What is radiation/radiation therapy?
Radiation therapy, in a nutshell, is the use of x-rays to destroy cancer cells.
The terminology around radiation can be confusing. Radiology – not radiation – is the practice of diagnosing disease through the use of x-rays; and radiologists are doctors who specialize in this. A radiologist may have been the one who identified your breast cancer via a mammogram.
On the other hand, radiation is the treatment of cancer using x-rays, under the direction of a radiation oncologist. When going for radiation treatment, you receive it in radiation therapy, or radiation oncology; NOT in radiology. The distinction is important, in order to make sure you show up at the correct waiting room!
Why is radiation necessary, even after surgery?
A single cancer cell can a spawn a whole new generation of cells. Even taking out your primary tumor via lumpectomy, and examining the tissue around it to make sure there are no cancer cells present (“clean margins”) doesn’t ensure that a few cancer cells aren’t still lurking somewhere in the area. Radiation is delivered as a backup to the initial treatment, in an attempt to kill every last cancer cell.
How does radiation distinguish between cancer cells and normal cells?
Radiation affects all of your cells. But fast-dividing cancer cells are vulnerable to injury, and while your normal cells can recover from high doses of radiation, cancer cells will die.
Step 1: tattoos
The first step in radiation therapy is using tattoos to mark the exact spots on your chest where the technicians will focus the high-power radioactive x-rays. You’ll probably get a minimum of four, and perhaps more. These tattoos are tiny; imagine taking a blue ballpoint, and poking yourself with its tip: that’s what the tattoo looks like. It’s smaller than a freckle, and many women report that their tattoos fade over time.
Step 2: the schedule
Traditional radiation therapy is given over the course of 5 to 7 weeks: 5 days a week, Monday through Friday. Each daily treatment takes just 10 to 15 minutes.
As with most cancer treatments, advances are being made all the time. Brachytherapy involves very close targeting of the tumor space, either with radioactive “seeds” placed internally, or with a highly focused external beam.
The benefit? It’s given on an accelerated schedule (one day up to 7 days), so the duration of treatment is much shorter. The downside? Most women aren’t good candidates for brachytherapy. And while the data continues to accumulate, at this point it’s not as effective at preventing recurrence as traditional radiation.
Step 3: treatment
What’s it like? Boring! You lie on the table, naked from the waist up, and relax while the techs tug you around to get your body to the exact right place on the table. Then you look at the ceiling for 15 minutes, while a huge machine about 5 feet above your head slowly works its way from one side of your chest to the other.
It’s not giving you radiation all that time; most of the time is spent with the techs coming in, repositioning it for a “shot,” then going back out again. You have to leave your arm up over your head, which to many women is the most uncomfortable part.
Some women report their only radiation side effect is the inconvenience of driving to the hospital every day. But other women experience side effects ranging from sunburn-like skin irritation to open sores to severe fatigue. For more on potential side effects, read our post Fast FAQS: Radiation Side Effects.
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Breast cancer survivor and award-winning author PJ Hamel, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network.