What Are The Side Effects Of Radiation For Breast Cancer

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

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.

Tips For Easing Side Effects Caused By Radiation Therapy:

Your doctor may recommend the following tips to help make the process more comfortable:

• Wear loose-fitting clothing on the day of treatment as well as the days following treatment to help reduce the chances of your clothes brushing up against your skin
• Use heating pads or ice packs to help reduce pain and swelling
• Apply unscented moisturizer to help with skin changes, especially itching and flaking
• Rest as much as possible before and after radiation treatment to minimize fatigue
• Reach out to a friend or family member to help with daily activities so you may rest

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How Does Radiation Therapy Work

Radiation therapy uses special high-energy X-rays or particles to damage a cancer cells DNA. When a cancer cells DNA is damaged, it cant divide successfully and it dies.

Radiation therapy damages both healthy cells and cancer cells in the treatment area. Still, radiation affects cancer cells more than normal cells. Cancer cells grow and divide faster than healthy cells and also are less organized. Because of this, it’s harder for cancer cells to repair the damage done by radiation. So cancer cells are more easily destroyed by radiation, while healthy cells are better able to repair themselves and survive the treatment.

The treatment area may include the breast area, the lymph nodes, or another part of the body if the cancer has spread.

Radiation treatments are carefully planned to make sure you receive the greatest benefits and the fewest side effects possible.

Brachytherapy/Internal Radiation

Internal radiation, called brachytherapy by doctors, uses a radioactive substance sealed in seeds or tiny tubes that are placed inside your body directly into the cancer or the place where the cancer was. Read about brachytherapy.

Another type of radiation therapy, called intraoperative radiation therapy, is a type of partial-breast radiation. With intraoperative radiation therapy, the entire course of radiation is delivered at one time during breast cancer surgery. Read more about intraoperative radiation therapy.

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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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.

Why Does Radiation Therapy Cause Side Effects

High doses of radiation therapy are used to destroy cancer cells. Side effects come from damage to healthy cells and tissues near the treatment area. There have been major research advances in radiation therapy in recent years that have made it more precise. This has reduced this treatment’s side effects, compared to radiation therapy techniques used in the past.

Some people experience few side effects from radiation therapy. Or even none. Other people experience more severe side effects.

Reactions to the radiation therapy often start during the second or third week of treatment. Or, they may last for several weeks after the final treatment. Some side effects may be long term. Talk with your treatment team about what to expect.

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How Is Radiation Therapy For Breast Cancer Performed

Most people lie on their back during the treatment though some breast treatments are performed while lying on your stomach . You place your arm above your head .

During the treatment, your treatment team:

• Positions and secures your body in the immobilization device. If you had a mastectomy, your provider might place a bolus on top of the treatment area to increase the radiation dose to the surface.
• Lines up the machine with the first treatment field. To protect themselves from radiation exposure, providers leave the room. Your provider can still hear and see you.
• Turns on the machine. You will hear a whirring noise, but you wont see the radiation beams. You must remain still. Depending on the radiation type and dose, treatment can take 30 seconds to several minutes.
• Returns to the room to position the machine to treat a different treatment field. Most people get treatment on two to five fields each day.
• Takes daily/weekly X-rays of the treatment field to make sure the radiation is hitting the correct area.

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.

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Accelerated Partial Breast Irradiation

In select women, some doctors are using accelerated partial breast irradiation 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 healthy breast. Treatments are given twice a day for 5 days.
• 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.

Women who are interested in these approaches may want to ask their doctor about taking part in clinical trials of accelerated partial breast irradiation.

Breast Cancer Awareness Month: Skin Changes After Treatment

From the initial shock upon discovery to the relieved sigh upon treatment completion, surviving breast cancer is not an easy feat. Chemotherapy, radiation therapy and hormonal therapy can all cause changes to your skin during and after treatment, from dryness to photosensitivity, these changes can take you by surprise. Its important to note that any skin changes you experienced should be noted and told to your doctor.

For Breast Cancer Awareness Month we at Five Dot Botanics have curated information dealing with therapy side effects, so you can not only spot your skin changes, but you can also go about dealing with them to minimise irritation and pain.

What skin changes can occur during and after treatment?

Like all forms of radiation and hormonal therapy, side effects are bound to occur in one form or another, with skin changes being one of the most common and early ones.

From xerosis to hyperpigmentation, the type of treatment can lead to different skin issues with some overlapping.

Radiotherapy for example can increase the chances of hyperpigmentation , pruritus and dermatitis . Chemotherapy also can lead to the same skin issues as radiotherapy, in addition to the chances of skin spots akin to acne, and hand-foot syndrome . Hormonal therapy while rarely leading to skin spots can still lead to the same issues as radiotherapy.

Some of these skin changes like hand-foot syndrome and dermatitis are temporary while others like hyperpigmentation may be permanent.

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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.

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.

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Nerve Damage Around The Treatment Area

Scaring from radiotherapy may cause nerve damage in the arm on the treated side. This can develop many years after your treatment. Symptoms include tingling, numbness, pain, and weakness. In some people, it may cause some loss of movement in the arm and shoulder.

Speak to your doctor if you notice any of these symptoms.

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.

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If Youre Getting Radiation Therapy To The Head Or Neck

People who get radiation to the head and neck might have side effects such as:

• Soreness in the mouth or throat
• Dry mouth
• Jaw stiffness

How to care for your mouth during treatment

If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat. Here are some tips that may help you manage mouth problems:

• Avoid spicy and rough foods, such as raw vegetables, dry crackers, and nuts.
• Dont eat or drink very hot or very cold foods or beverages.
• Dont smoke, chew tobacco, or drink alcohol these can make mouth sores worse.
• Stay away from sugary snacks.
• Ask your cancer care team to recommend a good mouthwash. The alcohol in some mouthwashes can dry and irritate mouth tissues.
• Rinse your mouth with warm salt and soda water every 1 to 2 hours as needed.
• Sip cool drinks often throughout the day.
• Eat sugar-free candy or chew gum to help keep your mouth moist.
• Moisten food with gravies and sauces to make it easier to eat.
• Ask your cancer care team about medicines to help treat mouth sores and control pain while eating.

If these measures are not enough, ask your cancer care team for advice. Mouth dryness may be a problem even after treatment is over. If so, talk to your team about what you can do.

How to care for your teeth during treatment

Radiation treatment to your head and neck can increase your chances of getting cavities. This is especially true if you have dry mouth as a result of treatment.

Changes In The Shape Size And Feel Of The Breast

In time radiotherapy can cause the breast tissue to change shape or shrink in size a little. This can happen to your natural breast tissue or a reconstructed breast.

After radiotherapy, the breast might feel hard and less stretchy. This is due to a side effect called radiation fibrosis. This side effect is usually mild.

Sometimes the breast can shrink a little over time. This is because radiotherapy can make the breast tissue contract so that the breast gradually gets smaller.

An implant in a reconstructed breast can become hard and may need replacing.

Let your surgeon know of any changes, they may be able to do some minor surgical adjustments to improve the look.

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Questions To Ask The Health Care Team

• What physical side effects are likely based on my specific radiation therapy treatment plan? When will they likely begin?

• How can these side effects be prevented or managed?

• How can I take care of the affected skin during my treatment period?

• Who should I tell when a side effect appears or gets worse?

• Are there specific side effects I should tell the doctor about right away?

• Who can I talk with if I’m feeling anxious or upset about having this treatment?

• If I’m having side effects that affect my nutrition, can you recommend an oncology dietitian?

• What are other ways I can take care of myself during the treatment period?

• Are there any restrictions on exercising or other physical activity during this treatment?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have a child? If so, should I talk with a fertility specialist before cancer treatment begins?

• What are the potential long-term effects of this type of radiation therapy?

• If I’m worried about managing the financial costs of cancer care, who can help me?

• Will special precautions be needed to protect my family and others from radiation exposure during my treatment period?

• After radiation therapy is completed, what will my follow-up care plan be?

• Why is follow-up care important for managing side effects of treatment?

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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