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Breast Cancer Treatment: Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Most women receive radiation therapy after breast conservation surgery, and some women receive radiation therapy after a mastectomy. The radiation destroys breast cancer cells before surgery or that may remain in the area following breast cancer surgery.

Some women have radiation therapy before surgery to destroy cancer cells and shrink the tumor. Doctors use this approach when the tumor is large or may be hard to remove. Treatment depends on the size of the tumor and other factors.

Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:

  • External Radiation —The radiation comes from a large machine outside the body. Most women go to a hospital or clinic for treatment. Treatments are usually five days a week for several weeks.
  • Implant Radiation — Thin, plastic tubes that hold a radioactive substance are put directly in the breast. The implant stays in place for several days.

Side Effects

Side effects depend mainly on the dose and type of radiation and the part of your body that is treated.
It is common for the skin in the treated area to become red, dry, tender and itchy. Your breast may feel heavy and tight, but these problems will go away over time. Toward the end of treatment, your skin may become moist and “weepy.” Exposing this area to air as much as possible can help the skin heal.

Bras and some other types of clothing may rub your skin and cause soreness. You may want to wear loose-fitting cotton clothes during this time. Gentle skin care is also important. You should check with your doctor before using any deodorants, lotions or creams on the treated area. The effects of radiation therapy on your skin will go away, and the area will gradually heal once treatment is over. However, there may be a lasting change in the color of your skin.

You may become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Although the side effects of radiation therapy can be distressing, your doctor can usually relieve them.

Frequently Asked Questions

Will I still have feeling in my breast after radiation therapy?
Most women who have breast conservation surgery followed by radiation therapy will still have sensation in their breast.

What does radiation therapy after breast conservation surgery involve?
Radiation therapy is usually performed as an outpatient procedure over a period of at least five weeks. Some women are not able to make that commitment. Some women live far from radiation facilities or can’t afford to take the time for daily treatments. Others may have health conditions, such as pregnancy, lupus or heart disease, that prevent them from undergoing radiation. Since radiation therapy lowers the risk of recurrence for women who choose breast conservation surgery, patients and their doctors must consider the requirements for radiation therapy before deciding which surgical option is best for them.

Why do I need radiation therapy if the tumor is removed with clear margins?
Women who have radiation therapy after breast conservation surgery are less likely to have cancer return in the same breast than women who have breast conservation surgery without radiation.

I heard that radiation can cause cancer. Will it increase my risk for other cancers?
Radiation therapy has improved greatly through the years, and the doses are much lower than they used to be. The risk of another cancer due to radiation therapy to the breast is very small. The bottom line is that women who have radiation therapy after breast conservation surgery are less likely to have cancer recur in the same breast, and they live just as long as women who undergo a mastectomy without radiation.

What are the chances of the cancer coming back if I have breast conservation surgery with radiation? If I decide on a breast conservation surgery with radiation, how can you be sure there are no other “spots” in the breast?
Most women who have breast conservation surgery followed by radiation will not have cancer recur in the same breast. In studies, recurrence rates within 10 years of breast conservation surgery followed by radiation range from 4 percent to 20 percent. This might seem like a big range, but keep in mind that cancer that recurs in the same breast can be treated and does not affect chances of a healthy recovery compared to a mastectomy. Another thing to keep in mind is that doctors suggest breast conservation surgery only if they feel it offers a very good chance of removing all of the cancer. Obtaining a clear margin is one way the surgeon can lower the risk of recurrence. Radiation also lowers the risk of the cancer recurring in the same breast.

What about the side effects of radiation? I hear it makes the breast hard.
Radiation therapy can cause a skin condition that looks like sunburn. This usually fades, but in some women it never goes away completely. Some women do find that radiation makes their breast feel hard or firm. This may last just a few months, or longer.

Keep in mind that the side effects of treatment vary for each person. Some women may have many side effects or complications, others may have very few. Pain medication, physical therapy and other strategies can help women manage side effects and recovery.