Radiation Pt 2: Angles and Setbacks

So, why radiation? 

After the last post it occurred to me that while I gave a pretty good detail of our transition from surgery/recovery to radiation, I skipped a key component. I completely omitted the big part of that transition: why? I mean surgery removed the cancerous tumor. Why was radiation necessary?

In many stage-one/grade zero cases, cancer surgery is the extent of treatment. No follow-up treatment necessary. Other types of cancer, dependent on stage/grade require presurgical treatment. Radiation or chemotherapy (sometimes both) is employed to fight the cancer. 

Each type/stage of cancer mandates a different treatment

However in most instances, (due primarily to breast cancer detection challenges) follow-up treatment is necessary to insure that no missed cells (or circulatory tumor cells) develop and lead to metastasis. The type, stage, and grade of cancer are the factors that determine patient candidacy for radiation or chemotherapy, before or after surgery.

As previously stated, in Gaye’s Invasive Ductal Carcinoma tumor and associated lymph nodes were removed in surgery. The plan of care called for a regimen of aromatase inhibitor to follow surgery and further reduce the risk of recurrence. Indeed, when combined with surgery for the maintenance medication reduced the risk  to 5%. Still, the lymph node involvement represented additional risk. As a result, the oncologist and surgeon recommended radiation therapy.

Belt and suspenders

Radiation is a one-two punch on cancer. In addition to shrinking tumors and killing existing cancer cells, radiation creates a physiological atmosphere hostile to cancer cells for months after treatment. Which means that months after treatment, the radiated tissue remains inhospitable to cancer cells that may circulate through.

All radiation therapy is not the same

Again, depending on the type of cancer, the radiology oncologist will opt for one of two treatments. Brachytherapy is for the whole breast and typically means the placement of material that radiates the entire area. But Accelerated Partial Breast radiation is a targeted approach to focus on the tumor site and a 1-2 cm margin. This is achieved using a beam projector, similar to an X-ray machine.

All lump locations are not the same, either

The left-sided tumor is difficult to treat with radiation due to proximity to the heart. Further, plotting an angle to spare the heart risks the lungs. The challenge, then, is to radiate the tumor while avoiding the vital organs. 

Game day: bring a friend

As instructed by Cindy, Dr. H, and the RT Answers video, Gaye arrived for her simulation with a friend, (yes, I’m her husband and her friend). Thankfully, I brought a book, (yes, a MacBook is a book). The simulation took two hours and that was on top of the wait, dressing, and undressing. By the end, Gaye was exhausted and in pain. It was the closest I saw her come to taking her post-surgical painkillers. Instead she sweated it out.

No pain, no gain

To be clear, Gaye’s pain was due to fatigue from the positioning and still-healing surgical incisions, not from the procedure. She said nothing about the CT scan itself was painful. The time factor was related to programming the machine to the positions Gaye had to maintain as well as for the molds to be placed which were intended to help Gaye hold the same position each time.

Measure twice, zap once, or something…

In total we were at the radiation center for two hours. But it was done and Gaye was increasingly anxious to get the actual treatments started. Unfortunately, Dr. H was not entirely satisfied with the angles and asked Gaye to do another simulation to validate his calculations. 

“Well begun is half-done,” -Aristotle 

The second simulation went much faster. There were no fewer people or additional machines, but having done it before, Gaye knew what to expect and how to work with the process. We were out in under an hour. Best of all, with less stress (of the unknown) Gaye was less fatigued.

“Best laid schemes o’ mice and men…”

Once Dr. H was satisfied with the angles and his calculations, Gaye was given a start date for her radiation treatments. Unfortunately, one of her incisions opened. As previously mentioned, radiation treatments affect the skin and therefore, healing. Gaye had to postpone her treatments pending wound closure.

Take aways:

• Every type and stage of cancer is different
• Each difference impacts the plan of care
• Patience is the most important thing in the process
• Experience makes the task easier

The photo at the top, Gaye in San Francisco c. 2010 belongs to herself and is used by her very kind permission.