Chest Pain After Radiation For Breast Cancer

Radiation Therapy And Risk Of A Second Cancer

In rare cases, radiation therapy to the breast can cause a second cancer.

The most common cancers linked to radiation therapy are sarcomas . For women who are long-term smokers, radiation therapy may also increase the risk of lung cancer .

The risk of a second cancer is small. If your radiation oncologist recommends radiation therapy, the benefits of radiation therapy outweigh this risk.

What Should I Expect On My First Visit

When radiation therapy might be of help, a family doctor, surgeon or medical oncologist will refer patients to a radiation oncologist.

The doctor will first review your medical records and X-rays. A physical exam will be done.

The doctors will then talk to you about his/her findings and decide how you should be treated. If radiation will help you, the staff will schedule the needed studies to develop a treatment plan. This is sometimes referred to as simulation.

During simulation, the therapist takes X-rays of the part of your body to be treated to help decide how the radiation will be given. Using the X-ray as a guide to the treatment site, the therapist uses a marker to outline the treatment area on your skin. This area is often called a treatment port or treatment field. These marks are very important. They act as a map of the treatment area and the therapist uses them each day to guide your treatment. Sometimes after a few treatments, tiny permanent dots can be used to replace the painted marks on your skin.

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Promising Results But Daunting Obstacles Remain

The studys results are considered preliminary, and further well-vetted research is needed to confirm its results. An additional barrier makes it difficult to translate these trial results to clinical practice: the reliability of the test used in the study to demonstrate that the cancers were slow-growing called Ki67 varies, and many hospitals dont routinely use it to assess breast tumors.

It will help to assess the results of other studies omitting radiation to feel confident we have identified additional patients with invasive breast cancer for whom radiation can safely be omitted, Dr. Tung says. Some of these studies use molecular testing to assess features of the breast cancer, and we await those trial results as well.

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What Is Radiation Recall

Radiation recall is a rash that looks like a severe sunburn. It is rare but it can happen when certain types of chemotherapy are given during or soon after external-beam radiation therapy.

The rash appears on the part of the body that received radiation therapy. Symptoms may include redness, tenderness, swelling, wet sores, and peeling skin.

Typically, these effects start within days or weeks of starting radiation therapy. But they can also appear months or years later. Doctors treat radiation recall with medications called corticosteroids. Rarely, it may be necessary to wait until the skin heals to continue with chemotherapy.

Cardiovascular Risk Factors And Fitness Assessment

At baseline, all subjects performed a maximal graded exercise stress test on a treadmill to determine their level of fitness. During the test, measurements were taken for heart rate, heart rhythm, blood pressure, and maximal metabolic equivalent capacity using the ramp/Bruce protocol 16. Blood samples taken immediately after completion of the questionnaires for assessment of cardiovascular risk factors were analyzed for B-type natriuretic peptide, C-reactive protein, total cholesterol, high-density lipoprotein , low-density lipoprotein , triglycerides, and ratio of total cholesterol to hdl.

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If Youre Having Radiation Therapy To The Pelvis

Radiation therapy to the pelvis can cause side effects such as:

• Bladder problems
• Fertility problems
• Changes in your sex life

You might also have some of the same problems people get from radiation to the abdomen, such as nausea, vomiting, diarrhea, or constipation.

Bladder problems

Radiation to the pelvis can cause problems with urination, including:

• Pain or burning sensations
• Blood in the urine
• An urge to urinate often

Most of these problems get better over time, but radiation therapy can cause longer-term side effects as well:

• Radiation cystitis. If the radiation damages the lining of the bladder, radiation cystitis can be a long-term problem that causes blood in the urine or pain when passing urine.
• Urinary incontinence. Radiation treatments for certain cancers, such as prostate and bladder cancer, may make you unable to control your urine or have leakage or dribbling. There are different types and degrees of incontinence, but it can be treated. Even if incontinence cant be corrected completely, it can still be helped. See Bladder and Bowel Incontinence to learn more. This side effect is most often a problem for men being treated for prostate cancer, but some of the information might also be helpful for women dealing with treatment-related incontinence.

Symptoms Of Breast Cancer Skin Changes

When breast cancer develops from abnormal breast cell growth, many people start to notice signs or changes in their breast. But what’s not always talked about is that some of those early-stage breast cancer symptoms can include changes to the skin.

The skin is more likely to be affected by the following two forms of breast cancer:

• Inflammatory breast cancer is a rare but aggressive type of breast cancer that spreads rapidly and isnt always noticed until later stages. IBC makes up around 1% to 5% of breast cancer cases in the United States.
• Paget’s disease of the breast is another uncommon form of breast cancer that primarily affects the nipple and areola. It accounts for up to 4% of breast cancer cases, and commonly affects people around menopause .

There’s also a chance for another type of breast cancer tumor to locally affect the skin on the breast, or for breast cancer to metastasize to the skin on the breast.

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Persistent Pain After Breast Cancer Treatment

Howard S. Smith1, Sheng-Xi Wu2

1Department of Anesthesiology, Albany Medical College, New York, USA 2Department of Anatomy, Histology and Embryology, K.K. Leung Brain Research Centre, the Fourth Military Medical University, Xian, China

Corresponding to:

Submitted Oct 06, 2012. Accepted for publication Oct 28, 2012.

Ann Palliat Med 2012 1. DOI:10.3978/j.issn.2224-5820.2012.10.13

Easing Worries About Radiation Therapy

Its normal to worry about possible side effects of radiation therapy.

Talk with your health care provider about your concerns.

Your health care provider may be able to suggest a hospital social worker, patient navigator, psychologist or support group to help ease anxiety related to radiation therapy .

Learn more about support groups.

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Are There Options To Prevent Or Treat Side Effects Caused By Radiation Therapy

Yes. Your health care team can help you prevent or relieve many side effects. Preventing and treating side effects is an important part of your overall cancer treatment. This is called palliative care or supportive care.

Before treatment begins, ask what side effects are likely from the specific type of treatment you are receiving and when they may happen. During and after treatment, let your health care team know how you are feeling on a regular basis. This includes if you are experiencing a new side effect, or a problem persists or has gotten worse.

Late Effects After Radiation For Breast Cancer

The physical side effects of radiation treatment are directly related to the area of the body being treated. Any area in the treatment field has a risk of being damaged, causing side effects. As radiation techniques have improved over the years, the risk of late effects has decreased.

Skin Problems

Radiation can lead to permanent changes in the skin.

• You may develop new scars or notice changes in the color or texture of your skin. Radiation can also change the color and texture of your hair or can cause permanent hair loss in the treated area.
• The soft tissue and muscles under the skin can develop scarring and/or shrinkage, which can lead to a loss of flexibility and movement or chronic swelling in this area.
• You may develop chronic or recurring ulcers of the skin in the area treated. Blood vessels of the skin may become dilated and more visible, although this is not harmful.
• If the skin feels tight or sore, you can apply vitamin E to the skin.
• Use fragrance and dye-free soaps and moisturizers in the area if your skin is sensitive after radiation.

After radiation, the skin in the treated area is more sensitive to sunlight. This sensitivity will last for your lifetime. Practice sun safety, use plenty of sunscreen, wear a wide-brimmed hat, and keep skin in the treated area covered with clothing. Try to avoid being out in the sun between the hours of 10 am-4 pm when it is the strongest.

Lymphedema Risk

Heart Problems

Damage to the Bones

Nerve Damage

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The Stages Of Breast Cancer And Your Treatment Options

Compared to most other cancers, staging breast cancer is more complex. And when it comes to treating breast cancer, there isnt a one-size-fits-all approach. Your treatment plan should be created especially for you and be coordinated across specialists and thats where your cancer care team comes in.

At HealthPartners, we believe cancer treatment and care is best managed by a group of doctors and specialists in whats known as multidisciplinary conferences. This is where breast surgeons, oncologists, radiologists, pathologists and other members of your care team gather to discuss the best treatment sequence for you.

Below we dive into the treatment options your care team might recommend at various breast cancer stages.

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How Is Radiation Therapy For Breast Cancer Performed

Most people lie on their back during the treatment though some breast treatments are performed while lying on your stomach . You place your arm above your head .

During the treatment, your treatment team:

• Positions and secures your body in the immobilization device. If you had a mastectomy, your provider might place a bolus on top of the treatment area to increase the radiation dose to the surface.
• Lines up the machine with the first treatment field. To protect themselves from radiation exposure, providers leave the room. Your provider can still hear and see you.
• Turns on the machine. You will hear a whirring noise, but you wont see the radiation beams. You must remain still. Depending on the radiation type and dose, treatment can take 30 seconds to several minutes.
• Returns to the room to position the machine to treat a different treatment field. Most people get treatment on two to five fields each day.
• Takes daily/weekly X-rays of the treatment field to make sure the radiation is hitting the correct area.

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Problems Moving Your Arm And Shoulder

Radiotherapy might make it harder to move your arm and shoulder. This can affect your activities and work. It usually improves when the treatment finishes. Your nurse or physiotherapist can give you exercises to help.

Its important to continue the arm exercise you were shown after your surgery. This will make it easier for you to lift your arm to the correct position during radiotherapy. It can also help stop your arm and shoulder from becoming stiff.

• There is help available ask the hospital for support
• Talk to your friends and family about how you are feeling
• Ask about local support groups
• Your GP or hospital can provide counselling
• You can get help and support online through forums

If you’re experiencing a side effect that hasn’t been covered in this video, you can find more information on the Cancer Research UK website.

On screen text: For more information go to: cruk.org/radiotherapy/side-effects

Pain And Qol Questionnaires

Validated questionnaires were used to evaluate pain and qol. The Short Form McGill Pain Questionnaire was used to measure bcp19. This validated questionnaire uses 15 pain descriptors to form the pain rating index, a pain index scale, and a visual analog scale. Patient qol, functioning, and symptoms were measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core module and breast cancerspecific module 20,21. Questionnaires were completed by the patients immediately before their baseline stress test evaluation, at completion of the chip, and at 6 months after completion of the chip. Participants were asked to evaluate pain related to the chest wall or breasts when answering the sf-mpq.

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Take Hormone Therapies As Prescribed:

If you have been prescribed endocrine therapy its very important to take it exactly as prescribed. Research has shown that many women dont take their medication every day, either because they forget or because of the side effects. Endocrine therapy reduces the chance of breast cancer recurrence and when not taken as prescribed, the drugs are less effective.

Whom To See: Diagnostic Steps

So youve noticed a change to the skin on your breasts. Maybe its a rash around your nipple, or perhaps part of your breast skin is starting to appear puckered. As soon as youve discovered the change, its important to give a healthcare provider a call to set up an in-person medical exam.

At the appointment, the provider will ask about your medical history, symptoms, and when you first noticed them. After physically examining the area in question, the healthcare provider may decide to obtain a biopsy to confirm or rule out a breast cancer diagnosis.

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During Your Radiation Therapy

On the day of your first radiation treatment, youll start putting triamcinolone 0.1% ointment on your skin in the treatment area. This is a prescription ointment that will help protect your skin. Youll use it every day, once in the morning and once in the evening. This includes the days you dont have treatment. Your radiation nurse will give you more information about it before your first treatment.

Your radiation oncologist may also recommend using Mepitel® Film to protect your skin in the treatment area. If they do, put it on your skin in the treatment area before your first treatment. Keep it on until the edges start to peel up.

Youll stay in one position for about 10 to 20 minutes during each of your radiation treatments, depending on your treatment plan. If you think youll be uncomfortable lying still, you can take acetaminophen or your usual pain medication 1 hour before your appointments.

How Much Radiation Did The Women Get After Breast Cancer Surgery

All the women had lumpectomy to remove the breast cancer. After surgery, the women were randomly assigned to one of three radiation regimens: 674 women had the standard full dose of 40 Gy of radiation to the whole breast. 673 women had 40 Gy of radiation to the tumor bed and 36 Gy to the rest of the breast. 669 women had 40 Gy to the tumor bed only.

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When Should I Talk To A Healthcare Provider

Seek emergency care right away if you suspect you may be experiencing a heart attack or cardiac arrest.

A note from Cleveland Clinic

People who received cancer radiation therapy to their chest can develop radiation-induced heart disease years later. But recent advances in radiation technology mean fewer people are developing heart disease from the effects of radiation. Heart disease treatment options are also improving and allow for better quality of life. Let your healthcare provider know if youve received radiation therapy in the past and if you experience any symptoms of heart disease.

Last reviewed by a Cleveland Clinic medical professional on 09/07/2022.

References

• Belzile-Dugas E, Eisenberg MJ. Radiation-Induced Cardiovascular Disease: Review of an Underrecognized Pathology. J Am Heart Assoc. 2021 10:e021686. Accessed 9/7/2022.
• Hufnagle JJ, Andersen SN, Maani EV. Radiation Therapy Induced Cardiac Toxicity. . In: StatPearls . Treasure Island : StatPearls Publishing 2022 Jan-. Accessed 9/7/2022.
• Wang H, Wei J, Zheng Q, et al. Radiation-induced heart disease: a review of classification, mechanism and prevention. Int J Biol Sci. 2019 15:2128-2138. Accessed 9/7/2022.

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Effects On The Lung Or Heart

Sometimes after treatment to the breast or chest wall area, part of the lung behind the treatment area can become inflamed, causing a dry cough or shortness of breath. This usually heals by itself over time.

More rarely, fibrosis of the upper lung can occur, causing similar side effects.

Although particular care is taken to avoid unnecessary radiotherapy to the tissues of the heart, if radiotherapy is given on the left side you may be at risk of heart problems in future.

Breath hold technique is thought to reduce the risk of any possible damage to the heart and lungs.

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