Radiation Questions
 

Hi, I have a couple questions from my wife about the radiation treatment she is about to begin. She completed TCH Chemo, had her lumpectomy surgery and is about to start IMRT Radiation treatments (28 + 7). She would like to know:

If there are any cases of just the area where the cancer was found is treated with radiation, verse using radiation on the entire breast.

Can she choose not to do radiation on the entire breast?

Are there ways to reduce the possibility of permanent color changes to the breast or skin scaring from the radiation treatments?

Is there any possibility of a change in shape or form?

Thanks!

Brett

Re: Radiation Questions
 

Hello Brett,
They will only irradiate the area where they suspect cancer so not the entire chest.
I needed heavy radiation over a large area because I had invasive bc but my skin is the same, no color change. I had scarring from the surgery only.
However none of this was not an issue for me, the only thing I cared about was could they kill all the cancer.
It sounds as if you should have another appointment with the radiologist or a nurse in that dept. to answer your questions also there are supplements you shouldn't take during radiation, stay out of the sun, no cream on the area before radiation, etc....so ask about these issues also. Generally they give you a printed fact sheet, but you can also do an internet search that might prove helpful. Besides this site, a general bc site is good: http://www.breastcancer.org/
The radiation will be at the same time daily for 5 or 6 weeks so you'll see the same people in the waiting room which makes it nice. It only takes about 5 to 10 minutes total and she won't be tired the way she was with chemo. Very tolerable.
Good luck,
Sarah

Re: Radiation Questions
 

I have not had any appreciable difference in skin color or even texture with radiation (now that it has healed). The radiation is very precision. You will see distinct demarcation of the irradiated area. The number of fields treated are determined by the type, position and suspicion of lymph nodes/vessels invaded by cancer cells. You should ask your RO for a specific map of your fields and why they are being treated if you have questions. I finished radiation the day before Thanksgiving and today, you can barely see a tan line.

Re: Radiation Questions
 

The skin may have minimal changes to texture depending upon the radiation load, but they should take this into consideration with a dose loading. I would use a good skin cream, making sure it has aloe in it. I know that Bag Balm and Udder cream are two good skin creams. Add Vitamin K cream for the blood vessel breakage minimization. This can also be done with Henna + Lemon Juice, but the ski turns yellow for a short period so tell your physician.

Re: Radiation Questions
 

Radiation can affect the shape if there is already an implant in. She should talk with her plastic surgeon. If she hasn't had the implants yet then they will do a transplant of skin and/or muscle to help the breast keep its shape to hold the implant better. My friend did her radiation with the implant in and it ended up shrinking a little and had to have fat implanted to help even it out.

Re: Radiation Questions
 

ClarkA,

My last radiation was in early December and the only thing I see now is a slight tanning of the skin under my arm, sort of like a shadow. I suspect that will go away over time. It seems as though my surgery scar is less visible after radiation too, although that could just be from the passage of time.

The actual radiation treatments were difficult for me because my joints are so sore from chemo and it was hard to keep my arms raised above and behind my head. Once they began placing bolsters under my arms it was much better. The Radiation Therapists were helpful. Still, once my skin started to get burned I was not a happy camper. I didn't think it was possible it would heal, but it did, and rapidly. I used Aquaphor and emu oil but I've heard good things about aloe too. It can be a sticky mess though!

I agree that it's good to run these questions past the radiation oncologist--your wife will probably meet with that person regularly (for me it was once a week, on "doctor day"). I was frustrated because I was not told in advance exactly how many treatments there would be (just something vague like "6 weeks" which was not entirely accurate), or that there would be boosters. I think the medical folks take those details for granted, but I'd advise always asking these questions upfront so that you aren't disappointed to have painful skin and then be told there are 3 extra treatments plus 5 boosters to go (boy was I mad!). Also, the boosters aren't the same as regular radiation. Those didn't bother me, other than the fact that I had to go to the rads clinic every day for them. Nobody in the medical field seems to have an understanding that some of us are taking time off from work or other responsibilities and that it is a big deal to be going through this. I did experience some of the "talk to the hand 'cause the face don't wanna hear it" attitude from the rads docs. I guess it's hard to hear it over and over from patients, but still....

As far as whether she could have a smaller area radiated, I think most docs would say it's either radiation or no radiation. I don't think there is an inbetween, but you should ask. IT REALLY IS THE PATIENT'S CHOICE. I considered not having the radiation, but for my profile I figured it really should be done. I might have decided against it if I had a different situation because I'm suspicious about this whole business anyway. It is my understanding that rads are usually recommended if a lumpectomy is done, so it is probably the standard protocol. Besides the breast and nodes under one arm they also radiated an oblong shaped area near the clavicle (that area is also tan now). Usually the techs will be happy to explain exactly where they are using radiation (docs might be bored to spend time discussing it LOL) .

Good luck to your wife. The radiation will be over before she knows it!

Shirley

Re: Radiation Questions
 

Hi,

The radiation oncologist should have answered most of your questions (area, etc) during the consult visit. As someone else mentioned, if your wife still has those questions then another visit may be in order.

I finished radiation in May, 2013. Because I had a mastectomy and my pathology, they did the entire breast plus super clavicle and underarm lymph nodes. My RO liked to get the "crispy" effect. I still have a bit of a tan, but it's fading. It really doesn't bother me at all.

I used aloe vera gel and both my plastic surgeon and RO were very pleased with the way my skin healed, looked and felt. One thing to remember - the effects of radiation keep on giving. In other words, the side effects do not stop after you are finished. My plastic surgeon tells me that all the time.

Best
Janis

Re: Radiation Questions
 

Ladies,

Thank you for the replies - Big Help. We'll take the advice- I'll go in with her to the doctors office Thursday to get her questions answers. It's not the first time we've needed to - through this crazy up and down the wall, happy go sad, fighting and laughing in the day and up all night! And we manage.

Interesting how before a new treatment tension builds until it blows up. Its always something else that makes it go BOOM- like the red light I ran last night. Then fighting, yelling-yapping, closer and closer to the point. Helping us get unrealized tension out. Nice not to judge - just let it happen. Yell, getting "it" out, talking your a** off until the point is lost - in the tension gone. Just needed a release. Ahh we love each other... its nice.

Understanding more now, I think her major concern is how her body will look and feel afterward. She is scared. I'm passing along everyone's experience here to her. We're living in Taiwan, I'm an American and she likes to hear the latest information from the states. See that - my ego just puffed. Can't wait to be back when all this is over.

Too all of you, a great thank you. I read here often and its helped me to understand her, and how to better be there. I can't completely understand what you are going through but I can try to be here for her the best I can with my attention and trust. Wishing you all the best with meditative love!

Re: Radiation Questions
 

Hello Clark,
You may want to share with your wife that usually and most often a lumpectomy is a ticket for radiation. When a patient has a mastectomy radiation is not usually done.
The radiation is a mop up of the surgery to ensure all cells are destroyed.

The worst part of the journey of breast cancer is the unknown. Once treatment begins she will feel much better and so will you. It is so normal to feel the anxiety
prior to the treatment. I can only share that the treatment is never as bad as we imagine it.

It helps for you wife to wear cotton Tshirts as often as possible during rad treatment to keep the chest area ventilated.

Sending both of you good wishes...
Kind Regards,
Jean

Re: Radiation Questions
 

Thanks Jean, everything went well at the radiologist office - all of her questions were answered and she felt better. I guess its the fear of not knowing. I appreciate the help and advice.

Brett

Re: Radiation Questions
 

Brett, I finished Christmas Eve and my skin is 90% normal! My surgical scar is certainly fainter. My RO gave me a prescription for Xclair cream. Not cheap but worked wonders. Best of luck to you and your wife. I'm sure she is as thankful for you as I am for my wonderful husband. You are so on target with the tension and letting off steam, it Alway comes back to the love!
Elizabeth

Re: Radiation Questions
 

Thanks Elizabeth, This has been one hell of a journey, and we're both staying aware to learn from it. All your words of encouragement really help a couple get through- while in the process. Otherwise I'd be very lost through these vast days!

Much Love,

Brett

Re: Radiation Questions
 

Hi Clark! I hope things are good with you and your wife. My thoughts and prayers are with you. You have gotten some good advice and counseling here. I can only add a few things, and if these wonderful ladies have already said these things, forgive me. "Jean's Cream" is a good product to apply to the radiated area. The tiring effects of radiation are cumulative, if I'm not mistaken. If possible, try to plan a light lunch and a nap after a few treatments. It's important for her to stay hydrated. Hang in there, Brett. You are in the right place at the right time.