Radiotherapy uses high energy x-rays to treat cancer cells.
You might have external beam radiotherapy after breast surgery to lower the risk of the cancer coming back.
You have your treatment in the hospital radiotherapy department. You usually have it from Monday to Friday with a break at the weekend. The treatment is usually over 3 weeks. Each daily treatment is called a fraction.
There are studies looking at giving different doses of radiotherapy over a shorter time. Doctors want to try to reduce the risk of side effects. How often you have treatment may change in the future if the results show that a different treatment is better.
You need to travel to the hospital each time you have treatment. Some hospitals have rooms nearby where you can stay if you have a long way to travel.
You go to the radiotherapy department from your ward if you are staying in the hospital.
Radiotherapy after breast conserving surgery
You usually have radiotherapy to the whole breast after having breast conserving surgery (wide local excision). You generally start it about 4 to 6 weeks after surgery.
If you need to have chemotherapy you have this before your radiotherapy.
People with a very low risk of the cancer coming back may only have part of the breast treated with radiotherapy. Or they may not have radiotherapy at all.
Radiotherapy after removal of the breast (mastectomy)
You might need radiotherapy after a mastectomy if there is a risk of the cancer coming back.
Your doctor may suggest you have it if:
- you have cancer cells in the lymph nodes in the armpit (axilla)
- cancer cells are seen close to the removed breast tissue
- the cancer is large
Radiotherapy to the lymph nodes
The lymph nodes in your armpit will need treatment if a biopsy shows that one or more lymph nodes contain cancer cells. This may be surgery to remove the rest of the lymph nodes (axillary clearance) or radiotherapy to the armpit.
You may also have radiotherapy to the lymph nodes above the collar bone or around the breast bone.
Radiotherapy breast boost
You may also have a boost of radiotherapy to the breast. A boost is an extra dose of radiotherapy targeted at the area in the breast where the cancer was.
You might have this if you have had your whole breast treated with radiotherapy after breast conserving surgery. It helps reduce the risk for people who have a higher risk of the cancer coming back.
You have about 5 doses at the end of your treatment.
You may need another planning appointment if you have this extra treatment. Not everyone needs boost radiotherapy. Your doctor will tell you if it’s suitable for you.
The radiotherapy room
Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position or able to rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.
Before your first treatment, your
Before each treatment session
The radiographers help you to get onto the treatment couch. You lie on a special board called a breast board. If you have had a shell (mould) made the radiographers will fix this in place. You might need to raise your arms over your head.
The radiographers line up the radiotherapy machine using the marks on your body or on the shell. Once you are in the right position, they leave the room.
It is important to continue the arm exercise you were shown after your surgery. This helps to stop your arm and shoulder from becoming stiff during your radiotherapy treatment.
During the treatment
You need to lie very still on your back. Your radiographers might take images (x-rays or scans) before your treatment to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.
Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.
This video shows you what happens, it is 1 minute 22 seconds long.
Daniel (radiographer): Before your treatment starts your doctor will need to work out exactly where the treatment needs to go and also which parts need to be avoided by the treatment.
To have radiotherapy you lie in the same position as you did for your planning scans. We then line up the machine based on your tattoo marks.
It’s really important that you stay very very still when you’re having your treatment. It’s also important to let the radiographers know right at the beginning if you’re not comfortable so they can adjust your position.
We leave the room and control the machine from a separate room. This is so we aren’t exposed to radiation.
Treatment takes a few minutes and you’ll be able to talk to us using an intercom. We can see and hear you while you’re having treatment and we will check that you’re OK.
When your treatment starts you won’t feel anything. You may hear the machine as it moves around you giving the treatment from different angles.
Because we’re aiming to give the same treatment to the same part of the body every day the treatment process is exactly the same everyday so you shouldn’t really notice any difference.
You’ll see someone from the team caring for you once a week while you’re having treatment. They’ll ask how you are and ask about any side effects.
You might need to hold your breath at times during the treatment if you have radiotherapy to your left breast. This is to protect your heart from the radiotherapy.
The radiographer talks to you over a speaker. They tell you when to hold your breath. It could last between 2 to 17 seconds. This technique is called deep inspiration breath hold (DIBH).
Sometimes you have a shield placed over the heart to protect it instead.
You won't be radioactive
This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.
Travelling to radiotherapy appointments
You might have to travel a long way each day for your radiotherapy, depending on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.
You can ask the
Car parking can be difficult at hospitals. You can ask the radiotherapy staff if they can give you a hospital parking permit for free parking or advice on discounted parking. They may be able to give you tips on free places to park nearby.
The radiotherapy staff may be able to arrange transport if you have no other way to get to the hospital. Your radiotherapy doctor would have to agree. This is because it is only for people that would struggle using public transport and have no access to a car.
Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this.
Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.
Side effects of treatment
Radiotherapy for breast cancer can make you tired and might cause other side effects.