Having radiotherapy for breast cancer

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 therapy radiographers Open a glossary item will explain what you will see and hear. In some departments the treatment rooms have docks for you to plug in music players. So you can listen to your own music while you have treatment.

Photo of a linear accelerator

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.

Breathing technique

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 therapy radiographers Open a glossary item for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7am till 9pm.

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.

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