Radiation Therapy
Radiation
is a type of local therapy for breast cancer that uses high-energy x-rays to kill cancer cells. There are two general types of radiation treatment to the breast for early-stage breast cancer – whole breast radiation and partial breast radiation.
The goal of radiation therapy is to kill any cancer cells left in areas of your body at high risk for cancer return. Those areas may be in your breast or chest wall, with or without the nearby lymph nodes.
When radiation is given after surgery as part of the primary treatment, it is called adjuvant therapy. Adjuvant radiation therapy helps protect you from the breast cancer coming back in the treated areas, also called local recurrence.
Radiation therapy may be part of your treatment for:
- Ductal carcinoma in situ, or DCIS (non-invasive breast cancer)
- Early-stage breast cancer
- Locally advanced breast cancer
- Inflammatory breast cancer
Very rarely, radiation is given as neoadjuvant treatment, before surgery, to shrink the size of a tumor in people with locally advanced breast cancer or with inflammatory breast cancer. In these cases, the cancer did not respond well enough to chemotherapy to allow for surgery.
Radiation treatment is very effective against cancer in the specific area it is directed, but it can’t treat cancer in areas of the body where it is not directed. It can be given to different parts of the body and depends on where the cancer is located. In early-stage breast cancer, you may receive radiation to part of your breast, your whole breast, the chest wall, the area above your collarbone or under your arm.
You will not be “radioactive” during radiation therapy. You don’t need to worry about exposing family members to radiation.
How Do I Know If I Need Radiation?
At some point after your diagnosis, you may meet with a radiation oncologist, a doctor with special training in treating cancer with radiation.
Your doctor will talk with you about your medical history, your breast cancer diagnosis and any other illnesses you may have. Then your doctor will explain whether radiation therapy plays a role in your treatment plan.
Almost everyone who has a lumpectomy benefits from radiation therapy to some degree, so it’s almost always recommended after that surgery.
If you have a mastectomy, you may not need radiation. Your doctor may recommend radiation therapy to reduce the chance of the cancer coming back in your skin or the chest wall or nearby lymph nodes if:
- the primary tumor is larger than 5 centimeters across
- the cancer involves the lymph nodes under your arm
- the cancer has grown into the skin or chest wall muscle under the breast
- you have locally advanced or inflammatory breast cancer
What Happens at Treatment?
Radiation can be given in different ways. Usually, you will receive it from outside your body by an external beam, but it can also be given from inside the body via a radioactive implant. Radiation isn’t painful. You won’t feel the beam going into your body.
Before you begin radiation therapy, your radiation oncologist plans your treatments. This plan ensures the radiation targets the exact area of the cancer, without causing too much harm to healthy tissues nearby.
To kill cancer cells, radiation treatment must be very precise. Your doctor will give you a CAT or CT scan to find the right places on your body to radiate. This special x-ray takes pictures of the inside of your breast from many different angles.
Your radiation oncologist then uses the pictures to choose where small tattoos, dots of permanent ink about the size of a small freckle, will be placed on your body. The tattoos help make sure the exact same spot is always radiated. Many women say that getting the tattoos feels similar to a pin prick.
Often, your radiation oncologist will ask you to complete a “dry run,” a treatment dress rehearsal. On that day you’ll do everything you would on a normal treatment day except receive the radiation. You may be asked to hold your breath, put your arms over your head or position your head a certain way. This rehearsal allows the radiation oncologist and radiation therapists to get familiar with the treatment plan and make adjustments, if needed. Several days to a week later, you will begin treatment.
How long radiation treatment takes depends on the kind of treatment you receive. Because there are different types of radiation for breast cancer, ask your doctors to explain why they recommend a certain kind for you.
Side Effects of Radiation Therapy
Radiation itself is not painful but it has some side effects. Because it is a local treatment, radiation treatment may not cause as many or as severe side effects as other whole-body therapies. That’s because most side effects are generally limited to the treatment area.
FatigueRadiation does not hurt, but sometimes it can make you feel more tired than usual. Radiation treatments and their effects build up in your body over time, so as your treatments go on, your fatigue may increase.
Expect to feel more tired in the last few weeks of treatment. Plan time for naps and resting. Gentle exercise such as walking, keeping a healthy diet and resting when you feel tired can help.
Skin ReactionsThe skin on or near the radiated area may become dry, red, scaly, itchy and sore. Your skin may also burn, peel or blister, like a sunburn. Remember not to pick or scratch, as this can lead to infection and delay treatment.
Your radiation oncologist can help you manage skin reactions by providing skin care tips, prescribing medicines or recommending salves, such as pure aloe. Avoid using products that have alcohol, as it can dry the skin and cause a burning feeling. If possible, wear loose cotton clothes to keep your skin from rubbing too much against your clothes.
Skin side effects often heal several weeks after you finish radiation therapy. Changes to the color of your skin may take longer to heal, but your radiation oncologist will monitor your skin for weeks after you complete treatment.
Other Side EffectsRadiation can increase the risk of lymphedema if the lymph nodes under your arm or around your collarbone are radiated. The risk is higher if lymph nodes were removed from the armpit region and if you are overweight.
Long-term side effects may include swelling of the breast (edema), a hardening or thickening of the breast tissue (fibrosis), the treated area becoming red (telangiectasia) and restricted arm or shoulder movement.
Rare side effects may include:
- Rib fracture
- Heart problems (if treated on the left side)
- Inflammation of the lungs
- Damage of nerves in the chest causing pain, tingling and weakness in the affected hand and arm
- A second cancer, such as sarcoma
Discuss all the benefits and possible side effects of radiation therapy, both short- and long-term, with your doctor. Be sure to also communicate any issues or concerns you have during treatment.