RADIOTHERAPY BREAST CANCER

Radiotherapy (Radiation therapy) uses high doses of radiation to kill cancer cells and shrink tumors. In low doses, radiation is used in x-rays to see inside your body, as with x-rays of your teeth or broken bones (which is why you do have to think about the age in which you start to take annual mammograms. Ultrasound maybe a better way forward but that’s another point.

Radiotherapy is like a slow burn. It doesn’t kill cancer cells immediately but takes days or weeks of treatment before DNA is sufficiently damaged for cancer cells to die. Cancer cells die off for weeks or months long after radiotherapy has ended.

Normal cells can also be damaged, which may cause side effects. It’s another part of the precision work to get radiotherapy right so that there’s a reduced risk to damaging healthy tissue and nearby organs.

CANCER CELLS CANNOT REPAIR THEMSELVES AFTER RADIOTHERAPY, BUT NORMAL CELLS USUALLY CAN.

TREATMENT

As part of your breast conserving surgery (BCS) your cancer doctor may recommend you have radiotherapy to the breast after surgery and chemotherapy. At least, that’s the order in which it happened for me.

I waited about 6-weeks after chemotherapy (it could be chemo then surgery for you) before my radiotherapy began.

Whether you decide to have radiotherapy or not is between you and your doctor. The truth is, I just went along with it all relatively uninformed about each step. It was my way of coping but that might not work for you.

RADIOTHERAPY AFTER A MASTECTOMY

Even after you have had your breast removed, you may still need radiotherapy to ensure there are no lingering cancer cells in the chest wall. You’re trying to make sure the cancer cannot come back. So, radiotherapy will depend upon,

• The size of the tumor
• Whether cancer has spread to the lymph nodes in the armpit
• Cancer cells still lingered close to where the breast tissue was removed.

RADIOTHERAPY TO THE LYMPH NODES

It’s only once the surgeon is removes the cancer cells that she can see the extent of the spread. In my case, they removed 14 lymph nodes in addition to the cancer in my breast. To my shock, this went right up to my collarbone. In similar circumstances, you may have radiotherapy to the rest of your lymph nodes.

BREAST CANCER

You could have radiotherapy as an outpatient. That’s all I knew. I can’t quite remember but I think I attended the hospital 2 or 3 times a week where I joined a whole group of other patients waiting for a similar treatment (not necessarily cancer of the breast). I went to Guys Hospital where the radiotherapy floor looked extremely modern, and the radiotherapy machine, state of the art to my eyes. Which means it looked big, posh and plastic clean.

You usually have radiotherapy for 3 weeks. Women who had breast-conserving surgery may have an extra dose (booster dose) to the area where the cancer was. Sometimes the booster dose is given at the same time as radiotherapy to the rest of the breast. Or it may be given at the end of the 3 weeks. This means you will need a few more treatments. Your doctor will tell you how many treatments you will need.

I had no idea why but if you have radiotherapy to your left breast, you’re asked to take a deep breath and hold it briefly. It’s called deep inspiration breath hold (DIBH). I actually didn’t find this easy or at least, they kept asking me to do it again, so I had the feeling that I was failing the demand somehow. At each of the planning and treatment sessions I started with a DIBH. Apparently, it keeps you still and also moves your heart (which is behind your left breast) away from the treatment area. DIBH helps protect your heart during your treatment and reduces the risk of late effects.

INTENSITY-MODULATED RADIOTHERAPY (IMRT)

Some women may have intensity-modulated radiotherapy (IMRT). This is another type of external beam radiotherapy. It shapes the radiotherapy beams and allows different doses of radiotherapy to be given to different areas. It allows for lower doses of radiotherapy to healthy tissue that surrounds the tumour.

External radiotherapy does not make you radioactive. It is safe for you to be with other people, including children, after your treatment.

RADIOTHERAPY TO PART OF THE BREAST

Apparently, it’s not as common to give radiotherapy to only part of the breast but this is something you could discuss with your doctor as an option to consider. Let them tell you the differences before you make what must be an informed decision.

INTERNAL RADIOTHERAPY

Some women are given radiotherapy from inside the body instead of to the whole breast. This radiation source can be solid or liquid and is called BRACHYTHERAPY – given over a much shorter time.

• With brachytherapy, the radiation source in your body will give off radiation for a while.
• The liquid source is called systemic therapy. The treatment travels in the blood to tissues throughout your body, looking for and killing cancer cells.
• You receive systemic radiation therapy by swallowing, through a VEIN via an IV line, or through an INJECTION.
• With systemic radiation, your body fluids, such as urine, sweat, and saliva, will give off radiation for a while.
• HOLLOW TUBES are put into the area where the cancer was removed from. Radioactive material is placed into the tubes.
• The radioactive material may be left in place for a few days. This is usually during a stay in hospital or given over a few sessions as an outpatient.
• The radioactive material is removed each time before you go home.

INTRAOPERATIVE RADIOTHERAPY

This isn’t suitable for everyone, but I don’t know why. Again, you must discuss this with your doctor to find out the advantages and disadvantages. It’s another form of radiotherapy that’s given from inside the body. It’s an internal thing that can be part of your breast-conserving surgery treatment.

• After removing the cancer, single doses of radiotherapy are given to the same area using another special machine.

• After intraoperative radiotherapy, you probably will not need any external radiotherapy to the rest of the breast. However, some women might need a short course.

• This sort of radiotherapy is not of standard use in the UK.

TREATMENTS DENIED / DELAYED FOR BLACK WOMEN

Breast cancer treatment has come a long way, but it appears black women are being left behind. According to a September study published by the Red Journal, Black women are 16% less likely to be offered hypo fractionated radiation therapy, an increasingly popular breast cancer treatment, than White women.

Hypo-fractionated radiotherapy means dosages are given over a shorter period in larger amounts. With these fewer sessions, patients experience fewer side effects, such as fatigue and loss of appetite. HF also reduces the need to travel to a clinic so is more convenient. 

The study found that HF was just as effective and cost effective compared to conventional radiation therapy. It’s obviously, preferred by patients and yet is not equally offered to black women.

Report findings included:

• Black women are less likely to be offered HF radiation therapy.
• Black women face several inequalities from the time of diagnosis.
• Access to breast cancer treatment is dependent upon trust, awareness, and finance.
• Healthcare for Black women with breast cancer requires a collaborative approach if we are to improve access.