When Should I Call The Doctor
You should call your healthcare provider if you experience:
- Severe skin or breast inflammation.
- Signs of infection, such as fever, chills or weeping skin wounds.
A note from Cleveland Clinic
Radiation therapy can lower the risk of cancer recurrence and cancer spread. The treatment affects everyone differently. Most side effects go away in a few months after treatments end. Some problems last longer. You should tell your healthcare provider about any problems you have while getting treatment. Your provider may change the therapy slightly to minimize issues while still effectively treating the cancer.
Last reviewed by a Cleveland Clinic medical professional on 03/19/2021.
Why And When People Start Radiation Therapy
Radiation therapy is a flexible and safe treatment. Doctors may use it after surgery to remove cancerous tumors, as it can reduce the chances of a recurrence by destroying any remaining cancer cells.
If an individual has metastatic breast cancer, which is when cancer has spread to other parts of the body, doctors may also opt to treat them with radiation therapy to ease their symptoms.
Vitamins And Dietary Supplements
Its OK to take a multivitamin during your radiation therapy. Do not take more than the recommended daily allowance of any vitamin or mineral.
Dont take any other dietary supplements without talking with a member of your care team. Vitamins, minerals, and herbal or botanical supplements are examples of dietary supplements.
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Where Do I Start
You first will meet with a radiation oncologist to decide if radiation therapy is a recommended treatment option for your particular situation. If you and your doctors decide to proceed, then you will have an extended consultation in which you discuss the details of your treatment. This includes the exact area to treat, the amount of radiation you will receive, the length of treatment time and potential treatment side effects. The radiation oncologist will also answer any questions you may have. These issues vary for each person, so it is important to make an individual treatment plan.
Side Effects Of Radiation For Breast Cancer
Radiation therapy is a common part of breast cancer treatment. It may be used alone, or in conjunction with other therapies. As with any kind of medical procedure, there can be side effects. Side effects can vary, depending on the kind of radiation therapy you have and your individual response to it.
Knowing what to expect, and potential side effects, can help you prepare for your treatment.
Skin changes are some of the main side effects of external radiation. These changes occur in the area being treated by the radiation. Its similar to a sunburn, and can include:
- redness and itching
- darkening of the skin
These changes happen gradually over the course of treatment, and in some people it can last for years after treatment. Some people also develop spider veins in certain areas months to years after treatment.
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Higher Risk Of Infections
All breast cancer therapies can weaken your immune response and raise your risk of infection. Common areas for infection include:
Chemotherapy and radiation therapy for breast cancer can stop your body from making white blood cells, which fight infections. Try to stay out of large crowds and away from sick adults and children for 7 to 10 days after you have chemotherapy. That’s when you usually have the fewest white blood cells.
Contact your doctor right away if you get sick. You might notice:
- Colored mucus in saliva or nasal drainage
- Fever of 100.5 degrees F or higher
- Sore or burning throat
- Swelling, redness, warmth, or pus at injury site
- Cough or shortness of breath
If your white blood cell counts are too low, your doctor may give you a treatment called G-CSF or GM-CSF .
Late Effects Of Radiotherapy For Breast Cancer
Radiotherapy to the breast may cause side effects that happen months or years after radiotherapy. They are called late effects.
Newer ways of giving radiotherapy are helping reduce the risk of these late effects happening. If you are worried about late effects, talk to your cancer doctor or specialist nurse.
The most common late effect is a change in how the breast looks and feels.
Radiotherapy can damage small blood vessels in the skin. This can cause red, spidery marks to show.
After radiotherapy, your breast may feel firmer and shrink slightly in size. If your breast is noticeably smaller, you can have surgery to reduce the size of your other breast.
If you had breast reconstruction, using an implant before radiotherapy, you may need to have the implant replaced.
It is rare for radiotherapy to cause heart or lung problems, or problems with the ribs in the treated area. This usually only happens if you had treatment to your left side.
Tell your cancer doctor if you notice any problems with your breathing, or have any pain in the chest area.
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Stage 0 Breast Cancer
What is Stage 0 breast cancer?
Stage 0 breast cancer is when the cells that line the milk ducts have become cancerous. This type of cancer is called ductal carcinoma in situ , or non-invasive or pre-invasive breast cancer.
At this stage, the cancer has not spread to surrounding tissues. And while its considered non-invasive, its important to remember that it can still become invasive and spread beyond the milk ducts if it isnt treated.
What are the treatment options for Stage 0 breast cancer?
- Surgery Breast surgery is often the first step at Stage 0. Depending on the size of the tumor, how fast the cancer appears to be growing and your personal preferences, there are two types of surgical options:
- Lumpectomy A lumpectomy is a targeted surgery that removes the lump or tumor in question, and a small amount of normal tissue around it. This is commonly referred to as breast conservation surgery . In the United States, most women with Stage 0 breast cancer undergo a lumpectomy followed by radiation therapy.
- Mastectomy If the cancer has spread throughout the ducts and affects a large part of the breast, doctors may recommend a mastectomy. With this surgery, the entire breast is removed and possibly some lymph nodes as well.
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.
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What Can I Expect From My Treatment
When you arrive, please check in at the desk. Each treatment should only last 10 to 15 minutes. You can change your clothes in the dressing room and then wait in the lounge to be called.
During each treatment session, you will lay on a table while the technician uses the marks on your skin to locate and treat the field. It is important to be still while getting the radiation, although you should continue to breathe normally.
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.
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Estrogen Receptor Blockers Estrogen Receptor Blocker Drugs Attach Directly To And Block The Estrogen Receptors On Cancer Cells So That The Cancer Cells Cant Use Estrogen They Do Not Affect The Level Of Estrogen In The Body Estrogen Receptor Blockers Are Also Called Selective Estrogen Receptor Modulators
Tamoxifen is the most commonly used anti-estrogen drug. It is used in post-menopausal and premenopausal women. Tamoxifen is given by mouth as a pill.
Tamoxifen is the hormonal therapy drug used most often to lower the risk that DCIS or LCIS will lead to an invasive breast cancer.
Tamoxifen very slightly increases the risk for uterine cancer, deep vein thrombosis and stroke. Doctors will carefully weigh these risks against the benefits of giving this drug before they offer it to women who have a personal or a strong family history of these conditions. Usually the benefits of taking tamoxifen outweigh these risks.
Fulvestrant is an anti-estrogen drug that reduces the number of estrogen receptors on breast cancer cells. It is given as an injection into the muscles of the buttocks.
Fulvestrant is used in post-menopausal women if the breast cancer has grown after they were treated with tamoxifen. It is also used in postmenopausal women with locally advanced or metastatic breast cancer that have never been treated with hormonal therapy.
Accelerated Partial Breast Irradiation
After whole breast radiation or even after surgery alone, most breast cancers tend to come back very close to the area where the tumor was removed . For this reason, some doctors are using accelerated partial breast irradiation in selected women 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:
- Intraoperative radiation therapy : In this approach, a single large dose of radiation is given to the area where the tumor was removed in the operating room right after BCS . IORT requires special equipment and is not widely available.
- 3D-conformal radiotherapy : In this technique, the radiation is given with special machines so that it is better aimed at the tumor bed. This spares more of the surrounding normal breast tissue. Treatments are given twice a day for 5 days or daily for 2 weeks.
- Intensity-modulated radiotherapy : IMRT is like 3D-CRT, but it also changes the strength of some of the beams in certain areas. This gets stronger doses to certain parts of the tumor bed and helps lessen damage to nearby normal body tissues.
- Brachytherapy: See brachytherapy below.
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What Type Of Drug Treatment Might I Get
Most women with breast cancer in stages I to III will get some kind of drug therapy as part of their treatment. This may include:
- HER2 targeted drugs, such as trastuzumab and pertuzumab
- Some combination of these
The types of drugs that might work best depend on the tumors hormone receptor status, HER2 status, and other factors.
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About External Beam Radiation Therapy
With external beam radiation therapy, a treatment machine will aim a beam of radiation directly to the tumor from outside your body. The radiation will pass through your body and destroy the cancer cells in its path. You wont see or feel it.
You may be having external beam radiation therapy to 1 or more of the following areas:
- Your breast
- The lymph nodes near your collarbone
- The lymph nodes under your arm
- The lymph nodes near your sternum
Your radiation oncologist and nurse will talk with you about your treatment plan.
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What Are The Different Kinds Of Radiation Therapy
Most radiation therapy is administered by a radiation oncologist at a radiation center and usually begins three to four weeks after surgery. The radiation is used to destroy undetectable cancer cells and reduce the risk of cancer recurring in the affected breast.
There are two main kinds of radiation therapy that may be considered, and some people have both.
- External Beam Breast Cancer Radiation
- Internal Breast Cancer Radiation
Keep in mind that the course of treatment you decide is something you should discuss with your radiation oncologist in order to ensure that it is as effective as possible.
How Breast Cancer Is Treated
In cancer care, doctors specializing in different areas of cancer treatmentsuch as surgery, radiation oncology, and medical oncologywork together with radiologists and pathologists to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others. For people older than 65, a geriatric oncologist or geriatrician may also be involved in their care. Ask the members of your treatment team who is the primary contact for questions about scheduling and treatment, who is in charge during different parts of treatment, how they communicate across teams, and whether there is 1 contact who can help with communication across specialties, such as a nurse navigator. This can change over time as your health care needs change.
A treatment plan is a summary of your cancer and the planned cancer treatment. It is meant to give basic information about your medical history to any doctors who will care for you during your lifetime. Before treatment begins, ask your doctor for a copy of your treatment plan. You can also provide your doctor with a copy of the ASCO Treatment Plan form to fill out.
Learn more about making treatment decisions.
Vitamins To Avoid During Radiation Therapy
Your radiation oncologist may tell you to avoid taking certain antioxidant vitamin supplements, such as vitamins C, A, D, and E, while you’re having radiation therapy. These vitamins might interfere with radiation’s ability to destroy cancer cells. This is because radiation works in part by creating free radicals highly energized molecules that damage cancer cells. Free radicals in the environment can damage all cells, but in the case of radiation treatment they are focused on the cancer cells. Antioxidants help keep free radicals from forming or neutralize them if they do form.
Because of the potential conflict between the goal of radiation therapy and the goal of antioxidants , it makes sense to stop taking any antioxidant supplements during radiation therapy. When radiation is finished, you can resume taking your supplements.
Throughout your treatment, do your best to eat a well-balanced diet that contains all of the vitamins you need. Vitamins that come naturally from food are unlikely to interfere with treatment.
What Are The Advantages Of Hypofractionation
The major advantage is convenience because patients can receive the full course of radiation treatment in fewer sessions. With both conventional and hypofractionated radiation, the patient receives radiation five days a week. In the conventional regimen, though, the schedule lasts for five to six weeks, whereas hypofractionation therapy is completed in three to four weeks.
Two large clinical trials found no loss of therapeutic effectiveness in hypofractionation despite its shorter length of treatment. One of the studies also found that swelling of the breast post-treatment as well as skin irritation, skin itchiness and fatigue were less common among women who received hypofractionation compared to other forms of radiation therapy.
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What Is Radiation Therapy And How Does It Work
Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated with the radiation. Breast cancer radiation therapy may be used to destroy any remaining mutated cells that remain in the breast or armpit area after surgery.
Note: There are special situations in which radiation is used for women with metastatic breast cancer experiencing painful bone metastasis. This section however focused on the use of radiation for adjuvant therapy .
Who should expect to be prescribed radiation therapy and what is involved?Some people with Stage 0 and most people with Stage 1 invasive cancer and higher, who have had a lumpectomy, can expect radiation therapy to be a part of their treatment regimen.
Breast Cancer Support And Resources
If youve received a diagnosis of breast cancer, you may be feeling fearful and anxious. But you are not alone. You may want to consider reaching out to a breast cancer support group or online community for help, advice, and resources.
Many other people are dealing with exactly the same questions and concerns that you are. And many people have also survived breast cancer and can provide invaluable advice and support.
You may want to:
- Join an online community to connect with other people affected by breast cancer. The Healthline Breast Cancer app may be a good place to find emotional support and connect with others who are on the same journey as you.
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When Is Radiation Therapy Recommended
Radiation therapy is recommended:
- after breast-conserving surgery
- after a mastectomy if pathology results suggest the risk of recurrence is high or if the cancer has spread to the lymph nodes you may have radiation to the chest wall and lymph nodes above the collarbone
- if the sentinel node is affected you may have radiation to the armpit instead of axillary dissection.
You will usually start radiation therapy within eight weeks of surgery. If youre having chemotherapy after surgery, radiation therapy will begin about three to four weeks after chemotherapy has finished. In some circumstances, radiotherapy may be offered after neoadjuvant chemotherapy and before surgery.