At a prominent state hospital, a 45 year old woman is recieving a combined modality' treatment for the intial stage of breast cancer. State the two aspects included in this treatment. State the methods by which a radiation oncologist can administer these therapies. Additionally, state four major differences between the two modes of treatment.

The two aspects included in the combined modality treatment for the initial stage of breast cancer typically consist of surgery and radiation therapy.

Surgery is the primary treatment for removing the tumor and nearby lymph nodes. It can be performed in different ways, such as a lumpectomy (removal of the tumor) or a mastectomy (removal of the entire breast). Sometimes, the surgeon may also remove some lymph nodes from the underarm area to check if cancer has spread.

After surgery, radiation therapy is usually given to destroy any remaining cancer cells and reduce the risk of recurrence. A radiation oncologist specializes in delivering radiation therapy and has several methods to administer it.

There are three main methods by which a radiation oncologist can administer radiation therapy:

1. External Beam Radiation Therapy: This method involves using a machine called a linear accelerator to deliver high-energy radiation beams to the affected area. The machine is positioned outside the body and directed towards the tumor site. Multiple treatments are scheduled over a few weeks.

2. Internal Radiation Therapy (Brachytherapy): This technique involves placing a small radioactive source directly into or near the tumor site. This can be done using temporary implants or permanent seed implants. Brachytherapy delivers radiation therapy from inside the body, targeting the tumor area specifically.

3. Systemic Radiation Therapy: This method is used when cancer has spread to other parts of the body. It involves administering a radioactive substance, either orally or intravenously, that travels throughout the body to target cancer cells.

Now let's discuss four major differences between surgery and radiation therapy in breast cancer treatment:

1. Approach: Surgery involves physically removing the tumor, while radiation therapy uses high-energy radiation to destroy cancer cells.

2. Timing: Surgery is typically performed as the initial treatment, whereas radiation therapy is often scheduled after surgery to eliminate any remaining cancer cells.

3. Invasiveness: Surgery is invasive since it involves making incisions and removing tissue. In contrast, radiation therapy is non-invasive as it doesn't require any physical contact or incisions.

4. Side Effects: Surgery may have immediate side effects such as pain, scarring, or infection. Long-term side effects might include changes in breast appearance or limited arm mobility. Radiation therapy side effects are primarily localized to the treatment area, such as skin irritation, fatigue, or breast swelling.

It's important to note that the treatment plan may vary depending on the specific characteristics of the patient's cancer and individual circumstances. Consulting with healthcare professionals can provide personalized information and guidance in each case.