Radiotherapy for breast cancer in women
Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. You may be given it to reduce the risk of breast cancer coming back in the breast, chest or lymph nodes.
Radiotherapy after breast-conserving surgery
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If you have breast-conserving surgery, your cancer specialist will recommend you have radiotherapy to the breast after your operation. Some women also have an extra dose to the area where the cancer was (a booster dose).
You usually start radiotherapy four weeks after surgery unless you’re having chemotherapy. Radiotherapy is given after chemotherapy.
Radiotherapy after a mastectomy
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Some women have radiotherapy after a mastectomy. This depends on the risk of the cancer coming back in the chest area. Your cancer specialist may recommend radiotherapy to your chest if:
the cancer was large
the cancer was high-grade
several lymph nodes in the armpit contained cancer cells or there were cancer cells in the fatty tissue surrounding affected nodes
there were cancer cells close to the edges of the removed breast tissue
there were cancer cells in the lymph vessels in the breast.
Radiotherapy to the lymph nodes
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If the surgeon removed some lymph nodes from your armpit and they contained cancer, you may have radiotherapy to the rest of the nodes. Some women also have radiotherapy to the lymph nodes close to the breast. This can include nodes in the armpit, above the collarbone and by the breastbone.
You usually have a course of radiotherapy for three weeks.
You have the treatment in the hospital radiotherapy department as a series of short daily sessions. Each treatment takes 10–15 minutes and they are usually given Monday–Friday with a rest at the weekend. Your cancer specialist or nurse will talk to you about the treatment and possible side effects.
Some women may have radiotherapy as part of a clinical trial.
External radiotherapy does not make you radioactive and it is safe for you to be with other people, including children, after your treatment.
Radiotherapy has to be carefully planned to make sure it’s as effective as possible. It’s planned by a cancer specialist (oncologist) and it may take a few visits. On your first visit to the radiotherapy department, you’ll be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated.
You usually have markings made on your skin to show the exact place where the radiographers (who give you your treatment) direct the rays. Usually, permanent markings the size of a pinpoint are made (tattoos). They’re only done with your permission. It can feel a little uncomfortable while they’re being made, but it makes sure treatment is given to the right area.
You’ll need to be able to position your arm so that the radiotherapy machine can give the treatment effectively. A physiotherapist can show you exercises to do to make this easier if your muscles and shoulder feel stiff or painful.
At the beginning of each session, the radiographer will position you carefully on the couch and make sure you are comfortable. During your treatment, you’ll be alone in the room, but you can talk to the radiographer who will watch you from the next room. Radiotherapy is not painful, but you will have to lie still for a few minutes during the treatment.
Side effects of radiotherapy
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You may develop side effects over the course of your treatment. These usually disappear gradually over a few weeks or months after treatment finishes. Your doctor, nurse or radiographer will discuss this with you so you know what to expect. Let them know about any side effects you have during or after treatment, as there are often things that can be done to help.
Your skin in the treated area may get red, dry and itchy. Dark skin may get darker or have a blue or black tinge. Your nurse or radiographer will give you advice on looking after your skin. If it becomes sore and flaky, your doctor can prescribe creams or dressings to help this. Skin reactions settle down 2–4 weeks after radiotherapy.
Here are some tips to help with skin irritation:
Don’t put anything on your skin in the treated area without checking with your nurse or radiographer first.
Have a tepid or warm shower rather than a bath if you can. Turn away from the spray to protect your breast.
Pat the area dry gently with a soft towel. Don’t rub the area.
Wear loose clothing or crop tops, as they are less likely to irritate your skin.
You need to avoid exposing the treated area to sunshine for at least a year after treatment finishes. Use suncream with a high sun protection factor (SPF) of at least 30 to protect your skin if it’s exposed.
This is a common side effect that may last up to a month or two after treatment. Try to get plenty of rest and pace yourself.
Balance this with some physical activity, such as short walks, which will give you more energy.
We have more information about coping with fatigue.
Aches and swelling
You may have a dull ache or shooting pains in the breast that last a few seconds or minutes and/or your breast may become swollen. These effects usually improve quickly after treatment. Some women still have occasional aches and pains in the breast area after radiotherapy.
Radiotherapy to the breast may cause side effects that occur months or longer after radiotherapy. If you’re worried about a particular side effect, talk to your cancer specialist.
The most common late effect is a change in how the breast looks and feels. Small blood vessels in the skin can be damaged causing red ‘spidery’ marks (telangiectasia) to show. Your breast may feel firmer, and shrink slightly in size. Some women have surgery to reduce the size of the other breast, to improve their appearance if this is a problem.
It’s rare for radiotherapy to cause any heart problems or problems with the ribs in the treated area. Lung problems as a result of radiotherapy are also rare.