Breathing Easy to Treat Cancer
Jul 01, 2018 Cedars-Sinai Staff
Nancy Senter knows the concerns running through the minds of patients about to have surgery.
As a former surgical coordinator who served as the liaison between doctors and patients, she addressed the small worries. ("Can I wash my hair after surgery?"). She also addressed the bigger ones. ("How will I feel?" "I'll be OK, right?" "When can I get back to work?")
"I will say, when you lie on the table during radiation therapy, it's like 'Star Trek,' with the equipment and noise, but it's not unpleasant. That's because there were all these people here ready to fix me."
She was always equipped with a smile, knew the value of listening and, when it applied, touted preventive care, like yearly mammograms. She has a new appreciation for the value of those important gestures — especially as a recent cancer survivor.
"As someone in this profession, I know that routine mammograms and preventive care are a big deal," said the 74-year-old. "Every year since I was 35, I've had a mammogram. They would say 'it's fine,' and to come back next year."
Then, two years ago, a routine mammogram at Cedars-Sinai detected an irregularity, and upon further examination, Senter was diagnosed with breast cancer. Specifically, she had ductal carcinoma in situ, the most common type of noninvasive breast cancer. It's found in the milk ducts of the breasts, and at that stage, has not affected the surrounding breast tissue.
Senter had a lumpectomy to remove the cancer and also had three lymph nodes under her arm taken out. Her oncologist, Barry E. Rosenbloom, MD, at Cedars-Sinai recommended multiple rounds of radiation, including five targeted doses to the site of the cancer in her milk duct, to sterilize the area.
While radiation therapy has been a very effective treatment against this type of cancer for decades, it was not always without residual side effects — including risk to the heart, which could lead to heart attacks. However, the radiation technique — called respiratory gating — used to treat Senter's cancer was developed specifically to protect the heart while targeting the cancer cells.
Breathing Through Radiation Therapy
The treatment starts with a deep breath.
"When you take a breath in, your entire heart gets pushed out of the way by the lungs," said Amin J. Mirhadi, MD, radiation oncologist in the Radiation Oncology Department of the Samuel Oschin Comprehensive Cancer Institute. "It positions the breast further from the heart, allowing us to deliver the radiation and minimize the chances of affecting the healthy organs and tissues. It's the gold standard for treating breast cancer on the left side of the body."
This type of technique applies to a patient in any stage of breast cancer.
Patients who receive this type of therapy are asked to lie down on their back with their arms suspended in a brace. A breathing device is placed on the patient's mouth to ensure the patient is able to monitor his or her own respiration and provide accurate feedback. Once the setup is complete, the radiation is delivered in a matter of minutes.
Senter's treatments were 40 seconds each, and she remembers having to inhale and exhale.
"I will say, when you lie on the table during radiation therapy, it's like 'Star Trek,' with the equipment and noise, but it's not unpleasant," Senter said. "That's because there were all these people here ready to fix me."
From the initial diagnosis to radiation then to follow-ups, Senter said what she appreciated the most is that there was always a team of nurses and physicians ready to take care of her.
"They were my dream team," she said.
A Cancer Patient's Advice
Senter shares this advice with other patients:
- Get your yearly mammogram. The type of cancer Senter had can't be found with a self-exam, because there is no lump or irregularity to feel. Catching cancer at this stage reduces the chances of it spreading. The American Cancer Society recommends yearly mammograms from ages 45 to 54, but women can start as young as 40, if they wish. Breast cancer screening has moved away from the one-size-fits-all approach. Women should speak with their physicians about the benefits and harms of screening, and make choices based on their personal risk and health.
- Don't let anxieties overwhelm you. Senter had 33 rounds of radiation. It was tiring but doable. "This isn't a catastrophe," she says. "This is a bump in the road." The cancer must be addressed promptly, but this specific cancer has very effective treatment options.
- Get to know who your care team is so you can have confidence in them. Senter says she was lucky — as a surgical coordinator, she had worked with Cedars-Sinai, so she knew the staff and the facility well. Getting familiar with who the doctors are and where you will be treated can help calm anxieties and fears about treatment.
- You can have cancer and a healthy, happy life. They're not mutually exclusive. "Women are afraid they are going to be changed. They are worried about their body image, their functionality," she says. "I look fine. I'm functional, and I was functional throughout my treatment. It didn't interfere with my life."
- Find a support group. Senter believes in paying it forward, which is why she volunteers with Imerman Angels — a one-on-one cancer support group. The nonprofit matches a cancer survivor with someone who was recently diagnosed. "You can talk to them over the phone or email," Senter said. "You can tell them what you went through and listen to what they are going through. It's great."