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How Soon After Breast Cancer Surgery Do You Start Radiation

Radiation Therapy Side Effects

Timing Of Radiation After Lumpectomy

The side effects of radiation therapy depend on the type of radiation therapy youre having. In general, the side effects tend to develop as treatment goes on and may be more troubling toward the end of treatment. Overall, the most common side effects are redness, swelling, and skin peeling in the area being treated. Read more about radiation therapy side effects.

Why Choose To Have Your Breast Radiation Therapy At Memorial Sloan Kettering

  • In order to deliver radiation in the best possible way, it takes a dedicated team of doctors, nurses, therapists, physicists, and treatment planners. Our breast cancer team is one of the largest and most experienced in the country.
  • Our radiation oncologists have access to and experience with every single form of radiation therapy available. There is not just one best type of radiation for all of the women we care for. But with our deep experience, we can select the best technique for each individual woman and tailor our approach as needed.
  • Our team of medical physicists ensures that the radiation dose each woman receives is accurately and safely targeted to cancer tissue and spares nearby normal tissue.
  • We consider the details of each unique woman. Our publications have demonstrated that our personalized care leads to superior outcomes.

Radiation Therapy And Sun Exposure

During radiation treatment, its best to keep the treated area completely out of the sun. This can be especially difficult if youre having radiation therapy in areas or seasons with warmer weather. To help avoid sun exposure:

  • Wear clothing or a bathing suit with a high neckline, or wear a rash guard top.
  • Try to keep the area covered whenever you go outside. An oversized cotton shirt works well and allows air to circulate around the treated area.
  • Avoid chlorine, which is very drying and can make any skin reactions youre having worse. Chlorine is used to disinfect most pools and hot tubs.
  • If you do want to swim in a pool, you might want to spread petroleum jelly on the treated area to keep the chlorine away from your skin.

After your radiation treatment is completed, the treated skin may be more sensitive to the sun than it was in the past, so you might need to take extra protective steps when you go out in the sun:

  • Use a sunblock rated 30 SPF or higher on the area that was treated.
  • Apply the sunblock 30 minutes before you go out in the sun.
  • Reapply the sunblock every few hours, as well as when you get out of the water.

Written by: Jamie DePolo, senior editor

This content was developed with contributions from the following experts:

Chirag Shah, M.D., breast radiation oncologist, director of breast radiation oncology and clinical research in radiation oncology at the Cleveland Clinic in Cleveland, Ohio

References

Read Also: Can Stage 1 Breast Cancer Be Cured

Radiation Therapy For Breast Cancer

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is often used to treat breast cancer. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.

Radiation therapy is given for different reasons. You may have radiation therapy to:

  • lower the risk of the cancer coming back, or recurring, after surgery
  • shrink a tumour before surgery
  • treat breast cancer that comes back, or recurs, in the area of a mastectomy
  • relieve pain or control the symptoms of advanced breast cancer

Doctors use external beam radiation therapy to treat breast cancer. During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it.

Some women may not be able to have radiation therapy because they already had radiation therapy to the chest or breast. Doctors may not offer radiation therapy to women with lung problems, damaged heart muscles and certain connective tissue diseases.

How Long Can You Wait For Radiation After Lumpectomy

Lumpectomy survival rates

Radiation therapy usually begins three to eight weeks after surgery unless chemotherapy is planned. When chemotherapy is planned, radiation usually starts three to four weeks after chemotherapy is finished. You will likely get radiation therapy as an outpatient at a hospital or other treatment facility.

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If Youre Getting Radiation Therapy To The Brain

People with brain tumors often get stereotactic radiosurgery if the cancer is in only one or a few sites in the brain. Side effects depend on where the radiation is aimed. Some side effects might show up quickly, but others might not show up until 1 to 2 years after treatment. Talk with your radiation oncologist about what to watch for and when to call your doctor.

If the cancer is in many areas, sometimes the whole brain is treated with radiation. The side effects of whole brain radiation therapy may not be noticeable until a few weeks after treatment begins.

Radiation to the brain can cause these short-term side effects:

  • Headaches
  • Trouble with memory and speech
  • Seizures

Some of these side effects can happen because radiation has caused the brain to swell. Medicines are usually given to prevent brain swelling, but its important to let your cancer care team know about headaches or any other symptoms. Treatment can affect each person differently, and you may not have these particular side effects.

Radiation to the brain can also have side effects that show up later usually from 6 months to many years after treatment ends. These delayed effects can include serious problems such as memory loss, stroke-like symptoms, and poor brain function. You may also have an increased risk of having another tumor in the area, although this is not common.

Talk with your cancer care team about what to expect from your specific treatment plan.

Are Some Therapies More Effective Based On Stage

The type of radiation treatment you get depends on the stage of breast cancer. People with early to stage 3 breast cancer will benefit most from radiation treatment. Radiation can also help ease side effects in people with advanced breast cancer.

External whole breast radiation works best:

  • for early stage to stage 3 breast cancer
  • for tumors that are an inch or smaller
  • if the cancer is in one spot
  • if you had breast-saving surgery or a mastectomy

External beam radiation can also help treat side effects of advanced breast cancer.

Internal radiation works best:

  • for early stage breast cancer
  • if the cancer is in one spot
  • if you had breast-saving surgery or a mastectomy

Sometimes, a person with advanced breast cancer will have internal radiation.

Intraoperative radiation works best:

  • during early stage breast cancer
  • when the tumor is too close to healthy tissue for external radiation to be possible

Not everyone can have intraoperative radiation or internal beam radiation. Whether you can have these procedures depends on:

  • size and location of the tumor
  • size of your breast

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Before Each Treatment Session

The radiographers help you to get onto the treatment couch. You lie on a special board called a breast board. If you have had a shell made the radiographers will fix this in place. You might need to raise your arms over your head.

The radiographers line up the radiotherapy machine using the marks on your body or on the shell. Once you are in the right position, they leave the room.

It is important to continue the arm exercise you were shown after your surgery. This helps to stop your arm and shoulder from becoming stiff during your radiotherapy treatment.

Risk Of Heart Disease From Breast Cancer Radiation

Who Needs Radiation Therapy After a Mastectomy?

Although radiation exposure from breast cancer treatment is associated with a small risk of subsequent heart disease, the risk is lower than it was 20 years ago, according to the results of a study published in JAMA Internal Medicine.9

Radiation is used after surgery to kill any remaining cancer cells and this decreases the risk of local recurrence and improves survival. Like any treatment however, radiation carries risksâincluding an increased risk of heart disease when radiation is used on the left breast, which is closer to the heart.

Because long-term breast cancer survival rates have improved dramatically in recent decades, researchers continue to look for ways to minimize long-term treatment-related complications. Researchers conducted an analysis to evaluate the risk of developing heart disease as a result of radiation treatment to the left breastâand found that the risk varies depending on the underlying risk of heart disease.

They report that the average risk of developing heart disease as a result of radiation exposure for breast cancer treatment is less than one percent. The risk increases for woman who already have a high underlying risk of developing heart diseaseâin these cases, the risk may be as high as 1 in 30. In contrast, women who already have a very low underlying risk of heart disease may face odds as low as 1 in 3000, which is a tiny risk.

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Internal Breast Cancer Radiation

Internal breast cancer radiation is also known as brachytherapy. You doctor will place a device that contains radioactive seeds in the area of the breast where the cancer was found. For a short time, internal radiation targets only the area where breast cancer is most likely to return. This causes fewer side effects. The treatment takes a week to complete.

If youve had breast-saving surgery, a doctor may treat you with both internal and external radiation to increase the boost of radiation. Doctors may only perform internal radiation as a form of accelerated partial breast radiation to speed up treatment.

Potential side effects of internal radiation include:

  • nausea

The Types Of Radiotherapy

The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.

Types of radiotherapy include:

  • breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
  • chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
  • breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
  • radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes

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The Pressure Of Patient Expectations

A majority of surveyed physicians reported that patients want the most aggressive treatment, even if the benefit is small, and that it takes more effort to tell patients that they do not need radiation than it does to recommend it.

Its important to recognize that this is a controversial area, says Shumway. You cant say that offering radiation to older women is wrong. It really is a patient-driven decision, and it depends on the patients own values and preferences, in addition to her risk of recurrence and overall health.

As the point of first contact for breast cancer patients, surgeons have a tremendous influence on how patients choose treatment options.

Which is why Shumway thinks they could play a crucial role in counseling older women about options for less aggressive therapy.

The population is aging, and this is going to be an issue that affects more women, says Shumway. There is increasing attention given to considerations that are unique to older patients and in this case, their vulnerability for overtreatment.

Shumways future work will focus on developing interventions to help patients make fully informed decisions and understand the concept of competing causes of mortality.

Learn more about breast cancer and breast cancer treatment:

What Kind Of Treatment Follow

Radiation After Lumpectomy Improves Breast Cancer Survival

The major goal of follow-up is, if possible, to detect and treat recurrences in the irradiated breast or lymph nodes and new cancers developing later in either breast before they can spread to other parts of the body. Theroutine use of bone scans, chest x-rays, blood tests and other tests to detect the possible spread to other organs in patients without symptoms does not appear to be useful. Your physician will determine a follow-upschedule for you. This may include a physical exam every few months for the first several years after treatment and then every six to 12 months or so after that. Annual follow-up mammograms are an important part of your care. If symptoms or clinical circumstances suggest a recurrence, diagnostic tests such as blood tests, ultrasound,computed tomography , magnetic resonance imaging , chest x-ray , or bone scan may be needed.

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How Long Is Chemo For Breast Cancer

Chemotherapy is often administered after surgery to remove any undetected breast cancer cells. Chemotherapy can also help reduce your risk of the cancer returning.

Chemotherapy should usually be given within 30 days of surgery and less than 120 days from the initial diagnosis. One study showed women who started chemotherapy two months after surgery had a 19 percent lower chance to survive compared to women who began chemotherapy a month after surgery.

Treatment comes in cycles that can occur once a week or once every three weeks. Following a period of recovery, this process can continue for up to six months. Women with more aggressive forms of cancer may receive chemotherapy for longer than that.

Not all stages of cancer require chemotherapy. Depending on the results of pathology from surgery, your doctor will decide the best plan for adjuvant treatment. You may also be a candidate for hormonal therapy.

What Can I Expect After My First Radiation Treatment

Most people start to feel tired after a few weeks of radiation therapy. This happens because radiation treatments destroy some healthy cells as well as the cancer cells. Fatigue usually gets worse as treatment goes on. Stress from being sick and daily trips for treatment can make fatigue worse.

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Will I Need Radiation After A Mastectomy

The answer is most likely, no. Post Mastectomy Radiation Therapy is the term for applying radiation to the area of the chest wall after a mastectomy, usually performed about 4 weeks after surgery or after both surgery and chemotherapy are completed. PMRT is generally recommended for those with a high risk of local recurrence.

If you or your surgeon. before surgery, think you might need PMRT it is essential to see your radiation oncologistbefore you have mastectomy surgery. This way, your radiation oncologist will better understand the size, shape, and extent of your breast tumor before it is removed by surgery or has shrunk away with Neoadjuvant Chemotherapy. Radiation oncologists have a unique insight into breast cancer treatment options that can assist your surgeon in planning the direction of your cancer care.

The decision to undergo Post Mastectomy Radiation Therapy is complicated. Patients should insist on a multidisciplinary team approach to get the best treatment recommendations for high risk breast cancer situations. When your breast surgeon works closely with your radiation oncologist and medical oncologist, you will be offered the best treatment options. Below is a general outline to help you understand when radiation after a mastectomy is needed.

If Youre Getting Radiation Therapy To The Abdomen

Surgery, chemotherapy and radiation increase chances of survival when treating breast cancer

If you are getting radiation to your stomach or some part of the abdomen , you may have side effects such as:

  • Nausea
  • Diarrhea
  • Constipation

Eating or avoiding certain foods can help with some of these problems, so diet planning is an important part of radiation treatment of the stomach or abdomen. Ask your cancer care team about what you can expect, and what medicines you should take to help relieve these problems. Check with your cancer care team about any home remedies or over-the-counter drugs youre thinking about using.

These problems should get better when treatment is over.

Managing nausea

Some people feel queasy for a few hours right after radiation therapy. If you have this problem, try not eating for a couple of hours before and after your treatment. You may handle the treatment better on an empty stomach. If the problem doesnt go away, ask your cancer care team about medicines to help prevent and treat nausea. Be sure to take the medicine exactly as you are told to do.

If you notice nausea before your treatment, try eating a bland snack, like toast or crackers, and try to relax as much as possible. See Nausea and Vomiting to get tips to help an upset stomach and learn more about how to manage these side effects.

Managing diarrhea

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Implications For Clinical Practice

Our most important message is that it is not necessary to start RT as soon as possible after BCS, as it does not increase survival rates. Patients should be informed about this, preventing them from worrying about tumour growth and worse outcomes in case of a longer time interval between BCS and RT. In addition, the relevance of the NBCA indicator may be questioned. These results may not only be useful for the Dutch clinical practice, but it may also be of importance for other countries. There is a lot of controversy regarding timing of RT. Population-based studies, such as this study, may contribute to a better understanding of the effect of timing on survival outcomes and may refute the common understanding that RT should start as soon as possible after RT. Clearly, we cannot conclude that delays can be extended infinitely: other studies suggested that delays exceeding 20 weeks lead to reduced survival rates. In addition, from a psychological point of view a short time interval can be more convenient.

The fact that the majority of our population was not treated with AST ,may limit the generalisability of the results to other countries, where the indication for administering AST may differ.

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