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Breast cancer treatment: radiotherapy BREAST CANCER TREATMENT: RADIOTHERAPY
Radiotherapy involves directing high-energy X-ray beams at specific areas of the body. The procedure is painless, and is similar to having a normal X-ray done, except the radiation dose is higher and exposure to it lasts a couple of minutes rather than a fraction of a second.
Cancer cells are more sensitive than normal cells, and are therefore selectively destroyed by the radiation directed at them. After a tumour mass has been surgically excised, the radiation is only required to destroy any remaining microscopic cancer. It should not normally alter the cosmetic appearance of your breast.
After a mastectomy
It is not usually necessary to have radiotherapy following a mastectomy unless the tumour was large or there was spread of cancer cells to the lymph nodes. The area around the mastectomy scar, and possibly the draining lymph nodes, may be treated in an attempt to destroy any cancer cells which have not been removed surgically.
After removal of a lump
If you have had a lumpectomy or wide lump excision, radiotherapy will almost certainly be necessary as there is a chance that malignant cells may have spread via the ducts to other parts of the breast. The glands under your arm and at the side of your neck may also be treated.
Pre-treatment appointment
Before your treatment starts, you will be given an appointment to meet the radiographers who will give you your radiotherapy, and the doctor who will supervise it. You will be asked to lie on the treatment couch and marks will be made on your skin to indicate the parts of your body at which the X-ray beam is to be directed. It is important that some of these marks remain until the treatment course has finished, and you should therefore be careful when having a bath that you do not wash them off. The marks may also leave traces on your underwear, and it is advisable not to wear a new or special bra while treatment continues. Measurements will be taken of your breast or chest, and an outline of your body will be drawn. These preparations enable you to be placed in the correct position each time you receive your treatment.
Receiving the treatment
Radiotherapy is not usually started until at least a couple of weeks after surgery. This is to allow time for the arm to regain its movement so that it can be raised above your head and thus placed outside the field of treatment.
The course of radiotherapy will probably last 4 to 6 weeks, with sessions daily or every other day. Each treatment session takes about 15 to 20 minutes, most of which time is spent getting you into the correct position.
You will be alone in the room during exposure to the radiation, but you will be watched carefully all the time.
Side-effects
Radiotherapy does not make you radioactive, and you do not need to avoid close contact with people after it. It will, however, make you tired, and your skin is likely to become sensitive and possibly red and uncomfortable towards the end of the course of treatment. Some women have more sensitive skins than others, and you will be given advice about skin care. If necessary, creams can be prescribed by the doctor if your skin becomes moist and painful.
The area being treated should not be vigorously washed or dried as this could damage the already tender skin. It can, however, be splashed with water and patted dry. Soap, deodorants and skin creams should be avoided. Unperfumed talcum powder, such as baby powder, can be used if desired.
If you do have a skin reaction, this should subside within a few weeks once the treatment is finished. Your skin may remain a darker colour for many months, and the treated areas should be protected from sunlight for at least a year after radiotherapy.
Other side-effects following radiotherapy are rare. You will not lose your hair and are unlikely to feel sick. The treated breast may be slightly swollen for a few months, and is likely to be sore, although probably intermittently. If the breast remains sore and uncomfortable, anti-inflammatory drugs may be helpful.
The X-rays will also reach a small part of the lung beneath the breast. Very occasionally, this causes inflammation, with breathlessness and a dry cough which may last for a few weeks. These effects may not develop until a month or two after the end of treatment. Lymphoedema may occur if the lymph glands are treated by surgery and radiotherapy. Do tell your doctor immediately if you develop any such side-effects so that treatment for them can begin as soon as possible.
Most women who go out to work are able to continue to do so, at least part time, during their course of radiation treatment.
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