I had a rule when I was undergoing active treatment for breast cancer, focus on one treatment at a time. One day at a time if necessary. So when radiotherapy rolled around after the great spectres of chemo and surgery had been monopolising my head space, I felt vastly unprepared.
Radiotherapy is often seen as the “easiest” of the first three lines of treatment for primary breast cancer. And while that is true in most cases, it still comes with its own myriad of side effects and hurdles to jump. Lets take a look at what you can expect.
Disclaimer; I am not a medical professional! I am a researcher that has also experienced it first hand. In this article I am talking about radiotherapy that is done to treat primary breast cancer. Everyone’s experiences will be different. So now we’ve got the housekeeping done…
What is radiotherapy?
For my fellow lay(wo)men out there, radiotherapy treatment directs beams of high energy radiation to cancer cells. The radiation destroys the DNA of the cancer cells, causing them to die.
The x rays of radiation are target the cancer with precision, to avoid damage to healthy tissue as much as possible. During my own treatment, even as I lay there in the vast machine pondering how this was my reality, I couldn’t help but marvel at the science and technology involved. It’s truly awe inspiring.
When is radiotherapy used for breast cancer?
For primary Invasive Ductal Carcinoma (IDC) and high grade DCIS (Ductal carcinoma in situ), radiotherapy is usually given after chemotherapy and/or surgery. Its purpose is to “mop up” any potential cancer cells left in the area, and ultimately help prevent recurrence.
How long do you have radiotherapy for?
Once you start radiotherapy, usually 3-6 weeks after surgery depending on your recovery, you will have treatment 5 days a week with weekends off. How many weeks this will happen depends on the type, stage and grade of the cancer you had.
I had high grade (aggressive) triple negative breast cancer, so I had 32 sessions of radiotherapy. That amounted to nearly 7 weeks in total. Sounds like a lot, and it is, but the actual treatment takes a matter of minutes. Also keep in mind that this is one extreme of the scale. Lower grade, less invasive breast cancers might only require as little as one week of radiation. Your oncologist will develop a regime tailored specifically to you.
How is radiotherapy administered?
Before you start radiotherapy you will have a “planning” session. This is a lengthy appointment at the radiotherapy department, during which you will have a CT scan. The scan will tell the radiologist the exact position of the cancer relative to your organs, bones and muscles. With that information they can “map out” the precise are that will be radiated.
They insert the coordinates onto the computer system, and match them up to your body. They will make pin prick sized tattoos on your chest, breast and under arm area to ensure that they line up the machine that emits the radiation perfectly each time. The tattoos are permanent, but pretty small. Here’s how my chest looked after my planning session. The red crosses are where they put the tattoos, there was also one under my arm.
Now you are ready to start.
I will admit I had absolutely no idea what to expect from my first radiotherapy session. I was nervous, but rest assured there’s really no need to be.
You will be asked to take your top and bra off (get used to having your boobs out a lot, if you’re lucky enough to still have them) and be shown to the table. They will position you on the table and tell you to put your arms up above your head. Make sure you are comfortable as you have to say as still as you can.
Then the magic happens. Lasers come out of the wall and the technicians line them up with the tattoos on your chest. The machine moves into position over you. Everyone leaves the room, always a little disconcerting, then it begins. It’s a bit noisy, I can still remember the distinctive sound it makes as if it was yesterday. But you don’t feel or see anything. After a few minutes you’re done and can go about your day as normal.
Your radiologist will check in with you from time to time to see how you are doing. If you are experiencing any side effects they can help you. Our healthy cells nearby can also suffer the effects of the radiation but it is usually temporary. Possible side effects may include;
- Reddening and burns in the area being radiated.
- Fatigue, especially if you are still experiencing the effects of chemotherapy.
- Pain and swelling in the affected area.
- Hair loss in the armpit.
- Problems moving your arm or shoulder.
You won’t necessarily experience all of these side effects. My main ones were sunburn-like reddening, and fatigue. They peaked in the final couple of weeks and gradually eased once treatment had finished.
My top tips.
Radiotherapy can be very time consuming, especially if you are having it for many weeks. You might need to fit it in around work and other commitments. The nurses will help you plan the timing of your sessions to suit your schedule. For example I had a 1 year old baby to take care of, and had to work out my sessions according to when my husband or mother in law could be there to look after her.
PLAN/BOOK YOUR TRANSPORT.
Ask your breast cancer nurse to help you with this if you need it. They will be able to advise you what is available to you depending on the country you are in. My radiotherapy department was an hour away from where I lived, but here in France I was able to arrange a taxi free of charge to pick me up and bring me home every day. It took off a huge amount of mental and financial strain.
BUY SOME AQUAPHOR.
I suffered relatively minor damage and burns to my skin even after 32 sessions. I swear by Aquaphor . I kept it in the fridge and applied as soon as I got home after each treatment, then again before bed at night.
IMPORTANT! Don’t use any oil or moisturiser on your skin before the treatment. Like putting oil on and sitting in the sun, it will make burns much worse. Take a shower before going to ensure there is nothing left on your skin.
DOWNLOAD SOME PODCASTS OR BRING A NEW BOOK.
My 2 hours travelling each day seemed like a drudge at first, but I soon learned to embrace the time to myself. I’d download some great podcasts, put my headphones in, and the time would fly by.
Side note: I also recommend listening to podcasts or reading books when you are waiting for scans, or any of those seemingly never-ending waits in depressing waiting rooms. They’re a great way to distract from what is happening and take your mind off of the “c” word. If you are curious to learn more about my personal journey with breast cancer, my book “Growing” is good company.
I know, I know, someone else telling you to drink damn water! But in this case it really is necessary. Think of radiation like sun exposure, too much of it can cause sunstroke and make you feel terrible. Drinking plenty of water will help combat the effects and help your skin heal.
GET SOME WIRELESS BRAS.
Underwired bras are an absolute no-no during radiotherapy, so treat yourself to some cute wireless ones. The aim here is comfort, breathability and gentle support. You don’t want anything that will rub or chaff on your chest area, so ideally cotton is best. This and these are great options. I’ll be honest, I can’t bring myself to go back to underwires now!
STAY OUT OF THE SUN.
Your radiologist will also advise you of this. Go out in to the sun, do what makes you feel good, just be sure to FULLY cover up your radiated area. Use sunscreen if necessary.
MASSAGE THE AREA.
This is so important. Once you have completely finished radiotherapy, use a moisturiser or oil and gently massage the area every day for many years. Include under your arm, your chest and your shoulder on the radiated side. I neglected to do this, and now suffer from radiation fibrosis. This is a thickening and hardening of the breast tissue, and for me it has appeared 3 years after completing radiotherapy. It is sometimes painful and causes psychological stress as it feels lumpy.
I hope this has helped prepare those of you that have radiotherapy in your future. It might seem daunting, but as with most things you will adjust. Even with the resulting fibrosis, it was by far the easiest of the treatments for me.
Take care, drink water 😉 and celebrate being nearly at the finish line!
If you enjoyed this article, you may also enjoy;
- My top tips to help you through chemotherapy.
- My lifestyle choices since having breast cancer.
- How to deal with the fear of recurrence.
- Was having cancer a gift?
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