What is Radiotherapy?
Radiotherapy is the use of powerful X-Rays, which are carefully focused on certain parts of the body to kill cancer cells that may be there.
When is Radiotherapy used in the treatment of Breast Cancer?
Radiotherapy is used in almost all cases where a person has undergone a lumpectomy (part of the breast removed) for breast cancer. It is used in selected cases where a person has undergone a mastectomy for breast cancer (the entire breast removed).
The aim of the radiotherapy is to eradicate microscopic cancer cells that may or may not be remaining after surgery. This is not a reflection on the surgery, but a reflection on the behaviour of breast cancer. Well conducted trials, with mature results, consistently show that radiotherapy lowers the risk of recurrence in the breast or chest wall by 65% – 70%. It is internationally accepted as an integral part in the treatment of breast cancer.
How long does it take?
Radiotherapy is given every working day (i.e. Mondays through to Fridays). Each treatment (also called a ‘fraction’) takes around five minutes to actually give. It takes around 40 minutes to get in and out of the department each day you are treated.
The entire course of radiotherapy takes from 3 to 6½ weeks. The same total dose is given in all cases, but the daily dose is bigger for a 3 week treatment and smaller for a longer one. Most courses in this department take between 5 and 6½ weeks.
You lie on a couch with a soft headrest, and a machine (called a Linear Accelerator) beams invisible X-Rays to the breast or chest wall. The machine is 3 to 4 feet away from you. The treatment does not hurt. You are alone in the room while the machine is on, but you are monitored on video camera by the radiotherapy staff and they can speak to you by intercom.
What are the Side Effects?
Most women report that radiotherapy is not a ‘severe’ treatment. It does not cause nausea, vomiting or hair loss. It does cause fatigue, although in most cases this is mild and you can generally do your normal activities while having radiotherapy. The commonest side effect during treatment is that the skin gets red, hot and sometimes sore – like sunburn. The skin may even develop small breaks in it, which can be painful. Radiation Therapists and Specialist nurses will monitor this and help you to manage the skin with appropriate creams, ointments and dressings. Skin breaks usually heal within 2 weeks of completing radiotherapy, and the redness is usually gone within a month. Darker skin may persist for 6 to 9 months after, and in most cases the skin goes back to its normal colour. The breast may be tender or slightly sore for up to a year after treatment, but is rarely severe.
Radiotherapy can have effects later in life. They include skin changes which may be permanent, or changes in breast shape, which are less common. More serious effects can include second cancers or heart disease, but these are rare. Careful studies have shown that the benefits of radiotherapy greatly outweigh these risks.
How does it all happen?
Your case will be discussed at a meeting by all the specialists involved in the treatment of breast cancer. If radiotherapy is recommended, your breast surgeon will refer you to a Radiation Oncologist – a doctor who specializes in radiotherapy for the treatment of cancer. When you meet them, they will take your history and explain the role of radiotherapy for your breast treatment: why it is given, how it is given, the benefits and the side effects of radiotherapy. Bring a list of questions that you have thought of, and bring a second person along to listen and ask questions (unless you prefer to attend on your own). If radiotherapy is appropriate the Radiation Oncologist will book it for you. It happens within 12 weeks of your last operation or 4 weeks after chemotherapy, if chemotherapy is given.
Radiotherapy must be planned carefully and precisely. To achieve this, a CAT scan is done of your breast or chest wall. It enables us 1.) to be sure we do not miss the breast and 2.) to minimize dose to surrounding tissues like lung and heart. The scan is done as a day case, and the whole appointment takes less than an hour on average. A Radiation Therapist will give you information on the procedure and the treatment process. You will have the scan, and tiny (1-2mm) tattoos will be marked on your chest. These tattoos are rarely noticeable but some women find them sore while they are being placed. These tattoos are essential to ensure that treatment is delivered accurately on a daily basis.
After this you go home; and the Radiotherapy Department staff work on producing a plan for your treatment that is effective and safe. You will be given a timetable for your radiotherapy treatment, which includes a starting date.
Do I have to be admitted to hospital for my radiotherapy?
No: radiotherapy is usually administered as an outpatient, and this is encouraged. Transport assistance is available for those who have difficulty making the journey. Accommodation is available in special situations where daily commuting is not possible.
Who looks after me during my treatment?
Nurses:specially trained in caring for people undergoing radiotherapy are available anytime during your treatment.
Radiation Therapists: specialized technical staff responsible for the accurate and safe administration of your radiotherapy treatment.
Doctors: consultants and junior doctors are available to attend to your medical needs.
Physics Staff: plan radiotherapy your treatment and perform Quality Assurance on the equipment in the department
Allied Health Professionals: Dieticians, Speech Language Therapists and Clinical Liaisons.