Which therapies will be given after breast cancer surgery?
One designates as adjuvant therapy the additional chemo-, radio- or hormone therapy for cancer patients whose tumor has already been surgically removed (lat. adiuvare: support). The adjuvant therapy should help, for instance, to destroy no longer detectable micrometastases, and to kill tumor cells in bloodstreams or lymphatic roads.
The adjuvant therapy can ideally prevent the recurrence of the metastasis formation of a tumor or, at least, extend the time before a relapse.
After a breast-conserving surgery, a radiotherapy (irradiation) has to be undergone urgently in order to be sure that really no cancer cells are present anymore.
An additional therapy is the taking of medicine during five years.
Fortunately, the lab investigations of my tumor and the other clarifications showed a favorable initial situation, so that for me no chemotherapy was indicated.
The postoperative radiotherapy will be accomplished with daily therapy meetings (on workdays, that means 5 x per week) during 4 to 6 weeks. Single dose and total dose depend on the situation. Usually the whole breast is exposed to radiation. Possibly, for the last therapy meetings, the irradiation is limited to the former tumor site (= boost).
Treatment for me:
Irradiation with a total of 50 Gy in single doses of 2 Gy. No boost.
A good planning of the radiotherapy treatment is very important, so that the side effects can be kept as low as possible.
The distribution of the dose is calculated by computer and optimized.
In oder that in the tissue an even dose distribution results, filters are used in the therapy machine (not visible in the illustrations).
The settings calculated by the planning computer are transferred electronically to the therapy machine. There, an electronic security ensures that the treatments with the correct settings can be carried out as planned.
Radiating fields from the view of the therapy equipment (beam's eye view):
They (as in a radiogram) see the body digitally reconstructed.
The radiating field is marked in blue or violet, in the shaded squares the therapy jet is shielded off.
In the left corner, a picture of the particular setting of the therapy machine is inserted.
The radiation takes place lying on the back with stretched arms.
Daily treatment approx. 1 minute for each irradiation field.
-Clearing-up discussion about the irradiation with a physician in the radiology.
-Computerized tomography, so that the radiotherapy can be planned in a body-contoured fashion.
-Simulation with skin markings to pinpoint the exact place where the radiation is to be directed.
TIP to the date "simulation":
Ahead of the "simulation" date, the breast to be irradiated and the body side should be washed thoroughly with water only, as on an oiled/creamed skin the felt-tip pen markings for the radiotherapy smear very fast. The markings must remain well visible during the whole radiation time.
Washing of breast and body side is made more difficult by the markings.
If the skin does not react sensitively to adhesives, the markings can be covered with transparent foil. Nevertheless, the markings must be redrawn occasionally.
On the date of an irradiation, it is very important to appear exactly on time, thus the planned time of 15 minutes for taking off clothes, the irradiation and for dressing, can be kept. In case of irradiation on both sides, this takes about 20 minutes.
After approximately 2 - 3 weeks of irradiation the skin will probably redden more and more, also the itching begins, depending on the type of skin. Wide underwear, if possible of silk, is very recommendable.
During the five or six weeks of radiotherapy treatment a physician will observe the irradiated skin weekly and will prescribe a special cream if necessary for a better feeling. Own skin creams should not be used!
The following pictures show the changes of my skin after the radiotherapy:
Appearance after 5 weeks of radiotherapy:
In the pictures at the left, still two irradiation sessions were missing for a total of 50 Gy.
After the last irradiation the markings were removed.
4 days had passed since the radiotherapy,
Dermovate NN cream (given by the dermatologist), put on during these 4 days, has nearly made the vesicles disappear.
Afterwards Solcoseryl gel (of the dermatologist), used during 14 days, has renewed the irradiated skin, particles came off.
From then on the appearance became better each day, itching had diminished.
The appearance 4 weeks after the end of the radiotherapy:
The skin became marvelous, it feels now softly and fine.
The cicatrices are still well visible.
The volume of the breast is now on both sides approx. a quarter smaller, but by the new shape given during the surgery, the look is aesthetically very acceptable.
TIP for the time after the radiotherapy:
The irradiation mostly changes the breast, therein hard parts will be formed.
These hardenings can be crushed with two fingers, but this would have to take place at least twice a day and immediately after the palpation of the first hard parts. After crushing these hardenings the best will be to knead throughly the whole breast like a sponge.
What is here mentioned, is indeed quite a procedure, but it is worthwhile! Now, in November of 2004, after I kneaded the breast tissue for half a year, no hardenings are present anymore. The breast is quite small, the tissue however became solid lately and got an evenly round form (a bra is superfluous). The good result makes me very happy!
About five months after the radiotherapy treatment the constant hardening of the breast tissue stopped. I still knead daily briefly throughout in order to make the cicatrices flexible.
Women with hormone-sensitive breast cancer will receive a medicine during five years following the treatment to prevent that the hormone estrogen stimulates still existing cancer cells.
My type of cancer showed positivity for:
left: 40 % estrogen and
20 % progesterone receptors
right: 100 % estrogen and
40 % progesterone receptors
I may not take the usual given Tamoxifen because of a thrombosis in the right leg arisen in former times. An aromatase inhibitor for five years has been prescribed to me. On May 16th, 2004, I started to take daily a tablet "Arimidex".
After one year I stopped taking the medication, see "Aftercare".