Here is some helpful information I have gathered from pieces available on the net. You will find this helpful in the event that you are told that you need radiation as part of your treatment protocol.
Radiation therapy — also called radiotherapy — is a highly targeted and highly effective way to destroy cancer cells in the breast that may stick around after surgery. Despite what many people fear, radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area.
Your radiation treatments will be overseen by a radiation oncologist, a cancer doctor who specializes in radiation therapy.
Types of Radiation
There are three main types of radiation:
External radiation is the most common type of radiation, typically given after lumpectomy and sometimes, mastectomy. In this section, you can read about how external radiation is given.
Internal Radiation is a less common method of giving radiation. It is being studied for use after lumpectomy. In this section, you can read about how radiation is delivered inside the breast.
Another relatively new type of radiation to treat breast cancer is intraoperative radiation therapy (IORT). IORT is given during lumpectomy surgery after the cancer has been removed. In this section you can read about how intraoperative radiation therapy is given.
The most annoying and uncomfortable side effects of radiation therapy involve the skin of the area being treated. In many ways your skin reaction will be like a sunburn, with a mild to moderate pink color or redness, with itching, burning, soreness, and possible peeling. But unlike what happens with a sunburn, your skin will react to radiation very gradually and possibly only in patches.
While you’re undergoing radiation treatment, the first thing you’ll likely notice will be a change in the color of your skin, from pink to red. If you’re African American or have a dark brown or black skin tone, the redness can be harder to see but you may still have other symptoms, such as soreness or dry skin.
Some areas of your skin may react more than others:
- The skin in the upper inner corner of your breast can get more red and/or irritated than other areas because:
- The angle of the radiation beam is parallel to the skin there, so the radiation skims across the skin (not just through it, as it does in other areas where the radiation beam is perpendicular to the skin).
- This area usually has received significant sun exposure over the years, so it takes longer to heal from additional damage.
- The skin within your armpit also tends to get more red and/or irritated than other areas because:
- The arm rubs back and forth against the radiated skin, which is already irritated by sweat and hair.
- The skin along the fold under your breast gets more red and/or irritated than other areas because:
- Most bras rub this area.
- The radiation beam skims across the skin in this region, too.
- The skin of the fold rubs against itself.
Your skin reaction may be mild and limited just to these areas, or your skin might have a more dramatic reaction to radiation, covering more of the breast area. This is more likely to occur if:
- Your complexion is fair and you’re susceptible to sunburn.
- You have large breasts.
- You are receiving radiation after mastectomy, and the treatment is designed to give a high dose to the skin.
- You’ve had recent chemotherapy.
As with a sunburn, the skin also may be dry, sore, and more sensitive to touch. Irritation may increase. The skin can sometimes start to peel in a dry way, like an old sunburn, or in a wet way, like a blister. If peeling happens, it tends to be toward the last third of your treatments or later. This peeling will probably be limited to a few areas of the involved skin. If the blister opens, the exposed raw area can be quite painful and weepy. Your skin reaction can become more serious if the exposed area is not treated and infection develops. Your radiation oncologist can work with you to help you manage any of these signs or symptoms. If problems become especially troublesome, your doctor or nurse might suggest taking a short break in treatment to allow your skin to recover.
These skin changes happen gradually and can be predicted in your weekly exams by your radiation oncologist and nurse. You should be aware of the range of possible skin reactions so that you’re not surprised by them. Fortunately, skin irritation caused by radiation is temporary. And your doctor and nurse can give you salves, medications, and prescriptions to ease any discomfort. If you find that the pain and irritation are not getting better, talk to your doctor.
After radiation treatment ends
After you finish radiation therapy, the effects on your skin may continue to get worse for another week or so and then your skin will start to get better.
If you have peeling skin and/or wet blisters, the skin may have slowly started to grow back while you were getting treated. Now that you’ve completed treatments, pearly-pink colored patches of new skin will grow back much faster in the affected areas. The new skin is very delicate as it grows. You might still have a blister or the overlying old, dry, flaky skin covering the new skin. Don’t pick at the blister or the old skin. They’re protecting the new skin underneath. If you experience problems or have questions as the new skin is growing, call your radiation oncologist or nurse.
The deep redness and the sensitivity should start to go away during the first weeks after treatment. Your skin will take a bit longer to return completely to its natural color. You may find that the treated area has a tanned or slightly pinkish look to it for up to 6 months after your last session of radiation. If you have a very dark skin tone, by the end of treatment your skin can become very dark, and it may take 3 to 6 months (and sometimes a bit longer) for changes to go away.
Some people may continue to have a slightly pinkish or tan hue to their skin for years after treatment. And a few people may notice a small patch of tiny blood vessels on the skin of the radiated breast area. These vessels — called telangiectasias — look like a tangle of thin red lines. Telangiectasias are NOT a sign of cancer recurrence. They usually don’t go away on their own.
If you are a smoker, stopping smoking may help your skin recover more quickly. Sometimes high oxygen therapy (also called hyperbaric oxygen) will help. If you want to get rid of the telangiectasias, laser therapy may help. Talk to a dermatologist (skin doctor) who is experienced using lasers to remove birthmarks and other skin pigmentation
Here are a few things you can do to make the skin less sensitive during radiation treatment and to help it return to normal after radiation treatment is over.
Prevent irritation before and after daily treatments
- Wear loose-fitting shirts, preferably cotton.
- Use warm rather than hot water while showering.
- Try to not let shower water fall directly on your breast.
- Avoid harsh soaps that have a lot of fragrance; instead use fragrance-free soaps with moisturizers (such as Dove).
- To help prevent redness and skin irritation, avoid having skin-on-skin contact. This most often happens;where your arm presses against your armpit and the outer portion of your breast
- along the bottom crease of your breast, where your breast might droop a bit and lie up against your upper belly wall Along your cleavage where the breasts snuggle up against each other
To avoid skin-on-skin contact:
Try to keep your arm away from your body whenever possible.
Wear a strong bra without an underwire to keep your breasts separated and lifted.
If you have large breasts, when you’re not wearing a bra, stick a soft washcloth or piece of flannel or soft cotton under your breast.
Dust the breast area and inside skin folds with cornstarch to absorb moisture, reduce friction, and keep you smelling fresh. You can use baby powder made from cornstarch (don’t use talc) or sifted kitchen cornstarch. Apply it with a clean makeup brush or put some cornstarch into a single knee-high nylon or thin sock and knot it at the top. Gently tap the sock against the skin to dust the surface. If your doctor has recommended using creams or salves, apply those first, then dust the area with the cornstarch.
- With or without radiation, yeast infections are common in the skin fold under each breast — particularly during warm weather in women with large breasts. Signs of yeast infections are redness, itchiness, and sometimes a faint white substance on the skin. If you have a yeast infection, take care of it before radiation starts so it gets better, not worse. An anti-fungal cream (such as athlete’s foot medicine) usually works well.
Manage irritation during and after your course of radiation
At the beginning of treatment, before you have any side effects, moisturize the skin after your daily treatment with an ointment such as A&D, Eucerin, Aquaphor, Biafene, or Radiacare. You also can put it on at night — wear an old T-shirt so the ointment doesn’t get on your bed clothes.
For mild pinkness, itching, and burning, apply an aloe vera preparation. Or try 1% hydrocortisone cream (available without a prescription at any drugstore). Spread the cream thinly over the affected area 3 times a day.
If areas become red, itchy, sore, and start to burn, and low-potency cream no longer relieves your symptoms, ask your doctor for a stronger steroid cream available by prescription. Examples include 2.5% hydrocortisone cream and bethamethasone.
Some people get some relief by blowing air on the area with a hair dryer set to “cool” or “air” (no heat).
Don’t wear a bra if there are raw areas.
If your skin becomes dry and flakey during the course of your treatment, moisturize frequently and cleanse skin gently.
If your skin forms a blister or peels in a wet way, leave the top of the blister alone! The bubble keeps the area clean while the new skin grows back underneath. If the blister opens, the exposed raw area can be painful and weepy. Keep the area relatively dry and wash it with warm water only. Blot the area dry and then apply a NON–ADHERENT dressing, such as Xeroform dressings (laden with soothing petroleum jelly) or “second skin” dressings made by several companies. To relieve discomfort from blistering or peeling, take an over-the-counter pain reliever, or ask your doctor for a prescription if you need it.
What about sun exposure during radiation therapy?
During radiation, it’s best to keep the treated area completely out of the sun.
Wear a bathing suit with a high neckline.
Wear a cover-up when you’re not in the water.
Wear an over-sized cotton shirt to cover the treated area and allow it to breathe.
Avoid chlorine. Chlorine is very drying and can make your skin reaction worse.
If you do swim in a pool, you might want to spread petroleum jelly (a product like Vaseline) on the treated area to keep chlorinated water away from your skin.
After your radiation treatment is done, the skin that has been exposed to radiation may be more sensitive to the sun than it was in the past. You can go out in the sun and have fun, but continue to protect your skin:
Use a sunblock that is rated SPF 30 or higher on the area that was treated. (A strong sunblock is a very good policy for every inch of your body.
Apply sun screen often