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Breast Cancer in women

Radiotherapy for breast cancer

Radiotherapy is given, where appropriate, to reduce the risk of a recurrence of breast cancer. It is a standard part of treatment after breast conserving surgery (it reduces recurrence rates from 26% to 7% *, and may be advised for some women after mastectomy treatment.

Radiotherapy treats cancer by using high energy X-rays to destroy the cancer cells, while doing as little harm as possible to normal cells. Treatment is normally given daily (from Monday to Friday) for 3-5weeks as an out-patient but can also be given on alternate weekdays for 5 weeks. Radiotherapy usually starts about 4-6 weeks after surgery unless chemotherapy is required. Radiotherapy is usually given after chemotherapy has finished. Patients go to radiotherapy planning sessions before treatment to make sure the radiotherapy rays are aimed precisely at the cancer and cause the least possible harm to the surrounding healthy tissues. 

Here women we interviewed talk about their experiences of radiotherapy and its side effects.

Women discussed the reasons why they needed radiotherapy and what it involved. A few mentioned delays in receiving treatment as a result of broken equipment.

 

Explains the reasons she was given radiotherapy.

Explains the reasons she was given radiotherapy.

Age at interview: 27
Sex: Female
Age at diagnosis: 24
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We went in there and they just said it had spread into my lymph nodes.

I think it had affected two or three, I can't remember but he had to, I think it was just two and he had to remove those.

But they didn't, you know, they felt sure that it hadn't spread to the rest of my body. They'd taken enough sort of cells and everything around the lump.

So they said' "Oh no, it's not gone right throughout everything." And that they'd caught it in time.

But they said that they felt they ought to still give me chemotherapy and radiotherapy to make sure that 'just in case' type thing.
 

Although some women were anxious before having radiotherapy, most found it painless and several continued working through it. Others pointed out that, while painless, radiotherapy was an impersonal or isolating experience.

 

Describes her experience of having radiotherapy.

Describes her experience of having radiotherapy.

Age at interview: 47
Sex: Female
Age at diagnosis: 44
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The process of having the radiotherapy treatment is actually quite short.

The first appointment you're sort of pinned up in a rather awkward position and it's a little bit cold and uncomfortable on the slab. But, in my instance, it was quite a nice wood panelled room, and it had quite a friendly feel to it.

And it's odd being lined up and measured and you do feel a bit like something on a dissecting board. But it's also quite an interesting experience.

Before the treatment you have a planning appointment where you're literally marked out before you're put under the radiotherapy treatment units.

You have this appointment where you're measured up and then you're sort of done again in the x-ray rooms.

And that again was measuring and drawing with felt tip pen and things, and actually quite an interesting thing to go through, it's certainly not painful, it's just a bit uncomfortable.

And you have to lie very, very still in a slightly awkward position for a few minutes, and they used to measure me up and move things around.

The first time it took about ten minutes for the first treatment to get it measured up, and then they'd got everything sorted and subsequent treatments it was very quick.

And the room was darkened and you'd see all these red lines and marks where the lights come down.

As I say it wasn't unpleasant but, if you're feeling a bit depressed, when everybody rushes out of the room and the lights flash you do feel very alone, or you can feel very alone.

And that's probably why it would be nice to take somebody with you. But people react differently in these circumstances and want different things.
 
 

Explains that she was able to work throughout her treatment.

Explains that she was able to work throughout her treatment.

Age at interview: 56
Sex: Female
Age at diagnosis: 53
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We were approaching Christmas, so they didn't start the radiotherapy until straight after Christmas.

That was no problem to me at all, I didn't have any side-effects, I actually asked for the last appointment every day, I went to work, left half way through the afternoon, drove up to the hospital, had the dose of radiotherapy and went home.

But I didn't feel, otherwise I didn't feel any side-effects, I, the hospital were efficient, I didn't ever wait very long.

As I said I was the last appointment so, even though it was the end of the day they weren't usually running late and I had no problems in driving to and from on my own. I managed that really well.

I think that I had about 16 doses of radiotherapy, they were scheduled for 3 a week, and then right at the end I had a shot of what they called a booster.

 

Discusses her feelings of isolation while having radiotherapy.

Discusses her feelings of isolation while having radiotherapy.

Age at interview: 27
Sex: Female
Age at diagnosis: 24
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But with radiotherapy you're put in this horrible sort of machine thing.

I'd just lie in there and you haven't got, you know, you're a bit exposed, and everyone just leaves the room and you're left and there's all these lasers going across you. And it's dark. 

Yeah. I think I found that really horrible because you just feel so strange. And because you haven't got anybody near you. And no one can sort of sit in there with you and say that it's okay. 

And it's always a strange feeling because where is everybody, you sort of think'"Oh, I understand why everyone leaves the room but how can this be good for me if everyone else has to, like, leave the room and go behind a closed door and I have to sit here taking all this, these lasers going into my body?" 

And they pull, you know, you do feel like a bit of a slab of meat, because they pull you around and push you. I mean obviously just to get it right and they probably do it all day so it probably drives them mad. But you do feel like a slab of meat eventually, and that's -

Yeah they probably don't talk, you know, they don't interact with you in the same way that the chemotherapy nurses did, so I think I found that that quite an impersonal experience. 

I'd say that would probably be the only time I ever felt that there wasn't much support. 
 

For some women radiotherapy was difficult. A few compared their experiences of radiotherapy with chemotherapy and explained why radiotherapy caused them greater anxiety.

 

Discusses her feelings while attending for radiotherapy.

Discusses her feelings while attending for radiotherapy.

Age at interview: 57
Sex: Female
Age at diagnosis: 54
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I went through radiotherapy, that was, that I found more difficult than chemotherapy. And I think it was the fact that for every day, every day in the week, Monday to Friday, I had to go through a door that said 'radiotherapy'.

I had to sit with quite a lot of different people, some looking very ill, some looking very well. A lot of people that wanted to talk. There was no counselling available there and people wanted to talk, there were so many that had problems.

And you have to undress every day to have, to have your radiotherapy and eventually after the first week you get used to it but I, I found that difficult. I think it was, I was facing my diagnosis every day and perhaps I hadn't before. I was treated very sensitively, very caringly, I was always covered up on the breast that wasn't having the treatment.
 

One woman took part in a clinical trial in which radiotherapy was given two days a week followed by a break, rather than daily for several weeks. Another had intra-operative radiotherapy, which involves having radiotherapy during breast surgery. One woman, who was awaiting treatment, explained that she did not know much about radiotherapy or what to expect.  

 

Describes her experience of intra-operative radiotherapy.

Describes her experience of intra-operative radiotherapy.

Age at interview: 56
Sex: Female
Age at diagnosis: 54
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So when I went to see Professor [name], by this time armed with a briefcase full of research, he told me about another new procedure called intra operative radiotherapy.

Instead of having six weeks post radiotherapy, which is traumatic, which is uncomfortable, which can be scarring, he explained to me that they had developed a tool that whilst you were in surgery, after they had removed the lump and made a wide excision so that if there's a little spread around where the tumour is they do what they call a wide excision, then they put a golf ball type thing into the wound, everybody evacuates the theatre and a sort of lead screen goes up.

And I was out of it because I was under anaesthetic.

So I had my sentinel node biopsy, then I had intra operative radiotherapy. And that in my opinion, as far as I was concerned, negated the need for post operative radiotherapy.

Although they are doing now larger doses under the operating, they didn't give me the full blast and therefore they wanted me to have continuing radiotherapy but for less weeks.

And that was then a personal decision I had to come to terms with.
 

Some women described their experiences with hospital staff as friendly and supportive, though a few felt that staff had been abrupt or cool. Talking with other patients was, for some women, encouraging. One woman preferred not to talk with other patients in the waiting room because she wanted to deal with her own feelings.

 

Explains that she did not talk with other patients in the waiting room because she was dealing...

Explains that she did not talk with other patients in the waiting room because she was dealing...

Age at interview: 66
Sex: Female
Age at diagnosis: 64
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To start with it was very slow and you had to wait a long time but you just accept that. But some days I was in and out very quickly. What I found I didn't want to do was get involved in conversations with the other patients. I did not want to hear anybody else's story because I was having a hard enough time coping with my own.

But some of the patients liked to treat the whole waiting room to their story, I found that difficult. And I used to go off and get a cup of coffee, thank God for the WRVS (waiting room vending services).
 

Some women had no side effects from radiotherapy. Many, though, did, either during or after treatments. These included tiredness and skin problems such as 'weepiness', soreness, redness or burning, for which most women used creams.

 

Explains feeling unexpectedly tired as a result of having radiotherapy.

Explains feeling unexpectedly tired as a result of having radiotherapy.

Age at interview: 52
Sex: Female
Age at diagnosis: 48
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So in the January I started my radiotherapy and I had 25 doses of radiotherapy.

And that was the most devastating thing that I've had. The treatment was fine, I've got lots of tattoos all around here, little dots so they can line up the lasers, but it was absolutely shattering. I worked, I worked full time for I think it was about the first three weeks of it. I used to come to the hospital, have my radiotherapy and then go to work.

And I sometimes think' "How did I manage?" But I think it was just sheer determination. But towards the end of the [radiotherapy], I think by the end of the fourth week, the radiographers were actually saying to me' "Are you not planning to have some time off? I think you should have some time off."

So I eventually had to give in and I had a couple of weeks off.

But it's incredible because you're just lying there and it appears as if nothing is happening and it just drains everything out of you. It's really quite astonishing. So it did, it did take mea wee while to recover from that.
 
 

Describes how she dealt with breast soreness after radiotherapy and the creams she used.

Describes how she dealt with breast soreness after radiotherapy and the creams she used.

Age at interview: 47
Sex: Female
Age at diagnosis: 44
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My breast became very red.

When you bathe you're not allowed to soak the breast or soap it, and you can just splash it. I mean for 6 weeks it's slightly awkward to lie in the bath. I prefer a bath. I found a bath was better than a shower because a shower would mean that it was constantly wet.

As I say I did use topical cream, a special cream that they recommended. I also used aloe vera which I know some places are doing a study on because it has very healing properties.

The whole breast went fairly red but the nipple itself went almost black as though I'd been grilled and eventually the top layer of skin came away completely and a new layer grew underneath.

That was rather surprising and I did look as though I'd been under a grill. But it really wasn't all that sore, it was odd but it wasn't all that painful.
 

A few women said they felt depressed during or after radiotherapy. Individual participants experienced temporary side effects such as frozen shoulder, aches in the bones, and loss of appetite. One woman had a pulmonary embolus (a blood clot in her lung) during radiotherapy.

 

Describes her feelings of depression after having radiotherapy.

Describes her feelings of depression after having radiotherapy.

Age at interview: 66
Sex: Female
Age at diagnosis: 64
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After about three weeks I started to get depressed, really depressed, and I said to the girls' "Does this make you depressed?" And they said' "Well it does some patients, would you like us to make an appointment with the counsellor?" So I said' "Yes." So again it was a Macmillan nurse who I saw.

I went on anti-depressants for a very short time in the summer, last summer, but felt worse and chucked them away. And I'm better off without them. [My GP] said to me' "Oh all cancer patients" - it was a bit of a sweeping statement - he said "all cancer patients get depressed". Perhaps they do.

I was depressed last summer, after about May, June. Because I had this thing - I remember sitting on the balcony of this hotel in [place], we went to [place] for a week - and crying and saying' "I don't know what to do with my life." I don't know why I thought I'd got to do something but I thought I had.
 
 

Describes some side effects of radiotherapy but has warm memories of the atmosphere in the...

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Describes some side effects of radiotherapy but has warm memories of the atmosphere in the...

Age at interview: 47
Sex: Female
Age at diagnosis: 46
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You mentioned that with the radiotherapy you had some burning at the end, did you? and tiredness, did you have any other side effects?

From the radiation?

Yes.

Not that I can think of no, it was fine. In fact it was, it was quite nice because, with going every day, it was a bit of a bind but it got me out of the house. I was meeting different people and I quite missed it when we finished, you know.

There was a lady in the cancer treatment centre who had had breast cancer and she was doing a hooky mat, you know where you poke wool through, and she was making this big wool covering.

And I used to go in and wait for my treatment and just sit and make this mat with her. And it was lovely.

It was very, very supportive. And they were lovely people, the radiographers were lovely.
 

Some women said having someone with them at appointments would have been helpful. Others advised taking plenty of rest during and after treatments, and accepting help if needed.

Healthtalk has a whole site on breast cancer in men, for more information see 'Radiotherapy for men with breast cancer'.

* BMJ 2008 337a421

Last reviewed August 2018.
Last updated May 2015.


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