Radiotherapy to the breast
Radiotherapy to the breast is a localised treatment and side effects depend on the exact area of your body receiving the X-rays. Your oncology team may have recommended treatment to the breast alone or the breast, armpit (axilla) and an area above the clavicle (supraclavicular area). There are two types of side effects; those which come on during or after the treatment (acute side effects) and those which can be long term (late side effects). Your oncologists will have taken these into account when considering the benefits of treatment. Please discuss any concerns with your doctor, specialist nurse or radiographer at the time of consent or at any time during radiotherapy. This information sheet provides a brief introduction to radiotherapy and explains the common side effects you may experience. This does not mean you will definitely get them. It is also possible you may experience a side effect not mentioned here.
Your first appointment at the radiotherapy centre will be a planning session in the planning CT scanner or simulator. Report to the reception desk, show them your card, and they will direct you. You will then be welcomed by a specialist radiographer, who are people who operate the machines to plan and give your treatment. You should not be embarrassed to ask them anything you are concerned about. The purpose of this visit is to plan and arrange the radiotherapy so you may not have a formal consultation with the Doctor at this stage. Of course any urgent issues will be addressed but others should be saved for the regular consultations you will have during treatment. It is often difficult to judge exactly how long each patient will take - unfortunately it is possible you may have to wait a long time.
The simulator is a machine which is a direct copy of a therapy machine. It takes X-rays pictures to enable the oncologist to decide the exact area of your chest which needs treatment. While very accurate measurements are taken, you will have to lie on a fairly hard couch which may be slightly uncomfortable. A small tattoo about the size of a pin head is made on your body with a needle, giving a permanent record of the measurements. Occasionally, this can be uncomfortable. If this is unsightly for the patient, after completion of the radiotherapy this can be removed with a lazer is some instances.
The CT scanner takes more accurate pictures which also help the oncologist decide which areas of your body need treatment. You will also have a tattoo made at this time as there is no need to go to the simulator in this situation.
The treatment machine looks similar to the simulator. You will not be required to do anything you haven't already done in the simulator or CT scanner. Although the radiographers are not in the room while you are being treated, you are being watched at all times on a video camera. If you feel any distress, the machine can be turned off and the radiographers will be at your side within seconds. There is also an intercom which is left on. Treatment usually lasts only 1 to 2 minutes. While the machine is on, you usually do not have any sensation. After treatment you will not be radioactive and you will not loose the hair on your head.
Potential acute side effects
Your skin in the treated area may become slightly red, itchy and sensitive towards the second half of the course. Skin elsewhere on your body will remain normal. You may wash the treatment area with lukewarm water but shower rather than soak in a hot bath. Non medicated, non perfumed soaps are recommended e.g. baby or simple soap. Do not rub or scratch the skin and try to pat dry with a soft towel. Its important to stop smoking as this increases the risk of a skin reaction, You may use baby talc to keep the area dry. Normally we advise the use of aqueous cream or E45. If you know you are allergic to these, please ask your treatment team for advice. (see skin care).
Your armpit may be included in the treatment area. Check with your radiographers. It is best not to use deodorants, depilatory creams or wax on your armpit during treatment. Avoid shaving unless with an electric razor. You will perspire less and have less hair growth after treatment. Take particular care of the skin creases area under your arm and breast as they are more sensitive and may even crack. If you notice severe cracking, soreness or oozing please let your radiographers know. You may also notice some dryness and colour change on your upper back behind the treatment area. This should return to normal after treatment.
Try not to wear tight clothing; loose, natural materials allow the area to breathe. You may be more comfortable wearing a camisole or vest rather than a bra. You need to be careful about exposing the treated area to the sun or sun bed as you will be more sensitive to the sun for as long as a year after treatment and will burn easily. Keep the breast area covered with light clothing and use sun block creams (available on prescription for the first year)
Any skin changes will start to improve some 10 days after treatment finishes and should return to normal over the next 4-6 weeks.
Potential late side effects
These side effects although infrequent can be troublesome and permanent. The risks dependent the areas treated:-
Breast or chest wall alone. In the first three months you may experience swelling and tenderness in your breast. This may make the breast heavier and some people may experience sharp, jabbing pains. This should disappear in time but please discuss with your doctor if you are very uncomfortable.
A few women develop a transient cough because of effects to the lung near the treated area. This gets better with time. In a very small percentage of people (less than 1%) lungs can be permanently affected by radiotherapy. This has been known, very rarely to lead to breathlessness. The heart is now excluded from all fields and the latest records have not shown any extra risk to the heart.
A few women may find their treated breast is smaller or a slightly different shape after treatment. This is causes by fibrosis or thickening of the underlying tissues.
8% of women develop dilation of the minute blood vessels in the breast (capillaries). This is not painful but can make the area noticeably red/purple. It is called telangiectasia.
Less than 1% of women may develop weakening of the underlying ribs increasing the risk of fracture which could lead to pain when you breath.
Breast or chest wall & axilla (armpit) Side effects as in the breast alone with the possible added risks of:-
Lymphoedema is a swelling of the arm on the affected side. 12% of women will develop some degree of lymphoedema especially if several lymph nodes were taken out during surgery. Less than 4% will have it severely.
Rarely shoulder joint stiffness may develop - this can be helped by special exercises.
There is a very small risk (for example 0.02% in Addenbrooke's Oncology Centre) of damage to the brachial plexus nerve. This can be painful and restrict movement in the affected arm.
Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.