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Melanie Cole (Host): At the Lourdes Regional Cancer Center and Radiation Oncology Department, the Cancer Care team is very aware of the many emotions and feelings that a person encounters when diagnosed with cancer. My guest today is Dr. Alexis Harvey. She's a radiation oncologist with Lourdes Health System. Welcome to the show, Dr. Harvey. What is a radiation oncologist?

Dr. Alexis Harvey (Guest): Hi and thank you for the welcome. A radiation oncologist is a person who treats cancer using radiation treatments. I always tell my patients that a medical oncologist delivers the drugs and we deliver the radiation. The difference between the two being the drugs treats the whole body versus radiation which treats a local part of someone's body. So, it can be used to treat specifically the breast, the colon, the lung, or whatever area needs to be treated. So, our treatments are very precise to one part of the body.

Melanie: Tell us a little bit about how it works. If we're talking about breast cancer specifically, what are the different types of radiation therapy that you provide? How do they work?

Dr. Harvey: There are multiple different types of radiation. The one known by most people would be the traditional external beam radiation; whereas, we're delivering a specific dose to the breast to treat the breast cancer. In most cases, being treated for breast cancer, the tumor has been removed. They've undergone surgery, generally with something called a “lumpectomy”, where the cancerous area has been removed, but the breast is still there. So, the radiation is basically used as a preventative treatment to the rest of the breast to sterilize it. So, I always tell the patient, “You come to us, you're cancer free, and we are just a preventative treatment to make sure that everything is okay.” When we deliver the radiation that way, what we do is we take the big dose that is needed to be delivered, for the total dose, and we divide it into smaller doses. And, therefore, patients get a small amount of radiation every day for a period of anywhere between four and seven weeks and that dose varies depending on the breast size and the stage of the cancer and things like that. So, that's our traditional radiation and it's usually delivered with something called a “linear accelerator”, or the newer units, they are tomotherapy units, which are similar to a stereotactic unit. So, that's the traditional breast radiation. Breasts can also be treated using implanted radiation which is called “high-dose rate brachytherapy”. When we do that, a device is put into the breast and radiation is delivered to that device twice a day, giving a very high dose, and those patients are treated only five days. So, with traditional radiation lasting five to seven weeks, the high-dose rate brachytherapy is a treatment that lasts for one week. Some patients are a candidate for that, some patients are not, and there are a lot of factors that get put into that before we actually decide which treatment would be best for the patient. It depends on the stage of the disease, whether lymph nodes were involved, so it's just something that we offer. Some patients have had a mastectomy, meaning they've had their breast removed. Quite often, they don't need any further treatment, but if things are found when they do the mastectomy, like a large tumor size or if they had a lot of lymph nodes involved at the time of her surgery, we deliver post-operative radiation. And, in that case, we're actually treating the chest wall and the draining nodal regions, once again, on a preventative basis to sterilize those areas in case something microscopic is still there. So, a lot of women have a mastectomy and don't need anything afterwards, but some will still need radiation. So, our treatments are all part of a combined plan, and when a patient is seeing us, they, of course, have always seen a surgeon, but quite often are also seeing a medical oncologist. So, when we do radiation, we're actually working as a team with lots of people, but my job is to deliver the radiation treatments to that specific part of someone's body, specifically to their breast.

Melanie: In high-dose radiation, is that exposure potentially harmful to the patient?

Dr. Harvey: No, it isn't. The way that it's delivered is that there's a catheter, basically, I say, like a straw placed inside of a cavity in a woman's breast. It is where the tumor was removed. Radiation is delivered via small seeds of radiation that are contained in a machine, so these seeds go in through that straw, they deliver a certain dose of radiation, and then, those seeds are then removed. So, the patient is not radioactive, and there's radiation involved at the time the seeds are out of the machine that they come from, but it's no different than the external radiation in that the radiation is active as it's happening, but once you walk out of the room, you don't need to worry about being radioactive.

Melanie: Should it hurt, Dr. Harvey? Should they feel a burning sensation or should there be redness at the site?

Dr. Harvey: There should not be pain during radiation. I've had some women say sometimes they feel a tingling sensation, but women never really complain of it hurting. It's a painless treatment. Side effects are always dependent on the area that we're treating and, unfortunately, when we treat the breast, our biggest side effect is a skin reaction. I always tell my patients it's like being out in the sun. Our arms have seen the sun all our whole lives. For most of us, our breast has not. So, that area is a little more sensitive. So, the biggest complaint women will have during radiation is that their skin is getting a little pink, like a suntan or even sunburn, and there are times when the skin breaks down a little bit. Nowadays, with the modern technology of IMRT and our tomotherapy units, we really can lighten up on the amount of that that happens. It's also our job to avoid any structures that would be near the breasts. You know, your breast sits on top of your lungs, so, as a radiation oncologist, it's our job to taper our radiation fields to the breast only. That's done all via computer work.

Melanie: Where do you see radiation oncology going in the future? What are some things that you're very excited about?

Dr. Harvey: Well, you know, over the years, I've been doing radiation oncology for many years. I won't say how many, and I've noticed a lot of changes. The fact that we now do CAT scans for planning which we didn't do 15 years ago, 20 years ago, has made for a lot of changes to be done. The equipment gets better and better, so we're therefore able to pinpoint our radiation much easier. When treating breast cancer patients, I find on our tomotherapy unit, we can deliver a radiation that literally curves around the chest wall of the patient, which that's a great thing because the contour of a breast sitting on top of the curve of our lungs, it's a tough area to treat sometimes. So, as the equipment is getting better, it is making our treatments get better, and we're also trying different techniques of can we give a little bit more radiation since it's more pinpointed, and, therefore, it shortens the course of radiation for these patients. So, I think that all of these are great advances for breast cancer. You know, no one wants to go for seven weeks of radiation if we can do it in four. So, we're doing a lot of things to try and get everyone done quicker, less side effects and just keeping them happier.

Melanie: Dr. Harvey, tell us about your team at 21st Century Oncology in the Lourdes Cancer Program.

Dr. Harvey: The Lourdes Cancer Program, I like to say it is a new program, but, interestingly, the doctors that are in the program, I've been working with some of them for at least 20 years. It's a team that consists of radiation oncologists, medical oncologists, who are the chemotherapy doctors, we have nurse navigators, and we have board-certified specialty breast surgeons. We have a team that is involved that from the minute a patient has told that they have an abnormal mammogram, we basically take control of everything. We make sure all of their appointments are arranged. We work together on a daily basis. We have tumor boards where every patient has their cases discussed. We make sure we're all on the same page whether they need chemotherapy up front, surgery up front. So, it's a team of board-certified specialists that work closely together and it's a nice personal touch for the patients.

Melanie: So, wrap it up for us with your best advice for women that have been diagnosed with breast cancer that may have to go for radiation therapy. What do you want them to know, Dr. Harvey, about what they're going to expect and what they should expect from radiation therapy?

Dr. Harvey: I want them to not be afraid, is the first thing. I mean, I always say, “You're afraid of the things that you don't know.” I tell all of my patients do not go on the internet, do not read anything, and do not listen to your friends. They have to have full faith in their doctors that their doctors are doing the best that they can for them. I try and reassure them that, really, when they come to us, most of them are cancer-free. I try and say, "Remember, this is preventative, prophylactic"--I let them choose whatever word they're most comfortable with--"that we're just sterilizing an area as a dotting the 'i' and crossing the 't' to make sure that nothing comes back." So, I really just try to ease their fears and I tell them they may get some side effects, if they do, we'll deal with them and we will be there for them the entire time. I have a staff of therapists and nurses that are the best. So, they're never going through this alone whether they have family and friends or whether they don't. So, what I do the most is reassure them.

Melanie: Thank you so much, Dr. Harvey, it's great information. For more information on 21st Century Oncology and Lourdes Cancer Program, you can go to www.lourdesnet.org. That's www.lourdesnet.org. You're listening to Lourdes Health Talk. This is Melanie Cole. Thanks so much for listening.