Radiation Therapy for Breast Cancer

Radiation therapy for breast cancer uses high-powered X-rays to kill or damage cancer cells in your breast. It often happens after breast cancer surgery to remove a tumor. After the tumor is gone, radiation oncologists use radiation to get rid of any remaining cancer cells. With advanced breast cancers, radiotherapy can stop or slow tumor growth. This can help manage symptoms.

There are different ways to receive treatment. Types of radiation therapy for breast cancer include:

• External beam radiation therapy (EBRT): A linear accelerator (LINAC) machine sends beams of radiation to the tumor. The beams are designed to deliver strong doses of radiation to cancer cells without exposing healthy tissue to harmful levels of radiation.
• Brachytherapy: This is internal radiation therapy. A radiation oncologist places a small radioactive source (“seed”) into the tumor site. The seed releases powerful radiation that kills cancer cells while sparing healthy tissue.

Benefits and risks

For most people, treatment benefits greatly outweigh the risks. Radiation therapy has been a standard breast cancer treatment for over 100 years. This is because it can destroy cancer cells with minimal damage to healthy tissue. It reduces the chance of cancer coming back after surgery. And it helps people live longer.

But with any treatment, there are also downsides. Although this treatment limits radiation exposure to areas that aren’t cancer, it can still impact some healthy tissue. This can lead to side effects.

Short-term side effects of radiation therapy for breast cancer include:

• Mild fatigue: Most people start to feel noticeably tired during treatment. The feeling usually goes away a few weeks after treatment ends.
• Skin irritation: Your skin may feel dry and flaky. It may blister and peel. Some people develop sores that weep in the fold under their breast or between their breast and arm.
• Changes in skin color: If you have fair skin, the skin in the treated area may look like you have a sunburn. If you have dark skin, you may notice your skin appears darker than usual.
• Breast pain: Some people have dull pain or sharp, shooting pain in their breast. The pain typically comes and goes. Your nipple or breast may feel sore.

Long-term radiation therapy side effects include:

• Change in your breast size or shape
• Persistent fatigue
• Spider veins
• Swelling in the arm that’s on the same side as the treated breast (a sign of lymphedema)

Sometimes, radiation therapy to your chest can cause more serious issues. For example, it may increase your chance of developing a second cancer. It can sometimes lead to issues with your heart and lungs. These complications are very rare.

Your cancer care team will go to great lengths to keep you safe during treatment to prevent issues like these. Still, they’ll review the risks with you before treatment and address any concerns you may have.

What happens at my first appointment for radiation therapy for breast cancer?

With external beam radiation therapy, your first appointment is a planning session called a simulation (“sim”). During sim, your radiation oncology team will do a CT scan to map out the treatment area on your breast. This helps them design the radiation beams. They’ll tailor the shape and strength of the beams to you.

A team member will walk you through exactly what’ll happen during treatment. They’ll:

• Position you on the treatment table: They’ll place you on the table as you’ll be during treatment. They’ll use a special mold that fits your body to hold you in the right position.
• Mark the treatment area on your breast: They’ll make markings on your skin to help your cancer care team direct radiation to the right place during each session. The marks are about the size of a freckle.
• Teach you techniques to protect your heart and lungs from radiation: This may involve taking a deep breath and holding it at certain times during treatment. These breaths move your heart further away from the areas receiving the radiation.

Sim may take an hour or more.

What happens during treatment?

The specifics depend on your treatment plan, including the type of radiation therapy. Usually, radiation takes place over many days as an outpatient procedure. This means you can go home after each session.

When you arrive, a team member will give you a hospital gown to wear and escort you to the treatment room. The next steps will be a lot like sim. Your care team will:

1. Help you onto the treatment table: Most people lie on their back while others are on their stomach. How you lie depends on your treatment plan.
2. Get you into position: The radiation therapists will put you in a position that helps you stay still. You may need to place one or both arms above your head.
3. Explain how the machine will move: This will vary depending on the type of EBRT. The machine will rotate around you as it delivers radiation from different directions.
4. Deliver the radiation: You’ll hear a whirring noise when the machine comes on, but radiation beams are invisible. You won’t feel anything. Your care team will be in a different room at this time, but they’ll still be able to see and talk with you.

A session lasts about 30 minutes. The actual treatment takes place in two-to-three-minute increments during a 15-minute period. Most people get treatment for five days a week for one to six weeks.

How successful is radiation for breast cancer?

It’s extremely successful. Over the years, several studies have shown that radiation therapy after breast surgery greatly reduces the risk of a tumor coming back. Related, radiation after breast surgery reduces a person’s long-term risk of dying from breast cancer.

If breast cancer is too advanced to cure, radiation therapy can relieve symptoms like pain, bleeding and ulcers. It can improve your quality of life.

How long will it take for me to feel better?

Side effects often don’t show up until closer to the end of treatment or shortly after. The most common ones are fatigue and skin changes. This is because the effects of radiation therapy build up over each session. Once you stop treatment, both your body and skin get a break from the radiation. This helps with healing.

Is there anything I can do to make this treatment easier on me?

Radiation therapy can make your skin feel tender, itchy and painful. It may affect your appetite and leave you feeling tired. Here are some tips to help you push through:

• Wear loose-fitting cotton clothes. Tight-fitting bras and clothes may rub against your breast and make your breast hurt or feel sore.
• Baby your tender, itchy skin. Wash your skin with gentle soap and warm water. Ask your radiation therapy team to suggest creams that’ll help your skin feel better during and after treatment.
• Get some rest. The effects of fatigue can build up. You may feel especially tired during the last few treatment sessions. It’s important to build rest time into your days.
• Stay active — but take care not to overdo it. Regular gentle exercise, like a 30-minute daily walk, can help manage fatigue.
• Eat well. Healthy grains, fruits, vegetables, lean protein and low-fat dairy will help you stay strong throughout treatment.

Can you work during radiation for breast cancer?

Generally, yes, but it depends on your situation. You’ll probably feel OK when you first start treatment. As treatment continues, you may start to notice you have less energy.

Talk with your cancer care team to see how much work (and what kinds) may be doable at different stages of treatment. You may need to switch from full-time to part-time for a while. You may need to take time off during treatment or for the first few months after.

When should I call my healthcare provider?

Let your provider know anytime you have side effects that are more severe than you expected. They can suggest treatments to help.

What shouldn’t I do during radiation therapy?

Your radiation oncologist will talk you through what you should and shouldn’t do during treatment. It’s important to follow their guidance.

For example, it’s important that you don’t move during treatment. Try to lie perfectly still. You should also take deep breaths when they tell you to in order to protect your heart and lungs from radiation exposure.

Make sure that you’re doing everything you should leading up to treatment, too. This may include:

• Making sure that you don’t rub off temporary markings on the treatment area
• Wearing comfortable clothes to each session
• Reaching out with any questions or concerns you have