Side Effects Of Radiation Breast Cancer

Treatment Areas And Possible Side Effects

Healthy cells that are damaged during radiation treatment usually recover within a few months after treatment is over. But sometimes people may have side effects that do not improve. Other side effects may show up months or years after radiation therapy is over. These are called late effects. Whether you might have late effects, and what they might be, depends on the part of your body that was treated, other cancer treatments you’ve had, genetics, and other factors, such as smoking.Ask your doctor or nurse which late effects you should watch for. See the section on Late Effects to learn more.

• Reviewed:January 11, 2022

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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.

Internal Breast Cancer Radiation

Internal radiation is a form of partial breast radiation. During the treatment, the physician or surgeon inserts a radioactive liquid using needles, wires, or a catheter in order to target the area where the cancer originally began to grow and tissue closest to the tumor site to kill any possible remaining cancer cells.

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Types Of Radiation For Breast Cancer

External-beam radiation therapy is the most common form of radiation treatment for breast cancer. In this approach, a machine called a linear accelerator, or LINAC, produces radiation. The radiation is delivered as precisely targeted x-ray beams.

At MSK, we deliver external-beam radiation therapy in a variety of ways. These approaches are designed to tailor the radiation treatments as much as possible to the exact size and location of your cancer, specifically aiming at tumor cells while avoiding side effects.

We also offer internal radiation therapy in the form of brachytherapy. Brachytherapy is generally reserved for women receiving partial-breast irradiation after lumpectomy.

Learn more about the techniques our breast cancer radiation team frequently recommends.

In this method, patients lie on their stomach . Radiation is directed to the affected breast as it hangs through an opening in the treatment table. This approach may reduce radiation exposure to nearby vital organs, such as the heart and lungs. Prone breast radiation has been shown to reduce radiation burn on the skin. Research has also shown that this therapy is especially useful for women with large breasts.

In this approach, our experienced radiation therapists guide women with cancer in the left breast through a breathing technique called deep inspiration breath hold . It minimizes the risk of injury to the heart.

Types Of Radiation Therapy

The most common type of radiation therapy for breast cancer is called external beam radiation therapy . During EBRT, a machine outside of the body delivers the radiation to the prescribed area of the body.

The exact type that is right for you will be based on many factors, including:

• The exact type of breast cancer

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Radiation Therapy Timing And Breast Reconstruction

The timing of radiation treatment in your overall breast cancer treatment plan depends on your individual situation and the characteristics of the breast cancer.

In many cases, radiation therapy is given after surgery. If chemotherapy is planned after surgery, radiation usually follows chemotherapy.

If youre having mastectomy and have decided to have breast reconstruction, its important to know that radiation can cause a reconstructed breast to lose volume and change color, texture, and appearance.

In particular, radiation therapy is known to cause complications with implant reconstruction. Research also suggests that a reconstructed breast may interfere with radiation therapy reaching the area affected by cancer, though this can vary on a case-by-case basis.

For these reasons, some surgeons advise waiting until after radiation and other treatments, such as chemotherapy, are completed before breast reconstruction surgery is done.

Other surgeons may recommend a more staged approach, which places a tissue expander after mastectomy to preserve the shape of the breast during radiation treatments. Once radiation is completed and the tissues have recovered, the expander that was used to maintain the shape of the breast is removed and replaced with tissue from another part of the body or a breast implant.

If Youre Getting Radiation Therapy To The Breast

If you have radiation to the breast, it can affect your heart or lungs as well causing other side effects.

Short-term side effects

Radiation to the breast can cause:

• Skin irritation, dryness, and color changes
• Breast soreness
• Breast swelling from fluid build-up

To avoid irritating the skin around the breasts, try to go without wearing a bra. If this isnt possible, wear a soft cotton bra without underwires.

If your shoulders feel stiff, ask your cancer care team about exercises to keep your shoulder moving freely.

Breast soreness, color changes, and fluid build-up will most likely go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem, ask your cancer care team what steps you can take. See Lymphedema for more information.

Long-term changes to the breast

Radiation therapy may cause long-term changes in the breast. Your skin may be slightly darker, and pores may be larger and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before treatment. Sometimes the size of your breast changes it may become larger because of fluid build-up or smaller because of scar tissue. These side effects may last long after treatment.

After about a year, you shouldnt have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, tell your cancer care team about them right away.

Less common side effects in nearby areas

Side effects of brachytherapy

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Coping With The Side Effects Of Radiation Therapy

Everyone’s experience with radiation therapy is different. Side effects vary from person to person, even when given the same type of treatment. Before your treatment, ask your health care team which physical side effects are possible and what to watch for. You may also experience emotional side effects. Seeking out mental health support to help with anxiety and stress is important.

Ask your health care team about ways to take care of yourself during the treatment period, including getting enough rest, eating well, and staying hydrated. Ask whether there are any restrictions on your regular exercise schedule or other physical activities. If so, talk with them about another way to get regular exercise.

Continue to talk to your health care team throughout your treatment. Tell them when side effects first appear, worsen, or continue despite treatment. That will help your health care team provide ways to help you feel better during and after treatment.

When To Call Your Radiation Oncologist Or Nurse

• You have a fever of 100.4 °F or higher.
• You have chills.
• Your skin is painful, peeling, blistering, moist, or weepy.
• You have discomfort in the treatment area.
• Your breast, underarm , or arm is getting more swollen.
• You have any new or unusual symptoms.

Many people find that counseling helps them. Our counseling center offers counseling for individuals, couples, families, and groups. We can also prescribe medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Integrative Medicine Servicewww.mskcc.org/integrativemedicineOur Integrative Medicine Service offers many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. To schedule an appointment for these services, call .

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call .

Nutrition ServicesOur Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. To make an appointment, ask a member of your care team for a referral or call the number above.

Tobacco Treatment Program

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Can Radiation Cause Fatigue

Radiation side effects are different for each person. You may be able to exercise or perform your normal activities. Or you may not. Side effects also tend to get worse as more treatments are given. I lost my hair, experienced a great deal of fatigue and nausea, and skin dryness on treated areas. When these changes happen, acknowledge your side effects and react. No one expects you to go through treatment and act like it doesnt affect you. Once treatment is over, your body quickly adjusts to its normal self.

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When Are Side Effects An Emergency

• A temperature over 100.4 F. If you have any fever or chills, tell your doctor right away. If you canât get in touch with your doctor, go to the emergency room.
• New mouth sores, patches, a swollen tongue, or bleeding gums
• A dry, burning, scratchy, or “swollen” throat
• A cough that is new or doesnât go away
• Changes in how your bladder works, including a need to go urgently or more often, burning when you pee, or blood in your urine
• Digestive changes, including heartburn nausea, vomiting, constipation, or diarrhea that is severe or lasts longer than 2 or 3 days or blood in your stools

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How Fertility Might Be Affected

For women: Talk to your cancer care team about how radiation might affect your fertility . Its best to do this before starting treatment so you are aware of possible risks to your fertility.

Depending on the radiation dose, women getting radiation therapy in the pelvic area sometimes stop having menstrual periods and have other symptoms of menopause. Report these symptoms to your cancer care and ask them how to relieve these side effects.Sometimes menstrual periods will return when radiation therapy is over, but sometimes they do not.

See Fertility and Women With Cancer to learn more.

For men: Radiation therapy to an area that includes the testicles can reduce both the number of sperm and their ability to function. If you want to father a child in the future and are concerned about reduced fertility, talk to your cancer care team before starting treatment. One option may be to bank your sperm ahead of time.

See Fertility and Men With Cancer to learn more.

Types Of Breast Cancer

Although most consider breast cancer as one disease, there are many different types of breast cancer. The all start in the breast cancers but differ in other ways. They can be non-invasive or invasive. Tumor cells can vary in location and how they look under a microscope. And Tumor characteristics can vary as well

Non-invasive Breast Cancer Ductal Carcinoma in situ :

In situ means in place. In this case the abnormal cells are contained in the milk ducts of the breast and have not yet spread to nearby tissues.

Without treatment, the abnormal cells could spread and become invasive breast cancer. Some call this type of cancer pre-invasive or pre-cancerous

Invasive Breast Cancer

Cancer cells that spread from inside the milk ducts or lobules into surrounding tissue is invasive breast cancer. There are many types of invasive breast cancer.

Metastatic Breast Cancer

Invasive breast cancer that spreads to other parts of the body, such as the liver, lungs, bones and brain is metastatic breast cancer. It is sometimes called stage IV or advanced breast cancer. Note that metastatic breast cancer is not a type of breast cancer, but a stage of disease.

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How Do I Prepare For My Treatments

Before your first radiation treatment, you will have a simulation appointment. This appointment will last approximately one to two hours. During this appointment, the doctor will identify the exact fields on your body to treat with radiation. This involves lying on a table while the radiation therapist marks the field with small dots made with permanent ink. Each dot is similar to a very small tattoo. You will not receive any radiation treatment during this appointment.

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.

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How Long Does Radiation Therapy Typically Last

With breast cancer, radiation therapy usually begins about 3 to 4 weeks after breast-conserving therapy or a mastectomy, according to the National Breast Cancer Foundation.

External beam radiation is typically given once a day, 5 days a week, for anywhere from 2 to 10 weeks on an outpatient basis. This means you can go home after the treatment.

Sometimes the schedule for external radiation can differ from the standard schedule. Some examples of this include the following:

• Accelerated fractionation. Treatment is given in larger daily or weekly doses, reducing the duration of the treatment.
• Hyperfractionation. Smaller doses of radiation are given more than once a day.
• Hypofractionation. Larger doses of radiation are given once daily to reduce the number of treatments.

For brachytherapy , treatments are usually given twice a day for 5 days in a row as outpatient procedures. Your specific treatment schedule will depend on what your oncologist has ordered.

A less common treatment option is to leave the radiation in your body for hours or days. With this type of treatment, youll stay in the hospital to protect others from the radiation.

Common side effects of external beam radiation therapy for breast cancer include:

• sunburn-like skin irritation in the treatment area
• dry, itchy, tender skin
• swelling or heaviness in your breast

Skin changes and changes to your breast tissue usually go away within a few months to a year.

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

Your doctor might recommend antibiotics as a precaution. Or they may suggest you get a flu shot before you start chemotherapy.

If your white blood cell counts are too low, your doctor may give you a treatment called G-CSF or GM-CSF .

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Swelling Of The Breast

Radiotherapy can make it more difficult for fluid to drain from the breast tissue. This can cause swelling of the breast or chest area. Doctors call this lymphoedema.

The swelling usually goes down a few weeks after the treatment ends. But tell your doctor or radiographers if it doesnt. They can arrange for you to see a lymphoedema specialist. You might have a type of massage called manual lymphatic drainage.