Treatments And Their Side Effects

Breast cancer is treated based on the type of cancer and the stage of the cancer. Because cancer treatment is likely to damage healthy cells and tissues, unwanted side effects are common. Specific side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, or even for women having the same treatments. And a woman’s side effects may change from one treatment session to the next. The health care provider will explain the possible side effects of treatment and how to manage them.

Here are the most common breast cancer treatments and their side effects.

Surgery

A lumpectomy is the surgical removal of a tumor without removing the surrounding tissue or lymph nodes.

A mastectomy is the surgical removal of a breast to remove cancerous tumors.

Common side effects of breast surgery are:

Surgery causes short-term pain and tenderness in the area of the operation. Before surgery, women may want to talk with their health care provider about pain management. Any kind of surgery also carries a risk of infection, bleeding, or other problems. Women who develop any problems should tell their health care provider right away.

Removal of one or both breasts can cause a woman to feel off balance – especially if she has large breasts. This imbalance can cause discomfort in her neck and back. Also, the skin in the area where the breast was removed may feel tight. The muscles of the arm and shoulder may feel stiff and weak, but these problems usually are temporary. The doctor, nurse, or physical therapist can recommend exercises to help a woman regain movement and strength in her arm and shoulder.

Because nerves may be injured or cut during surgery, a woman may have numbness and tingling in her chest, underarm, shoulder, and upper arm. These feelings usually go away within a few weeks or months, but for some women, numbness does not go away.

Some women who need a mastectomy decide to have breast reconstruction, either at the same time as the mastectomy or later on. Other women prefer to wear a breast form (prosthesis). Still others decide to do nothing. All of these options have pros and cons, and what is right for one woman may not be right for another. What is important is that nearly every woman treated for breast cancer has choices. A woman considering breast reconstruction should consult with a plastic surgeon before the mastectomy, even if the reconstruction would be done later on.

Various procedures are used to reconstruct the breast. Some women choose to have implants (either saline or silicone). The safety of silicone breast implants has been under review by the Food and Drug Administration (FDA) for several years. Women interested in having silicone implants should talk with their doctor about the FDA’s findings and the availability of silicone implants.

A woman also may have breast reconstruction with tissue that is moved from another part of her body. Skin, muscle, and fat can be moved to the chest from the lower abdomen, back, or buttocks. The plastic surgeon uses this tissue to create a breast shape.

Which type of reconstruction is best depends on a woman’s age, body type, and the type of surgery she had. The plastic surgeon can explain the risks and benefits of each type of reconstruction.

Axillary Lymph Node Dissection

Axillary lymph node dissection is surgery to remove lymph nodes found in the armpit region. Also called axillary dissection.

Common side effects of axillary lymph node dissection are:

Removing the lymph nodes under the arm slows the flow of lymph fluid. The fluid may build up in the arm and hand and cause swelling (lymphedema). This problem can develop right after surgery or months to years later. A woman needs to protect the arm and hand on the treated side for the rest of her life. She will need to:

• Avoid wearing tight clothing or jewelry on her affected arm.
  

• Carry her purse or luggage with the other arm.
  

• Use an electric razor to avoid cuts when shaving her underarm.
  

• Have shots, blood tests, and blood pressure measurements on the other arm.
  

• Wear gloves to protect her hands when gardening and when using strong detergents.
  

• Have careful manicures and avoid cutting her cuticles.
  

• Avoid burns or sunburns to her affected arm and hand.
  

A woman should ask her doctor how to handle any cuts, insect bites, sunburn, or other injuries to the arm or hand. Also, she should contact the doctor if that arm or hand is injured, swells, or becomes red and warm.

If lymphedema occurs, the doctor may suggest exercises and other ways to deal with this problem. For example, some women with lymphedema wear an elastic sleeve to improve lymph circulation. The doctor also may suggest other approaches, such as medication, manual lymph drainage (massage), or use of a machine that gently compresses the arm. The woman may be referred to a physical therapist or another specialist.

Radiation Therapy

Radiation therapy is a local therapy. It uses high energy radiation from x-rays, and other sources, to kill cancer cells and shrink tumors.  Brachytherapy is an internal radiation treatment in which radioactive sources are placed into or on cancerous tissues. The radiation source can be inserted either permanently or temporarily.

Common side effects of radiation therapy are:

During radiation therapy, women with breast cancer may become tired, especially toward the end of treatment. This feeling may continue for a while after treatment is over. Resting is important, but doctors usually advise patients to stay as active as they can.

It is also common for the skin in the treated area to become red, dry, tender, and itchy. The breast may feel heavy and tight. These problems will go away over time. Toward the end of treatment, the skin may become moist and “weepy”. Exposing this area to air as much as possible can help the skin heal.

Because bras and some other types of clothing may rub the skin and cause irritation, women may want to wear loose-fitting cotton clothes during this time. Gentle skin care also is important, and women should check with their doctor before using any deodorants, lotions, or creams on the treated area. These effects of radiation therapy on the skin are temporary, and the area gradually heals once treatment is over. However, there may be a lasting change in the color of the skin.

Chemotherapy

Chemotherapy is the treatment of cancer by chemicals. Chemotherapy acts by killing cells that divide rapidly, a main characteristic of cancer cells. This means that the treatment also harms cells that divide rapidly under normal circumstances. This includes cells in bone marrow, the digestive tract and hair follicles.

Common side effects of chemotherapy are:

As with radiation therapy, chemotherapy affects normal cells as well as cancer cells. The side effects of chemotherapy depend mainly on the specific drugs and the dose. In general, anticancer drugs affect cells that divide rapidly, especially:

• Blood cells: These cells fight infection, help the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected, patients are more likely to get infections, may bruise or bleed easily, and may feel very weak and tired.
  

• Cells in hair roots: Chemotherapy can lead to hair loss. The hair grows back, but the new hair may be somewhat different in color and texture.
  

• Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Many of these side effects can be controlled with drugs.
  

Some anticancer drugs can damage the ovaries. If the damaged ovaries stop making hormones, the woman may have symptoms of menopause, such as hot flashes, and vaginal dryness. Her menstrual periods may become irregular or may stop, and she may become infertile. For women over the age of 35, infertility is likely to be permanent.

On the other hand, if a woman remains fertile during chemotherapy, she may be able to become pregnant. Because the effects of chemotherapy on an unborn child are not known, a woman may wish to talk with her doctor about birth control before treatment begins.

Although long-term side effects are quite rare, there have been cases in which the heart becomes weakened. Also, second cancers, such as leukemia (cancer of the blood cells), have occurred in people who have had chemotherapy.

Hormone Therapy

Hormone therapy are drugs that are given to block the naturally occurring estrogen and progesterone to fight cancer growth.

Common side effects of hormone therapy are:

The side effects of hormonal therapy depend largely on the specific drug or type of treatment. Tamoxifen is the most common hormonal treatment. It blocks the effects of estrogen on cells. Not all women who take Tamoxifen have side effects. In general, the side effects of Tamoxifen are similar to some of the symptoms of menopause. The most common side effects are hot flashes and vaginal discharge. Some women experience irregular menstrual periods, headaches, fatigue, nausea and/or vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash.

Women who are still menstruating may become pregnant when taking Tamoxifen. Tamoxifen may harm the unborn baby. Women should discuss birth control methods with their doctor before taking Tamoxifen.

Serious side effects of Tamoxifen are rare. However, it can cause blood clots in the veins, especially in the legs and in the lungs. In a small number of women, Tamoxifen can slightly increase the risk of stroke. Also, it can cause cancer that arises in the lining or the muscular wall of the uterus. Any unusual vaginal bleeding should be reported to the doctor. The doctor may do a pelvic exam, as well as a biopsy of the lining of the uterus, or other tests.

If the hormonal therapy is surgery to remove the ovaries, a woman will go through menopause immediately. The side effects are likely to be more severe than problems associated with natural menopause. The health care provider can suggest ways to cope with these side effects.

Complementary and Alternative Medicine

Some women with breast cancer use complementary and alternative medicine healing approaches to reduce stress or to reduce side effects and symptoms:

• An approach is generally called complementary medicine when it is used in addition to treatments prescribed by a doctor.
  

• An approach is called alternative medicine when it is used instead of a standard treatment.
  

Some common types of complementary and alternative medicine are acupressure, acupuncture, massage therapy, herbal products, vitamins or special diets, visualization, meditation, and spiritual healing. Many women report that such approaches help them feel better.

Side effects of complementary and alternative medicine are:

Some types of complementary and alternative medicine may interfere with or may be harmful when used with treatments prescribed by a doctor. Before trying any of these therapies, a woman should discuss their possible benefits and risks with her doctor.

Some types of complementary and alternative medicine may be expensive. Health insurance may not cover the cost.

Please note that the above information was taken from the NCI (National Cancer Institute) booklet, What You Need to Know About Breast Cancer.