If you have already been given one of these forms, please bring the completed form with you when you come for

(1)

a patient’s guide

Information for patients at

Mount V

e

rnon Cancer Centr

e

Patient Information Series PI10

Radiotherapy

to the br

east

East and North Hertfordshire

NHS T rust

Ly

nd

a J

ac

ks

on

Macmillan Centr

e

... suppor

ting people affected by cancer...

2

Pr

egnancy

Female patients must not be pr

egnant or become pr

egnant at

any time during a course of radiotherapy

, or for up to 4 months

afterwar

ds.

If you think you may be pr

egnant at any time during tr

eatment,

it is very important that you discuss this with your oncologist, radiographer or nurse as soon as possible. Female patients will be asked to conﬁ

rm their pr

egnancy status

prior to radiotherapy

. This applies to all women between the

ages of 12 - 55 years. This is a legal r

equir

ement.

Identiﬁ

cation

Please note that it is a legal r

equir

ement for the staf

f

to check your name and details against your tr

eatment

sheet and your hospital name band each time you attend. Y

ou must wear your name band at all times

whilst in hospital.

Consent

It is a legal r

equir

ement to have a signed Consent Form

fr

om you befor

e the start of your tr

eatment.

If you have alr

eady been given one of these forms, please

bring the completed form with you when you come for your ﬁ

rst appointment.

If you have not been given a form, this will be discussed with you at your ﬁ

(2)

3

Radiotherapy to the br

east

Intr

oduction

This booklet pr

ovides a general guide for patients having

radiotherapy to the br

east at Mount V

e

rnon Cancer Centr

e.

It will pr

ovide answers to a number of commonly asked

questions. If anything in this leaﬂ

et is unclear or if you

have any questions, please ask a member of the team caring for you. Radiotherapy is one of a number of tr

eatments which may be of fer ed to patients with br east cancer . The choice of tr

eatment is determined by a number of

factors, and it is important that you discuss your speciﬁ

c

tr

eatment with your Consultant Oncologist

1 . As ther e ar e many dif fer ent forms of br east cancer , the length of tr

eatment and ways in which radiotherapy is given

can vary

.

The type of radiotherapy used to tr

eat br

east cancer in

this centr

e is called exter

nal beam radiotherapy

. This means

that a pr

ogrammed course of radiation therapy is applied

at r

egular intervals to your br

east.

Some patients will have a ‘boost tr

eatment’ at the end

of their exter

nal beam therapy

. This is known as electr

on

therapy and is given to the site of the original tumour

.

Exter

nal beam radiotherapy and electr

on therapy do not

make you radioactive. It is perfectly safe for you to be with people, including childr

en, as usual.

1

A Consultant Oncologist is a cancer specialist. In this leaﬂ

et the term

‘Oncologist’ will r

efer to both your cancer specialist and any doctors

(3)

5

Y

ou could be seen by both male and/or female

radiographers when you have your radiotherapy planning and tr

eatment.

What happens during planning?

Befor

e you begin your radiotherapy

, you will be asked to

visit the Radiotherapy Department to have your tr

eatment

planned. This appointment may take some time, and waiting times at this stage may vary

. Y

ou may be in the

department for a few hours. If you have had surgery to your br

east, it is important that

your scar has healed and that you can raise your arms easily above your head. If this is not the case for you, please contact your oncologist’

s secr

etary or br

east car

e nurse

(BCN) / keyworker prior to your planning appointment. The planning session will take place in the CT Simulator

.

For this appointment you may ﬁ

nd it easier to wear

separates as you will need to undr

ess to the waist.

W

e

r

ealise this may make you feel uncomfortable but

we will maintain your dignity as much as we ar

e able.

Y

ou will be asked to get on the couch and lay back on the

back r

est so your chest ar

ea is slightly raised with your arms

resting above your head. Please tell the radiographers if you ar

e uncomfortable as you will need to stay in this

position for up to 30 minutes. You may be asked to contr

ol your br

eathing during your

radiotherapy

. If your team decide this technique is

suitable for you, this will be discussed when you attend this appointment.

6

Ther

e may be several people in the r

oom with you. This

will include radiographers, doctors and physicists who will measur

e and r

ecor

d all the information needed to deliver

your tr

eatment accurately

.

The radiographers and oncologist will draw some marks on your chest. These ar

e done with felt tip pens and will

wash away

.

Once all the r

equir

ed measur

ements have been r

ecor

ded,

a CT scan of the chest will be done, this takes about ﬁ

ve

minutes. Some special markers will be placed on your skin for this scan. With your permission, the radiographers will make a few tiny permanent marks on the skin (tattoos). These ar

e

very small and ar

e done by pinpricking the skin with some

special dye. The permanent dots ar

e important as they

enable accurate positioning and tr

eatment delivery

each day

.

Some patients have a ‘boost’ ar

ea tr

eated. This is usually

planned at the same time as the br

east tr

eatment. The

‘boost’ ar

ea is a smaller ar

ea of the br

east i.e. the site of

the original tumour or the scar

. This may be tr

eated on a

dif

fer

ent machine using electr

on therapy

, and at a

dif

fer

ent appointment time.

The staf

f will be focussing on the technical aspects of your

planning and may not be able to talk to you but will keep you informed of what they ar

e doing.

Details of your tr

eatment appointments will be sent to you

(4)

7

What happens during tr

eatment?

Y

ou may be invited to attend a pr

e radiotherapy gr oup consultation wher e everything r egar ding your tr eatment

and possible side-ef

fects will be explained to you. If you

have not attended one of these sessions, a member of the tr

eatment team will talk to you befor

e you go into the

tr

eatment r

oom and will explain clearly what will happen.

Y

ou will have a chance to ask questions.

Please bring a dr

essing gown with you if possible.

This will enable you to change in the changing room befor

ehand. If you do not have a gown

we can pr

ovide you with a disposable gown to

use each time you attend. You will be asked to undr

ess to the waist and lie on the

tr

eatment couch in the same position as you did when your

tr

eatment was planned. The r

oom lights will be dimmed

and the radiographers will position the machine to line up with the permanent marks put on your skin when your treatment was planned. When all the changes have been made and you ar

e in

the corr

ect position, the radiographers will make sur

e you

ar

e comfortable befor

e leaving the r

oom to deliver your

tr

eatment.

The tr

eatment will last only a few minutes. Y

ou will

be alone in the r

oom during that time. However

, the

radiographers will be able to see you at all times thr

ough

closed cir

cuit television.

The radiographers will explain in advance how to alert them if you have a pr

oblem during tr

eatment. It is possible

to switch of

f the machine and interrupt your tr

eatment at

any time if necessary

.

8

Radiotherapy is completely painless. It’

s similar to having an

X-ray pictur

e taken, except instead of taking a pictur

e, the

machine delivers X-ray tr

eatment.

What special car

e should I take during

tr

eatment?

Skin car

e

Please continue washing as normal during your radiotherapy

. Y

our radiographer will monitor your skin each

time you attend for tr

eatment and advise you if you need

to change anything. Ƚ

W

ashing

Y

ou may bath or shower

, but try to avoid having the

water very hot or cold. We

r

ecommend you continue to use your usual soap

when washing the ar

ea being tr

eated. It is important

that you apply the soap gently

, using your hand

(rather than a sponge/ﬂ

annel), and that you rinse

the ar

ea well with warm water

. The tiny dots made

by the radiographers during your planning ar

e

permanent and will not be washed of

f.

When drying, use a very soft towel to ‘pat dry’. Try not to rub the skin, and pay extra attention to skin folds under the arm and under the br

east.

Ƚ

Using moisturiser If you alr

eady use a moisturiser then continue as

normal. It is not necessary to wash it of

f prior to

tr

eatment, as the cr

(5)

9

Ƚ

Using deodorant You may use a deodorant while on tr

eatment unless

you ﬁ

nd this irritates your skin.

Whilst having tr

eatment, try wearing loose, comfortable

clothing containing natural ﬁ

br

es such as cotton.

W

e

r

ecommend that you do not use talcum powder or

perfume in the ar ea being tr eated. However , ther e may be certain pr

oducts you can use. Please ask your radiographer

or staf

f at the L

e (LJMC).

Y

ou may notice that the sweat glands under your arm stop

working as a r

esult of the radiotherapy

, especially if you ar

e

having your armpit tr

eated. Y

ou may also notice that you

lose your underarm hair on the side being tr

eated (because

of the radiotherapy). Do not use any method of r

emoving

hair under your arm during tr

eatment.

Y

ou may go swimming during tr

eatment. However

, if the

chlorinated water irritates your skin you may need to stop. Please ask your radiographer for advice. If you have had a mastectomy you may ﬁ

nd it mor

e

comfortable to wear a soft lightweight bra and a temporary lightweight pr

osthesis (an artiﬁ

cial br

east form) during the

tr

eatment stage and for about six weeks afterwar

ds.

Exer

cises

If you have had a lumpectomy

, it is very important that

you continue with your arm exer

cises, both during and

for a couple of months after tr

eatment. If you have had a

mastectomy these exer

cises need to become part of your

daily r

outine for life. This will help r

educe the chance of

lymphoedema.

10

What ar

e the side-ef

fects of radiotherapy?

The most common side ef

fects ar

e discussed below

, and

these may not all apply to you. If you have any worries please talk to the staf

f tr

eating you.

Ƚ

Skin r

eactions

Some people experience changes to the skin in the area being tr

eated. This will peak about 7-10 days

after you ﬁ

nish your radiotherapy

. The skin may

become r

ed, similar to a sunbur

n r

eaction. Using a

mild moisturiser may help to soothe this side-ef

fect.

If the skin br

eaks/blisters, do not use the moisturiser

.

Please let the radiographers know when you come in for your radiotherapy

.

Some people complain of itchiness. Y

our skin will be

examined during your radiotherapy

, and you will be

given advice on how to continue to car

e for it. Skin

reactions may persist for up to four to six weeks after tr

eatment has ﬁ nished. Ƚ Br east changes During the tr

eatment you may have some tender

ness

in the ar

ea being tr

eated. Some people have short,

sharp shooting pains or a prickling sensation. If you have had a mastectomy

, you may notice

some slight swelling along the mastectomy scar

.

If you have had a lumpectomy or a partial mastectomy

, you may notice a change in the size,

shape or sensation of the br

east, and it may feel a

little swollen and mor

e tender in the ﬁ

rst few weeks

or months after radiotherapy

(6)

11

Ƚ

Numbness You may have numbness to the upper part of the inner arm on the tr

eatment side. For most women

this feeling should be temporary

. Sometimes some numbness may r emain. Ƚ T ir edness Most women ﬁ

nd that attending the hospital daily

and having tr

eatment causes them to become

generally tir

ed and lethargic. This can continue for

many weeks after tr

eatment has ﬁ

nished. Please

see our Helpful Hints factsheet ‘Living with tiredness (fatigue)’.

Ƚ

Arm lymphoedema (swelling) If you ar

e having radiotherapy to the br

east only

,

lymphoedema is rar

e, depending on the number of

nodes r

emoved during your surgery

.

If you ar

e having radiotherapy to the supraclavicular

lymph nodes (the ar

ea above the collar bone) or

to the axilla (armpit), then the risk of developing lymphoedema is higher

.

If you feel you would beneﬁ

t fr

om extra support in

coping with lymphoedema, please speak to your breast car

e nurse (BCN) / keyworker or clinic r

eview

radiographer

.

For mor

e information on lymphoedema you can

phone or dr

op in to the L

ynda Jackson Macmillan

Centr

e (LJMC) at any time befor

e, during or after

your tr

eatment.

12

Less common and rar

e late side-ef

fects

These side-ef

fects ar

e not common, and most patients

will not be af

fected by them. If you have any concer

ns, or

wish to ask if you ar

e at risk, please discuss them with your

oncologist, clinic r eview radiographer or br east car e nurse. Ƚ Fibr osis Radiotherapy to the br

east and armpit can cause

har

dness of the tissue. This is known as ﬁ

br

osis and

is caused by the build-up of scar tissue. If the ﬁ

br

osis

becomes sever

e, the br

east can become noticeably

smaller as well as har

der

.

Ƚ

Dry cough or shortness of br

eath

Sometimes, in or

der to deliver radiotherapy ef

fectively

to the br

east, it is necessary to tr

eat a small part of

the lung (although we take steps in the planning process to limit this as much as possible). V

ery rar

ely

the lung can become inﬂ

amed, causing a dry cough

or shortness of br

eath. These symptoms usually

resolve without any tr

eatment.

Ƚ

Telangiectasia You may be able to see tiny dilated blood vessels under the skin as a late side ef

fect of radiotherapy

.

This is known as telangiectasia.

Ƚ

Br

east lymphoedema

V

ery rar

ely patients may develop lymphoedema

acr

oss the br

east and chest wall ar

ea following

radiotherapy

(7)

13

Ƚ

Heart damage If you r

eceive tr

eatment on your left side, ther

e is a

small risk of damage to your heart. Y

our tr

eatment

will be car

efully planned to minimise the risk. Please

discuss any concer

ns with your consultant or clinic

review radiographer

.

Ƚ

Ef

fects on the bones

A rar

e delayed side ef

fect following br

east

radiotherapy can be a weakening of the ribs and collar bone within the tr

eatment ar

ea. If you have any

discomfort in these ar

eas please tell your oncologist.

What special car

e should I take after

tr

eatment?

Ƚ

Exer

cises

If you have had br

east surgery

, it is very important

to continue with your arm exer

cises both during and

following tr

eatment (see page 9).

Ƚ

Diet Radiotherapy to the br

east ar

ea should not af

fect

your diet or digestion of food. It is important that you eat well, and drink mor

e ﬂ

uids than usual during

and after your tr

eatment. Please visit the LJMC for

information on healthy eating.

Ƚ

Swimming Chlorinated water could irritate your skin so you may want to wait until your skin r

eaction has

settled down.

14

Ƚ

Emotions Ther

e may be times when you feel a little anxious or

concer

ned, or generally mor

e emotional. This is quite

normal, especially if taking hormonal therapy

.

If you feel you would beneﬁ

t fr

om extra support

in coping with these feelings, please speak to your breast car

e nurse (BCN) / keyworker or clinic r

eview

radiographer

. Y

ou can also phone or dr

op in to the

Lynda Jackson Macmillan Centr

e (LJMC) for advice at

any time befor

e, during or after your tr

eatment.

Ƚ

Sunbathing when tr

eatment is ﬁ

nished

It is unwise to become sunbur

nt on any part of your

body

. Do not expose the tr

eated ar

ea to the sun

until the ar

ea has fully r

ecover

ed. This may be up

to six weeks after tr

eatment has ﬁ

nished. It will be

necessary to apply a high pr

otective factor sun cr

eam

to the tr

eated ar

ea for life, as the skin will r

emain

mor

e sensitive to the sun.

If you have had the ar

ea above your collar bone and/

or your armpit tr

eated, you should take

car

e when

exposing your back to the sun. If you r

equir

e speciﬁ

c

guidance r

egar

ding sunbathing check with the

(8)

15

Follow-up car

e

Y

ou will be seen during your tr

eatment by a clinic r

eview

radiographer or your oncologist’

s team.

On your last day of radiotherapy you will be given details of how to make your ﬁ

rst follow up appointment, which

is usually arranged for about 6 weeks later

. If you do not

receive this information please contact your oncologist’

s secr etary or br east car e nurse (BCN) / keyworker . This

appointment may be with your Mount V

e

rnon oncologist

or a doctor within his/her team at either the Cancer Centr

e

or the District General Hospital near

er your home. In some

cases your own family doctor (GP) will take on the r

outine

monitoring of your condition. In between your follow-up appointments, if you ar

e

worried by any skin changes, lumps, arm swelling or any pains that you cannot explain, you can make a special appointment to see your own GP

, br

east car

e nurse

(BCN) / keyworker or your oncologist.

Additional help and support

People who have had cancer will say that thr

oughout their

illness they experienced a range of emotions, expected and unexpected. Many ﬁ

nd it to be a str

essful, anxious and

confusing time, both as individuals and within r

elationships.

Some patients ﬁ

nd it helpful to meet and discuss their

experiences with other patients who have been thr

ough

similar tr

eatment. If you would like to meet another

patient, please speak to a team member

.

16

Some patients ﬁ

nd it har

der to make decisions or to face

up to things, feeling overwhelmed and unable to focus on positive aspects within their lives. If you have dif

ﬁ culty making sense of your feelings or can

relate to any of these experiences, you may ﬁ

nd it helpful

to talk it thr

ough with a trained health car

e pr

ofessional,

who may r

efer you for counselling. Y

ou can also go to the

Lynda Jackson Macmillan Centr

e (LJMC) and ask to meet

with a counsellor

.

Counselling aims to pr

ovide individuals and families with

an opportunity to understand and manage these new experiences. The LJMC pr

ovides support and information. It also of

fers

a range of services including counselling, complementary therapies and r

elaxation sessions.

To

ﬁ

nd out mor

e see the back of this leaﬂ

et.

Contacts

Your oncologist:

... Y our br east car e nurse (BCN) / keyworker: ...

Radiotherapy clinic nurses:

...

020 3826 2186

Radiotherapy clinic radiographers:

...

020 3826 2612

or 07825 024058 Lynda Jackson Macmillan Centr

e:

...

(9)

17

Further Information

HOPE

(Help Over

come Pr

oblems Ef

fectively)

This is a course that helps people who have had cancer to move on with life after tr

eatment.

It runs for six weeks, 2½ hours a week, at the L

e (LJMC).

The course aims to enable people to cope emotionally

, psychologically and practically

by focusing on building on their existing str

engths.

Look Good... Feel Better

TM

A make-up workshop for women living with cancer

. W

ith the help

and encouragement of the beauty consultants, the two-hour sessions in the LJMC ar

e enjoyable,

morale boosting and informative. For mor

e information on any of these or support gr

oups,

please dr

op into the L

e or

call 020 3826 2555.

18

Glossary

Axilla

: the technical name for the armpit.

Chemotherapy

: a tr

eatment that uses chemicals called

drugs to destr

oy cancer cells.

CT scan (Computerised T

omography)

: a scan using a

special kind of X-ray machine. Instead of sending out a single X-ray thr

ough your body (as with or

dinary X-rays),

a CT scanner sends several beams fr

om dif

fer

ent angles

at the same time. Fibr

osis

: the formation of an abnormal amount of ﬁ

br

ous

tissue which can cause tissue har

dness. Lumpectomy : an operation that r emoves a lump fr om your br east. Lymph

: a clear liquid that ﬂ

ows ar

ound your body

. L

ymph

keeps your cells healthy and fr

ee fr

om infection.

Lymphatic system

: the network of lymph vessels (small

tubes) and lymph nodes, that carry lymph ar

ound your

body

.

Lymphoedema

: a swelling caused by the build-up of

lymph. It happens when the tubes carrying lymph ar

e

damaged or blocked in some way

. It might also happen if

some of your lymph nodes have been r

emoved.

Lymph nodes

(lymph glands): part of the lymphatic

system; they ﬁ

lter or trap anything that might cause harm.

For example, when you have a sor

e thr

oat the lymph nodes

(glands) in your neck become tender and swollen. Mastectomy

: an operation that r

emoves all of your br

(10)

19

Oncologist

: a doctor who specialises in tr

eating cancer

.

A clinical oncologist specialises in tr

eating cancer with

radiation and/or drugs, while a medical oncologist specialises in tr

eating cancer with drugs only

.

Pr

osthesis

: a specially made r

eplacement for a part of your

body which has been r

emoved (for example, an artiﬁ

cial

leg or br

east).

Supraclavicular nodes

: lymph nodes above the clavicle

(collar bone). Telangiectasia

: an abnormal dilation of blood vessels

pr

oducing blotched r

ed spots.

suppor

t & inf

or

mation at Mount V

er

non Cancer Centr

e

... suppor

ting people affected by cancer...

Lynda Jac

kson Macmillan Centr

e

This leaf let f or ms par t of a series of pub lications pr oduced b y the L ynda Jac

kson Macmillan Centr

e (LJMC).

If y

ou would like fur

ther inf

or

mation a

bout an

y aspect of

cancer and its tr

eatments

, please dr

op in to the centr

e or

call the Helpline. The LJMC is staf

fed b y healthcar e pr ofessionals and tr ained volunteer s and is par t of the Mount V er

non Cancer Centr

e. Ser vices of fer ed at the LJMC inc lude: Ƚ Dr op-in centr e f or suppor t and inf or mation Ƚ Tele phone helpline Ƚ Benefits advice* Ƚ Complementar y ther apies* Ƚ Relaxation c lasses Ƚ Counselling* Ƚ Look Good...F

eel Better™ beauty wor

kshops Ƚ Self-help cour ses The Lynda Jac

kson Macmillan Centr

e is situated

between the Cancer Centr

e and Gate 3 (White Hill)

Opening hour

s:

Mon-F

ri: 9.30am-1.00pm & 2.00-4.30pm

Mount V

er

non Cancer Centr

e, Nor thwood, Middlese x HA6 2RN Tele phone Helpline: 020 3826 2555 We bsite: www .ljmc.or g * T hese ser vices ar e av aila ble to NHS

patients under the care of

an oncolo gist based at Mount V er non Cancer Centr e.

If you have already been given one of these forms, please bring the completed form with you when you come for

a patient’s guide

Radiotherapy

to the br

east

Ly

nd

a J

ac

ks

on

Macmillan Centr

e

Pr

egnancy

Identiﬁ

cation

Consent

Radiotherapy to the br

east

Contents

Intr

oduction

What happens during planning?

What happens during tr

eatment?

What special car

e should I take during

tr

eatment?

What ar

e the side-ef

fects of radiotherapy?

Less common and rar

e late side-ef

fects

What special car

e should I take after

tr

eatment?

Follow-up car

e

Additional help and support

Contacts

Further Information

HOPE

Look Good... Feel Better

Glossary

suppor

t & inf

or

mation at Mount V

er

non Cancer Centr

e

Lynda Jac

kson Macmillan Centr

e