Long Term Effects Of Radiation For Breast Cancer

What Is Apbi In Breast Cancer

In select women, some doctors are using accelerated partial breast irradiation to give larger doses over a shorter time to only one part of the breast compared to the entire breast. Since more research is needed to know if these newer methods will have the same long-term results as standard radiation, not all doctors use them. There are several different types of accelerated partial breast irradiation:

These Steps Can Help:

• Gently cleanse the treated area using lukewarm water and a mild soap. Donât rub your skin. Pat it dry with a soft towel, or use a hair dryer on a cool setting.
• Donât scratch or rub the treated area. Use only an electric razor if you need to shave there. Donât put on medical tape or bandages.
• Donât apply any ointment, cream, lotion, or powder to the treated area unless your doctor or nurse has prescribed it. This includes cosmetics, shaving lotions, perfumes, and deodorants.
• Choose clothes made from natural fibers like cotton rather than tight-fitting clothing or harsh fabrics like wool or corduroy.
• Avoid extreme heat or cold where youve had radiation no electric heating pads, hot water bottles, or ice packs.
• Also avoid hot tubs and tanning beds.
• Stay out of direct sunlight, especially between the hours of 10 a.m. and 2 p.m., even after youre done with treatment. The sun can intensify skin reactions and lead to severe sunburn. Choose a sunscreen of SPF 30 or higher. Wear protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat, too.

Late Complications Of Radiation Therapy For Breast Cancer: Evolution In Techniques And Risk Over Time

Zachary Brownlee1, Rashi Garg1, Matthew Listo1, Peter Zavitsanos1, David E. Wazer1,2, Kathryn E. Huber1

1Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine , Rhode Island Hospital and Brown University School of Medicine , , USA

Contributions: Conception and design: DE Wazer, KE Huber Administrative support: KE Huber Provision of study materials or patients: None Collection and assembly of data: None Data analysis and interpretation: None Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Abstract: Radiation therapy in combination with surgery, chemotherapy, and endocrine therapy as indicated, has led to excellent local and distant control of early stage breast cancers. With the majority of these patients surviving long term, mitigating the probability and severity of late toxicities is vital. Radiation to the breast, with or without additional fields for nodal coverage, has the potential to negatively impact long term cosmetic outcome of the treated breast as well as cause rare, but severe, complications due to incidental dosage to the heart, lungs and contralateral breast. The long-term clinical side-effects of breast radiation have been studied extensively. This review aims to discuss the risk of developing late complications following breast radiation and how modern techniques can be used to diminish these risks.

Keywords: Radiation breast cancer late toxicity

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External Beam Radiation Therapy

EBRT is the most common type of radiation therapy for women with breast cancer. A machine outside the body focuses the radiation on the area affected by the cancer.

Which areas need radiation depends on whether you had a mastectomy or breast-conserving surgery and if the cancer has reached nearby lymph nodes.

• If you had a mastectomy and no lymph nodes had cancer cells, radiation will be focused on the chest wall, the mastectomy scar, and the places where any drains exited the body after surgery.
• If you had BCS, you will most likely have radiation to the entire breast . An extra boost of radiation to the area in the breast where the cancer was removed is often given if there is a high risk of the cancer coming back. The boost is often given after the treatments to the whole breast have ended. It uses the same machine, with lower amounts of radiation aimed at the tumor bed. Most women dont notice different side effects from boost radiation than from whole breast radiation.
• If cancer was found in the lymph nodes under the arm , this area may be given radiation, as well. Sometimes, the area treated might also include the nodes above the collarbone and the nodes beneath the breast bone in the center of the chest .

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Side Effects Of Adjuvant Cancer Therapy

Depending on what form of treatment is used, adjuvant therapy can have side effects, like all therapy for neoplasms. Chemotherapy frequently causes vomiting, nausea, alopecia, mucositis, myelosuppression particularly neutropenia, sometimes resulting in . Some chemotherapeutic agents can cause acute myeloid leukaemia, in particular the alkylating agents. Rarely, this risk may outweigh the risk of recurrence of the primary tumor. Depending on the agents used, side effects such as chemotherapy-induced peripheral neuropathy, leukoencephalopathy, bladder damage, constipation or diarrhea, hemorrhage, or post-chemotherapy cognitive impairment. Radiotherapy causes radiation dermatitis and fatigue, and, depending on the area being irradiated, may have other side effects. For instance, radiotherapy to the brain can cause memory loss, headache, alopecia, and radiation necrosis of the brain. If the abdomen or spine is irradiated, nausea, vomiting, diarrhea, and dysphagia can occur. If the pelvis is irradiated, prostatitis, proctitis, dysuria, metritis, diarrhea, and abdominal pain can occur. Adjuvant hormonal therapy for prostate cancer may cause cardiovascular disease, and other, possibly severe, side effects.

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If You Have Side Effects

Let your doctor or nurse know if you have side effects or are worried about anything.

When treatment ends you usually have regular appointments for about 5 years afterwards. You can talk to your doctor or nurse at these appointments. But you dont have to wait for your next appointment if you get a new side effect or are worried about anything. You can bring the appointment forward.

• National Institute for Health and Care Excellence June 2018

• Treatment of primary breast cancerScottish Intercollegiate Guidelines Network, September 2013

• Postoperative radiotherapy for Breast Cancer: UK consensus statement

  The Royal College of Radiologists, 2016

• Early Breast Cancer: ESMO Clinical Practice Guidelines 2019F Cardoso and others

Breast Radiation Side Effects

• Medical Review: Neil K. Taunk MD, MSCTS

Radiation therapy, also called radiotherapy, is a very effective treatment for lowering the risk of recurrence in early-stage breast cancer and for managing pain or complications of metastatic breast cancer. While radiation therapy itself isnât painful, there are side effects that can feel uncomfortable. This is because while radiation destroys cancer cells, it also damages healthy cells near the area being treated.

Itâs completely normal to be concerned about potential side effects of radiation therapy. Your healthcare team is there to support you and help you manage side effects. Weâre here for you too, with information about what you might experience and things you can do to feel better.

As you prepare for radiation treatment, consider what you may want to ask your team, such as:

• What kinds of side effects can I expect? When are they most likely to start?
• Are there side effects I should let you know about immediately?
• Can you recommend ways I can take care of my skin during treatment?

The type and intensity of radiation therapy side effects you may experience depend on a number of factors, such as:

You can learn more about the different types of radiation and why they are recommended on the Radiation therapy for breast cancer page.

• Sensitivity to sunlight
• Skin color changes

You can hear more of Dr. Garyâs recommendations for skin care during radiation therapy in our full video interview.

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Talk To Your Medical Team

If you are experiencing any unpleasant side effects dont suffer in silence. Talk with your breast care/oncology nurse or doctor about any side effects you may be having. There may be ways to reduce the intensity of your symptoms or there may be alternative medications that suit you better.

Find out more about the side effects of differenthormone therapies.

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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Breast Cancer Radiation Side Effects

It is important to remember that not everyone will experience breast cancer radiation side effects. Its also highly unlikely that anyone would experience all of them either, and they may appear differently depending on the individual experience.1. Changes to the SkinSkin reactions associated with radiation therapy include:

You might find that your skin becomes darker, thinner or dryer than it was, due to the radiation treatment.

Your skin may also burn more easily from sun exposure and may be prone to infection and breakdown.

Operation scars often remain tender or sensitive for a long time after treatment ends.

Some women can develop small red blotches on the breast caused by dilated blood vessels under the skin. This condition is known as telangiectasia . Telangiectasia is not a sign of cancer recurrence, but it usually doesnt go away on its own. If you’re worried or concerned about any changes or experiencing pain, speak to your doctor or nurse.Skin Care After Radiation Therapy For Breast Cancer

2. Effects of Radiation Therapy on Breast Tissue Oedema: Or swelling of the breast, may persist for months or years after treatment.

Fibrosis: A few women develop hardening or thickening of the breast tissue. This can cause the breast to feel and look harder and smaller than it was. In severe cases, this can make the radiated breast appear much different than the healthy breast.

Hair Loss In The Armpit

Radiotherapy to the armpit will make the underarm hair fall out on that side.

Men having radiotherapy will lose the hair on the area of the chest thats being treated.

Hair usually starts to fall out two to three weeks after treatment has started and it may take several months to grow back. For some people, hair lost from radiotherapy may never grow back.

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Radiation Therapy And The Effects On The Heart

• Heart Muscle Damage: When undergoing radiation treatments, there is a very small risk of damage to the heart muscle or the major blood vessels around the heart. This is a potential problem if you have had cancer in your left breast since the heart is on the left side of the chest. Ideally, the heart is either not within the radiation area or only a small amount of the heart will receive any radiation, which helps to lower the risk of significant damage.

• Breathlessness/Dizziness: If your heart has been damaged by radiotherapy you may find that you get tired very easily or get breathless on exertion, like climbing stairs. You may also notice that you sometimes feel dizzy or get chest pains.

Its important to remember that these symptoms can be caused by many things and they arent always a result of damage to the heart. You will want to immediately consult your doctor if you experience any symptoms that may be heart-related.

A promising clinical trial is underway at the Johns Hopkins Avon Foundation Breast Center to determine if The Active Breath Control device will help to better protect women against heart-related side effects. The device provides an innovative way for the patients heart to be spared radiation by controlling her breathing during the actual radiation treatment.

Possible Side Effects Of External Beam Radiation

The main short-term side effects of external beam radiation therapy to the breast are:

• Swelling in the breast
• Skin changes in the treated area similar to a sunburn

Your health care team may advise you to avoid exposing the treated skin to the sun because it could make the skin changes worse. Most skin changes get better within a few months. Changes to the breast tissue usually go away in 6 to 12 months, but it can take longer.

External beam radiation therapy can also cause side effects later on:

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Changes In The Shape Size And Feel Of The Breast

In time radiotherapy can cause the breast tissue to change shape or shrink in size a little. This can happen to your natural breast tissue or a reconstructed breast.

After radiotherapy, the breast might feel hard and less stretchy. This is due to a side effect called radiation fibrosis. This side effect is usually mild.

Sometimes the breast can shrink a little over time. This is because radiotherapy can make the breast tissue contract so that the breast gradually gets smaller.

An implant in a reconstructed breast can become hard and may need replacing.

Let your surgeon know of any changes, they may be able to do some minor surgical adjustments to improve the look.

The Effects Of Breast Cancer On The Body

At first, breast cancer affects the breast area only. You may notice changes in your breasts themselves. Other symptoms arent so obvious until you detect them during a self-exam.

Sometimes your doctor may also see breast cancer tumors on a mammogram or other imaging machine before you notice symptoms.

Like other cancers, breast cancer is broken down into stages. Stage 0 is the earliest stage with the fewest noticeable symptoms. Stage 4 indicates the cancer has spread to other parts of the body.

If breast cancer spreads to other parts of the body, it may cause symptoms in those particular areas, too. Affected areas may include the:

American Cancer Society , the most common sign of breast cancer is a newly formed mass or lump in your breast.

The mass or lump is usually irregularly shaped and painless. However, some cancerous masses can be painful and round in shape. This is why any lump or mass ought to be screened for cancer.

Invasive ductal carcinoma causes lumps and bumps in the breasts. This is a type of breast cancer that forms inside the milk ducts.

According to the Cleveland Clinic, invasive ductal carcinoma is the most common type of breast cancer. It makes up about 80 percent of all diagnoses. Its also more likely to spread to other areas of the body.

With breast cancer, your nipples may also undergo some noticeable changes.

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How Long Do Side Effects Last After Radiation Treatment

Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. Theyre usually gone within a few weeks after treatment ends. The most common early side effects are fatigue and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.

The Impact Of Breast Cancer Treatment On Your Long

The late effects associated with breast cancer treatments. Antonio Wolff, M.D., medical oncologist at the Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, encourages a relationship with a primary care doctor who is knowledgeable about these effects on breast cancer survivors and their long-term health care.

These long-term and late side effects may include:

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What Is The Most Common Drug Used For Radiation Therapy

The one most commonly used today is amifostine. This drug may be used in people with head and neck cancer to reduce the mouth problems caused by radiation therapy. Not all doctors agree on how these drugs should be used in radiation therapy. These drugs have their own side effects, too, so be sure you understand what to look for.

Causes And Risk Factors

Radiation therapy works by damaging DNA in cells. This damage isnt isolated to cancer cells, though normal cells can be damaged as well. While radiation therapy has improved significantly such that less damage occurs to healthy cells than in the past, some healthy tissues are inevitably exposed.

Several variables can increase or decrease your risk of developing long-term side effects of radiotherapy. Some of these are:

• Your age at the time of radiation
• The dose of radiation you receive
• The number of treatment sessions
• The type of cancer treated
• The area of the body that receives radiation
• Other cancer treatments, such as chemotherapy
• Other health conditions, such as heart disease or diabetes

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