page heading ninewells/breast care unit
radiotherapy

Introduction Planning
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Side Effects Skin Care
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INTRODUCTION
Cancer of the breast is a very common disease in women, but also occurs occasionally in men. This page aims to give you a brief outline of your radiotherapy treatment planning process, the treatment itself and more specific information about the possible side effects. The first appointment you will have will be with your Oncologist to discuss the treatment necessary for you. This is followed by a planning visit then the treatment itself.
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PLANNING
You will receive an appointment to attend the Radiotherapy Department to have your treatment planned. Planning is carried out on a machine called a simulator and may take up to 45 minutes to complete. During this time you have to lie very still for a time while measurements and x-rays are taken. This is all done while you are lying on a couch. Your arm will need to be put in the treatment position, so it is important that you have been doing the physiotherapy exercises and have sufficient movement in your shoulder. In the treatment position your elbow has to be raised to shoulder level. There is a support on the couch which you grip to keep your arm in the correct position.

Treatment is planned for everyone individually so just like the surgery options your treatment might not be the same as someone else even although you have had the same operation. The aim of planning is to ensure that the radiotherapy is given in the most effective and safest way, consistently in exactly the same place and in a way that minimises side effects.

Your Radiotherapist uses an x-ray screening device to plan carefully the exact area to be treated. Positioning marks are then drawn on your skin with a pen to enable the radiographers to reproduce accurately your treatment set-up each day. With your consent you will also be given a very small permanent tattoo mark about the size of a pin-head, which acts as an accurate reference mark. The marks put on your skin are essential and should not be removed during treatment.

When attending for your planning appointment it is a good idea to wear clothes which make it easy to undress above the waist. It is also advisable not to wear good clothes as the ink marks can rub off on them. They can rub off on your night clothes too.

Once the exact area to be treated has been decided, a computerised dose calculation is prepared for you. This can take one or two days to be completed and checked.

Your first treatment appointment will normally take place within one or two weeks of your planning appointment.

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CLOTHING
During your treatment, because your skin is likely to become rather tender it is best to avoid tight or under-wired bras. Maternity, sleep bras or cropped tops are especially comfortable and do not rub against fragile skin quite so much. You may find that a soft old bra or a camisole or a T-shirt gives you enough support. If you have had surgery and wear a prosthesis, it is best to wear the soft temporary kind during your radiotherapy. Arrangements for a permanent prosthesis can be made once the skin is back to normal. Your Breast Care Nurse, Clinic Nurse or Radiographer can advise you on how to obtain a suitable prosthesis.
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TREATMENT
Treatment is given on a machine called a Linear Accelerator (it is the high energy particles inside the machine which are accelerated not you!) and takes as little as 10 to 15 minutes including time to get undressed and dressed.

The radiographer will help to position you on the couch using the lines marked on your skin to ensure that you are lying in exactly the same position each time. When you are correctly lined up the machine is brought close to your body and you will be asked to lie very still and breathe normally. The radiographers then leave the room but have a window which allows them to watch and talk to you all the time. As soon as the dose of x-rays has been given the radiographers come back to you to move the machine to a different angle if your plan requires it.

The treatment itself is completely painless. However, because the position of your arm has to be rather unnatural to keep it out of the way, your shoulder and arm can get a bit stiff and uncomfortable. As with the planning machine there is a handle to hold on to for support.

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SIDE EFFECTS
Although radiotherapy to the breast is generally well tolerated, some side effects may develop around the third week of treatment and can continue after treatment has actually finished. The only areas affected are those being treated and most of the effects are only temporary. Given time they will wear off. Certain measures may help to reduce any discomfort caused by the treatment.

Breast and skin tenderness
The skin on and around your breast may become tender, dry and/or itchy during your radiotherapy. The areas most likely to be affected are under the breast, around the nipple, or under the arm particularly in women who have large breasts. You should not use any lotion, oils or other skin products (including deodorant) unless recommended by your Doctor, Radiographer or Nurse.
You should be given a skin care leaflet and you should follow these instructions carefully. The best advice is to treat your skin very gently. If your skin feels sore and/or itchy, or it looks red, blistered or cracked please tell your Radiographer, Breast Care Nurse or Doctor who may be able to give you something to make it more comfortable.
If you develop a skin reaction it will heal up a few weeks after the treatment is finished. Some women find that their treated breast feels firm, tender and slightly heavy or swollen during their course of radiotherapy. Wearing a soft supportive bra usually helps to minimise any discomfort.

Heartburn or sore throat
Occasionally, patients develop a sore throat or heartburn during treatment. This is because the radiotherapy beams may come very close to the throat and oesophagus (gullet) and the cells lining these areas are sensitive to radiotherapy. Again please tell your Radiographer or Nurse if you feel uncomfortable, as they can arrange for you to have a prescription for a liquid medicine which will help.

Intermittent aches
You might experience intermittent aches and twinges or sharp stabbing pains in the breast area. They can continue after treatment is finished, sometimes for as long as some years but they usually become less as time goes on.

Tiredness
Daily trips to the hospital can be tiring and stressful themselves. It is normal to feel much more tired during and after radiotherapy. Try to eat well and get plenty of rest and relaxation as well as a little exercise. Although it is not always easy this is a time when you should put your needs first and take time to rest. It is important to tell those around you that the tiredness can last for several weeks after treatment has finished.

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SKIN CARE
  • Do not use any perfumes, lotion, deodorant, or other skin products.
  • You may wash the area very carefully and gently but do not use any soaps, or shower gels except what the Radiographer recommends. Only use tepid water. You may feel more comfortable if you do not wash the area at all.
  • Do not use hot water bottles, heat pads, ice packs on the affected skin during treatment. If your skin feels hot and uncomfortable a hand held fan (or a hair drier set at cool) can be cooling.
  • Please avoid exposing the skin on and around your breast to the sun during treatment. After treatment is over it is important always to use a high factor sunscreen in the area which was treated whenever it is exposed.
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AFTER TREATMENT IS OVER
As already stated the effects of radiotherapy can last for several weeks after treatment is completed. Please continue to be gentle with your skin. Do not try to rub or scrub off any skin markings, these will wear off in time. It is important that you continue to examine your breasts for any changes during and after treatment. The vast majority of these changes will be due to either the treatment or to hormonal changes both of which are normal. However if you notice anything unusual or you are worried, please contact your Doctor.

Although coming to the end of your treatment is a relief, it is not unusual to feel a little vulnerable or emotional. Please discuss any fears or worries you may have with your Radiographer or Breast Care Nurse. It is also reassuring to know that your Oncologist will see you again 4 to 6 weeks after your treatment has finished and will continue to see you on a regular basis for several years.

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OTHER SITES ON THIS TOPIC:
The Breast Clinic - radiotherapy
CancerBACUP - radiotherapy
Breast Cancer Care - radiotherapy

last revised 12 April 2003