Q. I’ve been diagnosed with DCIS, and after my lumpectomy I’ll be having radiation. What does radiation do, exactly?
A. Radiation therapy, in a nutshell, is the use of x-rays to destroy cancer cells. Its delivery is directed by a radiation oncologist. (A radiologist, on the other hand, is a doctor who specializes in diagnosing disease through the use of x-rays. I couldn’t keep the two straight for the longest time! Remember, if you’re going for radiation treatments, you don’t go to the radiology waiting room; you go to radiation therapy, or radiation oncology.)
Q. So, if I have a lumpectomy with clean margins – they take the tumor, and they don’t find any more cancer cells anywhere – how come I still need radiation?
A. A single cancer cell can a spawn a whole new generation of cells, and put you right back where you started: heading down the cancer path again. Even taking out your primary tumor, 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.
Q. I don’t get it. How does radiation pick out and kill just the cancer cells, without hurting your other cells?
A. In fact, radiation does affect all 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.
Q. I’ve heard I’ll have to get tattoos. What’s up with that? I don’t want a tattoo...
A. It’s true, you’ll probably get some tattoos. But don’t worry about anything that would stop you from wearing a low-cut blouse or swimsuit! Tattoos are used 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. Imagine taking a blue ballpoint, and poking yourself with its tip: that’s what the tattoo looks like. It’s smaller than a freckle. So don’t sweat it. Many women report that their tattoos fade over time.
Q. How long does radiation take? I heard I’ll have to go every day. Sounds like a drag.
A. Traditional radiation therapy is given over the course of 5 to 7 weeks: 5 days a week, Monday through Friday. The treatment itself takes just 10 to 15 minutes, but between driving to the hospital, waiting, and driving home, yes, it’ll take a chunk of your day: especially if you live a long way from where you’re getting treatment.
As with most cancer treatments, advances are being made all the time. MammoSite®, a small “balloon” with a radiation “seed,” is inserted into the space where your tumor was removed to deliver radiation internally (rather than via external beams). It’s given twice a day for just 5 days. It’s appropriate for some women, and available at some facilities. Ask your doctor if it’s available, and if you’re a candidate.
Q. So, what’s the actual treatment like?
A. It’s 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. There won’t be anyone in the room with you; the techs all scurry into the safety of the control room before they turn on the machine.
If you’re lucky, they’ll pipe some music in for you. I used to spend my time counting the holes in the particle-board ceiling. When the radiation’s done, the techs come back, help you off the table, and you all agree to meet the next day – same time, same place.