You’ve been diagnosed with breast cancer, bombarded with information, and endured surgery and possibly chemotherapy. Now you are ready to begin radiation therapy and you wonder what to expect next. Below is information that should help take the mystery out of your next step toward a healthy recovery. This article is not meant to replace medical advice. It is a mixture of personal experience and information learned by going through the process. For specific questions, consult your physician.

How Does Radiation Therapy Work? Radiation therapy uses high-energy radiation to destroy cancer cells. Normal cells are constantly dividing and replacing themselves. Cancer occurs when these cells lose their ability to control their growth. Radiation therapy works by damaging the cancer cells’ DNA, the genetic information vital to its reproduction. Both cancer cells and healthy cells are affected by the radiation. However, most healthy cells are able to recover from this injury. The cancer cells, on the other hand, are more fragile and are unable to replicate themselves. Rapid growing cancer cells are particularly sensitive to radiation therapy.

What is the Process? Your radiation therapy will be guided and directed by a specialist known as a radiation oncologist. You will meet this physician in an initial consultation. Usually you will have to provide the facility with all your x-rays, laboratory studies, and pathology report so that the radiation oncologist can discuss with you your type of treatment, the number of treatments, and answer any questions that you may have.

Once you agree to the radiation therapy, a “simulation” appointment will be set up. This simulation is designed to pinpoint the treatment area. Alignment of your radiation dose is critical so x-rays will be taken to help define the treatment area. With this info, your radiation oncologist will then determine the angles at which you will be treated. At the end of your simulation, most facilities will tattoo several small freckle-sized dots to mark your treatment field. This allows you to bathe without losing those important marks that show where your radiation treatments are to be delivered. Other facilities may use a magic marker to outline the area but this requires the patient to be very careful when bathing. This simulation session may take 1 to 2 hours. More planning occurs after this session but you don’t have to be present.

Be sure to wear two-piece outfits to your treatments as you will only need to remove your upper clothing. Your first real treatment may take extra time because the technicians will want to be sure that you are aligned exactly as you were the day of the simulation. You lay on a table and your treatment-side arm may be placed in an armrest so that it is always in the same position. More x-rays may be taken to match those taken during the simulation to verify the setup. Once the proper position is confirmed, you will get your treatment from a linear accelerator. This treatment may last from seconds to a minute or two. You must remain very still, but they want you to continue to breathe normally. Don’t hold your breath. The machine is then rotated and you are given more radiation from other angles.

Radiation treatments are given daily, Monday through Friday, for a number of weeks determined by your radiation oncologist. The idea is that a lot of short treatments over an extended period of time causes less damage to healthy cells and gives them time to repair themselves. The cancer cells, on the other hand, get progressively more damaged. Your radiation oncologist will probably want to see you once a week during your treatments. He or she may have blood work done or other tests to help monitor how you are doing. This is a good time to ask any and all questions.

Many facilities are now administering 5 to 10 “boost” treatments to their patients. This boost treatment may be additional treatments with the linear accelerator or another machine that delivers an electron beam that doesn’t penetrate as deeply. The boost therapy is usually limited to your surgical area alone. Some facilities us a temporary radiation implant for the boost.

What are the Side Effects? Radiation therapy side effects are cumulative- they build up over time. Women always want to know if they will be nauseated or if they will lose their hair. Because the radiation is limited to the breast and not to your head or gastric organs, you won’t lose your hair (unless it’s already gone from chemotherapy) and you shouldn’t feel nauseated.

When you first start your treatments you won’t see any noticeable changes. I personally recommend that you start using the cream or aloe gel (that they usually provide) from day one rather than waiting for any redness or swelling to develop. After the first two weeks, the treatment field will start to darken, looking like a suntan. But just like each woman’s skin responds to sunlight differently, so do they respond differently to the radiation therapy. Some women will have little discoloration and others will burn more. Frequently, large breasted women have more trouble in the fold area under the breast than do small breasted women because of the sweat and rubbing irritation. One of the most troublesome consequences of the burn is the itching that occurs as your skin tries to heal. You also may experience some swelling in the areola or nipple area and it may get crusty. In addition, the skin often thickens during the course of the treatment.

Another concern women have is whether they will be able to continue to work through their radiation treatments. Although, fatigue is one of the most common symptoms of radiation therapy, the doctors don’t restrict their patient’s activities. However, like the redness, the effect is cumulative. Therefore it is advisable not to overdo your activities. By the end of the first four weeks of treatments, many women find the need to take naps or an occasional day off of work to recuperate. This fatigue usually peaks in the weeks immediately after your radiation therapy is completed.

One long term side effect that some women experience is sore or tender ribs. Depending on the angles of one’s treatment, part of your rib bones may get radiated as well. You may not feel any effect from this until months afterwards and then it may last up to a couple of years. In rare instances a minor injury might result in a fractured rib because your rib bones are weakened,

How Do You Deal with the Side Effects. Your radiation facility will normally give you a cream, lotion or gel to administer to your burned skin. These creams are usually to control the dryness and itching. Use these liberally. However, in rare cases, a woman might develop a sensitivity (or allergic reaction) to this cream. If you notice the redness outside of the treatment field, you should contact your doctor. Your doctor may also recommend Benedryl for sleeping through the night. The following suggestions were made by my radiation center:

• Avoid excessive sun exposure
• Do NOT apply heat (water bottles, heating pads or Jacuzzis)
• Do NOT use cold packs (no ice bags)
• Avoid wearing tight clothes or clothes that might rub and irritate the treated skin.
• Do NOT use deodorants with aluminum or perfumes on the treated skin. Use only the skin products given to you.
• Cleanse the skin in the treatment field with Ivory soap. Rinse with lukewarm water and pat dry. Do NOT rub.
• Gently apply gel or lotion to the skin two or three times a day.
• Do not apply anything to your skin one hour before a treatment.

Women also find some relief from the itching by wearing only 100% cotton on their chest. Not only are you less likely to sweat in 100% cotton, but the fibers are more soothing. If you feel that you need to wear a bra, consider getting an all-cotton one. Store like Target carry inexpensive ones. Underwire bras tend to irritate the breast and you will probably want to avoid wearing one. Many women choose to wear all-cotton tank tops or a man’s sleeveless undershirt under their normal clothes instead of a bra. In the case of summer, when wearing an undershirt might be too many layers of clothes, consider wearing a feminine tank top and a short sleeve blouse that is not buttoned up but tied at the waist. The blouse maintains some modesty while wearing no bra at work. At night, an all-cotton nightgown or all-cotton sheets can be very helpful.

Finally, take naps!   (Submitted by Rita)