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Breast tumour is a mass found in the breast as a result of the breast cells grow and divides more rapidly than normal cells. This can be due to the mutation of the breast cells. If the tumour is benign, then it is noncancerous as it does not invade other body parts. Their appearances are close to healthy cells. However, when a malignant tumour is found in the breast, it has to be removed as it is cancerous and may invade to other body parts, forming secondary tumour. This is called metastasis. So, the breast cancer refers to a malignant tumor that is found developing in the breast. 2, 22, 23 http://upload.wikimedia.org/wikipedia/commons/f/f6/Mammo_breast_cancer.jpg
Fig. 1 normal breast (left) vs. cancerous breast (right) http://www.mesrahealth.com/2008/06/what-is-breast-screening.html
Breast cancer is common nowadays. According to American Cancer Society, after skin cancers, it is the most common cancer in U.S.3, 26 Breast cancer also occurs in men, but it is less likely. In fact, breast cancer had caused 41,116 women's death in the United States in 2005. The bar chart below shows the top 10 diseases which cause the women's death in the United States in 2005.
Top 10 causes of death for women in the United States.
Fig. 2 Top 10 causes of death for women in the United States in 2005
Breast cancer can be treated. So, what are the current available treatments for breast cancer?
"Cancer cell growth is unwieldy and uncontrolled-these cells just don't have their act together like normal cells do. When normal cells are damaged by radiation, they are like a big city with a fire and police department and trained emergency squads to come and 'put out the fire.'" ------ Marisa Weiss M.D. ~http://www.breastcancer.org/treatment/radiation/how_works.jsp~
Radiotherapy is used to treat cancer including breast cancer. It can be used before and after surgery or during surgery. It aims to lower the chance of breast cancer recurrence after surgery by destroying or decelerating the growth and development of cancer tumours. The treatment is usually given everyday except weekends until the course of radiotherapy finishes. Each course may last from 3 to 6 weeks and each treatment takes about a quarter hour. Radiotherapy is carried out by using high-energy rays which will damage DNA of the cells that are in the path of its rays. Once the cancer cells are damaged by radiation, the rapid growth taking place in the cancer cells can be slowed or retarded. 6, 7, 8, 9, 21, 23
There are two different ways of radiotherapy can be given, either external beam radiation or internal radiation.
External Beam Radiation Therapy
External radiation is more familiar for breast cancer compared to other types of radiotherapy. The radiation ray from a machine called linear accelerator is focused on the cancer-affected area. The extent of radiotherapy depends on the type of surgery being done and whether lymph nodes are involved. Sometimes, radiotherapy may include the chest wall, supraclavicular lymph nodes and internal mammary lymph nodes. This type of radiotherapy is usually started when the remaining breast tissues are able to heal and is usually delayed if chemotherapy is given. 6
Before the treatment starts, measurement will be taken using a machine called CT simulator to provide a cross sectional view of the tumour so that the correct angles can be determined for focusing the radiation beams. Ink or tattoo will be made to mark. During the treatment duration, the patient will be informed not to use any chemical things such as lotion that can interfere with external radiotherapy. 6, 10, 22, 23
Image of a patient lying under a CT simulator
Fig. 3 CT simulator is used to determine the treatment area.
After marking, the patient will be positioned under the radiotherapy machine for a couple minutes. It will neither cause pain nor make the patient radioactive.
Image of a patient lying under a CT simulator with two radiographers by their side
Fig. 4 The patient has to lie still under the radiation machine.
Â Sometimes, some doctors shorten the course of radiation by giving larger daily amount of radiation, which seems to work well. This altered treatment is known as hypofractionated radiation therapy. In addition, intra-operative radiation therapy is another approach to shorten the course of treatment. This is a way that a large dose of radiation is given before the breast incision is closed during surgery. 6
Internal Radiation Therapy
Another name of internal radiation is brachytherapy. It is usually used after the surgery. Radioactive pellets are placed in the space where the tumour was removed. This can be done just before the incision is sealed or within few weeks afterwards. There are two ways of brachytherapy, which is intracavitary brachytherapy and interstitial brachytherapy.
Intracavitary brachytherapy takes less than a week. A small deflated balloon is placed into the space where the cancerous tumour being removed and is filled with a salt solution while the tube is left in the space with the end protruding out of the breast. Radioactive pellets will be placed into the balloon through the tube. After 5 days, the balloon will be deflated and removed. In interstitial brachytherapy, a few catheters are placed into the breast around the site of removed tumour. After that, radioactive seeds will be inserted into the catheters then removed. 6, 10
Diagram showing how you have internal radiotherapy for breast cancer
Fig. 5 Interstitial brachytherapy.
The treatment of breast cancer costs a lot and this may be a financial burden for some patients and their families. Furthermore, patients who are undergoing external radiotherapy have to travel to and fro between hospital and their houses. This may increase the expenses of patients, especially those who live far away from the hospital. If these patients do not have insurance or are unemployed, they will be unable to afford the cost. Thus, the government has to give aid in the form of financial so that patients can obtain the treatment. Besides that, insurance companies should offer some helps to the poor patients as well.
Patients suffer pain and always have an uncomfortable feeling. If the breast cancer patients are employed, they may cause their company losing money as they may always need sick leaves. Furthermore, if the patients decide to work during their treatment, they will be suffering some side effects such as nausea and fatigue. This may have an influence on their work routines. Sometimes, the treatment may have cognitive effects such as memory loss and lack of concentration. This may have an impact on work and causing company to loss money.21
Moreover, surgery can be done easier if the tumour is smaller and it leaves fewer side effects. Hence, education related to breast cancer should be given so that public can know more about breast cancer and go for breast screening every year. Furthermore, government should give some financial help to minimise the cost a person has to pay for breast screening or some poor people might rather do not go for breast screening and ignore the risk of getting breast cancer.
Benefits and risks
There are some benefits of radiotherapy. By carrying out radiotherapy, breast cancer cells can be destroyed while causing little effect to normal cells. High-energy ray is used to damage the DNA of the cells. DNA of cancer cells, which are less organised, is harder to mend the damage themselves. However, normal cells can repair themselves and live on. Moreover, radiotherapy is used to minimise a tumour and terminate the growth of cancer cells. Surgery can be done easier if the tumour is smaller. It is also carried out after surgery to stop the growth of the remaining cancer cells in breast. Study has shown that women who are under 35 years old with breast cancer can have 20% lower risk of breast cancer recurrence if they accept radiotherapy after surgery. The result of this study was presented by Professor Harry Bartelink and his colleasgues at the 23rd Meeting of the European Society for Therapeutic Radiology and Oncology. 11, 12
However, radiotherapy may bring about some risks as it causes some side effects. For example, it causes the swelling of the breast which is known as lymphoedema. This can happen if radiation damages the lymph nodes, causing accumulation of lymph fluid. Some patients may also get redness on the skin of the treated area. This can be due to tiny ruptured blood vessels and this condition is known as telangiestasia. These conditions will cause the chance of breast reappearance. Radiotherapy will cause fatigue for temporary as well. Furthermore, some patients will get a long-term side effect such as a continuing dry cough or out of breath. Radiotherapy may cause the fibrosis on the lung tissues which is called radiation fibrosis. Radiotherapy may result in brittle bone, particularly collar bones. The bones may break if it is weakened enough. However, this is rare. 23
Chemotherapy is another kind of breast cancer therapy which uses medicine to damage the cancer cells in the body to reduce tumour burden as well as inhibit them from dividing. It can be used to decrease the size of the cancerous tumour. Moreover, chemotherapy is also used to get rid of any remaining cancer cells that may leave behind after surgery. This type of therapy can reduce the risk of the breast cancer reappearance. The medicine affects the whole body through circulatory system. A combination of chemotherapy medicines are usually given rather than a single drug alone as the combination of medicine is more effective. Some combinations of the drugs are CMF (cyclophosphamide, methotrecate, fluorouracil), FEC (epirubicin, cyclophosphamide, fluoroiracil), MM (methotrexate, mitozanteone) and so on. Chemotherapy medicines can be infused orally or through injection, however there are some side effects of chemotherapy. For example, the patient may suffer hair loss with FEC.13, 14, 15, 16, 22, 24
Â Female hormones such as oestrogen can encourage the growth of breast cancer cells. So, hormonal therapy is given to influence the action of these hormones. Hormonal therapy medicines circulate in bloodstream. They are a few types of hormonal therapy medicines such as aromatase inhibitors, selective oestrogen receptor modulators (SERMs) and oestrogen receptor down regulators (ERDs). All medicines of hormonal therapy are in solid form except Faslodex which is liquid. These medicines treat breast cancer by minimising and decelerate the growth of tumour as well as reducing the likelihood of breast cancer reappearance in either reducing the amount of oestrogen in the body or inhibiting the action of oestrogen on breast cancer cells. For example, Tamoxifen can be consumed to block the growth of tumor as it has anti-oestrogenic effect. Yet, hormonal therapy is only effective against hormone-recertor-positive breast cancers and it has some side effects. For instance, aromatase inhibitors may bring about nausea, constipation, bone pain and severe fatigue as well as or other side effects such as vomiting and coughing after consuming certain hormone after consuming certain type of hormonal therapy medicine. 17, 18, 21, 23, 25
Radiotherapy can be carried out to destroy or slow down the growth and the development of cancer cells by using powerful X-rays, from reference [10.http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_therapy_5.asp]. This source is reliable since it also agrees with many other sources such as [11,http://www.royalmarsden.nhs.uk/RMH/cancer/treatmentofcancer/treatmenttypes/radiotherapy/] and [22,Mary Lou Mulrihill, PhD; Mark Zelman, PhD; Paul Holdway, MA; Elaine Tompany, PharmD; Jill Raymond, PhD; Disease of the Reproductive System, Human Diseases 6th Edition; U.S. ; Julie Levin Mexander; 2006.] Furthermore, reference number 10 is the service of the American Cancer Society which is trustable.
Besides that, [28, Steve Austin, N.D; Cathy Hitchcock, M.S.W; Breast Cancer, What You Should Know (But may be not be told) About Prevention, Diagnosis and Treatment; Prima Publishing; Rocklin; 1994] is also reliable as its author, Steve Austin who graduated from National College of Naturopathic Medicine in 1982 is a licensed naturopathic physician. He has Bachelor's degrees in psychological from Antioch College and human biology from Kansas Newman College. Moreover, the book was well-commented by Lendon H. Smith who is the author of "Feed Your Kid Right", Tori Hudson who is a professor at Natural College of Naturopathic Medicine, Michael Janson who is the vice president of the American Preventive Medical Association, Michael Murray who is the author of encyclopedia of natural medicine and other famous people in the field of medicine.