Long Term Side Effects Of Breast Cancer Radiation

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
• Fatigue

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:

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.

Pain And Skin Changes

During and just after treatment, your treated breast may be sore. Talk with your health care provider about using mild pain relievers such as ibuprofen, naproxen or acetaminophen to ease breast tenderness.

The treated breast may also be rough to the touch, red , swollen and itchy. Sometimes the skin may peel, as if sunburned. Your health care provider may suggest special creams to ease this discomfort.

Sometimes the skin peels further and the area becomes tender and sensitive. Its most common in the skin folds and the underside of the breast. If this occurs, let your radiation team know. They can give you creams and pads to make the area more comfortable until it heals.

Fatigue is common during radiation therapy and may last for several weeks after treatment ends.

Fatigue is mainly a short-term problem, but for some, it can persist .

You may feel like you dont have any energy and may feel tired all of the time. Resting may not help.

Regular exercise, even just walking for 20 minutes every day, may help reduce fatigue . Getting a good nights sleep is also important.

Talk with your health care provider if you are fatigued or have insomnia .

Learn more about fatigue and insomnia.

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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 you’ve 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 you’re 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.

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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Coping With Emotional Side Effects

Daily radiation therapy treatments can trigger many different emotions. Fear, anger, or sadness can come up at any point in treatment. Coming to the treatment center every day can be a regular reminder of your diagnosis, fears about cancer coming back, and for many people, the entire cancer experience. In other words, it can feel overwhelming.

Fortunately, there are ways to get the treatment you need and still have some balance in your life. Katharine Winner, MSW, LSW, who works closely with radiation oncologists to provide emotional support to people receiving radiation therapy, says, Its important to find a balance between treatment and everyday life, when possible, to help maintain a sense of normalcy. We can help arrange your schedule to accommodate the important things outside of treatment: work, time with family, self-care.

We want to help find the best way to realign your schedule to accommodate radiation. Theres a reason why youre doing radiation: to treat the cancer and prolong your life. Our goal is that treatment doesnt stall your life and that you can still do the things you love and enjoy doing. See how you can reschedule yourself to get a good balance for getting through treatment.

I like to ask, What are your plans this week/weekend? What do you look forward to doing after radiation is completed? I want to know what is important in your life and what you can focus on outside of treatment to help push through those difficult days, says Winner.

Possible Side Effects Of Radiation On The Bones

A rare late side effect of radiotherapy to the breast is damage to the bones, especially the ribs. The bones can become thinner and more brittle if you had certain chemotherapy drugs while undergoing radiation. If this happens, it can cause pain and make it hard for you to lift heavy objects or to exercise.

Its important to be aware that this problem can happen so that if you have any symptoms you can get them checked by your doctor.

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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:

• Fatigue
• Pain and numbness
• Dental issues

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.

• Find out more about arm exercises after breast surgery

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Coping With Side Effects

Let the nurse doctor know when you notice any breast cancer radiation treatment side effects and dont worry too much about anything. You get regular appointments for around five years when the breast cancer treatment ends. You can talk to nurses or doctors during such appointments. However, you wont have to look for another appointment when youve got any side effects or are worried about side effects occurring. At University Cancer Centers, we treat all types of stages of breast cancer with care, and the most researched breast cancer treatment approaches. Our leading-edge hospital care technologies with experienced practitioners ensure that youre under expert care and have a speedy recovery.

External Radiation Side Effects

External beam radiation therapy also results in some side effects later:

• After radiation therapy, some women may notice their breasts becoming smaller to skin becoming swollen or firm.
• Radiation can impact breast reconstruction. It can also have some risks to appearance and healing when provided after reconstruction, especially processes of tissue flaps.
• Women who went through radiation breast cancer treatment would be able to breastfeed from the radiated breast.
• Breast radiation sometimes damages some arm nerves. The medical term for this process is brachial plexopathy, and it results in pain, numbness, and weakness in the arm, hand, and shoulder.
• Underarm lymph node radiation can result in lymphedema, a pain that causes arm or chest swelling.
• In many cases, radiation therapy weakens the ribs resulting in fractures. Earlier, some parts of the heart and lungs were more likely to have radiation, resulting in long-term damage to such organs in women. Modern equipment for radiation therapy focuses on radiation beams much better than old machines, so such issues are rare nowadays.
• A rare radiation complication to the breast is getting another cancer known as angiosarcoma.

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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.

Association Of Taxane Chemotherapy With Long

Compared to non-taxane-based adjuvant therapies, the use of taxanes was associated with a strongly increased prevalence of nail changes , hair loss , and neuropathic symptoms: numbness and tingling of feet, numbness and tingling of hands, as well as tingling plus pain in feet and hands . The neuropathic symptoms in taxane recipients tended to be more prevalent in those with triple-negative versus receptor-positive tumors .

Table 4

Long-term prevalence of neuropathic side effects in patients who received adjuvant therapies with taxanes.

Fig. 4

Long-term prevalence of side effects in patients who received adjuvant therapies without chemotherapeutics versus those treated with taxanes, shown by receptor status.

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Heart And Lung Problems

Because of the location of your heart and lungs in relation to your breasts, radiation has the potential to cause heart and lung problems down the road though this is far less common than the other side effects weve covered, as radiation has improved significantly over the years.

Radiation can harm your heart by causing your arteries to harden or your heartbeat to become irregular, or it can inflict valve damage.

If your lungs are affected, this can present as chest pain, shortness of breath, or a cough or you may show no symptoms at all and the lung inflammation may only be caught on an x-ray. Symptoms typically dissipate on their own, but sometimes patients are given medications to ease the inflammation. If left untreated, the inflammation can turn ugly and cause pulmonary fibrosis, which is a permanent scarring of the lungs that can affect breath capacity.

However, todays techniques have advanced to the point where the heart and lungs are typically not affected by radiation treatment.

If Youre Getting Radiation Therapy To The Chest

Radiation treatment to the chest may cause side effects such as:

• Sore throat

Radiation can also cause other problems in the heart or lungs.

Heart complications

Getting radiation to the middle portion of the chest can raise your risk of heart disease. This risk increases with higher radiation doses and larger treatment areas in this part of your body. Radiation can also cause hardening of the arteries , heart valve damage, or irregular heartbeats.

Radiation pneumonitis

Radiation pneumonitis is inflammation of the lungs that can be caused by radiation treatment to the chest . It may occur about 3 to 6 months after getting radiation therapy. Its more likely if you have other lung diseases, like emphysema . Common symptoms of radiation pneumonitis include:

• Shortness of breath that usually gets worse with exercise
• Chest pain, which is often worse when taking in a deep breath
• Cough
• Weakness

Sometimes there are no symptoms, and radiation pneumonitis is found on a chest x-ray.

Symptoms often go away on their own, but if treatment is needed, it is based on trying to decrease the inflammation. Steroids, like prednisone, are usually used. With treatment, most people recover without any lasting effects. But if it persists, it can lead to pulmonary fibrosis . When this happens, the lungs can no longer fully inflate and take in air.

Be sure you understand what to look for, and tell your cancer care team if you notice any of these side effects.

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Causes And Risk Factors

Radiation therapy works by damaging DNA in cells. This damage isn’t 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

Heart Or Lung Problems

Some women experience lung inflammation years after radiation therapy. This is especially true if they have also had chemotherapy. If there is significant heart exposure because of left breast radiation, in some cases injury to the heart can occur, causing heart conditions or heart disease. This is not as common these days, thanks to greater understanding of this potential link.

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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.

Association Of Antihormonal Therapy With Long

Compared to patients who did not receive endocrine therapy, those who used antihormonal drugs more often reported hot flashes and vaginal dryness , while hair loss was less common . Dry eyes and visual disturbances were experienced by roughly one-third of patients taking these drugs.

Among the subclasses of antihormonal drugs, aromatase inhibitors were associated with a relatively high prevalence of joint pain, whereas loss of libido was prevalent with gonadotropin-releasing hormone analogs .

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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 don’t 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