Radiation Slays Cancer, Knowledge Slays Fear

Thirty days after surgery I drove Gaye to her consultation with Dr. H, the radiation oncologist. Flushed with good vibes from her oncology and reconstruction follow up, Gaye was upbeat. We had benefited from a lot of good news. 

The lymph-node biopsy had revealed two cancerous lymph nodes (which can be problematic in detecting malignancy). Additionally, Letrozole, the aromatase inhibitor prescribed as a maintenance medication would ultimately reduce recurrence risk to 5%. The oncologist would reassess at the five year mark.

Further, Dr. B’s excellent repair work benefited Gaye through good lymph fluid return and she bore no signs of lymphedema. No sleeve to prevent fluid-related swelling was needed. The walking Gaye had engaged helped return almost all of her range of motion.

Her incisions were healing nicely with no hypertrophic (bulging) scars. Things looked good. Of course I’m typing this from my perspective. I wasn’t the one facing radiation treatments just after getting my wind back from surgery.

Location, location, location

While Baylor College of Medicine’s Breast Center is still building out to include an in-house radiation center, patients are referred to a radiation center on the fringe of the medical center. Free parking, easy navigation in/out, and dedicated services are a big bonus. Still, having this service in the same building with the rest of the breast center will be an enormous benefit to patients.

At the outset, I have to say that the compassion and professionalism we witnessed at the radiation center went way above what we expected from an out-patient facility. The center provides care to patients battling many different forms of cancer. However the staff is top-notch and well aware that they are caring for folks who are often going through the worst event in their lives.

Cindy conducted our initial consultation. At first I worried about a personality clash. She seemed brusque and matter-of-fact but that was just until she got us to the examination room. Then she bloomed with care and consideration. 

First she presented Gaye with a pink care bag that contained a resource manual, and three skin moisturizers, and coupons for each moisturizer. Then she gave us the full-nickel orientation:

• Radiation causes skin burns (more on that in a moment)
• Pick the moisturizer that works best and stick with it—but don’t mix/alternate
• Radiation causes fatigue and the fatigue is cumulative
• On the day of treatment, no deodorant or powder (to avoid potential skin irritation)
• Hospital wipes are okay 

For context, (if you’re wondering about the last two) the average summer temp in Houston is 91f with 80% humidity. Folks get funky. 

Brass tacks:

• The initial consultation with Dr. H was a basic “what to expect” session
• Next was the simulation, (a dress-rehearsal with a CT scan) to gauge angles and positioning
•  It would take two weeks to formulate the plan (based on angles and radiation dosage)
• A nuclear physicist does the radiation dosage calculation, (position of heart in relation to the breast tissue)
• Treatments would be 5 days/week for a total of four weeks or 20 treatments
• Each treatment would take between fifteen and 20 minutes
•  Gaye would see the Doc at least once a week to assess radiation burns
• Pneumonitis (lung irritation similar to pleurisy) is a risk with radiation treatments to the upper chest
• Rib-fracture is another risk as is nausea
• Gaye would have to wait at least two weeks post radiation to start the Letrozole maintenance medication

Cindy also gave us a tremendous resource website: rtanswers.org that includes videos and stories.

Bad information and bad understanding is worse than myths and superstition

Gaye was told by multiple people, patients and clinical staff that radiation would turn her skin black as if she were sunburned. Cindy said the same, until Gaye drilled down on the question: if radiation burns skin like a sunburn, then wouldn’t the color change be dependent on pigmentation? Gaye’s base pigmentation means that when she suffers sunburn, she turns burgundy, (just as a caucasian person turns red). Cindy was unable to answer the question but to her credit, she didn’t disregard the question either. She made sure it was at the top of Dr. H’s notes.

“Are those Rothy’s?”

Right through the door, Dr. H flipped all ideas of how a radiology oncologist looks/behaves. Built like a former football player with a “Dad” demeanor he started by asking Gaye about her shoes. He had a pair of Rothy’s (cute, colorful loafers made of recycled plastic from water bottles) and loved them. Fashion is Gaye’s happy place and she takes pains to ensure her appearance reflects the joy that fashion imparts. Those two minutes of conversation completely diffused the tension in the room. 

Dr. H gave us a brief overview of the use of radiation therapy as supplemental breast cancer treatment. While the clinical efficacy of lumpectomy and mastectomy are nearly the same, including the risk of CTCs. Like the cells that were caught by Gaye’s lymph nodes, any cells that escaped excision could result in recurring cancer. Targeted radiation cut that risk down. 

Dr. H planned to target the axilla lymph nodes, (armpit) superclavicle lymph nodes, (collar bone) and the internal mammary lymph node (just what it sounds like). But if Dr. H thought that was all there was to it, he hadn’t treated many nurses like Gaye. She had researched and she had questions. Thankfully, he had answers.

• The treatment plan of radiation versus chemotherapy, like the choice of lumpectomy versus mastectomy is dependent on cancer type and staging
• The risk of lung and heart damage from radiation were both present however, the angles and dose would be calibrated to reduce the risk while providing maximum benefit
• Yes, darker pigmented people may darken deeply
• No, the targeted area would not, (based on Gaye’s base pigmentation) turn black but would darken
• Typically, skin returned to base color around two months after therapy
•  As previously addressed, (with Dr. M in the reconstruction consultation) Gaye could expected shrinkage in her radiated breast
• The possibility of skin damage at the incision site existed and if it occurred, would delay treatment
• The only other risk Dr. H could identify was that as fun as Rothy’s are, I would probably end up buying more for Gaye

If these sound like random concerns, they are in fact based on clinical findings for why many women opt-out of radiation therapy. Bad information, bad understanding, and unfounded fears are deadly. Gaye wanted the science-based information to make her own determination.

Takeaways

• Research, (I’ve included links to reputable, clinical websites in previous articles)
• Ask questions
• Understand the science to trust the science

Stay positive. Stay strong

The photo at the top, Gaye, in Philly, c. 2016 belongs to herself and is used by her very kind permission.