Radiotherapy to the Breast

  • Reference Number: HEY-196/2018
  • Departments: Radiotherapy

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Introduction

This booklet aims to provide you with general information about radiotherapy treatment to your breast and is additional to the information you will receive from your Clinical Oncologist and healthcare professionals. This information applies to both men and women who have been diagnosed with breast cancer and are referred for radiotherapy treatment. The treatment is exactly the same. Although men have a much smaller amount of breast tissue than women, cancer can still develop here.

What is radiotherapy?

Radiotherapy, also known as radiation treatment, is the controlled use of high energy X-rays to treat many different types of cancer. The X- rays are produced electrically by a machine called a Linear Accelerator (Linac).

Radiotherapy works by causing chemical and physical damage to the cancer cells in the treatment area. Although some normal healthy cells are also affected these are able to recover and repair themselves.

Radiotherapy has a number of different benefits from curing some cancers after surgery for example, but also may be used as symptom control. Radiotherapy does not make you radioactive and you are safe to be around people including children whilst you are on treatment.

The Clinical Oncology Consultant you are under will have already discussed the treatment, side effects and gained consent for you to receive your radiotherapy. There are several stages prior to you actually commencing your treatment.

Radiotherapy is the use of high energy X-rays and other types of radiation (e.g. electrons) to treat cancer. Radiotherapy works by causing chemical and physical damage to the cancer cells in the treatment area. Although some normal healthy cells are also affected these are able to recover and repair themselves, unlike the cancer cells which cannot and therefore are damaged beyond repair.

Radiotherapy has a number of different benefits, for example curing some cancers after surgery, as well as being used as symptom control. External beam radiotherapy does not make you radioactive and you are safe to be around people including children whilst you are on treatment.

The Clinical Oncology Consultant you are under will have already discussed the treatment and side effects with you together with obtaining your written consent for you to receive your radiotherapy treatment. There are several stages prior to you actually commencing your treatment.

Planning your treatment

Your first appointment in the Radiotherapy Department will be a planning appointment. This appointment will be approximately 15 – 30 minutes in duration. Further information regarding the planning of your treatment is available in the leaflet ‘Introduction to Radiotherapy CT Planning’.

Your course of radiotherapy will be planned on an individual basis using special CT planning scans. For this scan you will be laid on a piece of equipment known as a ‘breast board’ (Figure 1) in a comfortable position as shown in Figure 2.

It is important that you are comfortable as this will be the position you will be in for your daily treatment. If you are not comfortable please inform a member of staff at the time so adjustments may be made for your comfort.

Showing ‘the breast board’ positioned on the CT Planning Scanner bedFig 1: Showing ‘the breast board’ positioned on the CT Planning Scanner bed.
Showing your position on the breast board
Fig 2: Showing your position on the breast board.
Photographs by kind permission of Radiotherapy Department.

For your CT planning and treatment appointments your upper body on your affected side will need to be exposed from the waist up. We do offer the use of an upper body treatment gown to help maintain your privacy and dignity and this will be available for you to use when you attend your first visit for the planning appointment. As you are required to undress from the waist up, these gowns may help you to feel more comfortable whilst undergoing your treatment. It is your choice whether you want to have a gown to wear during your treatment or not.

Permanent Skin Marks

During the initial planning appointment pen marks will be drawn on to your skin, to ‘mark on’ the treatment site. As these pen marks will wash off, we prefer to make very small permanent skin marks before you leave the department. These permanent marks are made using a very fine needle and tattooing ink, and provide a permanent mark that we can use when delivering your radiotherapy treatment. These permanent marks mean you are able to bathe and shower during treatment as normal.

How do I prepare for treatment?

The clothing you wear over the treatment area should ideally be of natural fibres e.g. cotton, comfortable and loose fitting. Try to avoid wearing a bra especially tight or under wired versions. If you find it too uncomfortable to go without support, you should try to wear an older, softer bra without wires; or a crop top/sports top/bra.

You may continue to wear your prosthesis whilst attending for your radiotherapy treatment. You may find that the softer version is more comfortable. Placing a piece of soft cotton fabric between your skin and prosthesis will help to make it feel more comfortable, especially if you choose to wear the gel prosthesis. It will also prevent any pen marks from staining your prosthesis.

If you have been given some cream by the department and have not been using it, please do so. The radiographers and nurse specialists will explain routine skin care with you, following your CT planning scan or prior to treatment.

Radiotherapy treatment – what happens on the first day?

Every day you attend for your radiotherapy treatment please book in at the Radiotherapy reception desk. You will be asked to take a seat either in the main reception waiting area or directed to a specific waiting area. On your first day of treatment a radiographer will collect you and have a discussion with you explaining the possible side effects of treatment, how to minimise them and answer any questions/concerns you may have.

What happens during treatment?

Radiotherapy is delivered using a machine called a Linear Accelerator or Linac for short (Figure 3). Radiotherapy treatment is painless and appointments times are usually 10 – 15 minutes.

A Linear Accelerator, also known as a ‘Linac’ used to deliver your radiotherapyFig 3: A Linear Accelerator, also known as a ‘Linac’ used to deliver your radiotherapy.

A member of staff will escort you into the treatment room. The treatment machines and rooms are very large and can appear quite daunting when you see them for the first time. You will need to undress to the waist as for your planning scan unless you are wearing an upper body treatment gown. There is a curtained changing area within the treatment room should you wish to use it and there are changing cubicles adjacent to each machine.

The radiographers will then assist you into the correct treatment position on the couch, as you were in on the breast board, for your planning appointment. It will be necessary to open your upper body treatment gown at this point if you are wearing one to allow the radiographers to see your ‘permanent skin marks’. The radiographers will move you closer to the machine and will start to move you back into the exact position you were in for your planning scan, using the permanent marks. You will not go inside the machine, it will move around you. Although every effort is made to ensure the machine does not touch you during your treatment, sometimes this cannot be avoided. It is possible the machine may lightly rest on one of your arms. This is perfectly safe and treatment staff will warn you if this is going to happen, if you find it too uncomfortable please inform the radiographers who will try and make you more comfortable. The radiographers are controlling the Linac at all times.

For some patients the consultant may request ‘bolus’ to be placed over either the treatment area or scar during radiotherapy. This is a jelly like substance and it may feel a little cold when placed on your skin but forms an effective part of your treatment. Your treatment radiographers will be happy to explain how it works should you wish to know more.  Once you are set up in the correct position the staff will then leave the room for a few minutes to commence treatment.

The machine will rotate around you in different directions but is being controlled by the staff outside in the control area. The radiographers are watching you at all times on the TV monitors, should you need to attract their attention or if any assistance is required. You will not feel or see anything during your treatment however you may hear a buzzing sound when the treatment is being delivered.

Reviews during treatment

You will have regular weekly reviews with a radiographer as you progress through your treatment to assess how you are coping with any side effects, and your general health, please be honest in your answers. They will be documented as an assessment of your treatment. You may be referred to one of our nursing team if further medical advice or intervention is required.

Please do not feel this is the only time you can voice any concerns regarding your health, the radiographers will ask how you are feeling everyday before treatment.

Side effects of treatment

Side effects and reactions from the treatment may be experienced as you progress through your treatment. As every individual is different you may experience some and at varying levels. This is normal and temporary, you need not to worry. (You can speak to your Radiotherapy team about your symptoms and we can advise you on how to control them or if they worsen how we can treat you.)

Listed below are some of the most common side effects experienced. These usually begin midway into your treatment and may last for several weeks and continue for a short while once you have completed your radiotherapy but will then slowly settle down.

Skin Reactions

Sometimes radiotherapy may cause skin in the treated area to become pink, itchy or possibly sore. Advice will be given on how to care for your skin if this does happen and creams may be supplied by the nursing team.

Fatigue

As the treatment progresses, you may feel increasingly tired, especially if you are traveling some distance to the department. It is therefore important to have sufficient rest. As with all radiotherapy side effects this varies from person to person. You may feel that you need to sleep or it may just mean resting with your feet up for a while during the day. It is also important to increase your fluid intake, aim for a drink every hour. Although it does not matter what the fluid is, we do not recommend alcohol.

Nausea

Nausea can occasionally occur. We recommend drinking extra fluid and eating little and often. If the nausea persists, please inform your treatment radiographers who can offer advice, or arrange for medication to be prescribed.

Swallowing

Your treatment may include a small area of the neck. Occasionally patients having this area treated may find some discomfort in swallowing and may feel as if they have a lump in their throat. Should this happen to you we can prescribe medication to help. For the duration of your treatment, you may find eating softer foods helpful; dietetic advice is also available if required.

Late effects of radiotherapy can occur once you have completed your course of treatment

  • The skin in the treated area may appear drier than before and you may notice tiny blood vessels under the skin.
  • The breast tissue may be firmer to touch and there may be some shrinkage, but this is only noticeable in a small number of patients.
  • Patients may notice some discomfort in the breast and over the ribs. This should subside over a period of months.
  • Radiotherapy can make rib bones more brittle but this complication is rare.
  • Where the lymph nodes have been removed from the axilla (armpit) explain) and radiotherapy is given to the armpit, the drainage of the arm is affected.
    This may cause swelling of the arm called lymphoedema. This is rare.
  • A few patients may develop breathlessness this can be treated with a course of steroids.

What happens when I finish the treatment?

Once you have completed your course of radiotherapy treatment you will receive a follow-up appointment with you consultant or a member of their team. This appointment will be sent out via the post to return to see your Consultant Oncologist at the hospital where you were first seen. This is usually around 4 – 6 weeks after treatment has finished, allowing any side effects experienced to settle down. Your consultant will then decide if any further test/appointments are necessary.

General advice and support services

Most of your questions should have been answered by this booklet. If you have any further questions please ask any member of your healthcare team.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Radiotherapy Information and Support Team on telephone number: (01482) 461206, or Email: Radiotherapy.Info@hey.nhs.uk

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this examination.

Radiographers

These highly trained specialists help in several aspects of your treatment from CT and treatment. Where possible you will see the same team of radiographers each day you attend for your treatment. They are there to help you if you have any problems or worries, please speak to them for any help and advice. You may be referred to another member of the Oncology Team as necessary.

Radiotherapy Nursing Team

Consisting of Registered Nurses and Clinical Support Workers (CSW) and are based within the Radiotherapy Department they actively support and advise patients receiving radiotherapy treatment. They are able to make appropriate referrals and offer advice to patients and their families/carers.

Health Centre

The primary aim of our Health Centre is to help patients and their families to have the best possible health and quality of life during and after treatment. Open to all oncology patients and their families in offering an informal atmosphere to those who wish to “drop in” to the centre. Specially trained staff who are able to advise on different aspects of coping with cancer.

The centre is located in the main reception of the Queen’s Centre for Oncology and Haematology at Castle Hill Hospital. Opening times are Monday – Friday 9.00 am to 5.00 pm.

Here are the contact details of useful organisations that provide information about cancer including radiotherapy treatments:

Macmillan Cancer Support

Provides information from specialist nurses on all aspects of cancer and its treatment, and on the practical and emotional aspects of living with cancer.

You can drop into the Macmillan Cancer Information Centre at the Queen’s Centre or call them on: (01482) 461154 (Monday – Friday 9.00 am – 5.00 pm)
Alternatively freephone the national help line: 0808 808 0000 (Monday – Friday 9.00 am – 8.00 pm) The Centre is not open at Bank Holidays.
Online: http://www.macmillan.org.uk
Write to: Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ

PALS (Patient Advice and Liaison Service)

Provide confidential advice and support, helping you to sort out any concerns you may have about the care we provide, guiding you through the different services available from the NHS.

Telephone: (01482) 623065 (Monday – Friday 9 am – 4 pm)
Email: pals@hey.nhs.uk

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.