American Medical Association Family Medical Guide - American Medical Association [579]
If nerves were injured or cut during the surgery, you may have numbness and tingling in your chest, underarm, shoulder, or upper arm. These symptoms usually go away within a few weeks or months as the injury heals. Sometimes, when lymph nodes under the arm are removed, fluid can build up in the arm and hand and cause swelling (lymphedema). You will need to take precautions to protect your arm and hand on that side from injury or pressure; let your doctor know right away if an infection develops in your arm or hand.
Radiation therapy
Radiation therapy, the use of high-energy rays to kill cancers in localized areas of the body, is often used in addition to surgery to treat breast cancer. The radiation may be directed at the breast from a machine (called external radiation) or inserted into the breast in thin plastic tubes placed at the site of the cancer (called implant radiation). For external radiation therapy, a person goes to a hospital or clinic, usually 5 days a week for 6 weeks. For implant radiation, a person stays in the hospital with the implants in place for several days. In some cases, especially for small tumors that are removed in breast-conserving surgery such as lumpectomy, radiation therapy is given after surgery to destroy any breast cancer cells that may remain. For large tumors that cannot be removed easily with surgery, radiation is sometimes given before surgery, alone or with chemotherapy or hormone therapy (see below), to destroy cancer cells and shrink the tumor.
Fatigue is the most common side effect of radiation therapy, especially after several treatments. Although rest is important, your doctor will recommend that you try to stay as active as you can. The skin in the treated area may become red, dry, tender, and itchy, and the treated breast may feel heavy and hard. These symptoms will clear up after the treatments stop. Because the skin in the treated area will be especially tender, you should wear loose-fitting clothing and expose the area to the air as often as possible to help the skin heal. Your doctor will tell you how to care for your skin during this time.
Chemotherapy
For cancer that has spread from the breast, chemotherapy, usually as a combination of drugs, is given to kill cancer cells throughout the body. The drugs are given in pills or by injection at an outpatient clinic, at the doctor’s office, or at home.
The side effects of chemotherapy depend on the particular drugs and the dosage. Along with cancer cells, chemotherapy destroys healthy cells, especially those that divide rapidly, such as blood cells and the cells in hair roots and in the lining of the digestive tract. This cell loss can increase your susceptibility to infections and cause easy bruising or bleeding, weakness and fatigue, loss of hair, poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Many of these side effects can be controlled with medication and are usually short term. Because the effects of chemotherapy on a fetus are unknown, doctors usually recommend that women avoid getting pregnant during their treatment; discuss birth control (see page 470) with your doctor before your treatment starts.
Hormone therapy for breast cancer
For women whose breast tumors are stimulated by estrogen, hormonal medications such as tamoxifen or raloxifene may be given (usually for 5 years) to block the growth-stimulating effects of the hormone on the tumor. In addition to treating breast cancer, these drugs are also used to prevent breast cancer in high-risk women.
The side effects of hormone therapy depend on the particular drug or type of treatment. Tamoxifen may cause hot flashes, vaginal discharge or irritation, nausea, and irregular periods. Women who are still menstruating may become pregnant more easily when taking tamoxifen. Tamoxifen