Radiotherapy for Breast Cancer – what to expect

23 Aug 2021

Radiotherapy, also referred to as radiation therapy, is a common cancer treatment prescribed by a Radiation Oncologist to treat a cancer diagnosis.  Radiotherapy works by making small breaks inside the DNA of cells, causing them to die and prevent them from continuing to grow, spread or multiply.

The radiation is delivered as External Band Radiation Therapy (EBRT), which consists of precisely targeted radiation beams, from outside of the body. It is a fast, painless and safe treatment commonly started about four weeks after surgery, or if chemotherapy is also prescribed, about four weeks after chemo has finished.

Radiotherapy will be prescribed:

    • following breast-conserving (lumpectomy) surgery to ensure any undetected cancer cells that may be in the breast are destroyed and to reduce the risk of a localised cancer reoccurrence.
    • after a mastectomy, depending on the risk of a cancer reoccurrence in the chest area.
    • if lymph nodes from the armpit were removed and the risk of a cancer reoccurrence in this area, is high.

What to expect
Before starting a course of radiotherapy treatment, a CT scan will be taken of your chest so that the area to be targeted can be mapped out.

If you had breast conserving surgery, the radiotherapy will be targeted to the specific part of your breast where the tumour was. If you had a mastectomy, the radiotherapy will be targeted to your chest wall. Some women may also have radiotherapy on their armpit or neck if the lymph nodes are also being targeted.

Many women will require very small (similar in size to a freckle), permanent tattoos on their chest. These tattoos help the radiation therapist position you correctly on the machine and deliver treatment to the right location.

You can expect to have radiotherapy administered every day, Monday to Friday. The total number of treatments any individual has, however, will vary from person to person and will be based on that person’s cancer type and stage as well as the size and location of the tumour.

During each treatment session, a technician will place you into the correct position on a bed underneath the machine.  Once in position, you will be required to lie still until the machine has finished, generally around 1-5 minutes. The treatment is painless.

The side effects of radiation therapy accumulate over time, and you may experience:

Tiredness – tiredness (fatigue) can start to be felt 1–2 weeks after radiotherapy starts and will continue during treatment. This will usually ease a few weeks after your treatment finishes.

Red and dry skin – skin at the targeted area may start to become red and dry after a few weeks of treatment. It usually returns to normal 4–6 weeks after treatment ends. The nurses will show you how to care for your skin. They will suggest a cream to apply to the radiated area, such as Sorbolene cream or MooGoo, and how frequently to apply it. This should be commenced from the day you begin treatment.

Inflammation and blistering – are less common and will depend on how many treatment sessions that you have. Your skin may become itchy and/or very irritated and blisters may develop. The nurses will closely monitor your skin and recommend how you should treat the area.

Aches and pains – you may experience minor aches or shooting pains that last for a few moments during treatment.

Swelling – some women develop fluid in the breast (breast oedema) that can last for up to 12 months or, in some cases, up to five years and radiation therapy to the armpit may increase the chance of developing lymphoedema in the arm. Talk to your radiation oncologist or radiation oncology nurse about any changes you experience.

Armpit hair loss - radiation therapy to the breast does not cause you to lose hair from your head, however, you may lose hair from the treated armpit.

The radiation does not stay in your body during or after treatment, so it is safe for you to spend time with family and friends.

Longer term effects of radiotherapy

Changes to breast and skin – you will attend regular checks with your Radiation Oncologist post treatment to monitor changes to your breast and skin, but you may experience your breast becoming firmer or smaller and there may also be mild, permanent tanning of the skin and underarm area that was treated.

Lymphoedema – if radiotherapy is delivered to the lymph nodes in the armpit area you may develop lymphoedema, a condition where fluid collects in the arm, causing it to develop some swelling.  Your oncologist will discuss this possibility with you and advise what signs and symptoms to look out for and what to do if you are concerned.

There are also rare, long and short term side effects that may impact your ribs, lungs, heart or nerves, although these are not very common with modern treatment. Your oncologist will discuss these with you before your treatment commences.  If you are concerned that you may be experiencing any of these side effects, please speak to your medical team immediately.

Tips and tricks while undergoing radiotherapy
Wear soft natural cotton tops, under your bra, to reduce irritation to your skin.

Keep talking to your breast care nurse or a member of the radiotherapy team about how to look after your skin, as it changes, during and after treatment. They will recommend gentle soaps, creams or moisturisers that are suitable to treat radiotherapy burns, dryness and inflammation.

Ask if there are any special parking spots available at your radiotherapy clinic. Sometimes spots are reserved, or fees reduced, for people undergoing treatment.

Take a book with you to each session or have a good podcast lined up, as some days you may have to wait for a machine to be available.