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.
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,
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.
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.
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.
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.
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:
After my experience with chemotherapy, I was really expecting something just as awful, but it was completely the opposite. I felt so little, I wondered whether anything was actually happening?
I carried on working. I don’t think I felt any tiredness, but the truth is, with only weeks since the end of my chemotherapy, I didn’t feel right enough to know what was what?
EITHER WAY, RADIOTHERAPY IS NOT AS AGGRESSIVE AS CHEMOTHERAPY
The process was a bit like getting yourself prepared for a medical examination. Your name is called. I would go into a cubicle to change into a surgical gown on. Then I would wait a short time for my turn to go into the machine.
If you want to you can ask for your own music to be played while you’re being zapped. I remember feeling a bit cold and there being a lot fiddling about first to get the settings right.
Your body is marked and shifted around a lot. Your job is to try and behave like a dead weight so that they can move different parts of you like a lump of meat to get a precise setting. My instinct was always to help which made it more difficult for them.
Sometimes it took ages but once it started, the time went very quickly, and I was out.
Apart from the very first meeting where you are given your dates and times to attend, and the last meeting when they check that’s all gone ok, that was it.
Possible side effects include:
If you have any new side effects or if side effects get worse, tell them straight away.
Your skin in the treatment area may get darker, or have a blue, or black tinge.
Your specialist nurse or radiographer will give you advice on looking after your skin.
DON’T USE ANY CREAM ON YOUR SKIN WITHOUT ADVISE FROM YOUR DOCTOR / RADIOLOGIST
The most common late effect is a change in how the breast looks and feels. Radiotherapy influences small blood vessels in the skin.
THERE ARE RADIATION LIMITS
You can have too much radiation in your body over the course of your lifetime. From a black perspective this is important given we tend to be diagnosed with breast cancer at much earlier ages.
OVER-EXPOSURE TO RADIATION CAUSES CANCER ITSELF
You must discuss these matters with your doctor, but ULTRASOUND might be a safer alternative breast screening circumstances.