Breast radiotherapy

What is radiotherapy?

Radiotherapy uses high-energy x-rays to treat cancer. You usually have it after breast surgery. It lowers the chance of the cancer coming back in the breast or chest wall, and it can help you live longer. A lot of research shows it works well.

A machine called a linear accelerator (LINAC) gives the treatment. Radiotherapy does not make you radioactive. It is safe to be around other people, including children, after your treatment

Oncology appointment

Informed consent

After receiving your surgery results, you will meet a cancer doctor (oncologist) and/or advanced practice radiographer. They will:

• explain why radiotherapy is right for you
• talk through the benefits and the risks
• answer your questions

This helps you make an informed choice. It is important you take your time to consider your options. If you are not sure, you can ask for more time to think. You can also ask for a copy of your consent form to read at home.

Areas we may treat:

• Whole breast
• Partial breast
• Chest wall

We may also treat some lymph nodes, and your consent form may list:

• Lymph nodes in the armpit (axilla)
• Lymph nodes in the lower neck (supraclavicular fossa)
• Lymph nodes behind the breast bone (internal mammary chain)

Sometimes we give a little extra treatment to where the lump was removed. This called a tumour bed boost. You will be told whether this will be beneficial to you.

Key Contact

Your key contact during radiotherapy is the advanced practice therapeutic radiographer. You can contact them at any point if you have any more questions about your radiotherapy on the details provided below.

Poppy Thompson:

01223256710

poppy.thompson9@nhs.net

We are part of the East of England Radiotherapy Network For more information about radiotherapy visit the East of England Radiotherapy Network.

What happens next?

Planning your treatment

About 2-3 weeks after your first appointment, you will come to the Radiotherapy Department (Outpatients, level 2, near Oncology) and have a CT scan of your chest. We use this to design the treatment just for you..

This appointment takes about 30 minutes. The scan itself, only takes a few minutes. The rest of the time is spent finding a comfortable position that you can manage for the radiotherapy

You will need to take off your top clothing off down to the waist so that we can plan the area for treatment. A west top is easy to wear and remove. A gown or cover is available but you can bring your own scarf or use your top to cover yourself as you walk to the couch.

You will lie on your back with both of your arms raised above your head, resting/holding on to a support it is really important that you let the radiographers know if this is uncomfortable as you will be in this same position for every treatment.

You will meet both male and female radiographers in our department. Everyone is professionally trained to treat you with dignity and respect.

Politely speak to the team if you have any concerns.

Other important things to consider

When we design your treatment it is important that everything is the same between appointments. This is to make sure that the radiotherapy is delivered accurately.

Sometimes, we may need to wait to do this first appointment because you are not able to bring your arms above your head, you still have a wound following your surgery or you are still having fluid drained from the breast.

If you have any concerns or are experiencing any of these and are due to attend this first appointment please phone/email your key contact for radiotherapy.

Surface Guided Radiotherapy

We are now use surface guided radiotherapy or SGRT. Special cameras make a map of your skin surface. We use this to check your position before and during each treatment.

We no longer use permanent skin marks. If we need to, we may make a few temporary marks on your skin with pen that will wash off.

For SGRT to work, your chest needs to be uncovered so that the cameras can see your skin clearly.

You may need to have two CT scans:

• the first while you hold your breath
• the second while you breath normally (this scan is a low-dose scan to keep the amount of radiation small, and it is safe to have this on the same day).

This is not always the case and you may only need to have one scan on the day. The radiographers can explain this to you when you have your appointment.

Holding your breath

You may be told about breath-hold which is sometimes called deep inspiration breath-hold (DIBH) and asked to practice this for the planning scan and for treatment. This means taking a deep breath in and holding this for a short time in short intervals (25-30 seconds). We do this to help move the heart away from the radiotherapy field shown in the image below.

It is really important to note that this in not the only way to protect the heart. If you find this hard, please do not worry as we will always plan your treatmen to to keep the dose to the heart very low.

If holding your breath is something that you have been asked to do, it helps to practice before your planning scan. This will help you to build your confidence and for how long you can hold your breath.

There are some free videos that were created and designed by patients like you to help you practise which can be found at www.respire.org.uk (opens in a new tab).

We suggest:

• Practise for 10-15 minutes a day
• Build up slowly: hold only for 5 seconds, then 10, 15 and 20 seconds
• Aim for up to 30 seconds if you can. This is close to the time needed for your CT scan.

During the treatment we adjust this to suit you as you will be guided by a screen above your face that shows a moving bar (this is moving as you breathe).

• Yellow means you are breathing normally
• Green means you are holding your breath in the right position.

It is normal for this to take a few tries on your first day of treatment. The screen looks a bit like this below. You can request not to have this screen if you don’t think this is helpful.

If you are worried about holding your breath for the treatment please speak to your key contact for radiotherapy who can talk this through with you.

Radiotherapy treatment

It takes time to design your treatment plan as there are many things that happen behind the scenes in order to make sure we create a safe and effective treatment plan for you.

• After your CT scan, there is a gap of about 2-3 weeks until your first treatment.
• We do many safety checks in this time.
• The gap doesn’t make the treatment less effective.
• Usually, you receive your appointments after your CT scan appointment, this may be by post or through MyChart (if you use it).

Therapeutic radiographers will greet you on your first day and explain what will happen on your first treatment and discuss any concerns that you may have. They will also go through some of the possible side-effects and confirm that you still would like to go ahead with the radiotherapy.

• Therapeutic radiographers will ask your name, date of birth and address every day, this is important to check we have the correct person in the treatment room.
• You will be asked to remove your top half of clothing, similar to when you had your CT scan (remember you can use your own scarf/top or ask for a gown to cover you as you walk to the treatment couch).
• You will be in the room between 15 to 40 minutes, depending on your treatment (the treatment itself is much quicker than this).
• You will lie flat with your arms raised above your head. (Your position may be a little different to this if this was too uncomfortable for you) and the radiographers will position you for your treatment.
• The radiographers will leave the room when you are in the correct position. You are alone, but you are being watched on cameras at all times. The radiographers will remind you that they are about to leave and to keep nice and still.
• There is nothing to see or feel during the treatment, but it is normal to hear some buzzing noises as the machine moves around you and swicthes on and off.
• Breathe away normally, unless you have been asked to hold your breath. The radiographers will talk you through this via an intercom.
• If you need to get the radiographers attention, they are watching you all the time, you can raise your hand carefully and wave so that they can stop the machine and come in.

We are partnered with the Little Lifts charity and you are entitled to receive a Little Lifts Radiotherapy gift box during your treatment. Please ask for one if you are not given one at the start of your treatment.

Number of treatments

The number of treatments is different for each person and your cancer doctor will have explained the best plan for you.

Radiotherapy trials

We are a leading centre for breast cancer treatment. Our trials team may ask if you would like to join a clinical trial. You will get information to read, plenty of time to decide, and you can change your mind at any time. Trials are not available to everyone and change often. If no one approaches you, we likely do not have a trial for you right now.

Possible side-effects of treatment

Early / Short-term

These side effects tend to start during the radiotherapy or shortly afterwards and usually resolve within two to six months of finishing radiotherapy. All of the ‘possible’ side-effects will be mentioned to you as it is to ensure you are fully informed of what ‘could’ happen. It does not mean that you are going to get every side effect that is discussed here

Expected (50% - 100% chance)

• Tiredness
• Temporary hair loss in the treatment area

Common (10% - 50%)

• Skin soreness, itching, blistering and colour changes in the treatment area
• Redness in white skin tones and subtle darkness, yellow / purple / grey appearance in brown and black skin tones.

Less common (less than 10%)

• Breast / chest wall / axilla discomfort
• Breast swelling
• Change in breast texture

Rare (Less than 1%)

• Sore throat
• Skin blistering
• Lung inflammation (pneumonitis) – which can lead to a cough / breathlessness

Late / Long-term

These are side-effects that may happen many months or years after radiotherapy and may be permanent.

Expected (50% - 100%)

• Breastfeeding – after breast radiotherapy (and or surgery), you may not produce milk in that breast but the other breast will not be affected.

Common (10% - 50%)

• Skin colour change in the treatment area including; lighter / darker or pinker
• Subtle changes to the breast appearance including; changes to breast size, shape and texture
• Breast / chest wall / axilla discomfort including; aching and shooting pains
• Worsened cosmetic outcome after reconstruction surgery – may require the implant to be replaced

Less common (Less than 10%)

• Marked change to breast appearance including; change to breast size, shape and texture
• Breast / chest wall swelling
• Shoulder stiffness
• Swelling (Lymphoedema) of the arm – fluid collecting in the arm which may cause swelling, pain and or movement difficulties

Rare (Less than 1%)

• Skin changes (Telengiectasia) in the treatment area – these are small visible blood vessels that look like spidery marks
• Rib fracture
• Fibrosis (scarring) of the underlying lung – can cause breathlessness, cough or changes on x-ray
• Increased risk of heart disease later in life
• Brachial plexopathy – nerve damage which may cause pain, numbness or tingling affecting the arm and shoulder
• A different cancer in the treatment area

Some of these sound worrying, but the benefit of radiotherapy is greater than these risks. We look at your own risks carefully and will talk to you if they are different than from above.

Advice and guidance on side-effect management

Looking after your skin

You cannot stop a skin reaction, but you can help yourself feel more comfortable. Tell your radiographers and breast care nurse about your usual skincare and any changes. Tell them if your skin is painful, so they can suggest pain relief. Talk to them about any worries.

Washing and moisturising

• Keep using a moisturiser you like. No single product is proven to be best.
• Put it on often. Smooth it on gently until it soaks in.
• If you do not use a moisturiser, ask the team to suggest one.
• You do not need to wipe it off before treatment, but do not put it on just before treatment.
• Stop using it if it irritates your skin, and tell the team.
• If your skin blisters or peels, stop using moisturiser there and ask the team for advice.
• Use water that is not too hot. Wash gently with your usual products and pat dry.
• Keep using your usual deodorant, unless it irritates your skin. Stop if your skin blisters or peels.

Please avoid (on the treatment area)

• rubbing the area
• sticky tape (such as plasters or Micropore)
• shaving — reduce it if you can, unless the team advise otherwise
• wax, hair-removal cream or lasers
• make-up, hair dye, perfume and aftershave on or near the area.

After your treatment ends

• Your skin may get worse for 10 to 14 days before it gets better.
• Most people’s skin improves about 4 weeks after treatment.
• Blistered or peeled skin may take longer to heal.
• The treated area stays more sensitive than the rest of your skin, especially to heat and sunlight.

This skincare advice (opens in a new tab) is from the Society and College of Radiographers (updated 2020).

Health and well-being

It helps your health if you drink 6 to 8 glasses of water a day and eat a healthy, balanced diet with fruit, vegetables, wholegrains and lean protein.

• You can swim if your skin is not blistered or peeling. Shower straight after to wash off the chlorine, then moisturise. Stop if it irritates your skin.
• Loose clothes made of natural fabric (like cotton or silk) may feel more comfortable.
• Protect the treated area from the sun. Cover up and wear a wide-brimmed hat. Keep protecting it for at least a year after treatment. Use sunscreen SPF 50, as your skin will be more sensitive.
• Reduce alcohol and try and keep within the recommended government guidelines or less
• Avoid smoking or vaping
• Maintain a healthy weight

Tiredness (fatigue)

You may have less energy than usual during treatment and for a few weeks after. This is different for each person — from none at all to very tired. You may feel weary, weak or slower than usual. This is normal. Many things can add to tiredness, such as the effort of coming for treatment, stress, a change in routine, poor sleep, or other treatments. Things that may help:

• gentle, regular activity during and after treatment
• good sleep. Some people need a rest in the day — notice how naps affect you
• choose the activities that matter most and do others later (this is called pacing)
• let family or friends help with jobs, errands or lifts, so you have more time to rest
• do what is right for you at work. A phased return or change to your hours may help.

Breast changes

Some people get breast tenderness during or after treatment, and the breast can feel swollen. If you have had a mastectomy, the chest area may feel tight. You may feel aching, twinges or sharp pains. This is a normal part of healing. It usually settles within a few weeks, but can take a few months for some people. If you are worried, please contact the advanced practitioner or the breast care nurses.

After your radiotherapy — follow-up

You will have an end-of-treatment appointment in your final week (if you have 15 treatments) or within 2 weeks of finishing (if you have 5 treatments). This may be face-to-face or by phone. At this appointment we will talk about any side effects and explain what to expect now treatment has finished.

Radiotherapy keeps working for about 2 weeks after treatment, so side effects can get worse before they get better. On your last day, you will get information on what to expect and how to manage any worries. You can always call the advanced practitioner.

We will also talk about patient-initiated follow-up (PIFU), any further appointments, scans, and any other treatments. If you do not get an appointment within 2 to 3 weeks of finishing, please call the Breast Unit 01223 217627 or the advanced practitioner 01223 256710.

It is common to feel overwhelmed when treatment ends. This usually improves. If you are worried, please reach out for support — see below.

Support for you

There is lots of support — in person, by phone or online. Use what feels right for you. You can contact these services at any time after treatment.

Maggie’s Centre, Cambridge

A charity support and information centre for people with cancer. Free help with feelings, practical things, and managing symptoms and side effects.

Website: www.maggies.org (opens in a new tab).

Phone: 01223 249220 (Mon–Fri, 9am–5pm).

Maggie’s Cambridge,

Addenbrooke’s Hospital,

21 Milton House,

Puddicombe Way,

Cambridge,

CB2 0AD.

Email: cambridge@maggies.org

Macmillan Cancer Information and Support (“The Pod”)

A drop-in service in the Oncology department — no appointment needed. Help, advice and signposting, including grants and benefits advice.

Helpful websites

• Macmillan Cancer Support (opens in a new tab)
• Breast Cancer Care (opens in a new tab)
• Breast Cancer Now (opens in a new tab)
• Cancer Research UK (opens in a new tab)
• East of England Radiotherapy Network (opens in a new tab)

Apps

• Sleepio (Macmillan) — for poor sleep and insomnia
• Daylight (Macmillan) — for worry and anxiety

REACT programme

Rehabilitation and Exercise during Addenbrooke’s Cancer Treatment. Free for all patients having cancer treatment here, led by specialist physiotherapists and cancer exercise specialists. It includes exercise assessments, group classes and short courses (such as breast cancer recovery, lymphoedema prevention, bone health, strength and balance, Pilates, Tai Chi, yoga, Zumba and Nordic walking). Ask the breast care nurses or advanced practitioner for a referral.

Useful information and contacts

Radiotherapy

• Poppy Thompson- Advanced Clinical Practitioner in Breast Radiotherapy: 01223 256710
• Radiotherapy reception: 01223 216634
• Breast Unit Reception: 01223 217627

How to get involved

We believe that involving patients and carers can help us improve the services we provide.

There are many ways that you can get involved and help us improve the services we provide. For further information you can visit the CUH website to read more about the following;

Patient and Carer User Groups

• Cancer Participation Group
• My Chart Stakeholder Group
• Outpatient Experience Group
• Reader Panel – Patient information
• The CUH PPI Panel

Just want to say thank you? How you can support Addenbrooke’s and the Rosie hospitals

In our busy hospital, our dedicated staff do amazing things every day. Of course, they never expect thanks, however, we know that many patients want to express their gratitude for the wonderful care they have received.

Here are five ways to do just that.

Make sure great work gets recognised

Our Patient Advice and Liaison Service (PALS) would be delighted to receive your thanks for a job well done and will share your feedback with the staff involved.

Telephone: 01223 216756

12:00 to 16:00, Monday to Friday

e-mail CUH PALS

You can help us make Addenbrooke’s and the Rosie hospitals even better

Did you know we have our own charity, Addenbrooke’s Charitable Trust (opens in a new tab)

Whether you can donate, fundraise or volunteer your time, you can help change and save lives every day.

Telephone: 01223 217757

e-mail ACT

Staff awards

Nominate an individual or a team for our monthly You Made a Difference Award, a little public recognition goes a long way.

Telephone: 01223 274775

e-mail the You Made a Difference team

Become a member of the Foundation Trust

Become a member of the Foundation Trust and have your say about the issues that matter to you and help shape the future of patient care at Addenbrooke’s.

Telephone: 01223 216756

e-mail CUH Foundation

Become a hospital volunteer

Our volunteers occupy a special place in our hearts. If you have time to give, there’s a volunteer role for you.

Telephone: 01223 586616

E-mail CUH Volunteers

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and / or specialist one to one care is required.