What Are The Side Effects Of Radiotherapy For Breast Cancer

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

If Youre Getting Radiation Therapy To The Chest

Radiation treatment to the chest may cause side effects such as:

• Sore throat

Radiation can also cause other problems in the heart or lungs.

Heart complications

Getting radiation to the middle portion of the chest can raise your risk of heart disease. This risk increases with higher radiation doses and larger treatment areas in this part of your body. Radiation can also cause hardening of the arteries , heart valve damage, or irregular heartbeats.

Radiation pneumonitis

Radiation pneumonitis is inflammation of the lungs that can be caused by radiation treatment to the chest . It may occur about 3 to 6 months after getting radiation therapy. Its more likely if you have other lung diseases, like emphysema . Common symptoms of radiation pneumonitis include:

• Shortness of breath that usually gets worse with exercise
• Chest pain, which is often worse when taking in a deep breath
• Cough
• Weakness

Sometimes there are no symptoms, and radiation pneumonitis is found on a chest x-ray.

Symptoms often go away on their own, but if treatment is needed, it is based on trying to decrease the inflammation. Steroids, like prednisone, are usually used. With treatment, most people recover without any lasting effects. But if it persists, it can lead to pulmonary fibrosis . When this happens, the lungs can no longer fully inflate and take in air.

Be sure you understand what to look for, and tell your cancer care team if you notice any of these side effects.

Short Term Side Effects

The following list includes some of the most common side effects of radiation therapy for breast cancer. Remember that the treatment can affect each patient differently and you may not experience these problems. Talk with your care team about what you can expect from your specific treatment.

• Skin irritation: Your skin may become red, irritated, dry, or sensitive. This may start to look like a sunburn. The skin may also become darker under the arm and under the breast. In more severe cases, the skin can peel, and moist ulcers can occur. Treat the skin gently to avoid further irritation, and bathe carefully using only warm water and mild soap. Avoid perfumed or scented lotions or soaps, as these may cause further irritation. Avoid spending too much time in the sun, which can worsen the irritation.
• Mild fatigue that generally gets better a month or two after treatment ends.
• Some patients have mild tenderness in the breast or chest wall.
• Some patients have swelling to the ipsilateral arm that may make the movement of that arm more difficult. Any swelling should be brought to the attention of your oncology team.
• Reduced blood counts, including neutropenia , anemia , or thrombocytopenia .

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What To Expect With External Beam Radiation

If you have external beam radiation, youll meet with your radiation oncologist and a nurse before starting treatment. They will walk you through what to expect with external beam radiation, and the risks and benefits of this treatment.

At this time, youll likely have a physical exam and go over your medical history.

Additionally, the radiation oncologist and a radiation therapist will take scans of your treatment area. This will help define the boundaries of the affected area so they know where to aim the radiation beams.

They will put marks on your skin to mark the area. You will need the marks throughout the course of your treatment. The marks will be used to line up your body, so the radiation beams target the exact area that needs to be treated.

Sometimes a body mold will be made to immobilize you during the treatment and to help keep your body still.

Each treatment will only last a few minutes. The session setup will take longer than the actual treatment. You wont feel anything when the machine is turned on for the treatment. Its a painless procedure.

Ask The Expert: Late Effects Of Breast Cancer Radiation Therapy

After receiving radiation oncology treatment, you may experience some acute and chronic side effects, many of which are common and can be addressed through conversations with your care team. Most often, acute effects from radiation therapy begin within a few weeks of starting treatment and go away within two to four weeks after treatment ends. Chronic effects, however, may persist and have recently garnered attention with breast cancer patients as survival continues to improve, creating the largest group of cancer survivors. It is important to be mindful of your body and tell your doctor about any changes you may see as quality of life as a survivor is an important goal.

Dr. Cherylle Hayes, Radiation Oncologist and Medical Director at North Florida Radiation Oncology, a part of Sarah Cannon at North Florida Regional Medical Center in Gainesville, Florida, discusses possible late side effects one may experience when treated with radiation therapy, including what to look for and how to prevent them.

What should patients know?

As treatment approaches and techniques have improved over the last few decades and continue to improve with newer systemic and endocrine therapies, the most important thing a patient can do is to understand their own body and its reactions to treatment up front. Dr. Hayes tells all of her patients You are the CEO and president of your body and you help direct the future of your outcomes.

What should patients look for, or be aware of?

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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?

Reddening Or Darkening Of Your Skin

Your skin might go red or darker in the treatment area.

The red or darker areas can feel sore. Your radiographers will give you creams to soothe your skin.

The soreness usually goes away within 2 to 4 weeks of ending the treatment. But your skin might always be slightly darker in that area.

• Find out about caring for your skin

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What Are The Side Effects Of Radiation Therapy For Breast Cancer

Many patients with breast cancer will receive radiation therapy at some point in their treatment course. External beam radiation therapy delivers painless, high-energy particles to destroy or damage cancer cells. The radiation therapy precisely targets the breast and lymph nodes to stop the growth or spread of the breast cancer cells.

Some patients experience side effects from their treatment. Your treatment team will discuss these with you in more detail and a nurse will monitor any side effects regularly and assist you with management. If at any point you are worried about your treatment or side effects, do reach out to your doctor or nurse.

Common short-term, side effects of radiation therapy to the breast

• Breast swelling
• Skin changes in the treated area that are similar to a sunburn
• Changes in skin sensation

If side effects do occur, your GenesisCare treatment team will monitor them closely. Side effects usually appear after the first two weeks of therapy, then may peak 5-10 days after treatment completes, and settle down thereafter. Most of these skin changes improve within a few months and usually go away within 612 months, but some women may experience skin effects for longer.

Other common short-term side effects include:

• Fatigue, which varies in its severity between individuals and may persist for a few weeks after treatment has finished
• Breast heaviness, tenderness, itchiness, and swelling

How can short-term side effects be managed?

Got questions or concerns?

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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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.

What Are The Side Effects Of Radiation For Breast Cancer

From Comments from Jennifer Gerson, MD, radiation oncologist with OHC. Article by Nicole Galan, Medical News Today

Image credit: Stephen Kelly, 2018

Common short-term side effects include:

• Pain: Some people experience mild discomfort or pain around the breast, or stiffness in the shoulder area. Over time, treatments should become less uncomfortable.
• Skin changes: Skin damage is a common side effect of radiation therapy, and having a good skin care routine is essential during treatment. Changes to the skin can include color changes, peeling or flaking, skin that feels tender, dry, itchy or sore, blisters, and excess moisture and weeping.
• Swelling: The breast or surrounding tissue may become swollen or inflamed. Swelling should reduce within a few weeks of the end of treatment.
• Hair loss in the armpit or chest: When a doctor applies radiation to the lymph nodes in the armpit and chest, it can cause hair loss in these areas.
• A sore throat: Applying radiation to the lymph nodes around the collarbone can cause a sore throat or difficulty swallowing. These symptoms should improve once the treatment is complete.
• Fatigue: Radiation can cause someone to feel very tired or fatigued. Its important to sleep and rest as much as possible during treatment.

Long-term side effects can include:

Rare side effects of radiation can include:

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Radiation Therapy And The Effects On The Heart

• Heart Muscle Damage: When undergoing radiation treatments, there is a very small risk of damage to the heart muscle or the major blood vessels around the heart. This is a potential problem if you have had cancer in your left breast since the heart is on the left side of the chest. Ideally, the heart is either not within the radiation area or only a small amount of the heart will receive any radiation, which helps to lower the risk of significant damage.

• Breathlessness/Dizziness: If your heart has been damaged by radiotherapy you may find that you get tired very easily or get breathless on exertion, like climbing stairs. You may also notice that you sometimes feel dizzy or get chest pains.

Its important to remember that these symptoms can be caused by many things and they arent always a result of damage to the heart. You will want to immediately consult your doctor if you experience any symptoms that may be heart-related.

A promising clinical trial is underway at the Johns Hopkins Avon Foundation Breast Center to determine if The Active Breath Control device will help to better protect women against heart-related side effects. The device provides an innovative way for the patients heart to be spared radiation by controlling her breathing during the actual radiation treatment.

How To Manage The Side Effects Of Radiation

Despite radiation therapy having side effects, there are ways by which we can alleviate them. Some are simple remedies, while others may need the evaluation and help of a doctor. For breast soreness or pain, common pain relievers such as ibuprofen or acetaminophen can be helpful. If the breast becomes red, itchy, or beings peeling, some creams can be used for relief.

Exercising and getting enough sleep can help combat fatigue. Short, simple exercises such as walking for 20 to 30 minutes per day can help alleviate this side effect. If fatigue or sleeping problems persist or lymphedema is evident, a doctor can help manage them.

Breast cancer is a very challenging illness, but we have many treatment options for people with it. Remember, no treatment is without side effects. It is crucial to be aware of these treatment options and their side effects to give the best management for every person.

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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
• fatigue
• swelling or heaviness in your breast

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

Does Radiation Affect The Emotions

Nearly all patients who receive treatment for cancer feel some degree of emotional upset. “It’s not unusual to feel depressed, afraid, angry, frustrated, alone or helpless,” says Dr. Wilson. “Radiation therapy may affect the emotions indirectly through fatigue or changes in hormone balance, but the treatment itself is not a direct cause of mental distress.”

Many patients help themselves by talking about their feelings with a close friend, family member, chaplain, nurse, social worker or psychologist with whom they feel at ease. You may want to ask your doctor or nurse about meditation or relaxation exercises that could help you unwind and feel better. American Cancer Society programs can provide support. Groups such as the United Ostomy Association and the Lost Chord Club offer opportunities to meet with others who share the same problems and concerns. Some medical centers have formed peer support groups so that patients can meet to discuss their feelings and inspire each other.

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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.