What Are Side Effects Of Radiation For Breast Cancer

Effects On The Lung Or Heart

Sometimes after treatment to the breast or chest wall area, part of the lung behind the treatment area can become inflamed, causing a dry cough or shortness of breath. This usually heals by itself over time.

More rarely, fibrosis of the upper lung can occur, causing similar side effects.

Although particular care is taken to avoid unnecessary radiotherapy to the tissues of the heart, if radiotherapy is given on the left side you may be at risk of heart problems in future.

Breath hold technique is thought to reduce the risk of any possible damage to the heart and lungs.

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.

Early And Late Effects Of Radiation Therapy

• 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.
• Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. Its always best to talk to your radiation oncologist about the risk of long-term side effects.

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Radioprotective Drugs For Reducing Side Effects

One way to reduce side effects is by using radioprotective drugs, but these are only used for certain types of radiation given to certain parts of the body. These drugs are given before radiation treatment to protect certain normal tissues in the treatment area. 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.

What Can I Expect During Radiation Treatment

I went to radiation therapy every day for five weeks. It was a really simple and fast process.

I arrived each day around 9:00 in the morning and went straight back to the changing rooms. I had to wear a gown from the waist up.

They also made me take off my wig and hat during my sessions. Since I was just in the beginning stages of hair growing out after chemo, my head was still pretty bald.

I was a bit overcome with emotion during my first treatment. You lay on the machine in a room by yourself. I felt really exposed with my arms above my head, my breasts out in the open, and my head coverings removed.

My mind couldnt help but wander since there was nothing else I could really do. They played music into the room, so I eventually tried to just focus on that.

During the treatments, I laid perfectly still and held my breath or breathed whenever the therapists asked over the intercom. The machine moved to different spots over my body. I didnt feel any pain or anything during this process.

My left arm did get pretty numb a few times. This is the arm where four lymph nodes had been removed. My circulation wasnt the greatest in this arm so it fell asleep really easily. I cant imagine what it must be like for people who have way more than four nodes removed!

The numbness got a bit worse with radiation treatment, but it is normal now that its over. So, if you are dealing with a tight arm, know that there is an end in sight!

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Deep Inspiration Breath Hold

Various techniques are used to minimise the exposure of the heart to radiation. One technique is to voluntarily hold a deep breath for 20-30 seconds while the radiation is delivered, as this expands the lungs and moves the heart away from the radiation field. Pre-treatment assessment of lung capacity and breathing patterns is carried out and the patient is given instruction on breath-holding for the required time.

To accurately maintain a deep inspiration breath hold, some centres use an active breathing co-ordinator device. Using this, patients are taught to take and hold a measured deep breath while the radiation dose is delivered. Using this method, patients can monitor their own breathing and the machine links to the linear accelerator ensuring that the radiation dose is only delivered when optimal breath hold is reached and maintained.

Both methods have been shown to reduce the exposure of the heart to radiation.

What To Expect With Internal Radiation

Before you get any internal radiation, youll meet with your radiation oncologist. They will:

• do a physical exam
• ask about your medical history
• go over what your internal radiation treatment will entail

Most internal radiation, or brachytherapy, is given with a catheter. This is a small, flexible tube thats surgically placed into the space left from breast-conserving surgery.

At the end of the catheter is a device that can be inflated inside your breast so that it stays in place for the duration of the treatment.

During your treatment, radiation pellets or seeds are put down the tube and into the inflatable device. They usually stay there for about 10 to 20 minutes or longer, and then theyre removed. How long the radiation pellets stay in place depends on:

• your type of cancer
• other cancer treatments that youve had

Once your course of treatment is over, the catheter and inflatable device will be removed.

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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

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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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 .

Why Do I Feel Fatigued

During radiation therapy, the body uses a lot of energy healing itself. Stress related to your illness, daily trips for treatment, and the effects of radiation on normal cells all may contribute to fatigue. Most people begin to feel tired after a few weeks of radiation therapy. Feelings of weakness or weariness will go away gradually after your treatment is finished, says Dr. Wilson.

You can help yourself during radiation therapy by not trying to do too much. If you feel tired, limit your activities and use your leisure time in a restful way. Do not feel that you have to do all the things you normally do. Try to get more sleep at night, and rest during the day if you can.

If you have been working a full-time job, you may want to continue. Although treatment visits are time consuming, you can ask your doctors office or the radiation therapy department to help by scheduling treatments with your workday in mind.

Some patients prefer to take a few weeks off from work while theyre receiving radiation therapy others work a reduced number of hours. You may want to have a frank conversation with your employer about your needs and wishes during this time. You may be able to agree on a part-time schedule, or perhaps you can do some work at home.

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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

What Are The Types Of Radiation Therapy For Breast Cancer

There are different ways to receive radiation therapy. Your healthcare provider will choose the best method based on the cancer location, type and other factors.

Types of radiation therapy for breast cancer include:

• External beam whole-breast irradiation: During external beam whole-breast radiation therapy, a machine called a linear accelerator sends beams of high-energy radiation to the involved breast. Most people get whole-breast radiation five days a week for one to six weeks. The time frame depends on factors including lymph node involvement. In some cases, intensity-modulated radiation therapy may be used.
• External beam partial-breast: This treatment directs radiation to the tumor site only, not the entire breast over 1 to 3 weeks with 3-dimensional conformal radiation or IMRT.
• Brachytherapy: Some people get internal radiation therapy or brachytherapy. Your provider places an applicator or catheter. A radioactive seed is moved into the tumor site. The seeds give off radiation for several minutes before your provider removes them. You receive two treatments every day for five days.
• Intraoperative:Intraoperative radiation therapy takes place in the operating room before your provider closes the surgical site. Your provider delivers a high dose of radiation to the tumor area of the exposed breast tissue.

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External Radiation Therapy Side Effects

One of the main side effects of external radiation therapy is skin changes in the treated area.

The reaction is much like a sunburn, with redness and possible itching, burning, soreness, peeling, blisters, or darkening of the skin. These skin changes happen gradually over the course of treatment and may happen only in certain areas.

Places where skin touches skin, such as the armpit and the area under the breasts, and places where you may have had a lot of sun exposure, such as the upper chest, are more likely to be affected. Some people have a change in skin color that lasts for years after treatment.

Some people may have telangiectasias develop months to years after radiation to the breast. A telangiectasia is a small patch of tiny blood vessels on the skin of the treated area that looks like a tangle of thin red lines. Telangiectasias are not a sign of cancer recurrence, but they can sometimes cause bothersome symptoms such as itching or pain. If you develop telangiectasia after radiation therapy and wish to treat it, you can talk to a dermatologist about laser therapy or other treatments.

You may be more likely to have significant skin side effects if you have fair skin, larger breasts, certain health conditions that affect skin healing , or had mastectomy or chemotherapy before radiation.

Other common side effects of external radiation therapy are:

• swelling in the breast

Other, less common side effects that external radiation may cause are:

Oral Devices Need Special Care During High

The following can help in the care and use of dentures, braces, and other oral devices during high-dose chemotherapy or stem cell transplant:

• Have brackets, wires, and retainers removed before high-dose chemotherapy begins.
• Wear dentures only when eating during the first 3 to 4 weeks after the transplant.
• Brush dentures twice a day and rinsing them well.
• Soak dentures in an antibacterial solution when they are not being worn.
• Clean denture soaking cups and changing denture soaking solution every day.
• Remove dentures or other oral devices when cleaning your mouth.
• Continue your regular oral care 3 or 4 times a day with dentures or other devices out of the mouth.
• If you have mouth sores, avoid using removable oral devices until the sores have healed.

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Talking To Your Partner About Sex

Being able to talk openly with your partner about sex is very important. What worked for you both before cancer may not work now. You may need to try different things to find what works for you both. If it has been a while since youve been intimate, start slowly with simple kissing and touching. Here are some basic guidelines for talking to your partner:

• Be honest.

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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:

• Lungs
• Sinuses
• Skin

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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