Breast Cancer: Detection & Treatment Options

Diagnosing Breast Cancer

When breast cancer is found early, the success rate is nearly 100%. But when and how often do you start looking? The American Cancer Society recommends breast screenings annually for women over 45 and continuing as long as you are in good health. Other organizations, including the Mayo Clinic and your radiology oncologists at Orange County Cyberknife and Radiation Oncology Center, suggest you begin annual screenings at age 40.  However, the U.S. Preventive Services Task Force (USPSTF) recently contradicted this advice, recommending mammograms for women between the ages of 50 and 74 every two years.

Whenever you decide to begin breast cancer screenings, Orange County Cyberknife will work directly with your imaging center to access all of the information needed to create the optimal treatment plan for you.

Types Of Radiation Therapy For Breast Cancer

Breast cancer may show up in many different ways. It could just be a small spot found on an annual mammogram. Or it could be a web of cancerous cells spread throughout the breast and body. These varied types of breast cancer require a variety of treatment options, such as surgery, chemotherapy, and radiation therapy. When it comes to treating your breast cancer with radiation therapy, Orange County Cyberknife and Radiation Oncology Center is your expert choice.

• CyberKnife (Stereotactic Body Radiation Therapy, or SBRT) – Usually, breast cancer treatment begins with a lumpectomy, or removal of the tumor from the breast, followed by whole or partial radiation treatment. The CyberKnife comes into play for breast cancer in later stages when the breast cancer has metastasized to other parts of the body, such as the lungs, brain, or spine. The CyberKnife Robotic Radiosurgery System beams high doses of radiation directly to your cancerous cells while you rest on an outpatient treatment couch. Because CyberKnife can target and track these tumors in all areas while minimizing risk to surrounding healthy tissue and organs, it can provide you with the best possible outcomes. The flexible, robotic arm of CyberKnife can deliver high-doses of radiation in multiple angles to best treat the size, position, and shape of even the smallest metastasized tumor. This minimizes the radiation exposure to healthy surrounding tissue and organs and limits some of the short and long-term side effects common with conventional treatments. Unlike other methods of radiation delivery, CyberKnife is made to move with your body and the tumor, tracking the smallest of movements and adjusting the beams of high-dose radiation directly to the cancerous cells using sophisticated software and continuous x-rays. Essentially, CyberKnife follows your tumor. Much shorter than traditional radiation treatment, CyberKnife treatment is one short daily treatment administered in one to five days. Orange County Cyberknife was one of the first cancer treatment centers to offer this advanced radiation therapy.

External Radiation Therapies

• Electron Therapy –  Electron therapy may be a good choice when you need to destroy cancer cells close to the skin’s surface. Electrons have different physical properties, but work the same way as photons when it comes to treating cancer. However, electrons release their energy close to the skin’s surface so are commonly used to treat superficial tumors such as skin cancers and superficial lymph nodes which may be involved with a tumor, such as breast cancer. Because the radiation doesn’t penetrate much past the skin, other organs and tissue are not negatively affected.

• 3D Conformal Radiation Therapy for Breast Cancer – Three-dimensional (3D) conformal radiation therapy is a technique where the beams of radiation used in treatment are shaped to match the tumor. Previously, radiation treatment matched the height and width of the tumor, meaning that healthy tissue was exposed to the beams. Advances in imaging technology have made it possible to locate and treat the tumor more precisely. Conformal radiation therapy uses the targeting information to focus precisely on the tumor, while avoiding the healthy surrounding tissue. This exact targeting makes it possible to use higher levels of radiation in treatment, which are more effective in shrinking and killing tumors. Three-dimensional conformal therapy is, in many ways, similar to intensity-modulated radiation therapy (IMRT); both are used to target cancer while sparing healthy tissue. The radiation oncologist will determine which therapy is best for you, depending on your tumor’s shape and location.

• • Intensity Modulated Radiation Therapy (IMRT)-  IMRT is an effective treatment a special computer program is used to deliver a consistent dose of radiation to the breast. This technology prevents so-called hot spots (areas that receive more radiation than others due to the shape of the breast). It also minimizes acute (immediate) and late (delayed) side effects. In special situations, IMRT is also used to limit the radiation dose to organs close to the breast or lymph nodes being treated.

• • Advanced Image Guided Radiation Therapy (IGRT) – Orange County Cyberknife and Radiation Oncology Center houses the most advanced equipment including the IGRT which can track and capture your breast tumor using high-resolution, three-dimensional images as it moves or adjusts from day-to-day. This treatment option pinpoints exactly where your tumor is so that you can focus the treatment on only that area, leaving the rest of the surrounding tissue unharmed. When treating metastatic breast cancer, IGRT is able to target tumors where they have spread with precision and high-dose radiation, excluding surrounding vital organs. With IGRT, innovative radiographic, fluoroscopic and cone-beam CT modes are combined with software that automatically repositions the radiation beam and adjusts as the patient moves. This enables clinicians to verify that treatments are completely in sync with respiration.

• • RapidArc Radiotherapy Technology or Volumetric Arc Therapy (VMAT) – RapidArc is a form of IMRT that delivers treatments two to eight times faster than our other dynamic treatments and it increases precision. Unlike traditional IMRT that requires multiple rotations around the patient or makes repeated stops and starts to treat the tumor from different angles, this volumetric arc therapy delivers precice 3-D doses with a single 360° rotation of the machine, typically in less than two minutes. It uses your treatment planning algorithm to simultaneously change the rotation speed, the shape of the treatment aperture, and the delivery dose rate. The shape and position of the tumor are determined from computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) diagnostic studies. This permits improved dose sculpturing over 3-D conformal radiation therapy.

Internal Radiation Therapies

Accelerated Partial Breast Irradiation (APBI):

• MammoSite Targeted Radiation Therapy – Women who choose a lumpectomy rather than a full mastectomy need radiation treatment following surgery. APBI is designed specifically to treat early stages of breast cancer quickly and efficiently by delivering radiation directly into the tumor cavity from inside the body. Orange County radiation oncologists work directly with breast surgeons to treat the cavity after surgery. Radiation therapy is usually performed one to four weeks after a lumpectomy. The temporary devices for example MammoSite or Savi applicator is placed in the cavity by the breast surgeon. The device stays there throughout the treatment, usually 5 days. During your approximately 10 minutes of treatment, the radiation is delivered into the applicators through a wire or cable inserted into a catheter and then removed between treatments. The radiation is delivered based on your treatment plan that is created by your radiation oncologist and the physicist. Treatment plan is usually two treatments per day, 5-6 hours apart, for five days. After the final treatment, the MammoSite or the Savi device is easily removed by the radiation oncologist.

• Breast Intraoperative Radiation Therapy (IORT) – When you have early-stage cancer, your medical team may suggest radiation treatment during surgery, immediately after the removal of your breast tumor. Orange County CyberKnife’s leaders in Radiation Oncology are at the forefront of development in this exciting treatment of delivering radiation directly to the tumor bed during surgery. IORT delivers a concentrated dose of radiation therapy to a tumor bed during surgery. It allows immediate radiation that can kill any microscopic tumor cells left behind after tumor removal. This treatment spares healthy organs like your skin, heart, and lungs from the effects of radiation. This advanced radiation method drastically reduces the treatment from three to five weeks of traditional radiation therapy, to one single four to five minute treatment during surgery.

• High Dose Rate Brachytherapy (HDR) – This extremely precise radiation therapy can destroy breast cancer by using an intense source of radiation delivered through temporarily-placed applicators implanted into the tumor site. It is delivered internally via a computer-controlled machine typically in two to ten convenient treatments. HDR minimizes the risk of common side effects due to its ability to focus the radiation directly on the cancerous cells. This also reduces the danger of radiation exposure to nearby vital structures like the heart and lungs. The radiation is delivered into the applicators through a wire or cable inserted into a catheter and then removed between treatments. Orange County radiologists can vary the position of the wire and the length the radiation is administered to satisfy the shape and need of the cancer. At the end of the treatment, all traces of radiation are removed. Because of the high-dose rate and precision, HDR is often used as an alternative to surgery.

• Hyperthermia (Thermal therapy or Thermotherapy) – Our doctors are worldwide leaders in the field of hyperthermia. Non-invasive hyperthermia treatment focuses on exposing tumors to extremely high temperatures to stimulate blood flow, increase oxygenation and make the tumor cells more responsive to radiation. By adding hyperthermia to radiation therapy, radiation oncologists can better control tumors with high doses of radiation while minimizing side-effects and damage to healthy tissue. Hyperthermia has also been proven effective with recurrent breast cancer, where the prognosis can be grim. If you’ve already had a full dose of radiation, a second full dose is usually not recommended because of the damage it could cause to healthy tissue. Hyperthermia treatment has the ability to increase the effectiveness of radiation on re-treatment, giving new hope for patients with recurrent cancers.

Contact Us To Find Out More

We look forward to explaining each of these treatment methods to you on your first visit to Orange County CyberKnife.  We will ensure that you know the radiation options available to you at our comprehensive cancer center. Call us today at (714) 962-7100 with any questions. Check out our team of oncology radiologists and find out how we can treat tumors throughout your body using the most advanced non-surgical and non-invasive radiation therapy systems available. Check out what other patients say about our cancer care. You can trust us to help choose a treatment option that is right for you.

Use these links to find out more about breast cancer:

• Breast Cancer – What is Breast Cancer?
• Breast Cancer – Types & Stages
• Breast Cancer – FAQs

Breast Cancer: Types & Stages

Orange County Cyberknife is the premier cancer treatment center of Southern California and Orange County, with the ability and expertise to treat all types of breast cancer with a comprehensive array of radiation options. Not all tumors are cancerous. For those that are, you should investigate all treatment options available to you and choose the one that best meets your individual needs.

Breast cancer can begin in different areas of the breast — the ducts, the lobules, or in some cases, the tissue in between. In this section, you can learn about the different types of breast cancer, including non-invasive, invasive, recurrent, and metastatic breast cancers. You can also read about breast cancer in men.

Types Of Breast Cancer

The most common types of invasive breast cancer are:

• Invasive Ductal Carcinoma (IDC) – The most common type of cancer encompassing 80% of diagnosed breast cancers. This cancer starts off in the inner lining of milk ducts or the lobules that supply them with milk and invades other parts of the breast. It can spread to lymph nodes and other parts of the body. This is more common in women 55 years or older.

• Invasive Lobular Carcinoma (ILC) – Similar to IDC, but much more rare. This cancer begins in lobules and grows into surrounding tissues. Only about 10% of invasive cancers are ILC and they tend to occur in women over 60 years old. Some research has suggested that the use of hormone replacement therapy during and after menopause can increase the risk of ILC. There are several subtypes of rare IDC cancers including tubular, medullary, mucinous, papillary, and cribriform carcinomas.

There are two types of breast tumors that are non-invasive, meaning they have not spread past the original tumor. These types of cancer are not life-threatening, but they increase the risk of future breast cancer:

• Ductal Carcinoma In Situ (DCIS) — This type of cancer is found when abnormal cells appear in the lining of breast ducts. It is important to treat DCIS since there is no way of knowing which cells might develop into breast cancer.

• Lobular Carcinoma In Situ (LCIS) — This non-cancerous grouping of abnormal cells is found in the breast lobules. Unlike DCIS, it is unlikely the abnormal cells will become cancerous. However, you could still be at a higher risk to develop breast cancer in the future.

There are a few other rare types of cancer which can be benign or malignant:

• Inflammatory Breast Cancer (IBC) – This type of breast cancer is characterized by swelling and reddening of the breast, rather than a lump. It is an aggressive type of cancer that can progress in days, even hours. It occurs in less than 1% of breast cancer patients.

• Paget’s Disease Of The Nipple – This rare breast cancer in which cancer cells collect in or around the nipple is found in less than 5% of breast cancer patients. The nipple may become red and scaly. Patients with this disease usually have another type of cancer of the breast.

• Phyllodes Tumors – Another rare type of breast cancer found in less than 1% of all breast tumors. The name means “leaf-like” and refers to the growth of the abnormal cells. Most of these tumors are benign, but some are malignant and so all require treatment to prevent recurrence.

Male Breast Cancer

Breast cancer in men is very rare, but approximately 2,600 men are expected to be diagnosed this year. A number of factors can increase the risk of breast cancer in men, including:

• Older Age – Like women, older men are more at risk for breast cancer than their younger counterparts.

• High Estrogen Levels – Men can have high estrogen levels from taking hormone medicines, being overweight (which produces estrogen), being exposed to estrogens in the environment, being heavy alcohol users, or having liver disease.

• Klinefelter Syndrome – Klinefelter syndrome is a condition that occurs in 1 in 1000 men as a result of being born with an extra X chromosome. Men with this syndrome may develop breast tissue as a result of having higher amounts of estrogen.

• Family History – Men with a strong family history of breast cancer, especially of men with breast cancer, are more likely to develop breast cancer themselves.

• Radiation Exposure – Being exposed to radiation before age 30 increases your risk of having breast cancer.

Stages Of Breast Cancer

The most common method for rating the stages of cancer is called TNM, or tumor, node, metastasis. It features:

1. Tumor – The larger the primary tumor or abnormal growth, the more serious.
2. Node – The more lymph nodes that have cancerous cells, the more serious the cancer.
3. Metastasis – Serious stages involve the spreading of cancer to other parts of the body.

Doctors assign levels for each of the above factors and then combine these levels into stages. They feature:

• Stage 0 – This is a non-invasive cancer when the disease remains in the ducts and lobules of the breast tissue and has not spread to other surrounding tissue.

• Stage 1A – An invasive cancer, but in which the tumor is still small and has not spread to the lymph nodes.

• Stage 1B – The cancer has spread ONLY to the lymph nodes and is between .2 millimeters (mm) and 2 mm in size. There is no tumor in the breast or the tumor is less than 20 mm.

• Stage 2A – This stage can mean several things:

• • There is no tumor in the breast but the cancer has spread to nearby lymph nodes.
  • The tumor is smaller than 20 mm and has spread to nearby lymph nodes.
  • The tumor is larger than 20 mm and has spread to nearby lymph nodes.
  • The tumor is between 20 mm and 50 mm, but not spread.

• Stage 2B – Either of the following puts you at this stage:
  • The tumor is between 20 mm and 50 mm and has spread to up to three nearby lymph nodes.
  • The tumor is larger than 50 mm but has NOT spread to the nearby lymph nodes.

• Stage 3A – Any size tumor has spread to between four and nine nearby lymph nodes, but not to other parts of the body. Or, a tumor larger than 50 mm that has spread to up to three lymph nodes.

• Stage 3B – The cancer has spread to the chest wall or caused swelling or ulceration of the breast or is diagnosed as inflammatory breast cancer. It may have spread to the lymph nodes under the arm, but it has not spread to other parts of the body.

• Stage 3C – This stage refers to any size tumor that has spread to 10 or more nearby lymph nodes, but not to distant parts of the body.

• Stage 4 –  In the stage, the cancer is metastatic, having spread to other organs such as the lungs, brain, distant lymph nodes, bones, liver, or chest wall. This stage of cancer is usually found after a previous diagnosis of early breast cancer.

• Recurrent – This stage of cancer is used when the cancer returns after treatment. Once that happens, doctors run more tests to establish a current stage.

Call Us Today To Find Out More

Orange County Cyberknife wants to answer all of your questions, insuring you know the radiation options available to you at our comprehensive facility. Use these links to find out more about breast cancer:

• Breast Cancer – What is Breast Cancer?

• Breast Cancer – Detection & Treatment Options

• Breast Cancer – FAQs

Or, contact us today at (714) 962-7100 with your questions. Our team of internationally renowned radiotherapy and radiosurgery specialists can treat tumors throughout your body using the most advanced non-surgical and non-invasive radiation therapy systems available. Orange County CyberKnife is your comprehensive cancer center in Southern California that offers multiple advanced radiation treatments, including the CyberKnife Robotic Radiosurgery system. Orange County CyberKnife has established itself as the trusted choice of more than 100 area doctors for their patients’ radiation oncology needs. You can trust us to help choose a treatment option that is right for you.

Breast Cancer: FAQs

Cancer is never something you want to hear about or deal with. It is sometimes too scary to even say out loud sometimes. Let Orange County CyberKnife help relieve some of your fear by answering the most frequently asked questions about breast cancer for you.

Have Additional Questions? Call Us Today

If you still have questions, give us a call at (714) 962-7100. We are ready and waiting to help you better understand your cancer treatment options available to you at Orange County CyberKnife and Radiation Oncology Center. Our team of cancer specialists can explain the different ways they can treat tumors throughout your body using the most advanced non-surgical and non-invasive radiation therapy systems available. Orange County CyberKnife has established itself as the trusted choice of more than 100 area doctors for their patients’ radiation oncology needs. We look forward to your questions.

Find out more about breast cancer:

• Breast Cancer – What is Breast Cancer?

• Breast Cancer – Types and Stages

• Breast Cancer – Detection and Treatment Options