Radiotherapy SECRETS Every Breast Cancer Patient Should KNOW

If you need to have radiotherapy for breast cancer, this video will tell you everything you need to know. I’m a breast surgeon, and I’ve had radiotherapy myself for breast cancer. In this video, I’m going to tell you what it is, how it works, why you have it, and what the side effects are.

## What Is Radiotherapy?

Radiotherapy is a cancer treatment that uses high-energy X-rays. The X-ray beams release pockets of energy as they pass through your body, and this damages and kills cancer cells. However, the X-rays can also damage healthy cells. Most of these cells do recover and repair themselves. Radiotherapy doesn’t make you radioactive, and it’s safe for you to be around pregnant women and children during your treatment.

## Why Do We Give Radiotherapy After Breast Cancer?

Radiotherapy is used to reduce the risk of a local recurrence. This means that it can stop breast cancer cells from growing in your breast, chest tissues, and lymph nodes in the future.

Radiotherapy is offered to four groups of breast cancer patients:

### 1. Women Who’ve Had a Lumpectomy
After a lumpectomy, breast radiotherapy gives you the same survival as a mastectomy. This means that a lot of women can safely keep their breast tissue. If you are under 50 or over 50 with a large or Grade Three cancer, you may also get a boost to the tumor bed. This is the area of your breast that surrounded the cancer, and this further reduces your risk of recurrence.

### 2. After a Mastectomy
If your cancer is large (over 4 to 5 cm), Grade Three, or has grown into the skin or the muscle under the breast, you have a higher risk of local recurrence. Also, having cancer in some of the lymph nodes in your armpit increases this risk, and radiotherapy is given to your chest wall to reduce it.

### 3. After Lymph Node Surgery
If you have cancer in four or more lymph nodes, you will get radiotherapy to those nodes. It will target the nodes above your collarbone (the supraclavicular fossa). This reduces the risk of cancer coming back in those lymph nodes. Doctors may also give it to you if you have cancer in one to three axillary nodes and your cancer is large or high grade.

### 4. Instead of Further Lymph Node Surgery
If your sentinel lymph node biopsy was positive, your doctor may suggest radiotherapy to your armpit lymph nodes instead of more surgery to remove them. Trials have shown that surgery and radiotherapy both reduce the risk of recurrence equally, and your oncologist will help you decide which treatment to have.

## Does Everyone Need Radiotherapy After a Lumpectomy?

No. If you are over 65 with a small ER-positive cancer and normal lymph nodes, you might not need radiotherapy. There are trials that have shown that your benefit from radiotherapy is small, so you might not need it.

## When Do You Have Radiotherapy?

You will have radiotherapy after you’ve recovered from your surgery, and you should receive it within a month or two. However, in some parts of the country, people are having to wait longer for treatment.

If you have a wound infection, a large seroma that needs draining, or you need further surgery, we may have to delay it. You also need to be able to lift your arms above your head, and this is why it’s so important to do your shoulder exercises so your treatment isn’t delayed.

If you need chemotherapy, you will have that first, then you’ll get radiotherapy once you finish the chemo. If you are having Herceptin, your injections will continue during radiotherapy, and you will then continue with Herceptin when it’s finished.

## How Is Radiotherapy Given?

We measure radiotherapy in Grays. In the UK, you will either have 26 Grays over 5 days or 40 Grays over 15 days from Monday to Friday. If you need a boost, this will involve an extra 5 to 8 sessions. Most units run from early in the morning to late in the evening, which means you can ask for your sessions to be at a certain time to fit in around work and other commitments.

Most patients have external beam radiotherapy. The beams are modulated so that stronger beams hit the target area and the healthy surrounding tissue gets a smaller dose.

If you have a left-sided cancer or a heart problem, two techniques are being used to reduce the effect of radiotherapy on your heart. The first is respiratory gating, and the second is deep inspiration breath hold. Your radiotherapy team will coach you and tell you what to do.

## What Happens at Your First Appointment?

Your first appointment is to plan your radiotherapy using a CT scan. The CT scan takes 15 to 30 minutes to do, and the appointment can take up to an hour in total. You lie topless on a table with one or both of your arms above your head, resting on a support. You need to be in the same position for every treatment.

Some radiotherapy units may give you three tiny tattoos: one in your cleavage and one under each arm. These are used to line you up in the right place. They look like little black dots and they are permanent. Other units use surface-guided radiotherapy techniques, so the tattoos are no longer needed.

## What Happens at a Radiotherapy Session?

After you are in the correct position on the table, the therapeutic radiographers will go next door and watch you through CCTV. They will speak to you through a two-way intercom. Depending on which machine they use, it will either move around you or you will be moved inside it.

The treatment takes a couple of minutes and it can be quite noisy, but it doesn’t hurt. The room might get cold because of the air conditioning, but there will be blankets to put over your legs. However, your arms might get cold. I used an old pair of thick woolly tights cut in two to keep my arms warm, with a pair of gloves for my hands as well.

It can be very emotional having radiotherapy, and I found it unsettling to lie topless in an empty room with only my thoughts for company. You may feel vulnerable and exposed. Please talk to the therapeutic radiographers about how you feel. You can even bring in your own music to listen to, which might help.

## Is Radiotherapy Safe?

Yes, it is, but very rarely radiotherapy can cause cancers. If you had mantle cell radiotherapy for leukemia or a bone marrow cancer as a teenager, you do have a greater chance of developing breast cancer in the future. You’ll be given yearly screening like mammograms and MRIs at a much earlier age.

Radiotherapy for breast cancer does have a very small risk of causing angiosarcoma. This is a tumor of the blood vessels of the chest wall. It is rare and it normally takes over 10 years to form. Overall, the benefits of radiotherapy to prevent a breast cancer recurrence far outweigh the risks of a second cancer forming.

## Does Radiotherapy Cause Side Effects?

Yes, it does, and there are two types. Some occur in the first few weeks and months of treatment (called immediate), and others happen several months or even years later (these are late).

### Immediate Side Effects

**Skin Reactions**
These are very common. The radiotherapy beams have to pass through your skin to reach your breast. Your skin could become dry, sore, and flaky and feel warmer to touch. It helps to wear loose clothing and maybe stop wearing a bra during treatment.

If you have light skin, you’ll notice that your skin in the treatment area changes to a pink or red color before darkening to a tan. If you have darker skin, your skin may darken a bit at first before turning yellow, purple, or even gray in the treated area.

We know that dehydration, eczema, being overweight, and smoking can make the skin reaction worse. Use your usual soap, shower gel, and moisturizer. Stay out of the sun during treatment and use a high-factor sunscreen for life. If your skin isn’t settling, ask the therapeutic radiographers looking after you for advice. Most skin reactions settle in a month or two, but you may have skin changes for life.

**Breast Swelling**
The breast can swell and feel uncomfortable because of a buildup of fluid in the breast and skin. Regular breast massage can help. Firmly rub your breast in a circular motion using a gentle, non-perfumed moisturizer or massage oil for a couple of minutes every day.

**Change in Breast Appearance**
It’s normal for your breast to change in size or shape after radiotherapy. Your breast may feel firm or shrink in size, and there are surgical options to help, like lipofilling (transferring fat from your thigh or your tummy to the breast). You’ll need to wait at least 6 to 12 months after treatment has finished.

**Shoulder Stiffness**
Your shoulder might feel sore and stiff, and this can make it hard to move, especially if your armpit is being treated. Do your shoulder exercises every day for the rest of your life. They will reduce the risk of late effects like radiation fibrosis, which I’ll talk about later.

**Sore Throat and Difficulty Swallowing**
If you’ve had your collarbone treated, you may get a sore throat and find it difficult to swallow for a few weeks. Simple painkillers and throat sweets can help, as well as eating softer foods. It does usually get better after a few weeks. I had it and I know.

**Chest Pain**
You may feel sharp, mild aches in your breast or chest wall. They don’t last long and they should get better in time.

**Hair Loss**
Radiotherapy makes your armpit hair and chest hair (if you’re a man) fall out. It normally starts to grow back after a month or two, but sometimes the hair loss is permanent.

### Late Side Effects

**Arm Swelling or Lymphedema**
Radiotherapy to the armpit can damage the lymph nodes, and in a small number of people, this can cause lymphedema or a permanently swollen hand and arm.

**Skin Changes**
Little red dots might appear on your skin due to tiny broken blood vessels. These are called telangiectasia. They are harmless but permanent.

**Radiation Fibrosis**
This is a rare side effect that can happen up to 10 years later. Radiotherapy can cause scar tissue in healthy areas, and this can lead to permanent problems in the future. Your breast may shrink and feel hard to touch. The skin on your chest wall can darken. Your arm’s nerves may be affected, and this can cause tingling, numbness, pain, and weakness on that side. Your ribs can weaken, so you are more likely to break them from a simple fall. You can get lung inflammation called pneumonitis. This can cause shortness of breath and it’s less likely to happen with newer radiotherapy techniques, but you do need to know about it.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820065/

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