VIEWS: 32 PAGES: 4 POSTED ON: 7/4/2009
Radiation Therapy Radiation therapy—also called radiotherapy—is a highly targeted, highly effective way to destroy cancer cells that may linger after surgery. This reduces the risk of recurrence. Despite what many women fear, radiation therapy is relatively easy to tolerate, and the side effects are restricted to the area being treated. Next Page: Ten Key Points About Radiation Therapy Ten Key Points About Radiation Therapy Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. 1. Radiation is a local, targeted therapy designed to kill cancer cells that may still exist after surgery. 2. The actual delivery of radiation treatment is painless. But the radiation itself does cause some pain and discomfort over time. 3. External radiation treatment, the most common kind of radiation therapy, does not make you radioactive. 4. You will receive treatment five days a week for up to seven weeks. Occasionally, radiation may be given twice a day over one week. 5. Since the daily appointments are usually about a half-hour, you will most likely be able to keep to your normal routine during your course of treatment. 6. You will not lose your hair when you are undergoing radiation therapy, unless you also being treated with chemotherapy. 7. Your skin in the area where you are receiving radiation can turn red, become more sensitive, and get easily irritated. 8. Over the course of your treatment, you may begin to feel tired. This feeling can last for a few weeks—even months—after treatment ends. 9. The side effects of radiation treatment are usually temporary. 10. For most types of breast cancer, radiation therapy after surgery significantly decreases the possibility of cancer recurring. Next Page: Why Radiation's Necessary Why Radiation's Necessary Research News: No Radiation after Lumpectomy Lowers Survival Studies have shown that women with breast cancer who are 75 or older are less likely than younger women to be offered chemotherapy or radiation following breast cancer surgery. Read more. Although it's quite possible that your surgeon "got it all" —removed the whole cancer—breast cancer surgery cannot guarantee that every last cancer cell has been removed from your body. No cancer therapy can. Individual cancer cells are too small to be felt and seen at surgery or detected by X-ray. Any cells that remain after surgery can grow and eventually form a lump or show up as an abnormality on a mammogram. Or, cancer cells can spread to other parts of your body as metastases. After surgery for breast cancer, every woman wants to have the greatest possible chance that she'll never see this cancer again. Radiation therapy provides an extra insurance policy to help you try to achieve that goal. Read an article about the importance of radiation after surgery. The time to deal with any possible lingering cancer cells is right after surgery. This is the time when the chances are good that hardly any cancer cells are there. For this reason, your doctor will suggest that you start radiation therapy soon after your breast cancer surgery or after you complete chemotherapy. Without radiation or other additional therapies after surgery, you may have a much higher risk of the cancer returning. Recent research has shown that women who receive radiation after lumpectomy are more likely to live longer and remain free of cancer longer than women who do not get radiation. Another research study showed that women who don't get radiation after lumpectomy have a 40% greater chance of the cancer coming back in the same breast. Other research has shown that even women with very small cancers (one centimeter or smaller) benefit from radiation after lumpectomy. More on combined therapies for better treatment. Next Page: How Radiation Works How Radiation Works Light is a form of energy that we can see. Radiation behaves much like light, but has much more energy, and is invisible to the human eye. In radiation therapy, high-energy beams of radiation are focused on the breast from which cancer was removed. Over time, this focused radiation damages cells that are in the path of its beam—normal cells as well as cancer cells. Cancer cells are very busy growing and making new cells—two activities that are very vulnerable to radiation damage. And because cancer cells are less well organized than healthy cells, they are less able to repair the damage and recover. So cancer cells are more easily destroyed by radiation, while healthy, normal cells repair themselves and survive. There are two ways to give radiation therapy: externally and internally. External radiation Most likely, you will receive radiation externally. With this technique, a large machine called a linear accelerator delivers high-energy radiation to the affected breast. You will receive this treatment as an outpatient in daily sessions over five to seven weeks, depending on your particular situation. When you hear the term "radiation therapy," you can usually assume it means external radiation unless otherwise specified. As indicated in these illustrations, you will probably receive radiation to the breast from two different treatment fields, which face each other. The two fields come from opposite directions: the One starts from the side of is). breast and faces the middle of the chest (where the breastbone One starts in the middle of the chest and faces the side. The radiation oncologist can maximize the amount of radiation delivered to the breast area and minimize radiation received by other parts of the body, by doing the following: with treating the breast area area, angled fields that skim across the chest, just catching the breast and placing the back of the two fields as close to the breast area as possible. Internal radiation In some cases, your doctor may recommend that you have "internal radiation" (also called "brachytherapy" or "high-dose intracavitary radiation") instead. With this technique, radioactive material is temporarily placed inside the breast, where the tumor used to be. This is typically reserved for the end of treatment and is given as an additional "boost," to supplement the regular radiation given to the whole breast. Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. In some cases, after breast-conserving surgery for early-stage breast cancer, internal radiation limited to the area where the cancer was might be as effective as whole-breast radiation. The studies on this type of radiation treatment are still going on. After five years of follow-up, one study showed no difference in recurrence or survival rates between women with early-stage disease who had breast-conserving surgery plus whole-breast radiation, and women who had the same type of disease and surgery but received limited-field radiation. Talk to your doctor about which option would be best for YOU. Next Page: Radiation AND Chemotherapy Radiation AND Chemotherapy Tumors are complex collections of cells that have a different kinds of potentially dangerous, erratic "personalities. Because of this, doctors have to attack these cancer cells in a number of different ways. You may have needed more than one type of chemotherapy, together, or in sequence. Now, you're moving on to radiation therapy; and maybe tamoxifen is waiting for you around the corner. Radiation and chemotherapy work very differently, even though patients often confuse them with each other. Radiation is a "local" treatment, which means it is a therapy focused on a specific area of the body. Chemotherapy is "systemic," meaning it attacks cancer by treating the whole body. Because they are so different, radiation and chemotherapy can provide a strong one-two punch in attacking cancers. In fact, studies have shown that by attacking some cancers with radiation AND chemotherapy, you will actually increase the strength of each therapy (this is called synergism). In determining the right combination for you, your doctor will be careful to tailor your treatment to the cancer and your sensitivity to potential side effects. Next Page: When Is Radiation Appropriate? When Is Radiation Appropriate? Because it is so effective and relatively safe, radiation therapy has a defined role in treating breast cancer in all of its stages, from stage 0 through stage IV. It may be appropriate for women who have had lumpectomy or mastectomy. Find out more about radiation after breast cancer surgery. understanding the right More on stages of breast cancer treatment for you More on After lumpectomy Today, radiation therapy is recommended to most woman who receive breast preservation surgery (lumpectomy or partial mastectomy). Find out more about the benefits of radiation therapy. Typically a doctor will recommend lumpectomy followed by radiation if the cancer is: early stage four centimeters smaller than site and able to be removed without taking too much located in one surrounding normal tissue. After mastectomy About 20–30% of women need to receive radiation therapy after mastectomy, to the area where the breast used to be. Women who receive radiation after mastectomy are typically those who have a greater chance of the cancer recurring. Women who are at moderate risk for recurrence (in the "gray zone,") may opt for radiation for both medical and emotional reasons. Most women want to know they have done everything reasonable to attack their cancer, so that (they hope) they'll never have to deal with it again. Typically, a doctor will recommend radiation therapy after mastectomy if: The tumor is larger than five centimeters. of resection. tissue has a The removed lymph nodes positive margin or more were Four cancer is multi-centered—itinvolved. in a number of locations occurred The the breast. within Radiation is NOT an option if you are facing one of these situations: to that area of You have already had radiation disease, such the body. or vasculitis, have connective as lupus You makesayou sensitive tissue side effects of radiation. that to the so should radiation therapy. You are pregnant and to commit not havedaily schedule of radiation not willing to the You are or distance makes it impossible. therapy, Can radiation therapy be repeated? Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. Doctors try to do all they can to get rid of any possible cancer cells that may be remaining in your body. In radiation therapy, your radiation oncologist will typically give you close to the maximum therapeutic dose—the dose that destroys cancer cells and that the normal tissue of your breast can also safely withstand. Because you have received about as much radiation as your healthy cells can safely handle, it is not possible to treat this area again with another full dose of radiation. If cancer returns to the same breast area, depending on the radiation dose you already received, you may or may not be able to receive a limited amount of additional radiation treatment in that same area. It is important to note that this refers to re-treating the same part of the body. If cancer should occur elsewhere in your body, outside the treated breast, radiation can be used to its full effect. Next Page: What to Expect How Much Radiation? The basic unit of measurement of radiation is called a rad or centiGray. The daily dose is also known as a "fraction," because each dose is a fraction of the total dose prescribed. Generally, you will receive 180–200 rads or centiGrays during each daily session (based on the size of your breast and whether or not you underwent chemotherapy as well). Throughout the first phase of treatment you will receive about 4500–5000 centiGrays in all. During the second phase of treatment you will receive an additional 1000–2000 centiGrays delivered as a "boost," targeted to the area where the tumor used to be. The total amount you receive depends on factors such as the size, surgical margins, and "personality" of the tumor, as well as the type of surgery you had (mastectomy or lumpectomy). the "boost dose" More about surgical margins More about the personality of breast cancer More about Next Page: Your Treatment Team Daily Treatment Routine Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. Even if the planning session went smoothly and everything is ready for you to start your treatment, you will probably feel uneasy on the first day of radiation therapy. Dr. Marisa Weiss notes, "Only after you begin your treatment can you really relax, get into the routine, and be reassured that the treatment is going to help you, not hurt you." To give you a sense of what to expect, this list walks you through a typical visit to the treatment center: you arrive at center When or robe. You'll the treatmentremove you'll change into a hospital gown also need to clothing on the upper half of your body as well as any jewelry that might get in the way of the treatment (such as long necklaces). therapist will bring you to a treatment room A radiationin the treatment position. Typically, you'll liewhere you will be placed on your back with your arm (the one on the side of the breast area being treated) raised above your head. Most treatment centers use an immobilization device to secure your position and make you more comfortable. If you are receiving radiation after mastectomy, the therapist may place a bolus (a flat piece of rubberlike material) on top of your skin, which increases the radiation dose to your skin and to the tissues right below it. the technician the linear accelerator Next, treatment field.will carefully line upin the treatment room to treat each Most of the time will be spent waiting for the technician to move the linear accelerator into position. After the machine is positioned, the technician will leave the room. Although you may feel alone, you are not. The technician can see you through a window or on a television screen and can hear through an intercom at all times. the machine to the dose of The technician will then turn onradiation, the onlydeliveryou will know radiation. Since you cannot feel way when you are exposed is by the whirring sound of the machine. During this time, you must remain completely still, though you don't have to hold your breath. It only takes between thirty seconds and a few minutes to deliver the radiaion (depending on the equipment being used). technician the second The that will be will then return to find your position for two different field treated that day. Typically, you will have fields treated each day. If the adjacent lymph nodes are also being treated, one to three additional fields may be added. differences, all radiation oncology Although there are individual that the daily treatment process takes centers try to work efficiently so between fifteen and thirty minutes. will have X-rays taken the Each week, you films." Your doctor usesofthesetreatment field. These are called "port to double-check that the radiation is precisely hitting the correct areas of your body. (Because the tattoos on your skin can move from side to side, its important to have one more way of making sure that the treatment is precise.) Next Page: Is the Radiation Working? Is the Radiation Working? In general, you will be receiving radiation to eliminate any cancer cells that may have been left behind in the breast area after surgery (mastectomy or lumpectomy, with or without lymph node removal). And because cancer cells are too small to be seen (except by microscope), unfortunately there is no way of really knowing if the radiation is working. The port films (X-rays of your treatment field, taken weekly throughout radiation) tell your doctor if radiation is reaching the areas where it can do the most good. But they cannot tell you if there were cancer cells present or how they are reacting to the radiation. Essentially, undergoing radiation therapy is almost like buying disability insurance or auto insurance. You hope you don't ever have to rely on that policy, but you certainly want it there to protect you, just in case. Because there is no physical evidence of how cancer may be responding to radiation, it is essential that you receive the entire course of treatment as originally planned. Next Page: Vitamins to Avoid Vitamins to Avoid Your radiation oncologist may tell you to avoid taking supplemental vitamins that are known to be "anti–oxidants" (such as vitamins C, A, D, and E) while you are undergoing radiation therapy. This is because these vitamins can interfere with radiation's ability to destroy tumor cells. Here's why: Radiation works in part by creating "free radicals"—highly energized molecules that damage the cancer cells. But anti-oxidant vitamins PREVENT free radicals from forming, or neutralize them if they do form. Because of this conflict between the goal of radiation therapy and the goal of anti–oxidants, it makes sense to stop any anti–oxidant supplements you are taking during radiation therapy. When radiation is finished, you can resume your supplements. Throughout your treatment, do your best to eat a well–balanced diet that contains all of the vitamins you need. Vitamins that you absorb naturally from food are unlikely to interfere with treatment. Next Page: Boost Dose Boost Dose Through the first five to six weeks of your treatment, you will receive radiation to your entire breast area. During the final week or two, you will also receive a supplemental dose targeted directly to the area around your surgery. This dose is called the "boost" and can be delivered either through external radiation or internal radiation. External radiation If you receive your additional "boost" of radiation externally—as the vast majority of women today do—you won't really notice any difference from the usual method of treating the whole breast. You will receive this dose from the same machine that is used for your other therapy, and you'll probably lie in the same position. Internal radiation Internal radiation, also called brachytherapy, is not as common as external radiation. However, it is still used in some parts of the country to provide a "boost" dose. With this process, you will have small tubes or catheters sewn under your skin in the area where the tumor was removed. Next, radioactive "seeds" are placed in these tubes that emit radiation to the nearby tissue. In most cases, you will have these "seeds" within you for a day or two. During this time, you will be required to remain in the hospital. You should not feel slighted when your visitors are limited and the staff spends little time with you. This method of internal radiation makes you radioactive to yourself and to anyone who comes in contact with you. However, the hospital staff know how to protect everyone in this situation. A newer method lets you receive internal radiation as an outpatient. The process uses a "high-dose rate machine" to briefly implant seeds in and then take them out. With this internal radiation you will still have catheters placed under your skin, but you do not remain radioactive when you leave the treatment center. A number of current studies are investigating the value of internal radiation as the sole form of treatment. Although it can be much less convenient than external radiation, it may be more effective in some situations. Next Page: Radiation Side Effects Radiation Side Effects Expert Answers: Managing Treatment Side Effects Breast Cancer Pain Many patients are surprised to discover that radiation therapy is less difficult than they first thought. Many of the side effects they first expected proved to be misperceptions. Still, the radiation used to kill cancer in your body can also damage normal cells, and you will feel the impact of this. Just as the benefits of radiation are gradual, you'll find a gradual onset of side effects. In this section, we outline the kind of reactions you can expect with radiation therapy, so that you can anticipate these problems. By anticipating these reactions and responding quickly to them, you and your doctor can minimize their effect on your life. Not everyone suffers from these side effects. After treatment ends, the side effects typically stop without further medical treatment. The helpful tips that follow—in addition to your weekly appointments with your radiation oncologist and nurse—will assist you in dealing with these reactions, should they arise. Next Page: Skin Reactions Skin Reactions The most annoying and uncomfortable side effects of radiation therapy involve the skin of the area being treated. In many ways your skin reaction will be similar to a sunburn, with a mild to moderate pink color, or redness, and with itching, burning, soreness, and possible peeling. But unlike a sunburn, your skin will react to radiation much more gradually, and perhaps only in patches. The first thing you'll notice will be a change in the color of your skin, from pink to red. Some areas of your skin may turn redder than others: near the armpit, in the upper inner part of the breast area, and along the fold under your breast. Your skin reaction may be mild, and limited just to these areas. Your skin might have a more dramatic reaction to radiation, covering more of the breast area. This is more likely to occur if: complexion is Yourare big-busted.fair and susceptible to sunburn. You are receiving radiation after mastectomy, and the treatment is You designed to give a high dose to the skin. You've had recent chemotherapy. As with a sunburn, the skin may also become dry, sore, and more sensitive to the touch. Irritation may increase. The skin can start to peel in a dry way, like an old sunburn, or in a wet way, like a blister. This peeling will probably be limited to a few areas of the involved skin. If the blister opens, the exposed raw area can be quite painful and weepy. Your skin reaction can become more serious if the exposed area is not treated, and infection develops. Your radiation oncologist can work with you to help you manage any of these signs or symptoms. Eventually, pearly patches of new skin will grow in and cover the exposed areas. As the new skin grows back in, it is protected by the top of the blister or the overlying old, dry, flaky skin. Your radiation oncologist or nurse will need to see you more often than once a week to help you through this tough (but temporary) time. If problems become especially troublesome, your doctor or nurse might suggest taking a short break in treatment to allow your skin to recover. Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. All of these skin changes happen gradually, and can be predicted in your weekly examinations by your radiation oncologist and nurse. You should be aware of the range of possible skin reactions so that you're not taken by surprise. Fortunately, radiation–induced skin irritation is temporary. If you find that the pain and irritation are not getting better, you should consult your doctor and nurse. After you complete radiation therapy, the effects on your skin may continue to worsen for another week or so after treatment has ended. Your skin will then begin to improve. The deep redness and the sensitivity should go away over the first weeks after treatment. The skin will take somewhat longer to completely return to its natural color. You may find that the treated area has a tanned or slightly pinkish look to it for up to six months after your last session of radiation. If you are African-American, your skin may be more tan and less red. Your skin can become very dark, and it may take longer for changes to go away. Over the long term, some women may retain a slightly pinkish or tannish hue. And a few women may notice a small patch of tiny blood vessels on the skin of the radiated breast area. These vessels—called telangiectasias—look like a tangle of thin red lines similar to spider legs. They are not a sign of cancer recurrence, but they are a less-than-attractive cosmetic side effect of radiation, without an easy remedy. What about sun exposure? The skin that has been exposed to radiation therapy may be more sensitive to the sun over the years than it was in the past. This area is especially vulnerable with some bathing suit styles. You can go out in the sun and have fun, but be sure to use a sunblock that is rated SPF 30 or higher on the area of concern. A strong sunblock is actually a good policy for every inch of your body, as a general recommendation from dermatologists. Next Page: Sensitive Skin Areas Sensitive Skin Areas The skin within the upper inner corner of your breast gets more irritated because: Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. angle of the skin in this The radiation the radiation beam is parallel to through it, as it area, so the skims across the skin (not just does in other areas where the radiation beam is perpendicular to the skin). area usually has received significant sun exposure, so it's less This to heal from additional damage. able The skin within your armpit gets more irritated because: forth against the radiated skin, which is The arm rubs back andand hair. already irritated by sweat The skin along the fold under your breast gets more irritated because: bras rub this area. Mostradiation beam skims across the skin in this region. The inside the fold rubs against itself. Skin Wear loose clothing Just as with any sunburn, the skin in the area being treated might become more sensitive to touch. For this reason, you should try to wear loose-fitting shirts, preferably cotton, during the period of your treatment. If the skin around the treated breast area becomes especially uncomfortable, wear a loose cotton bra without underwires. Or go bra-less! Next Page: Skin Care Tips Skin Care Tips If you are in the middle of your radiation treatment and your skin becomes irritated, you will still have to return for treatment. Here are a few things you can do to make the skin less sensitive and to help it return to normal after radiation treatment: warm rather Usenot let showerthan hot water while showering. on Do harsh soapswater fall directlyDial,your breast. (such as Ivory, and Irish Spring); instead use Avoid fragrance-free soaps with a moisturizer (such as Dove). daily treatment with an ointment Moisturize the skin after youror Radiacare. Put a lot on at nightsuch as A&D, Eucerin, Aquaphor, and wear an old T-shirt so it doesn't get on your bed clothes. burning, apply an aloe vera preparation. Or try For mild itching andcream (available without a prescription at any 1% hydrocortisone drugstore). Spread the cream thinly over the affected area three times a day. itchy, and If areas become especially red, relievessore, and start to burn, your low–potency cream no longer your symptoms, ask doctor for a stronger steroid cream that is available by prescription. Try 2.5% hydrocortisone cream first. If necessary, you can go up to Psorcon 0.05% cream or ointment. Dry flaking skin–like an old sunburn–responds nicely to frequent moisturizing and gentle cleansing. skin forms blister or peels in a wet way, the If your alone! The abubble keeps the area clean leave the top ofskin blister while the new grows back underneath. If the blister opens, the exposed raw area can be quite painful and weepy. Keep the area relatively dry and clean with only warm water. Blot the area dry and then apply a NON– ADHERENT dressing, such as Xeroform dressings (laden with soothing petroleum jelly) and "second skin" dressings made by several companies. To relieve discomfort from blistering or peeling, take Tylenol or even Percoset as you need it (no need to suffer!). Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. Learn more about good Skin Care. The raw areas and discomfort will start to get much better about one to two weeks after your radiation treatment is finished. Special comfort tricks Some women get some relief by blowing air on the area with a hair dryer set to "air" (no heat). Don't even think of wearing a bra during this time. Next Page: Armpit Discomfort Armpit Discomfort Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. After lymph node surgery, many women report discomfort and fullness in their armpit, which can be made worse by radiation. Surgery alone can cause your some discomfort in armpit: when nerves are cut. The skin gets numb and tenderness under the surface because your feel You mayhad topaina lot of pulling, pushing, and cutting there. surgeon do and of Fullness Also,swelling are part of your body's reaction to the traumaup surgery. if your lymph nodes were removed, fluid will back because it now drains differently than it did before. Added to surgery, radiation can make your armpit feel even worse, three or four weeks into your radiation treatment course. Plus the constant rubbing together of your arm against your armpit can irritate the skin in this area further. Sweat adds to the friction. To help your poor, besieged armpit, try the following: Use cornstarch powder instead of deodorant to reduce friction. deodorants. Avoid strong soaps, antiperspirants, or the course of your radiation under your arm Don't shave very European!). over treatment (it's Next Page: Fatigue Fatigue Expert Answers: Ease Fatigue, Boost Energy Fighting cancer is hard work. Many women undergoing radiation therapy find that fatigue is a common and persistent side effect of this treatment. The fatigue you will feel with radiation therapy is not the kind of tiredness that comes after "overdoing it" and goes away with a good night's sleep. This treatment-related fatigue is an overall, deep-felt lack of energy. About one in three women develops this exhaustion. Women become fatigued during radiation because of a combination of factors, including: effect on body radiation'sof keepingthe the routine of daily treatments to the rigors toll of the months since diagnosis the emotional effects from prior chemotherapy lingering physical lifestyle because of the disruption the treatment changes in diet and causes weight gain can there may be thatcure slow you down. are ways to limit the impact of Although no for fatigue, there fatigue on your life. Although immune suppression and anemia are not commonly associated with radiation therapy to the breast area alone, your doctor might want to keep an eye on your blood count if you have a substantial lack of energy. If your radiation follows right after a full course of chemotherapy, your blood counts may drop significantly enough to require treatment. Combating fatigue Although there may be no cure for fatigue, there are ways to limit the impact of fatigue on your life: body. You Listen to yourtreatment. If should expect fatigue intermittently during your radiation you acknowledge and expect it, you will better be able to deal with it when it occurs. is Re-establish a reasonable routine. If your daily routinestickmore structured and more realistic—a routine you can reasonably to— you will minimize the stress associated with fatigue. to exercise. Try to establish aA little bit of exercise should give you more energy. Try regular routine of walking or light swimming. If you feel more energetic afterwards, you might be able to increase the amount you work out each day. Just don't overdo it! more rest. Many patients Getday give them more energyfind that regular, brief "catnaps" during the overall. Save your energy for only the most important activities during the day. for and accept help. When you are Ask serious illness, it is a good time to ask undergoing treatment for any for help—at home and at the office. Asking your family, friends, and co-workers to help with chores, cooking, shopping, or office tasks gives them an important opportunity to help you in your fight against cancer. That's a plus for everyone. Often, religious communities (churches, synagogues, etc.) will eagerly rally around a member who is in need. Next Page: Breast Area Effects Breast Area Effects During a course of radiation therapy to the whole breast, most women will notice increasing fullness, swelling, and stiffness of the whole breast. The swelling combined with the skin irritation makes the breast area sore. Once treatment is over, and the swelling slowly goes away, the breast can become firmer, rounder, and more "youthful," with less of a droop (some women joke about having radiation to the other side to make a perkier match). These changes are due to scar tissue and fluid retention. You may feel that your breast appears smaller than it used to. That's mostly because the tissue removed during the biopsy, lumpectomy, and any related surgery doesn't grow back, and because your rounder contour may make your breast seem smaller. Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. Between the surgery and the radiation, your breast may remain somewhat numb and tender—an unpleasant combination that takes some getting used to. If this is how your breast feels to you, you may not want it touched. Over months, these sensations should improve substantially—but maybe not completely. For younger women, one unfortunate side effect of radiation is that they will probably not be able to nurse their babies in the breast that received radiation, because that breast is no longer able to produce significant milk. Next Page: Chest Wall Effects Chest Wall Effects Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. Your medical team works very hard during the planning session to limit the radiation to only the breast. But, in order to treat the whole breast as it curves around the wall of the chest, your doctor cannot avoid including part of the chest wall within the radiation treatment fields (this includes part of the muscles of the chest wall and the ribcage just beneath the breast). Both during and soon after radiation treatment, you may experience brief shooting pains—something like an electric shock. You may have had similar discomfort after surgery. These pains are due to swelling and irritation of the tissues, and can be eased with Tylenol or another anti-inflammatory medication. Soon after treatment is over they will go away on their own. Over the long term, you may feel muscle stiffness in the chest wall area, brought on by extra exertion such as vacuuming or other household chores. You're most likely to notice stiffness in the "pectoralis major muscle"—the one that connects the front of your shoulder to the front of your chest (as shown in the X-ray). The stiffness is caused by scar tissue, a result of the radiation treatment, that makes the muscle less supple and pliable. This problem is usually minor, occurs on and off, and improves with over-the-counter pain medications. Over the years, radiation to the ribcage makes the ribs slightly more likely to break. The chance of this happening is quite small (less than 1% of women experience this). If a break does occur, it usually happens only after a trauma, injury, or violent movement, such as a coughing fit. A fractured rib usually heals completely on its own. Next Page: Heart and Lung Effects Heart and Lung Effects In the past, some women who received radiation to the left breast area experienced a higher-than-expected number of heart attacks. That's because older machines gave a significant dose of radiation to the heart (just underneath the left breast). Fortunately, major technological advances over the years have resulted in fewer heart complications. The machines used today to design treatment fields, plan the way the dose is given, and deliver the radiation do a much better job of sparing normal tissue from the effects or radiation. Even with today's state-of-the-art equipment, a small part of the lung just underneath the chest wall is within the treatment fields that encompass the whole breast area. Scar tissue can form in this small part of the lung after radiation is over, just like the scar tissue that can occur if you have a bout of pneumonia. This is not dangerous to you, but you should be aware of what happens. Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. If scar tissue does form, it's usually found by a chest X-ray that's done for an unrelated reason. Keep this in mind in case you have a chest X-ray that shows an area of scar tissue—otherwise the doctor who reads the X-ray may be concerned that you have pneumonia or a recurrence of tumor. Symptoms, which are uncommon, can include a dry cough that doesn't produce any phlegm and shortness of breath. If the symptoms don't go away on their own, they usually disappear with a short course of steroids taken in pill form. Next Page: Five Radiation Myths Five Radiation Myths It is natural for anyone beginning a new medical treatment to be a little fearful— or scared to death, depending on who you are. For women beginning radiation therapy, this fear seems to be heightened by some common misunderstandings about the treatment. Myth #1: Radiation therapy is painful. Most patients cannot feel radiation from the machine during daily treatments. A few patients report a slight warming or tingling sensation in the area while the radiation machine is on. Over time, the skin in the area being treated will become dry, sore, itchy, or will burn. While these feelings can be uncomfortable, usually the discomfort is not enough for a woman to stop or interrupt her treatment. More on coping with skin reactions Myth #2: Radiation therapy will cause me to be radioactive. If you are treated with external radiation, you will not be radioactive at any time. The radiation you receive delivers its dose to your tissues within an instant— there is no lingering radiation once the treatment machine is turned off. As you try to keep to the normal rhythms of your life, it is important to remind friends, family, and co-workers that you will not expose them to radiation. If you receive internal radiation as a "boost" at the end of treatment, you will be radioactive while the radioactive material is in you. While you receive this internal treatment, you will be secluded in the hospital in a private room. Myth #3: Radiation therapy will cause me to lose my hair. If you are undergoing just radiation treatment, you won't lose the hair on your head (the hair on your nipple or in your lower armpit next to the breast might come out during radiation, but will grow back). The misperception that radiation makes you lose your hair comes from the confusion of radiation and chemotherapy. Since many patients begin radiation treatment right after their chemotherapy, it's understandable that the side effects of the two therapies are confused. Because chemotherapy is a "systemic" treatment, meaning it affects the whole body, you will likely lose your hair during this treatment. Radiation therapy is a "local" treatment, which means it is directly focused on the tissue of the breast area, and possibly nearby lymph nodes. Unless radiation is targeted at your head, you will not lose your hair from radiation. Myth #4: Radiation therapy will cause nausea and vomiting. Radiation treatment to the breast and lymph nodes will not cause nausea or vomiting. Most likely, this myth also arises from the common confusion of radiation and chemotherapy. Certain chemotherapy drugs may cause nausea and vomiting. Medicines such as tamoxifen and certain pain medications can also cause mild nausea. You also might find that your stomach becomes upset just from all the stress and anxiety of dealing with your illness. Myth #5: Radiation therapy will increase my chance of getting more breast cancer. Related Areas: Learn how to stay on track with radiation treatment, and why it's so important to stick with it. The purpose of having breast radiation therapy is to reduce the risk of recurrence in that breast. Radiation to one breast does not increase your chance of getting cancer in the other breast. It's true that there is a relationship between radiation and cancer: Adolescent girls receiving chest radiation for Hodgkin's disease have a higher risk of getting breast cancer because the newly developing breast is especially vulnerable to radiation damage. And a small percentage of women who were exposed to the atomic bomb blast at Hiroshima during World War II suffered from higher levels of breast cancer later in life. We now understand that this occurred because women were exposed to low levels of radiation over their entire body. The therapeutic radiation you will receive, however, is targeted precisely to the breast area, with almost no "scatter" to other areas of your body. Next Page: Research News on Radiation Therapy Research News on Radiation Therapy Radiation therapy is a highly targeted, highly effective way to destroy cancer cells that may linger after surgery. This reduces the risk of recurrence. In recent years, researchers have looked at whether radiation boosts to the area where the tumor was can help to further lower the risk of recurrence. And they have also looked at the benefits of radiation after lumpectomy. You'll find more research reports on lumpectomy and radiation in the Current Research on Surgery section. All of these research reports are part of the breastcancer.org monthly Research News program. Each month, our experts examine recent breast cancer research for exciting advances, important updates, and changes in how breast cancer is treated and diagnosed. We present these studies in easy-to-understand language, explaining their importance, how they were conducted, and what impact the results might have for YOU. If you'd like to find out about upcoming Research News reports, as well as other important breastcancer.org programs, including Ask-the-Expert Online Confernces, we encourage you to sign up for free email updates. If you find the Research News articles at breastcancer.org helpful and informative, please consider making a donation to breastcancer.org. This will enable us to continue providing up-to-date medical information and news on research breakthroughs to many more visitors like you.
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