When Does Someone With Breast Cancer Get Radiation Therapy
The timing for radiation therapy depends on several factors. The treatment may take place:
- After a lumpectomy: A lumpectomy removes the cancerous tumor, leaving most of the breast. Radiation therapy lowers your risk of cancer coming back in the remaining breast tissue or nearby lymph nodes as well as reduces your chance of passing away of breast cancer.
- After a mastectomy: Most people dont get radiation therapy after a mastectomy . Your provider may recommend radiation if the tumor was larger than 5 cm ; if theres cancer in surrounding lymph nodes, skin tissue or muscle; or if all the cancer can’t be removed .
- Before surgery: Rarely, healthcare providers use radiation to shrink a tumor before surgery.
- Instead of surgery: Sometimes, providers use radiation therapy to shrink a tumor that they cant surgically remove . A tumor may be unresectable due to its size or location. Or you may not be a candidate for surgery because of concerns about your health.
- To treat cancer spread: Stage 4 breast cancer is cancer that spreads to other parts of the body. Your provider may use radiation therapy to treat cancer that spreads to other parts of the body.
If you had surgery, radiation therapy typically starts about one month after the incision heals if chemotherapy is not received. Some individuals receive chemotherapy after surgery, followed by radiation therapy. You may get the two treatments at the same time.
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 provider may suggest special creams to ease this discomfort.
Sometimes the skin peels further and the area becomes tender and sensitive. This is called a moist reaction. Its most common in the skin folds and the underside of the breast.
If a moist reaction 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 problems sleeping .
Learn more about fatigue and insomnia.
Managing The Challenges Of Hormone Therapies
Hormone therapy for early breast cancer affects people differently. Some people experience more side effects than others and its not something you can predict before treatment. Many women find that the side effects are often worse at the start of treatment, and can settle down after weeks or months, but some symptoms persist for the duration of treatment.
Hormones occur naturally in the body and control the growth and activity of cells. We know that the female hormones, oestrogen and progesterone, can help some types of breast cancer to grow. Hormone therapy works by reducing the amount of oestrogen in the body or blocking its effects. You can have side effects from hormone therapies because they lower your levels of oestrogen or stop your body from being able to use it.
The side effects you experience will depend on the type of hormone treatment you are on.
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How Is Yale Medicines Approach To Hypofractionation For Breast Cancer Unique
Yale Medicine patients receive highly personalized care from a team of cancer specialists. Each week, those specialists meet to discuss all of the patients who are about to start treatment, and those who have just begun. The team discusses whether each patient will benefit from hypofractionation or conventional radiation, and the patients overall treatment plan. Theres lots of peer review, lots of discussion among the group and lots of experiences shared, says Dr. Evans.
Doctors develop a treatment course based on each patients individual case, and informed by all available medical evidence. Input from patients is also sought. Ultimately, this is a shared conversation and decision that the clinician has with the patient, Dr. Evans says. There is a certain amount of this thats personalized based on both the patients and the clinicians values, and on the clinicians experience treating people with that particular regimen.
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.
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What Are Common Side Effects Of Radiation Therapy
Radiation therapy is called a local treatment. This means that it only affects the area of the body that is targeted. For example, radiation therapy to the scalp may cause hair loss. But people who have radiation therapy to other parts of their body do not usually lose the hair on their head.
Common physical side effects of radiation therapy include:
Skin changes. Some people who receive radiation therapy experience dryness, itching, blistering, or peeling. These side effects depend on which part of the body received radiation therapy and other factors. Skin changes from radiation therapy usually go away a few weeks after treatment ends. If skin damage becomes a serious problem, your doctor may change your treatment plan. Lotion may help with skin changes, but be sure to check with your nurse or other health care team about which cream they recommend and when to apply it. It is also best to protect affected skin from the sun. Learn more about skin-related side effects.
Fatigue. Fatigue is a term used to describe feeling tired or exhausted almost all the time. Many patients experience fatigue. Your level of fatigue often depends on your treatment plan. For example, radiation therapy combined with chemotherapy may result in more fatigue. Learn how to cope with fatigue.
How Effective Is Radiation Therapy
If early-stage breast cancer hasnt spread, radiation therapy after a lumpectomy significantly reduces the risk of cancer coming back by approximately 50%. Studies show that a lumpectomy followed by radiation therapy is as effective as a mastectomy without radiation therapy.
People who undergo a lumpectomy have a 20% to 40% chance of the cancer coming back at 10 to 20 years. With the addition of postsurgical radiation therapy, that risk drops to 5% to 10%. However, there are some patients who derive less benefit from radiation including patients 65 years or older with small cancers.
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What Do Radiation Burns Look And Feel Like
According to the National Cancer Institute, people may experience skin changes over the course of radiation treatment, including:
- Redness or darkening of the skin: The skin may become red on white skin, and darken on darker skin. It can also be painful.
- Dry, peeling, or blistered skin: A persons skin in the treatment area may become extremely dry and peel. If the skin peels faster than it is able to heal, a person may develop blistered sores.
- Swollen skin: The skin in the treatment area can swell and appear puffy.
- Excessive itching: The skin in the treatment area can itch intensely. It is important that people avoid scratching, which can lead to skin breakdown and infection.
- Moist reaction: The skin in the treated area can become sore, wet, and infected. This most often occurs under the breasts, where there are skin folds.
Skin changes happen gradually during the course of radiation treatment, and may only occur in certain areas.
Breastcancer.org notes that people are more likely to experience them on parts of the body where skin touches, such as under the breast or the armpit. It can also occur in places that have had more sun exposure, such as the upper chest.
Some people experience a change in skin color that lasts for years after treatment.
Staying On Track With Radiation Treatments
The benefits of radiation therapy strongly depend on getting the full recommended dose without significant breaks, because:
- The full dose of radiation is needed to get rid of any cancer cells remaining after surgery.
- Radiation therapy is most effective when given continuously on schedule. In the past, it was given every day, 5 days a week, for 5 to 7 weeks. Accelerated, also called hypofractionated, radiation therapy schedules deliver about the same total dose of radiation over a shorter schedule usually 3 to 4 weeks, which can be more convenient. Partial breast radiation can be completed in 1 to 3 weeks. Also, by seeing your doctor regularly during and after treatment, you can best deal with any side effects.
Why you might have problems sticking to your radiation therapy plan:
- The treatment schedule may conflict with job demands, family needs, or the distance you live from the treatment facility. This may cause you to miss or postpone appointments, even if youre on an accelerated schedule.
- Skin irritation from radiation can cause soreness, peeling, and sometimes blisters. If you’ve also had lymph-node surgery, radiation treatment may worsen breast or underarm pain or discomfort. If you have these side effects, you might feel like stopping radiation.
Ways to overcome problems and stay on track with radiation treatment:
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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.
Will Radiation Therapy Cause My Hair To Fall Out
Only people who get radiation to the scalp or the brain may have hair loss. Others won’t. If it does happen, itâs usually sudden and comes out in clumps. In most cases, your hair will grow back after therapy stops, but it may be thinner or have a different texture.
Some people choose to cut their hair short before treatment begins to make less weight on the hair shaft. If you lose hair on top of your head, be sure to wear a hat or a scarf to protect your scalp from the sun when you go outside. If you decide to buy a wig, ask the doctor to write a prescription for one and check to see if it’s covered by your insurance or is a tax-deductible expense.
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Radiotherapy To Part Of The Breast
Less commonly, some women are given radiotherapy to part of the breast instead of the whole breast. There are different ways of doing this.
Your cancer doctor or specialist nurse will explain if any of the following treatments are options for you. They will tell you what the possible side effects are and any risks involved.
It is important to have information about all your treatment options. They can explain how these treatments compare with external radiotherapy.
External Radiation Planning And Treatment: What To Expect
Daily external radiation treatments require careful planning to make sure the treatment area is mapped out as accurately as possible and that each day of your treatment goes smoothly.
Heres what you can generally expect from the planning session through your daily treatment routine.
Planning and simulating external radiation treatment
Your first radiation therapy session is called a simulation. It is a planning and practice session, and you receive no radiation.
During the simulation session, your radiation oncology team maps out the area of the breast that needs treatment using imaging such as a CT scan, MRI, or X-ray.
Because it is so important to position the angles of radiation accurately, the simulation session can sometimes last up to an hour.
During the simulation session, your doctor will:
- explain the pros and cons of radiation, the planning and treatment process, and answer any questions or concerns you may have
- review the consent form and have you sign it
- introduce you to the treatment team
- precisely identify the area where you will receive radiation
A second planning session usually is needed to confirm the treatment and your positioning. Special X-rays are taken of each treatment field to make sure they are all set up correctly, and additional markings may be made to better define the confirmed treatment fields.
External radiation therapy routine
Here’s what to expect during your visit to the radiation treatment center:
Written by: Jamie DePolo, senior editor
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Take Hormone Therapies As Prescribed:
If you have been prescribed endocrine therapy its very important to take it exactly as prescribed. Research has shown that many women dont take their medication every day, either because they forget or because of the side effects. Endocrine therapy reduces the chance of breast cancer recurrence and when not taken as prescribed, the drugs are less effective.
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.
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Possible Side Effects Of External 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:
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.
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