Preparing for Radiation

Well I got my 6 little blue marks to prepare for 35 radiation treatments. I was down graded from 37.  I will be going Monday thru Friday until May 13, 2016.  The entire breast will get radiation. The machines are enormous. There are 2 treatment rooms but I was in a simulation room in order to get the  placement of the marks. I know this part was supposed to be no big deal but it felt a little intimidating.  Fortunately I was able to secure an 8:15 am time slot for when I return from my cruise.   I took a questionnaire about how I have been feeling in the last week. My distress level I reported as a 4 on a scale of 1 to 10 - ten being the worst- I am sure going away is the reason I am not too distressed but I did report to feeling quite sad. I am so sad to learn that cancer for me, will likely be a chronic disease because of the lymph node involvement.  I just wanted to go through this and then be done- kind of like a divorce. But I guess not..... more like shared custody--- we will have to deal with each other for the rest of our lives. 
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You'll meet with your radiation therapy team, health care professionals who work together to plan and provide your radiation treatment. Team members usually include:

• A radiation oncologist, a doctor who specializes in treating cancer with radiation. He or she determines the appropriate therapy for you, follows your progress and adjusts your treatment, if necessary.
• A radiation physicist and a dosimetrist, who make calculations and measurements regarding your radiation dosage and its delivery.
• A radiation oncology nurse, who can answer questions about the treatments and side effects, and help you manage your health during treatment.
• A radiation therapist, who operates the radiation equipment and administers your treatments.

Before your first treatment session, you'll go through a simulation in which a radiation oncologist carefully maps your breast area to pinpoint the precise location of your treatment. During the simulation:

• A radiation therapist helps you into a position best suited to pinpoint the affected area and avoid damage to surrounding normal tissue. Sometimes pads or other devices are used to help you hold the position.
• Using a CT scanner, the radiation oncologist locates the treatment area. You'll hear noise from the CT equipment as it moves around you. Try to relax and remain as still as possible to help ensure consistent, accurate treatments.
• Ink marks or tiny permanent tattoo dots are placed on your skin to guide the radiation therapist in administering the radiation. Be sure not to wash ink marks off until you're told to do so. If the marks can't be seen, you may need to go through the mapping process again.
• The dosimetrist, radiation physicist and radiation oncologist use computer software to plan the dose of radiation you'll receive. Once the simulation and planning are complete, you can begin treatment. For each session, avoid wearing jewelry, latex bandages, powder, lotion or deodorant on or near your treatment area. These substances can interfere with delivery of the radiation.

Radiation therapy usually begins three to four weeks after lumpectomy surgery to remove a breast cancer. Radiation therapy is used to eliminate any remaining cancer cells in the breast or armpit area.There are two primary types of radiation used in treating breast cancer. They are:

• External Beam Radiation - a traditional approach to delivering radiation.Treatment usually takes several weeks with a Monday through Friday schedule. In certain instances, a shorter treatment regimen, called accelerated radiation, is used. It delivers a higher dose of radiation over three or four weeks. Daily treatment with external beam radiation consists of set up time and positioning activities followed by receiving radiation, which takes about 2-3 minutes. Treatment is painless.

Radiation therapy for breast cancer

Radiation therapy is treatment with high-energy rays or particles that destroy cancer cells. Radiation to the breast is often given after breast conserving surgery after to help lower the chance that the cancer will come back in the breast or nearby lymph nodes. Radiation may also be recommended after mastectomy in patients either with a cancer larger than 5 cm, or when cancer is found in the lymph nodes.

Radiation is also used to treat cancer that has spread to other areas, for example to the bones or brain.   Radiation therapy can be given externally (external beam radiation) or internally (brachytherapy).

External beam radiation

This is the most common type of radiation therapy for women with breast cancer. The radiation is focused from a machine outside the body on the area affected by the cancer.

The extent of radiation depends on whether mastectomy or breast-conserving surgery (BCS) was done and whether or not lymph nodes are involved.

If mastectomy was done and no lymph nodes had cancer, radiation is targeted at the chest wall and the places where any drains exited the body.

If BCS was done, most often the entire breast gets radiation, and an extra boost of radiation is given to the area in the breast where the cancer was removed to prevent it from coming back in that area. The boost is often given after the treatments to the whole breast have ended. It uses the same machine, but the beams are aimed at the place where the cancer was removed. Most women don’t notice different side effects from boost radiation than from whole breast radiation.

If cancer was found in the lymph nodes under the arm, radiation may be given to this area as well. In some cases, the area treated may also include supraclavicular lymph nodes (nodes above the collarbone) and internal mammary lymph nodes (nodes beneath the breast bone in the center of the chest).

When given after surgery, external radiation therapy is usually not started until the tissues have been able to heal, often a month or longer. If chemotherapy is to be given as well, radiation therapy is usually delayed until chemotherapy is complete.

Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. They will make some ink marks or small tattoos on your skin that they will use later as a guide to focus the radiation on the right area. You might want to ask your health care team if these marks will be permanent.

Lotions, powders, deodorants, and antiperspirants can interfere with external beam radiation therapy, so your health care team may tell you not to use them until treatments are complete.

External radiation therapy is much like getting an x-ray, but the radiation is more intense. The procedure itself is painless. Each treatment lasts only a few minutes, but the setup time—getting you into place for treatment—usually takes longer.

Breast radiation is most commonly given 5 days a week (Monday through Friday) for about 5 to 6 weeks.   Some older women who have breast conserving surgery for early stage breast cancer don’t need radiation. 

Possible side effects of external radiation: The main short-term side effects of external beam radiation therapy to the breast are swelling and heaviness in the breast, skin changes in the treated area, and fatigue. Skin changes can range from mild redness to blistering and peeling. Your health care team may advise you to avoid exposing the treated skin to the sun because it may make the skin changes worse. Most skin changes get better within a few months. Changes to the breast tissue usually go away in 6 to 12 months, but it can take up to 2 years.

In some women, the breast becomes smaller and firmer after radiation therapy. Having radiation may also affect your options for breast reconstruction later on. It can also raise the risk of problems if it is given after reconstruction, especially tissue flap procedures. Women who have had breast radiation may have problems breastfeeding later on. Radiation to the breast can also sometimes damage some of the nerves to the arm. This is called brachial plexopathyand can lead to numbness, pain, and weakness in the shoulder, arm and hand.

Radiation therapy of axillary lymph nodes also can cause lymphedema. 

In rare cases, radiation therapy may weaken the ribs, which could lead to a fracture. In the past, parts of the lungs and heart were more likely to get some radiation, which could lead to long-term damage of these organs in some women. But modern radiation therapy equipment allows doctors to better focus the radiation beams, so these problems are rare today.

A very rare complication of radiation to the breast is the development of another cancer called angiosarcoma.  These rare cancers can grow and spread quickly.