Radiation 101: Your Guide to Radiation

Patient Expert

Jacki Donaldson, who has been through radiation for breast cancer treatment, explains what you need to know before, during, and after radiation.

When it comes to breast cancer treatment, radiation can seem like a walk in the park compared to major surgery and months of chemotherapy. For me, it was a breeze. I had already survived a lumpectomy and chemotherapy before my turn at radiation. I'd endured hair loss, nausea, low blood counts, fever, two hospitalizations, and a blood transfusion. Radiation couldn't - and didn't - even compare. But it's still quite a process, and what follows will shed some light on how you might breeze through radiation. It's all quite do-able - if you know what to expect.

Preparation for Radiation

If your doctor has prescribed radiation as part of your treatment plan, preparation is key. Radiation is a detailed, precise process that aims to kill cancer cells in the breast while sparing healthy cells in the same area. It's administered by a machine that accelerates charged particles and shoots them at a target that generates photons. Photons travel directly to the breast, in the form of a beam, where they kill the cancer cells.

Radiation is used in combination with lumpectomy primarily to reduce the chance of local recurrence in the breast or on the chest wall. Radiation after lumpectomy is considered the standard of care for all women and is part and parcel of the treatment plan. For women whose breast cancer has gone to the lymph nodes radiation may also increase the cure rate after lumpectomy. For women who have had a mastectomy there are still clinical situations where a patient benefits from post-mastectomy radiation - if the tumor is in multiple lymph nodes or is a very large tumor (5 cm. or more).

To ensure the proper delivery of this treatment, you will visit your radiation team several times prior to your first session. Your first visit with a radiation oncologist will include a review of your history, pathology reports, and x-ray films, as well as a physical examination. After the exam, your doctor will discuss recommendations, review side effects, and prepare a plan.

Next, you will attend two planning sessions called simulations. During these sessions, a mold is created to ensure that you lie in the same position for each treatment. X-rays and CT scans are performed to identify the specific delivery of radiation from a variety of machines, temporary markings are drawn on the skin, and small permanent tattoos (little blue dots) are placed around the breast so machines line up without any variation during each radiation session. You may attend additional appointments to fine-tune this process. Behind the scenes, your medical professionals will craft the perfect scenario for your individualized treatment.

Prior to your first treatment, your team should show you how to check in for each session, brief you on where to park (you may need to ask for a parking pass since you will visit your facility every day for weeks), and allow you to ask questions.

Radiation Treatments

You will report to radiation once per day, five days per week, for a number of weeks. Consider your schedule to figure out how radiation will fit into your day most easily. You might want to stop in for radiation before work, after work, or on your lunch hour. You might need to arrange for on-going childcare or for someone to drive you to and from appointments. Often the biggest hassle of radiation is getting to and from the appointment, which takes more time than the treatment itself.

Radiation appointments are relatively quick. My appointments lasted no longer than 30 minutes. I checked in, waited for a few minutes, and then reported to the treatment area. I removed my shirt and bra and all accessories (wig, hat, jewelry), and walked to the treatment table holding a towel to cover my breasts. Once I reclined on the table, my radiation therapists covered me with sheets, exposed my left breast, positioned the machines properly (with tattoos as guides), and exited the room. They spoke to me over a speaker from another room where they watched me on monitors. They told me what to do (I used a breathing tube to assist in moving my heart out of the way for each loud zap of radiation), and quickly returned to excuse me from my session. I walked away from each session feeling no different than when I arrived.

Skin irritation is a common side effect of radiation, and I saw my oncologist once a week to monitor how my skin was tolerating the treatment. Radiation can cause burning, itching, and blistering, and products offered for relief can include aloe (100%), silfer sulfadiezene, and other ointments.. To avoid further irritation of the skin, consider wearing soft shirts that do not rub or chafe your skin and shirts with built-in bra liners (regular bra straps may feel too tight). I wore a bikini top as a bra. I could position the ties so they didn't touch any affected areas. Avoid the sun, shaving, deodorants, perfumes, lotions, and use only gentle soap.

Fatigue, believed to be caused as the body uses all its resources during radiation, is also a common side effect, and it may last for a few months after treatment. It is generally modest compared to chemotherapy.

There is a newer technique called brachytherapy that may be available, either on or off a clinical trial. This uses focused local radiation therapy over a short time period. A new device called Mammosite applies radiation directly to the surgical cavity and is over in a few hours. You might ask your radiation oncologist his or her opinion about this option if you don't want to get treatment every day for a number of weeks.

Beyond Radiation

Once your radiation treatments are over, skin irritation may last for a few more weeks, especially if "boost" treatments are given. The boost is an extra amount of radiation given to the spot where the tumor was removed and can cause a more severe reaction. I did not suffer any skin irritation throughout radiation until I had my boost treatments.

Other long-term effects of radiation may include sharp, shooting pains in the breast, depression, weakness in otherwise healthy areas (like ribs, lungs, the heart) that were not completely protected from radiation, and in rare cases, radiation can cause a second cancer (as can chemotherapy). Still, they're the best weapons we have to fight breast cancer, so they're both valuable tools.

The tiny tattoos that mark the radiation spot do not fade. They are permanent, visible reminders of radiation. You can choose to have your tattoos removed. My 10 tattoos do not bother me, and I plan to keep them. Since radiation can't be used on the same exact location more than once, my tattoos will forever mark the area that is now off limits.

Many women seek physical therapy after radiation due to limited range of motion in the arm and shoulder. Physical therapy is also effective in preventing and monitoring lymphedema (swelling in the arm due to removed lymph nodes during surgery). You might consider physical therapy for your overall healing during and after breast cancer treatment.

For a few years after radiation, you will visit your radiation team periodically to monitor your progress and address concerns. Hopefully, life will continue with breast cancer as nothing but a memory.

Kevin Knopf, MD. Review provided by VeriMed Healthcare Network.