Radiotherapy treats cancer by using high energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. Treatment is usually given daily for several weeks as an out-patient. It is often used after surgery for breast cancer, though may occasionally be used before or instead of surgery. More medical information about radiotherapy can be found on Macmillan Cancer Support’s website.
After a wide local excision, radiotherapy is sometimes given to the remaining breast tissue to reduce the risk of the cancer coming back in that area. After a mastectomy, radiotherapy to the chest wall may be given if the doctor thinks there is a risk that any cancer cells have been left behind. Some women with DCIS have radiotherapy after surgery, but it depends on the grade of DCIS and the type of surgery given.
Radiotherapy is normally given in the hospital radiotherapy department as a series of short daily sessions. The treatments are usually given from Monday to Friday, with a rest at the weekend, and may last from 3-6 weeks. Each treatment takes 10-15 minutes and is usually given as an outpatient.
To ensure maximum benefit from radiotherapy, it has to be carefully planned. This is done using a CT scanner, which takes x-rays of the area to be treated. Treatment planning is a very important part of radiotherapy and it may take a few visits before the clinical oncologist (the doctor who plans and supervises the treatment) is satisfied with the result. Marks are usually drawn on the skin to help the radiographer (who gives the treatment) to position a person accurately and to show where the rays will be directed. These marks must stay throughout the treatment, and permanent marks (like tattoos) may be used. These are tiny, though some people feel a little discomfort while it is being done.
Several women said they had been surprised to be invited to choose a radiotherapy appointment time that suited them. Some used hospital transport to get to the hospital while others used their own car or were driven by their husband or a friend. At the beginning of each radiotherapy session, the radiographer positions the woman carefully on the couch and makes sure she is comfortable. During treatment, women are left alone in the room but will be able to talk to the radiographer who will be watching from the next room. Radiotherapy is not painful, but the woman does have to lie still for a few minutes while the treatment is being given. Many women praised the care they got when they went for radiotherapy, several commenting on the friendliness of the staff, the efficiency of the procedure and the niceness of the environment.
Radiotherapy to the breast sometimes causes side effects such as reddening and soreness of the skin, tiredness and feeling sick (nausea). These side effects gradually disappear once the course of treatment has finished. The tiredness may continue for some months. Some women wondered whether their tiredness was more to do with the daily journey to the hospital rather than due to the treatment itself. Perfumed soaps, creams or deodorants may irritate the skin and should not be used during the treatment. At the beginning of the treatment, women are given advice on how to look after their skin in the area being treated. Many women said they massaged their breast with cream for several months to look after it.
Radiotherapy may make the breast tissue feel firmer. Over a few months or years the breast may shrink slightly. The radiotherapy may also, rarely, leave small red marks on the skin, which are due to tiny broken blood vessels. For many women, however, the appearance of their breast is very good.
Some of the women we spoke with said they had very few side effects and that it was only towards the end of treatment that they noticed their breast was peeling or slightly sore. One woman said she had no redness or burning, though her breast felt hot on the last session and she felt a bit tired afterwards. Another said she worked throughout her treatment and, though she had no side effects to her breast, she did feel tired.
A younger woman with DCIS said she felt ‘exhausted’ during radiotherapy. She hadn’t realised she would be having it daily for five weeks and also had two small children to care for.
Most women were happy with the information they were given about radiotherapy, though a few said they would have liked more beforehand because they hadn’t known what to expect when they got to the hospital. Several said they were not told that the breast had to heal before they could have radiotherapy. A few were also concerned about the effects of radiotherapy to their heart. One woman said that the doctors looking after her disagreed on whether she needed radiotherapy after her mastectomy, so she had to decide for herself and declined it. She didn’t want any more treatment but also felt she didn’t have enough information about it and whether she really needed it.
One woman said she had radiotherapy to her reconstructed breast and nipple after a mastectomy. A few women said they were waiting to have radiotherapy. One of these women noted that, although she had invasive breast cancer in one breast and DCIS in the other, she would only be having radiotherapy to the breast in which she’d had invasive cancer. Another said she’d had a wide local excision and was waiting to find out if she would need radiotherapy, which she would be told about at her next hospital appointment.
Some women said they were told they didn’t need radiotherapy and they were pleased not to be given any more treatment. One woman said that, after having a mastectomy and immediate reconstruction, her doctor told her that she’d had DCIS as well as Paget’s Disease (a rare cancer affecting the nipple). He recommended she have radiotherapy and hormone therapy. After a team meeting, however, doctors decided radiotherapy was unnecessary because she’d had a mastectomy, but she found this worrying and confusing.