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7. Radiotherapy

Radiotherapy is the use of high-energy X-rays, in this case to destroy any cancer cells that may have been left behind in the breast area after surgery.

Radiotherapy also reaches normal cells which are in the treatment area. All cells are more vulnerable to damage when they are dividing.

Cancer cells divide more rapidly than normal cells so will be damaged or killed at a greater rate than the normal cells in the treatment area.

Any normal cells that are affected by radiotherapy recover or repair themselves more easily.

But radiation can cause cancer: how can it be used to treat it?

Radiation may cause cancer if someone is exposed to large doses in a very short time period. When radiation is used as radiotherapy it is very carefully controlled. The beam of rays is directed exactly, and only, at the area needing treatment. The dose of radiation is relatively small and is given over a period of weeks. When radiation causes cancer it is due to someone being exposed to a very high dose in a short period of time, such as the very rare instances when someone is close to a leak in a nuclear power plant.

Can I have radiotherapy instead of an operation?

No, radiotherapy would not be effective enough to treat the breast cancer if used on its own. It is usually recommended after any type of breast conserving surgery and after mastectomy if cancer cells are seen in the lymph nodes under your arm, to reduce the chances of the breast cancer coming back. If you are not having chemo therapy, you will ideally start radiotherapy within a few weeks of surgery. If you are having chemotherapy, then the radiotherapy will usually follow this.

Is radiotherapy painful?

Having the treatment is painless but it can have a few side effects that are described in answers later in this section. Most side effects of radiotherapy for breast cancer occur towards the end of the course of treatment and may continue for a few weeks afterwards.

How is radiotherapy given?

Radiotherapy is given using machines that produce X-rays that are beamed directly at the breast/chest area.

 How long does radiotherapy last? Will I just have one treatment?

Radiotherapy to the breast or chest area is usually given as a course of treatment lasting three to six weeks. There are usually between three and five treatments each week, normally on weekdays. The actual treatment only lasts for a few minutes, but before each one you, and the machine, have to be carefully placed in the right position by the radiographers, and this often takes longer than the treatment itself. The bones or brain, the course of treatment will be shorter, lasting only a few days.

I’ve been told I have to attend for ‘planning’ before starting my treatment. What is this?

Planning is an essential part of your radiotherapy, and will make sure the treatment is accurate. Your treatment planning involves working out the exact dose of radiotherapy you need and precisely where in your body it needs to go. The radiotherapy beam must be directed accurately to hit the right area but to avoid unnecessarily hitting healthy tissue with X-rays. In the planning session a simulator will create a mock-up of treatment using measurements or scans or both. The planning phase may take an hour or more.

After all this preparation, how can the doctors be sure that treatment is identical each day I have it?

When the doctors have decided on the exact area to be treated, it will be marked out on your skin. These marks can then be used to line up the machine each time so that the correct area is treated. They will use either an indelible pen or a permanent pinprick tattoo. Although indelible, the pen will not be permanent so don’t wash it off during the course of treatment. The tattoo is permanent but should be small enough as to be almost invisible to anyone not looking for it.

Am I radioactive during a course of radiotherapy?

Certainly not. The machine emitting X-rays is only on for the treatment time and is switched off afterwards. There is no radiation left in you or in the air around you when the machine has been switched off at the end of your treatment.

Do I need to stay overnight in hospital for radiotherapy?

No, radiotherapy is given as an outpatient treatment.

What will actually happen when I go for my radiotherapy treatment?

Every day’s treatment routine is the same. When you enter the radiotherapy room you’ll be asked to undress to the waist so that the marked out area is visible. You’ll lie down like you did in the simulator and the radiographers, who supervise and deliver your treatment, will use light beams to help position you correctly. When you are in the correct position, they will ask you to remain very still, although you can breathe and swallow normally. They will leave the room and switch on the radiotherapy machine. For a very short time you will be on your own, but the radiographers will be able to see you all the time on a closed-circuit television, and you can talk to each other via a microphone system.

The radiographers work with radiotherapy daily and it is important that they are not exposed to unnecessary radiation. This is why they cannot stay with you. As your treatment goes on you will get used to this procedure. If you have any questions or concerns, talk to the radiographers who will advise you. They understand that at first this is a frightening experience for most people.

Will the radiotherapy give me radiation sickness?

No. ‘Radiation sickness’ describes a whole series of symptoms which people experience when they have been exposed to large amounts of radiation after major nuclear accidents, such as the Chernobyl disaster. Radiotherapy to the breast or chest area doesn’t cause nausea or vomiting or any of the symptoms associated with radiation sickness.

 Will radiotherapy make my hair fall out?

Radiotherapy causes hair loss only in the area being treated. So a woman having radiotherapy to the breast won’t lose any hair on her head. Men being treated for breast cancer can lose chest hair. You will lose your underarm hair with radiotherapy to the armpit. Hair loss from radiotherapy can be permanent.

Radiotherapy causes sore skin, doesn’t it?

The radiotherapy burns that people once talked about are very rarely seen now. Research is going on to find the best way of giving radiotherapy with the fewest side effects. Sometimes your skin may become sore and you may get symptoms such as redness, skin darkening, itching or moist, weepy skin. Always follow the radio - graphers’ advice about the care of your skin.

Apart from sore skin, what other kind of side effects am I likely to experience during radiotherapy?

Some people feel extremely tired towards the end of their treatment, and for a few weeks or even months afterwards. But often you can carry on your usual life and even go to work if you choose. If part of your oesophagus (gullet) is in the treatment area, you may have difficulty swallowing towards the end of treatment. This is because the cells in that area can be affected by repeated doses of Xrays and gradually lose their ability to recover between the daily doses. Any discomfort usually goes away within a week or two of the end of the course of treatment.

Will I have any long-term side effects after my course of radiotherapy?

In the longer term the skin over the breast may remain reddened and the breast may be slightly swollen. Also, the area under the skin that has been treated can feel hard and sometimes be uncomfortable. This is because of fibrosis which is similar to scar tissue, and can happen some months – or even years – after treatment. In severe cases it can distort the shape of the breast and may also lead to lymphoedema (swelling) by blocking the lymph drainage of the arm.

Rarely, the radiotherapy can damage parts of the body near to the area being treated. In breast cancer treatment, this would be the lung, the heart (if it is the left breast) and the ribs. For most people any such damage will gradually heal.

Will I see a doctor during my course of radiotherapy?

Yes, you will probably see a radiotherapy doctor (called a radiotherapist or clinical oncologist) each week or two. If you are worried about anything during treatment, take the opportunity to discuss it with your doctor, radiographer or breast care nurse.

Is there anything that I shouldn’t do during radiotherapy treatment?

You will be told if there is anything specific you should or shouldn’t do, but here is a list of general points.

• Do look after yourself, eat well and have plenty to drink, especially water.

• Do make sure you get lots of rest. You might be able to carry on as usual but, on the other hand, you may find you can only work part-time or you may need help with shopping or housework.

• Do wear comfortable clothes. If you have treatment marks on your skin you might prefer to wear older clothes so new things are not marked by the ink. Loose-fitting underwear and clothes are best, as they won’t rub on the treatment area and make your skin sore.

• Do take notice of the skin care advice the radiographers give you, especially about whether or not you can use any creams or lotions. The ink marks must not be washed off but you will usually be able to splash tepid water on your skin and gently pat it dry to keep yourself feeling clean.

• Do follow your breast care nurse’s advice about wearing breast prosthesis during treatment. You will usually be advised to wear a ‘comfy’ or post-operative one in order to avoid any skin irritation.

• Do keep your treatment area out of the sun and cold winds, and don’t use hot-water bottles or ice packs. Your skin will be more sensitive than usual.

• Do ask if you are unsure about anything, or have specific concerns about your personal treatment or side effects.

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