What Happens After Radiation Treatment For Breast Cancer

Why And When People Start Radiation Therapy

Radiation therapy is a flexible and safe treatment. Doctors may use it after surgery to remove cancerous tumors, as it can reduce the chances of a recurrence by destroying any remaining cancer cells.

If an individual has metastatic breast cancer, which is when cancer has spread to other parts of the body, doctors may also opt to treat them with radiation therapy to ease their symptoms.

What To Watch For

• Skin rashes, redness, or swelling
• New lumps in your breast or chest

Also pay attention to:

• Shortness of breath or chest pain
• Persistent belly pain
• Weight loss

If you take tamoxifen, tell your doctor about any unusual vaginal bleeding. If you take it and still have your uterus, you need an annual Pap smear, regardless of age.

If you are postmenopausal, if you are taking a medicine called an aromatase inhibitor, or if you’ve had chemotherapy in the past, get regular screening tests for osteoporosis.

Radiation For Metastatic Breast Cancer

Sometimes breast cancer spreads to other parts of the body. When this happens, the breast cancer is called metastatic or stage IV.

If youve been diagnosed with metastatic breast cancer and are having symptoms, your doctor may recommend radiation therapy to:

• ease pain
• lower the risk of a cancer-weakened bone breaking
• open a blocked airway to improve breathing
• reduce pressure on a pinched spinal cord or nerve that might be causing pain, numbness, or weakness
• treat cancer that has spread to the brain

The radiation dose and schedule to treat metastatic breast cancer depends on a number of factors, including:

• the level of pain or amount of function lost
• the size of the cancer
• the location of the cancer
• the amount of previous radiation youve had
• the schedule for any other treatments

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Who Is On My Radiation Therapy Team

A highly trained medical team will work together to provide you with the best possible care. This team may include the following health care professionals:

Radiation oncologist. This type of doctor specializes in giving radiation therapy to treat cancer. A radiation oncologist oversees radiation therapy treatments. They work closely with other team members to develop the treatment plan.

Radiation oncology nurse. This nurse specializes in caring for people receiving radiation therapy. A radiation oncology nurse plays many roles, including:

• Answering questions about treatments

• Monitoring your health during treatment

• Helping you manage side effects of treatment

Medical radiation physicist. This professional helps design treatment plans. They are experts at using radiation equipment.

Dosimetrist. The dosimetrist helps your radiation oncologist calculate the right dose of radiation.

Radiation therapist or radiation therapy technologist. This professional operates the treatment machines and gives people their scheduled treatments.

Other health care professionals. Additional team members may help care for physical, emotional, and social needs during radiation therapy. These professionals include:

• Social workers

Learn more about the oncology team.

Internal Beam Radiation Or Brachytherapy

Brachytherapy is a type of radiation therapy that generates radiation from within the body. In comparison with external beam radiation, which projects particles of radiation from outside the body, brachytherapy can deliver higher doses of radiation in a precise fashion, resulting in fewer side effects and shorter treatment times.

The type of brachytherapy that doctors use depends on the location of the tumor, how much the cancer has spread, and the persons overall health.

Intracavity brachytherapy

The doctor will use a tube or cylinder to deliver a radioactive substance into the body and place it in the tumor.

Interstitial brachytherapy

The doctor will use a needle or catheter to place radioactive material within a cavity either a natural one or one that surgery has created. For breast cancer, they will place it in the breast.

Brachytherapy can also involve either high-dose-rate or low-dose-rate treatments.

High dose rate

This type consists of multiple treatment sessions in which doctors place radioactive material in the body for about 1020 minutes before removing it.

Low dose rate

This type uses substances that release a constant, low dose of radiation over 17 days, during which time a person will likely stay in the hospital. Doctors will remove the radiation source after a designated amount of time.

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Types Of Radiation Therapy

• External beam radiation is most commonly used to treat breast cancer. A machine outside your body aims a beam of radiation on the area affected by the disease.
• Brachytherapy delivers radiation to the cancer through something implanted in your body.
• Proton therapy sends highly targeted radiation just to your breast tissue and not into your heart or lungs.

Is Radiation Therapy Safe

Some patients are concerned about the safety of radiation therapy. Radiation has been used successfully to treat patients for more than 100 years. In that time, many advances have been made to ensure that radiation therapy is safe and effective.

Before you begin receiving radiation therapy, your radiation oncology team will carefully tailor your plan to make sure that you receive safe and accurate treatment. Treatment will be carefully planned to focus on the cancer while avoiding healthy organs in the area. Throughout your treatment, members of your team check and re-check your plan. Special computers are also used to monitor and double-check the treatment machines to make sure that the proper treatment is given. If you undergo external beam radiation therapy, you will not be radioactive after treatment ends because the radiation does not stay in your body. However, if you undergo brachytherapy, tiny radioactive sources will be implanted inside your body, in the tumor or in the tissue surrounding the tumor, either temporarily or permanently. Your radiation oncologist will explain any special precautions that you or your family and friends may need to take.

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What Are The Different Kinds Of Radiation

The goal of radiation therapy is to get enough radiation into the body to kill the cancer cells while preventing damage to healthy tissue. There are several ways to do this. Depending on the location, size and type of cancer, you may receive one or a combination of techniques. Your treatment team will help you to decide which treatments are best for you. Radiation therapy can be delivered in two ways, externally and internally. During external beam radiation therapy, the radiation oncology team uses a machine to direct high-energy X-rays at the cancer. Internal radiation therapy, or brachytherapy, involves placing radioactive sources inside your body.

Breast Cancer Survivors: Life After The Treatments End

The breast cancer treatments are over. Now what? Here’s how to return to your “new normal.”

Life after breast cancer means returning to some familiar things and also making some new choices.

The song says “It ain’t over ’til it’s over,” but when you’ve had breast cancer, you discover that it’s not even over when it’s over.

After a marathon of breast cancer diagnosis and treatment that may last six months to a year, you can hardly wait to get back to a normal life again. But the day of your last radiation treatment or chemotherapy infusion doesn’t mark the end of your journey with breast cancer.

Instead, you’re about to embark on another leg of the trip. This one is all about adjusting to life as a breast cancer survivor. In many ways, it will be a lot like the life you had before, but in other ways, it will be very different. Call it your “new normal.”

From your relationships with your family and your spouse to eating habits and exercise, breast cancer will change your life in ways that last well after treatment ends. How do you fight lingering fatigue? What should you eat to help prevent a breastcancer recurrence? Will you ever have a regular sex life again? These are just a few of the questions that may nag at you as you make the transition from breast cancer treatment to breast cancer survival.

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Follow Up Care After Breast Cancer Treatment

Many women are relieved or excited to be finished with breast cancer treatment. But it can also be a time of worry, being concerned about the cancer coming back, or feeling lost without seeing their cancer care team as often.

For some women with advanced breast cancer, the cancer may never go away completely. These women may continue to get treatments such as chemotherapy, hormone therapy, or other treatments to help keep the breast cancer under control and to help relieve symptoms from it. Learning to live with breast cancer that doesnt go away can have its own type of uncertainty.

Even if you have completed breast cancer treatment, your doctors will want to watch you closely. Its very important to go to all of your follow-up appointments. During these visits, your doctors will ask if you are having any problems, and will probably examine you. Lab tests and imaging tests aren’t typically needed after treatment for most early stage breast cancers, but they might be done in some women to look for signs of cancer or treatment side effects.

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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What Are The Cosmetic Results Of Breast Conservation Therapy

Eighty percent to 90 percent of women treated with modern surgery and radiotherapy techniques have excellent or good cosmetic results that is, little or no change in the treated breast in size, shape, texture or appearance compared with what it was like before treatment.

Patients with large breasts seem to have greater shrinkage of the breast after radiation therapy than do patients with smaller breasts. However, this problem usually can be overcome with the use of higher x-ray energies or with IMRT. Partial breast radiation using brachytherapy can also be considered if the patient has a small early-stage tumor. This treatment is still undergoing clinical investigation. Certain single institution studies on brachytherapy and intraoperative radiation have shown some promising results. You would need to discuss this with your doctor before or shortly after surgery to determine if you qualify for partial breast radiation.

External Beam Breast Cancer Radiation

External beam radiation is the most common kind of radiation treatment for breast cancer. Its a painless treatment, like getting an X-ray. A doctor will place a machine on the outside of your body and aim the radiation beams at the area of the cancer. Your doctor will figure out where to aim the rays and how much radiation to use before each treatment. They will mark the area with temporary or permanent ink.

Each treatment only lasts a few minutes. The session setup will take longer. External radiation treatment happens five days a week for about five to seven weeks. Its the longest type of radiation treatment available.

Short-term side effects of external radiation include:

• fatigue

• swelling and pain in the arm or chest
• weakened and fractured ribs
• future cancer in the inner lining of your blood vessels

External radiation does not leave radiation in your body. You will not be radioactive during or after treatment.

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Rejecting Cancer Treatment: What Are The Consequences

There have been several studies of people who have refused scientific treatments for cancer. The results have not been good.

These do not cure cancer

One of the points Ive tried to emphasize through my contributions to Science-Based Medicine is that every treatment decision requires an evaluation of risks and benefits. No treatment is without some sort of risk. And a decision to decline treatment has its own risks. One of the challenges that I confront regularly as a pharmacist is helping patients understand a medications expected long-term benefits against the risks and side effects of treatment. This dialogue is most challenging with symptomless conditions like high blood pressure, where patients face the prospect of immediate side effects against the potential for long-term benefit. Ones willingness to accept side effects is influenced, in part, by and understanding of, and belief in, the overall goals of therapy. Side effects from blood-pressure medications can be unpleasant. But weighed against the reduced risk of catastrophic events like strokes, drug therapy may be more acceptable. Willingness to accept these tradeoffs varies dramatically by disease, and are strongly influenced by patient-specific factors. In general, the more serious the illness, the greater the willingness to accept the risks of treatment.

Keeping Personal Health Records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed. At the conclusion of active treatment, ask your doctor to provide you with a treatment summary and a survivorship care plan.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor, another health care professional, or a specialized survivorship clinic. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

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These Steps Can Help:

• Gently cleanse the treated area using lukewarm water and a mild soap. Donât rub your skin. Pat it dry with a soft towel, or use a hair dryer on a cool setting.
• Donât scratch or rub the treated area. Use only an electric razor if you need to shave there. Donât put on medical tape or bandages.
• Donât apply any ointment, cream, lotion, or powder to the treated area unless your doctor or nurse has prescribed it. This includes cosmetics, shaving lotions, perfumes, and deodorants.
• Choose clothes made from natural fibers like cotton rather than tight-fitting clothing or harsh fabrics like wool or corduroy.
• Avoid extreme heat or cold where you’ve had radiation — no electric heating pads, hot water bottles, or ice packs.
• Also avoid hot tubs and tanning beds.
• Stay out of direct sunlight, especially between the hours of 10 a.m. and 2 p.m., even after you’re done with treatment. The sun can intensify skin reactions and lead to severe sunburn. Choose a sunscreen of SPF 30 or higher. Wear protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat, too.

Planning Your Radiotherapy Treatment

You will have a hospital appointment to plan your treatment. You will usually have a CT scan of the area to be treated. During the scan, you need to lie in the position that you will be in for your radiotherapy treatment.

Your radiotherapy team use information from this scan to plan:

• the dose of radiotherapy
• the area to be treated.

You may have some small, permanent markings made on your skin. The marks are about the size of a pinpoint. They help the radiographer make sure you are in the correct position for each session of radiotherapy.

These marks will only be made with your permission. If you are worried about them, talk to your radiographer.

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What Can I Expect From My Treatment

When you arrive, please check in at the desk. Each treatment should only last 10 to 15 minutes. You can change your clothes in the dressing room and then wait in the lounge to be called.

During each treatment session, you will lay on a table while the technician uses the marks on your skin to locate and treat the field. It is important to be still while getting the radiation, although you should continue to breathe normally.

Who Gets Radiation

Your doctor may recommend radiation:

• During surgery as a single dose at the site where the tumor was removed
• After a lumpectomy or after a mastectomy to lower the odds of the cancer returning in that breast
• To treat some symptoms of advanced cancer

Treatments generally start several weeks after surgery so your body has some time to heal. If your doctor recommends chemotherapy, too, you might start chemo first.

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