killed all the same cells and it's
shrunk away then a patient that would have needed radiation after their
mastectomies after their mastectomy. it's a small subset of people but it's
important to note and it's one of the benefits of neoadjuvant chemotherapy.
Lastly, genomic assays are an involving technology and science that's now being
applied to some patients to help decide if they can avoid radiation, so let me
explain. These genomic tests look a little deeper into your cancer and they
tell us if your cancer is more likely to recur or less likely to recur than what
we know I'll already. And these tests can sometimes identify a patient that is at
a low risk of the cancer growing back in the breast after surgery without
radiation and in these low-risk patients it's reassuring that they might avoid
radiation because the chance of something growing back is already low
and it's hard to make a low number even lower. It's approved in a few situations
and it's an evolving science. It's not applied to many but it's important to
know that this is coming for breast cancer patients in the future.
It is super important for you to learn early on in your breast cancer treatment
journey what role radiation therapy will play for you and along the way learn as
much as you can about radiation so you make the very best breast cancer
treatment decisions for yourself. To learn more about if you will need
breast radiation visit the breast cancer school for patients where we actually
teach you everything you need to know. We're here to help you get the best
possible breast cancer care in your community. Register on our website to get
our list of questions to prepare you for your next doctor visit.