What To Expect During Radiation Treatment For Breast Cancer

Working During Radiation Therapy

Some people are able to work full-time during radiation therapy. Others can work only part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect from the treatment you will have.

You are likely to feel well enough to work when you first start your radiation treatments. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished treatment, it may take just a few weeks for you to feel betteror it could take months.

You may get to a point during your radiation therapy when you feel too sick to work. Talk with your employer to find out if you can go on medical leave. Check that your health insurance will pay for treatment while you are on medical leave.

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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.

Your Role On Your Radiation Therapy Team

Youll have a team of healthcare providers working together to care for you. Youre part of that team, and your role includes:

• Getting to your appointments on time.
• Asking questions and talking about your concerns. Weve included a list of possible questions at the end of this resource.
• Telling someone on your radiation therapy team when you have side effects.
• Telling someone on your radiation therapy team if youre in pain.
• Caring for yourself at home by:
• Quitting smoking if you smoke. If you want to quit, call MSKs Tobacco Treatment Program at .
• Caring for your skin following your radiation therapy teams instructions.
• Drinking liquids following your radiation therapy teams instructions.
• Eating the foods your radiation therapy team suggests.
• Staying around the same weight.

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Top 5 Ingredients Of A Healthy Diet During Radiation Cancer Therapy

Radiation therapy is a type of cancer treatment that shrinks and destroys cancer cells. During radiation, its important to eat well. This keeps the body and its immune system strong, giving it the nutrients it needs to promote the regrowth of healthy tissues. Eating well during radiation also maintains energy, helps patients tolerate radiation side effects, lowers risks of infection, and speeds up recovery.

However, the nutrients and foods a person needs during cancer treatment vary based on the individual, how their body responds to radiation, the treatment area, and the length of treatment. While there is no one-size-fits-all radiation diet, there are some guidelines and tips that can help you find the best one during your cancer treatment.

Contents

• What Foods Should I Avoid During Radiation?

Pain In The Breast Or Chest Area

You may have aches, twinges or sharp pains in the breast or chest area.

Although these are usually mild, they can continue for months or even years, but they usually become milder and less frequent over time.

You may also have stiffness and discomfort around the shoulder and breast or chest area during and after treatment.

Continuing to do arm and shoulder exercises during radiotherapy and for several months afterwards may help minimise or prevent stiffness or discomfort.

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What Emotional Responses Might I Expect

You may or may not experience anxiety or fear when you begin your treatment. Most people tell us that their concerns lessen as they adapt to the new environment and treatment.

Please speak to the staff if you feel that you need either emotional or practical support. There is a social worker on staff in the Radiation Oncology department. This may be a time when you think again about support groups or one-to-one consultation for the feelings that arise or to support your coping. For information about support services, please call the Breast Care Center at 353-7070.

Expectations And What To Avoid

Radiation therapy should not cause pain or discomfort during the procedure. However, minor side effects are common in the days or weeks afterward. Before beginning radiation therapy, an individual should schedule a consultation with their doctor to work out the details.

People should also take some precautions while they are receiving radiation therapy. For example, they should avoid direct sun exposure by using sunscreen and covering up areas of bare skin when outside.

Also, taking antioxidant supplements, such as vitamins A, C, D, and E, can interfere with radiation therapys effectiveness. People should, therefore, focus on eating a well-balanced diet so that their body can absorb the nutrients and vitamins it needs from food.

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What Happens After Radiation

Radiation side effects are different for each person. You may be able to exercise or perform your normal activities. Or you may not. Side effects also tend to get worse as more treatments are given. I lost my hair, experienced a great deal of fatigue and nausea, and skin dryness on treated areas. When these changes happen, acknowledge your side effects and react. No one expects you to go through treatment and act like it doesnt affect you. Once treatment is over, your body quickly adjusts to its normal self.

Radiation side effects are also different based on location. When I had radiation to my spine, I played baseball and rehabbed. When I went through craniospinal treatment or full body radiation, I exercised some, but had fatigue, general uneasiness, and internal side effects. Radiation to your brain causes hair loss, but over time it grows back. As your hair grows again, so will you.

Remember, during and after radiation treatment, listen to your body, ask questions, acknowledge side effects and adjust.

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
• Fatigue

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:

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Why Is Radiation Given

Radiation therapy is used to treat cancer and a few non-cancerous diseases. Radiation treatments can be used to:

• Treat cancer by killing, stopping, or slowing the growth of cancer cells
• Shrink tumors to reduce pain, pressure, or other side effects if a cure is not possible. The term palliative is often used to describe this process.

Radiation therapy is often used with other treatments

Radiation may be used before, during, or after surgery. It is used to shrink the tumor to a smaller size before surgery or to kill any remaining cancer cells after surgery. Sometimes doctors give radiation during surgery so the radiation can be directed right at the cancer cells without having to go through the skin.

Radiation can also be used with chemotherapy. Sometimes radiation is given to shrink the tumor before or during chemotherapy so the medicines will work better. Other times the chemotherapy helps the radiation treatment work better than chemotherapy alone.

Are There Options To Prevent Or Treat These Side Effects

Yes. Your health care team can help you prevent or relieve many side effects. Preventing and treating side effects is an important part of your overall cancer treatment. This is called palliative care or supportive care. Before treatment begins, ask what side effects are likely from the specific type of treatment you are receiving and when they may happen. And during and after treatment, let your health care team know how you are feeling on a regular basis.

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Side Effects Of Radiation Therapy

If you are going to get radiation therapy, its important to ask your doctor beforehand about the possible side effects so you know what to expect. Possible Side effects of external radiation therapy can include:

• Skin changes in areas getting radiation, such as redness, blistering and peeling
• Nausea and vomiting
• Painful sores in the mouth and throat
• Dry mouth or thick saliva
• Pain with swallowing

These side effects are often worse if chemotherapy is given at the same time as radiation.

Most side effects of radiation are temporary, but some less common side effects can be permanent. For example, in some cases radiation can cause a stricture in the esophagus, which might require more treatment. Radiation to the chest can cause lung damage, which may lead to problems breathing and shortness of breath.

If you notice any side effects, talk to your doctor right away so steps can be taken to lessen them.

What Is The Difference Between Radiation Therapy And Chemotherapy

There are several distinct differences between radiation and chemotherapy. One is the delivery method. Chemotherapy is delivered either orally or through an infusion, whereas radiation therapy involves high-dose radiation beams. Radiation therapy is more targeted, but it can impact adjacent cells. Chemotherapy can unintentionally target cells throughout your body, including hair follicles, bone marrow, and other vital components.

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Having Radiotherapy For Breast Cancer

You will have radiotherapy as an outpatient. It is usually given using equipment that looks like a large x-ray machine. You might hear it called external beam radiotherapy .

You usually have radiotherapy as a series of short, daily treatments. These are called sessions. The treatments are given from Monday to Friday, with a rest at the weekend. The person who operates the machine is called a radiographer. They will give you information and support during your treatment.

You usually have radiotherapy for 3 weeks. Women who had breast-conserving surgery may have an extra dose to the area where the cancer was. Sometimes the booster dose is given at the same time as radiotherapy to the rest of the breast. Or it may be given at the end of the 3 weeks. This means you will need a few more treatments. Your doctor will tell you how many treatments you will need.

If you have radiotherapy to your left breast, you may be asked to take a deep breath and hold it briefly. This is called deep inspiration breath hold . You do this at each of your planning and treatment sessions. It keeps you still and also moves your heart away from the treatment area. DIBH helps protect your heart during your treatment and reduces the risk of late effects.

External radiotherapy does not make you radioactive. It is safe for you to be with other people, including children, after your treatment.

Vitamins To Avoid During Radiation Therapy

Your radiation oncologist may tell you to avoid taking certain antioxidant vitamin supplements, such as vitamins C, A, D, and E, while you’re having radiation therapy. These vitamins might interfere with radiation’s ability to destroy cancer cells.This is because radiation works in part by creating free radicals highly energized molecules that damage cancer cells. Free radicals in the environment can damage all cells, but in the case of radiation treatment they are focused on the cancer cells. Antioxidants help keep free radicals from forming or neutralize them if they do form.

Because of the potential conflict between the goal of radiation therapy and the goal of antioxidants , it makes sense to stop taking any antioxidant supplements during radiation therapy. When radiation is finished, you can resume taking your supplements.

Throughout your treatment, do your best to eat a well-balanced diet that contains all of the vitamins you need. Vitamins that come naturally from food are unlikely to interfere with treatment.

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External Beam Radiation Therapy

The most common way of delivering radiation to the breast is with a treatment machine called a linear accelerator, which delivers radiation beams from outside the body, targeting the whole breast or chest wall.

The patient is positioned on a bed and the head of the linear accelerator is lined up to focus the radiation to the targeted area. At each treatment appointment additional time is taken to ensure the correct positioning of the patient prior to treatment delivery. Once correctly positioned, the treatment takes only a few minutes to deliver. The head of the linear accelerator moves around the patient, delivering the beams. Patients do not feel the treatment being delivered.

Although the radiation therapists leave the room while the treatment is being given, they monitor the patients on closed circuit television and through microphones in the treatment room.

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.

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Radiation Therapy And Sun Exposure

During radiation treatment, its best to keep the treated area completely out of the sun. This can be especially difficult if youre having radiation therapy in areas or seasons with warmer weather. To help avoid sun exposure:

• Wear clothing or a bathing suit with a high neckline, or wear a rash guard top.
• Try to keep the area covered whenever you go outside. An oversized cotton shirt works well and allows air to circulate around the treated area.
• Avoid chlorine, which is very drying and can make any skin reactions youre having worse. Chlorine is used to disinfect most pools and hot tubs.
• If you do want to swim in a pool, you might want to spread petroleum jelly on the treated area to keep the chlorine away from your skin.

After your radiation treatment is completed, the treated skin may be more sensitive to the sun than it was in the past, so you might need to take extra protective steps when you go out in the sun:

• Use a sunblock rated 30 SPF or higher on the area that was treated.
• Apply the sunblock 30 minutes before you go out in the sun.
• Reapply the sunblock every few hours, as well as when you get out of the water.

Written by: Jamie DePolo, senior editor

This content was developed with contributions from the following experts:

Chirag Shah, M.D., breast radiation oncologist, director of breast radiation oncology and clinical research in radiation oncology at the Cleveland Clinic in Cleveland, Ohio

References

What Side Effects Can I Expect After Radiation Therapy

How you feel after your first radiation treatment for cancer will depend on the type of treatment you had, the location of your cancer, and other characteristics that are unique to you. In many cases, you will not experience any side effects initially, but may experience some after multiple treatments as the therapy has a cumulative effect.

If you had internal radiation, you may experience soreness or tenderness where the catheter was inserted, and you likely will experience some degree of fatigue. You also may have side effects from any medication you were given during the treatment.

If you had external beam radiation, you may experience skin changes and fatigue following your initial treatment, or you may not have any radiation therapy side effects at all. Some people dont develop side effects from external radiation until theyve had several treatments.

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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.