There’s been a big question since the beginning of this latest cancer journey as to whether or not I could have radiation again. Also, there is the addition of the PTEN mutation to the whole equation, making things that much more complicated.
In 2004, I had radiation to my right breast after I had completed chemotherapy and a lumpectomy with sentinel node biopsy. As the biopsy of the lymph node was negative, the radiation only covered the breast and not the axillary lymph nodes in the armpit.
This current cancer is also on the right side. As it is inflammatory breast cancer, the standard radiation treatment would cover the entire right breast as well as the axillary lymph nodes and part of the neck. This treatment protocol would have been the case no matter the results of the lymph node biopsies during the bilateral mastectomy.
Having not had radiation to the armpit and neck areas in the past is a plus, but the problem will lie in radiating the right side of my chest again, especially as I no longer have breasts to “target” in the treatment. The main risks include rib fracture and tissue necrosis, as well as problems related to those organs that may receive radiation (lungs, liver, etc.).
And of course, “feel the burn” will be literal. Causing a reaction in the skin–i.e., burn–will be sought after. I have had plenty of sunburns in the past, but I think those may pale in comparison to what this upcoming radiation treatment will bring.
Scary so far?
The positive in my case is that there has been such a long time since my last radiation treatment. According to my radiation oncologist, there have been studies over the past ten years or so showing that the tissue can repair itself after radiation treatment, making a second treatment to the same area safer.
Regarding the PTEN mutation and radiation, there was apparently much discussion among the local radiation oncologists and my medical oncologist. Some patients with both the PTEN mutation and breast cancer are warned not to receive radiation treatment. As this mutation and its associated problems do not result in DNA breakage, my oncologists believe that radiation treatment will be fine in my case. They could not find any studies that led them to believe that Cowden Syndrome would be a contraindication when it comes to radiation treatment.
Basically, the consensus is that they can repair the damage caused by the treatment, but they cannot treat a recurrence. The risks associated with the cancer outweigh those of the treatment.
So radiation treatment will begin soon. I had my simulation appointment on Friday; this is where a CT scan is taken and marker tattoos–these are used to align the machine during treatment–are placed. (Yes, I now have one more tattoo to add to my collection of “dots,” making a total of three.) The oncologist will use the CT scans to begin formulating a treatment regimen.
As she went through the process, she decided that she would treat a much wider area of my chest than I expected. The treatment area will cover part of my left chest, my entire right side and part of my back, and part of my neck.
I will be having a pulmonary function test and bone density scan to provide a baseline before treatment begins. Also, due to the complexity of my case, the radiation oncologist may take a couple of weeks to research and further refine the treatment protocol.
Although I was able to slide through the surgery and treatment in 2004 with minimal long-term problems, this is obviously not the case with the current cancer. My body has already been changed permanently by the bilateral mastectomy, and now there will be lasting consequences from what lies ahead (radiation treatment, hysterectomy, and anti-estrogen therapy).
Scary therapy or deadly cancer?
I’m going with therapy and a hope for a cure.