Radiotherapy for breast cancer

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1 Radiotherapy for breast cancer This information is an extract from the booklet Understanding breast cancer. You may find the full booklet helpful. We can send you a copy free see page 6. Contents Radiotherapy after surgery to keep (conserve) the breast Radiotherapy after removing the whole breast (a mastectomy) Radiotherapy to lymph nodes (glands) in the armpit External radiotherapy Planning radiotherapy Side effects of radiotherapy Long-term side effects Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. It decreases the risk of breast cancer coming back in the breast or chest area (local recurrence). Radiotherapy after surgery to keep (conserve) the breast If you ve had the area of cancer and surrounding tissue removed (lumpectomy), you will be advised to have radiotherapy to the breast afterwards. If your cancer specialist thinks the risk of local recurrence is high, you may have an extra dose to the area of the breast where the cancer was (booster dose). You ll usually start radiotherapy about four weeks after your surgery unless you re having chemotherapy (anti-cancer drug treatment). Radiotherapy is usually given after chemotherapy has finished. Macmillan and Cancerbackup have merged. Together we provide free, high quality information for all. Questions about cancer? Ask Macmillan Page 1 of 6

2 Radiotherapy after removing the whole breast (a mastectomy) If there s an increased risk of your cancer coming back in the same area after a mastectomy, your cancer specialist will advise you to have radiotherapy to the chest. They may advise this if: you had a large cancer the cancer was high-grade (cells look very different from normal cells and tend to grow quickly) four or more lymph nodes (glands) in the armpit contained cancer cells there were cancer cells close to the edge of the removed breast tissue. Radiotherapy to lymph nodes (glands) in the armpit If the cancer has spread to the lymph nodes but only some were removed, you ll usually have radiotherapy to the remaining nodes. If you had all the lymph nodes in your armpit removed, you may not need to have radiotherapy as well. Radiotherapy can be internal or external. The following section is about external radiotherapy. We can send you a booklet with more information about the different types of radiotherapy. External radiotherapy The treatment is given in the hospital radiotherapy department as a series of short daily sessions. Each treatment takes minutes and they are usually given Monday Friday with a rest at the weekend. Your doctor will discuss the treatment and possible side effects with you. A course of radiotherapy for breast cancer is usually given for three weeks. Some women may be given radiotherapy in different ways or over a different timescale as part of a clinical trial. Trials are carried out to try to find new and better treatments for cancer. Page 2 of 6 Questions about cancer? Ask Macmillan

3 Radiotherapy is normally given to the whole breast area. Depending on the risk of the cancer coming back, it may also be given to areas of lymph nodes close to the breast. This includes the armpit and the area just above the collarbone and by the breastbone (sternum). External radiotherapy does not make you radioactive and it is safe for you to be with other people, including children, after your treatment. Planning radiotherapy 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 (computerised tomography) scan a series of x-rays, which builds up a three-dimensional picture of the inside of the body or lie under a machine called a simulator, which takes x-rays of the area to be treated. Marks are usually drawn on your skin to help the radiographer (who gives you your treatment) position you accurately and to show where the rays will be directed. These marks must stay visible throughout your treatment, and permanent marks (like tiny tattoos) might be used. These are extremely small and will only be done with your permission. You may feel some discomfort while they are being done. Positioning You ll need to be able to position your arm so that the radiotherapy machine can give the treatment effectively. Sometimes your muscles and shoulder joint may feel stiff. If you can t move your shoulder normally, it may be painful or difficult to give the treatment. A physiotherapist may teach you some exercises to make the position for treatment more comfortable. Treatment sessions At the beginning of each session of radiotherapy, 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. Questions about cancer? Ask Macmillan Page 3 of 6

4 Positioning the radiotherapy machine Side effects of radiotherapy 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. Skin irritation You may develop redness, dryness and itching of the skin in the treatment area. If you have dark skin it may get darker or have a blue or black tinge. Your doctor can prescribe creams to soothe your skin if it becomes sore and flaky. Usually, any skin reaction settles down 2 4 weeks after radiotherapy. You ll be given advice on how to look after your skin. Here are some tips that may help ease skin irritation: Don t use perfumed soaps, talcum powder, deodorants/ antiperspirants, creams or lotions unless they ve been prescribed by your cancer specialist. Page 4 of 6 Questions about cancer? Ask Macmillan

5 Have showers rather than baths but turn away from the spray to protect your breast. If you do have a bath, don t soak the affected area for too long. Pat the area dry gently with a soft towel don t rub. Wear loose clothing or crop tops, as these may be more comfortable and less likely to irritate your skin. You ll 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) to protect your skin if it s exposed. Tiredness (fatigue) You re likely to feel tired during treatment and this may continue for a month or two after it finishes. Pace yourself and save energy for the things you have to do, and that you enjoy. Get plenty of rest but balance this with some physical activity, such as short walks, which will give you more energy. We have a booklet about coping with fatigue. Aches and swelling You may notice a dull ache or shooting pains in the breast that last for a few seconds or minutes. You may find that your breast becomes swollen during treatment, but this usually improves quickly after treatment finishes. Some women continue to have occasional aches and pains in the breast area after radiotherapy. Long-term side effects Radiotherapy to the breast can sometimes lead to long-term side effects, but most of these are rare. How the breast looks and feels After radiotherapy, small blood vessels in the skin can be damaged causing red spidery marks (telangectasia). These affect how the breast looks but are harmless. Your skin may also have a slightly darker tone. It s not unusual for the breast to feel firmer, and over months or years it may shrink slightly in size. If you re unhappy with the shape of the breast or if it isn t the same volume as your other breast, discuss this with your doctors. There are usually techniques, such as reducing the size of your other breast, that can be done to improve the appearance. Questions about cancer? Ask Macmillan Page 5 of 6

6 Other late effects Rarely, a few months after radiotherapy some women develop breathlessness due to the effect of radiotherapy on the lung. It usually gets better within 2 4 weeks without any treatment or it may be treated with a short course of steroids. Radiotherapy rarely causes any long-term damage to the lungs. Women may worry about the effects of radiotherapy on the heart. Radiotherapy is now very carefully planned to avoid including the heart in the treatment area. It very rarely causes heart problems and only women who have cancer in their left breast are at risk. Rarely, radiotherapy weakens the ribs in the treated area, making them more likely to fracture (break) than normal. These side effects are uncommon. If you re worried about the risk of developing particular side effects from radiotherapy, talk to your cancer specialist. We can send you information about the possible long-term side effects of radiotherapy for breast cancer. More information and support If you have any questions about cancer, ask Macmillan. If you need support, ask Macmillan. Or if you just want someone to talk to, ask Macmillan. Our cancer support specialists are here for everyone living with cancer, whatever you need. Call free on , Monday Friday, 9am 8pm To order a copy of Understanding breast cancer or one of the other booklets mentioned in this information, visit be.macmillan.org.uk To order the fact sheets mentioned in this document, call We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN AUGUST 2011 Page 6 of 6 Questions about cancer? Ask Macmillan