Radiation induced skin reactions following breast cancer treatment
When a woman has had radiation treatment for a breast cancer, it is not uncommon for various ‘radiation-induced‘ skin reactions to develop. These can cause a certain amount of anxiety as any new sore or bulge, discoloration, or change in hardness can set of alarms of a possible return of the breast carcinoma.
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Breast cancer radiation treatments can cause lasting damage for the skin
Radiation therapy can have some acute and lasting damaging effects on the skin. Some may develop right away, but others may develop after months or years. Common skin reactions include: telangiectasia, atrophy, irregular hyperpigmentation, edema (dropsy or hydropsy), and the formation of scars.
‘Radiopithelieits, which is inflammation of epithelial tissue, is another common side effect from breast cancer radiotherapy. Sometimes inflammation is also called ‘radio-recall‘ or radio-toxicity.
‘Radio-dermatitis‘ is a name sometimes used to describe the whole range of possible skin reactions including erythema, edema, vesicular eruptions, ulceration, and erosions, but tends more specifically to a thickening or hardening of the skin due to accumulations of keratin. Sometimes the skin has a characteristic ‘ridges and hollows‘ appearance.
Is radiation treatment given only following breast surgery?
During the normal course of management for breast cancer, radiation therapy is generally applied to the site of a tumor which has been surgically removed. In fact, breast radiation is usually given to the ‘whole breast‘. But sometimes surgeons can remove most of the tumor but there are still found to be ‘positive margins‘ at the edge of the surgery site.
Normally this calls for an additional surgery, but on occasion a women will not give permission to have another surgery, opting instead for intensified radiation treatments.
Are radio-dermatitis and other skin reactions of serious concern for breast cancer patients?
Any suspicious new development at or around a breast cancer site should be brought to the attention of a physician. A common skin reaction to radiation such as radio-dermatitis is usually readily apparent to an experienced doctor, but it should probably be investigated further with a mammogram nonetheless.
Wall of blood vessels are the most effected
The negative effects of radiation are felt primarily by the walls of blood vessels, arterioles in particular, much more-so than the breast ducts. But, the muscle-layers in the walls of ducts, may experience similar radiation effects to the muscle layers around arterioles.
What would distinguish a mammogram and ultrasound of radio-dermatitis from breast cancer?
On a mammogram a radiologist will usually note an increase in the density of breast tissue, and possibly a reticulated (‘net-like’) pattern of fibroglandular tissue. A sonogram of a radio-dermatitis lesion might identify inflammatory changes, possibly edema, and quite likely some areas of necrosis.
These kinds of findings would be typical secondary effects following radiation therapy. However, it may be difficult to definitively rule out the remote possibility that any observed changes might be the result of malignant neoplasm (a return of cancer cells growth), so a histological evaluation of the lesion will often be requested.
A thick keratin layer is characteristic
In the microscopic image of a radio dermatitis lesion given below, one can easily distinguish the thick keratin layer below the epidermis, which would certainly show as an area of increased density on a mammogram. But clearly, there is no evidence of any malignant cell activity.
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- Meibodi, NS., Maleki, M., Javidi, Z., Nahidi, Y.; Clinicopathological evaluation of radiation induced basal cell carcinoma. Indian J Dermatol. 2008; 53(3): 137–139.
- Martin, FC., Cuadrado, PS., Hernandez, FR., Collagen Power: Hydrocolloidal dressings. Their effectiveness in radiodermatitis. Rev Enferm. 2004 May ;27 (5):17-22
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