Radiation After Lumpectomy for Breast Cancer

This video is a basic overview of why we do radiation after lumpectomy and the risks involved in this treatment.

Read the full video transcript below:

After lumpectomy, some women require additional treatment to maximally reduce the chance that the tumor ever comes back. One of the most common treatments used is radiation therapy. 

Let's look at an example of a woman with a tumor in the left breast upper outer quadrant. She has a lumpectomy, and the surgical margins are negative, meaning there's no visible tumor left in the breast. However, we know from large clinical trials that there could be small amounts of microscopic tumor left behind. Left alone, these microscopic bits of tumor could grow and result in a tumor recurrence. Radiation therapy is used to destroy those microscopic bits of tumor and reduce the chance of a recurrence ever happening. 

To understand the side effects and risks of radiation to the breast, it's easier to look at the patient from a different perspective we're not used to. Imagine the patient is sliced almost like a loaf of bread, and you're looking from the patient's feet up towards their head. From that perspective, the patient's body looks like this, with the lungs and heart just below the chest wall and the breasts. 

When radiation is used for the right breast, the heart should not get any radiation at all, but the right lung may get a small amount of radiation. When the left breast is treated, the heart can be quite close or even inside the radiation field, and the left lung is exposed as well. There are several different techniques that can reduce the chance of damage to the heart or lung. Ask your radiation oncologist if those techniques are available at your cancer center.

Almost all women experience some fatigue, which is usually mild, and a skin reaction during the course of radiation. Many months or even years after treatment, some women will have scar tissue formation in the breast, which is called fibrosis. This can make the breast change in size or shape and can also cause it to feel a little bit more dense than the other breast. 

Modern techniques make lung and heart injury very uncommon, but it is still possible. Injury to the chest wall or ribs is an extremely rare complication from radiation.

Some women who have a very extensive lymph node removal may also get lymph swelling called lymphedema. A second cancer, like a sarcoma, is an extraordinarily rare but possible late effect of radiation. 

This is not medical advice. Talk to your doctor before making a medical decision.