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Radiotherapy Radiotherapy is the use of high energy x-rays to treat cancer. These high-energy rays are produced by a machine called a linear accelerator and are able to damage and destroy cancer cells within the treatment area. Radiotherapy also affects normal cells in the area being treated, but they are generally more able to recover than cancer cells. Treatment is usually given regularly over a period of time to have the greatest effect on the cancer cells whilst limiting the damage to normal cells. When is radiotherapy given? In most cases, radiotherapy is used after surgery. The aim is to get rid of any remaining cancer cells in the breast area to reduce the risk of the cancer coming back. If you have the lump or part of the breast removed you will usually be given radiotherapy to the remaining breast tissue. If you have a mastectomy (complete removal of the breast), you may be given radiotherapy to the chest area, particularly if the tumour is large or cancer cells have spread to the lymph nodes under the arm. Occasionally, radiotherapy is given to reduce the size of a large tumour before surgery. If you are going to have chemotherapy (drug treatment) as well as radiotherapy, the radiotherapy treatment may be given before or after he course of chemotherapy, or between courses of chemotherapy. Sometimes the lymph nodes (glands) above the collarbone and in the axilla (armpit) will also be treated with radiotherapy. This will depend on the surgery you have had and whether or not the lymph nodes contained cancer cells. If all the lymph glands have been removed, you will not usually need radiotherapy to the armpit area. If you have had any surgery or radiotherapy to your axilla, it is important for you to take particular care of your arm to reduce your risk of swelling (known as lymphoedema) in the arm on the treated side. For more information see Breast Cancer Care'' Lymphoedema factsheet. Radiotherapy may also be used in more advanced stages of breast cancer. It can help to control previously untreated disease in the breast or help relieve cancer-related symptoms, such as pain caused by the cancer spreading to other parts of the body (secondary breast cancer). In these situations, the extent of treatment will depend on individual circumstances, but would usually be given over a much shorter period of time. What about treatment arrangements? Radiotherapy generally starts about four weeks after surgery, and will usually be given daily, Monday to Friday, for a total of three to six weeks. Some centres treat patients on alternative days, rather than every day. First you will see the radiotherapy specialist (clinical oncologist) in the outpatient department to talk about your treatment. A further appointment will be made to plan the treatment (see below) and you will then be given a starting date. Radiotherapy is a specialised treatment and so is not available in every hospital. However, each breast unit will have a link with a hospital that has a radiotherapy department. You will usually be treated as an outpatient. If you think you will have problems attending appointments, tell the radiotherapy staff. Transport can usually be arranged if necessary. It is important that treatment continues as planned and that you don't miss any appointments. If, for example, you have a holiday booked, tell the specialist or radiographer who is treating you so that s/he can decide what arrangements to make. The staff treating you will check how you are each day, but if you have any problems tell the radiographer or clinic nurse. An appointment can then be arranged with your specialist and/or breast care nurse if necessary. What is treatment planning? Treatment is individually planned for each patient so don't be concerned if someone you know is having different treatment, even though you seem to have had the same surgery. Radiotherapy needs to be given in the most effective way, causing the fewest possible side effects. Treatment planning identifies the exact area to be treated and the most effective dose of radiation. A special x-ray machine known as a simulator is used for treatmentplanning. This machine helps the specialist to see the treatment area clearly and so set up the treatment accurately. This planning session may last from half an hour to an hour, and during this time you will need to lie still while measurements and x-rays are taken. It is important that you have enough arm movement after your operation to allow you to raise your elbow to at least shoulder level so that you are comfortable in the treatment position. If you find this difficult, talk to your breast care nurse or ask to see the physiotherapist. When the exact area of treatment is decided, some temporary ink markings are usually put on the skin to indicate it. With your permission, one or more tiny permanent marks (referred to as tattoos) may be made using a pinprick of ink. Try not to wash off the skin markings until treatment is finished. However, they do face and sometimes rub off. Wearing a cotton T-shirt or vest top next to the skin can help to avoid staining your clothes. During treatment, many hospitals suggest that you use unperfumed moisturising cream to make sure your skin does not get too dry. How is radiotherapy given? When you go for treatment you will be asked to undress to the waist and lie on the treatment couch. The radiographer will position you carefully to make sure that you are in exactly the same position each time you have treatment. When you are in the correct position you will be asked to stay very still but you can, of course, breathe normally. Treatment to the breast or chest wall is usually directed from different angles. The radiographers responsible for your treatment will reposition the machine for each angle. You won't feel pain while the treatment is being given, although you may feel a little uncomfortable staying in the treatment position. Treatment only takes a few minutes and, although you will be alone in the room, the radiographers will watch you through a special window or on a television screen. Most departments also have an intercom system sothat the radiographers can hear you and speak to you. What are the side effects of treatment? Side effects happen because radiotherapy affects normal cells as well as cancer cells. Normal cells are more able to recover than cancer cells, but they may be damaged in the short or long term by the effect of the radiation. Most side effects are temporary, but some may be permanent. Some may even occur months or years after treatment. Everyone reacts differently to treatment but certain side effects are more common than others. Common side effects You may develop a skin reaction during or after radiotherapy to your breast. The extent of the reaction depends on a numbers of factors, including the dose of radiotherapy given. You may notice some redness, increased pigmentation (darkening), tenderness or itching of the skin around 10 to 14 days after starting treatment. Your skin may peel or flake as treatment goes on, and this may sometimes be associated with a red, sore, moist and weepy skin reaction. The radiotherapy staff will keep an eye on this and advise you how to take care of your skin according to the type of reaction you have. Now and then, you may have aches, twinges or sharp shooting pains in the breast area. Although these pains are usually mild, they can go on for some time after treatment is finished. In some cases, they can last for months or even years but they usually become milder and less frequent. This section is an extract from "Radiotherapy" one of Breast Cancer Care booklets and is used with permission. For further details go to www.breastcancercare.org.uk |