Breast Cancer: Side Effects of Radiation
Guest: Dr. Buddy Jenrette – Radiation Oncology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Buddy Jenrette who is a radiation oncologist and chair of the department here at MUSC. Dr. Jenrette, in an earlier podcast, we started talking about radiation therapy for breast cancer. One of the concerns, I am sure, for any woman is what are the side effects of that treatment?
Dr. Buddy Jenrette: Of course, everybody worries about that and people are afraid of medical tests. They are afraid of medical treatments and they all come with horror stories that somebody told them about somebody that they might not have even really known but heard about it through somebody else. So, the side effects of x-ray treatment are really very straight forward. When treating the breast, there is always a degree of redness of the skin. It is like a suntan, although the reaction that is actually taking place in the skin is not exactly a suntan reaction. But, effectively, that is what it looks like. For most women, it is only a mild redness of the skin. Unfortunately, sometimes, just like with the sun, some women are more susceptible to x-ray treatments and they will actually have burns. Thankfully, that is unusual. But, they will see, occasionally, peeling and blistering of parts of the skin, particularly under the breast or under the arm.
Today, we have very good creams that are used as preventatives. We try to get the women involved, right from the beginning, on a skin care program by using these specially designed creams. If they do have a bad effect, we have creams that will help the skin heal. They have these epidermal growth factors which help promote healing of the skin. So, the skin is the biggest thing.
Most women will report a degree of fatigue associated with the treatments as well. That is really subjective and all I can do is give them validation. If they tell me they are tired, I understand. It can range from women who get a treatment and go home and lie down and take a nap to women, I have treated, who go home and ride their bicycle 25 miles everyday, and another woman who is in her late 70s who played three rounds of golf every week. So, tiredness is so subjective, I do not have a machine that I can hook people up to and measure their fatigue. I just listen to them and accept that there are differences. Those are the only major side effects of the treatment. There is no ulcer, nausea or vomiting associated with x-ray treatments to the breast.
Dr. Linda Austin: Generally, in the more severe cases of fatigue, how long will that last, after the last radiation treatment?
Dr. Buddy Jenrette: It starts resolving immediately. Over the course of the next few weeks, most women get back to their peak performance. It depends on whether they have had chemotherapy as well or other problems associated with their general medical health. Some women have underlying illnesses, such as diabetes or some of the autoimmune diseases, and that may make things a little slower. Most women, by a month, are feeling really good. Within two or three months, they do not even remember that they had the fatigue.
Dr. Linda Austin: Generally, are women able to continue to work, while they are getting radiation therapy?
Dr. Buddy Cunningham: Most women do work. In fact, I have treated many of my colleagues right here at MUSC who just come down from their office, or floor that they work on, or clinic or lab, and get their treatment and go right back, and their colleagues do not even know they have gone. They just think they have gone for a coffee break and come back. I have women who do construction work. I have women who work in offices. I have women who are professionals. Almost without a doubt, they all continue to work.
Dr. Linda Austin: In the earlier podcast, we talked about the simplest treatment, radiation therapy treatment. Let’s go on and talk about more complex treatments. What might they consist of?
Dr. Buddy Jenrette: Once the treatments gets beyond Stage 1, or even in special situations with younger women with breast cancer, women in their 20s or 30s and even 40s, the treatment involves not only surgery and radiation but also involves chemotherapy. Then, we have to intertwine our activities with the other physicians as well. Again, working as a team, we have worked out the protocols of how we think is the best way to manage the sequencing and timing of the different treatments. But, it does add more complexity to that. Or, sometimes the patient may have disease that has spread outside of the breast. So, we may be called in, not even to treat the breast, but to treat cancer that has spread to the lung or a bone or that sort of thing. Then, again, we work with surgeons, maybe even surgeons from other divisions that are not breast cancer surgeons, maybe orthopedic surgeons or neurosurgeons and other medical oncologists who take care of those particular diseases. So, it can get really complex, as the disease gets more complex.
Dr. Linda Austin: This is kind of a subjective question, I suppose. Relative to 5 years ago, or 10 years ago, what do you observe in the prognosis of women with breast cancer? How much progress, in other words, are we making?
Dr. Buddy Jenrette: It is better. We have better treatments. We have better earlier diagnosis. We have gone from women who presented 25 years ago with breast cancers that, on the average, were about 4 cm to now, they are less than 3 cm. We still have women who come in with huge breast cancers, but we also have women who come in that have breast cancers that are just a few mm in size. Because of the earlier diagnosis, we are able to do a much better job. The surgical techniques, the chemotherapy and the radiotherapy techniques have all improved dramatically.
Over the last few years, our ability to look inside of the breast by doing three- dimensional treatment planning and mapping out of the areas and volumes we want to treat, are things we could not do five years ago. So, we start out by doing a specialized CT scan of the woman, through the chest area. We do a three-dimensional reconstruction into our computers and we can look at, not only, the outside of the breast but, really, we are interested in looking at the inside, so we can see exactly where the tumor arose. We also can see the relationship of where the heart is. There use to be some toxicity to the heart in the old days. We can look at the lungs. We can look at the esophagus and spine, and trachea. So, we have a whole volume of area that we can completely see now that we could not before.
We can also subsegment the breast so that the base of the breast, which is wider than the area around the nipple, the areolar area, will get the same amount of radiation. Before, we just accepted that some parts were going to get more and some parts were going to get less and that women should have a pretty good cosmetic outcome. But, that did not always happen, especially with women with really large breasts, or really small breasts. So, now, it is not just one size fits all. We are able to tailor the treatment to each individual woman by doing complex planning with our physics department and our physics division within our department.
Dr. Linda Austin: Dr. Jenrette, thank you so much for talking with us today.
Dr. Buddy Jenrette: It has been my pleasure.
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