|surgical | oncology|
High energy x-rays are used to penetrate the tissue and destroy any cancer cells that may remain in the surrounding tissue. Radiotherapy is also used for the local management of breast cancers. This is effective in the local control of breast cancer. Its use decreases the incidence of local recurrence. Radiotherapy may improve overall survival in certain patients. Radiotherapy will prevent local recurrence after breast conserving surgery (it is standard treatment to give DXT to the remaining breast tissue after lumpectomy in Stage I disease). Remember that in medial tumours (inner half of the breast), where there is a chance of internal mammary node involvement (glands under the ribs), the radiotherapist does not only irradiate the remaining breast tissue; he or she may also add an additional blast to the internal mammary nodes. This must be done with caution, as the DXT rays must not hit the heart and lungs.
The following patients must get radiation therapy:
This is effective in the local control of breast cancer. Its use decreases the incidence of local recurrence. Radiotherapy will:
The axilla should never be treated by both surgical clearance and DXT. This combination is very likely to cause swelling of the ipsilateral upper limb (brawny oedema of the arm).
Finally DXT is invaluable treatment of Stage IV breast cancer with bony metastases.
Dissemination to bone warrants treatment with DXT in the following situations:
This will allow the patient to mobilise early and get around relatively easily. The quality of life is dramatically improved. It is important to realise that DXT is time consuming and in some patients where travel every second day, and lying in a machine when they have back problems may make DXT difficult for them and these patients might do better with a mastectomy due to lifestyle and environmental factors.
Locally Advanced Breast Cancers (5cm and bigger)
The clinical features of locally advanced (Stage III) breast cancer can be summarised as follows:
Clinical features of locally advanced breast cancer:
The mainstay of treatment of Stage III is chemotherapy and radiation therapy Occasionally surgery is also required to remove a cancer that is not responding to chemotherapy and radiation therapy. This is called a “toilet mastectomy”. It is important that this procedure is done inconjunction with a plastic surgeon, as it is better to have clear tumour margins. Skin grafts are not advisable as one can not give radiation treatment to a skin graft.