Download Breast issue 17 FPI12

Radiotherapy for breast cancer at Velindre hospital
This booklet will help you understand what will happen when
you come to Velindre hospital to have radiotherapy
treatment.
The booklet will explain how your treatment is planned and
given. It will discuss side effects you may have and will tell
you how to get more information and support.
Contact telephone numbers are given at the end of the
leaflet.
We hope this answers your questions. Please ask us if you
have other questions that we have not covered.
Please bring a list of all the medication you are taking every
time you come to Velindre.
Patient information is available on Velindre website
Please go to: www.wales.nhs.uk/cancercentre
Smoking is not allowed within the grounds and inside
Velindre Hospital. If you need help giving up please ask
us.
This information is evidence based and reviewed annually
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Contents
Page
What is radiotherapy?
The radiotherapy team
Transport arrangements
Advice starting treatment
Planning your radiotherapy
Starting radiotherapy
At your first treatment
During your radiotherapy treatment
Side effects
Late side effects
Lymphoedema advice
After treatment has finished
Contact numbers
Helplines and websites
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What is radiotherapy?
Your doctor has decided you would benefit from a course of
radiotherapy to your breast.
Radiotherapy is a treatment for cancer using high energy xrays. The type and amount of radiotherapy that you receive
is carefully calculated to damage the cancer cells. This
stops them from dividing properly so they are destroyed.
Your treatment is planned to avoid as much healthy tissue
as possible. However some normal tissue is affected which
causes side effects. We will tell you more about this on page
12.
Radiotherapy treatment can be given alone, after or instead
of surgery. It can also be given after chemotherapy and
before hormone treatment.
The radiotherapy team looking after you
The doctor responsible for your care is called a Clinical
Oncologist. They will prescribe your radiotherapy treatment.
Your treatment will be planned by a team of physicists and
planning radiographers. A team of therapeutic radiographers
will give you your treatment.
Velindre is a teaching hospital so your team may include a
student radiographer, student nurse or a medical student.
Please tell us if you don't want a student present.
We will ask your name, address and date of birth every time
you come to the radiotherapy department. This is to avoid
any confusion.
During your treatment you will be seen by the information,
support and review team. The team includes specialist
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radiographers with extra training to advise you on how best
to deal with any side effects. They can also prescribe
medication to help. They can provide information and advice
on any practical, financial and emotional concerns you have
during treatment. You can speak to them at any point
through your treatment; their number is on page 14.
How many treatments will I need?
Radiotherapy is normally given Monday to Friday as an
outpatient. The number of treatments depends on many
facts about you and your particular type of cancer. Your
doctor will decide how many treatments are best for you.
Transport to and from Velindre
Hospital transport is available but most people use their own
transport. If you want to use hospital transport, please give
us as much notice as possible to arrange this for you. There
is a high demand for transport so you need to be prepared
to wait for some time to be picked up and taken home.
Some local support services can also arrange transport (see
page 15). Also patients on particular benefits can claim
travelling expenses, please ask when you come for your
treatment.
Advice before starting your treatment:
Arm stiffness
You need to have good movement in your shoulders and
arms for your treatment as we will position your arms above
your head, supported by arm rests. If this is a problem, you
may need to see a physiotherapist who can give you
exercises to help keep your shoulder mobile. Here are
examples of two exercises you can do:
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1. Place your arm by your side with your elbow straight.
Raise your arm forwards and up above your head
leading with your thumb. Then slowly bring it back
down, keeping your elbow as straight as possible.
2. Clasp your hands behind your neck. Keeping your
head up, push your elbow out to the side. Hold for 5
seconds and return back to the middle.
These exercises are included in the ‘Exercises and advice
follow your breast surgery’ leaflet. You may have been given
this when you had your surgery. If not, please contact the
physiotherapy department. Their telephone number is on
page 15.
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Planning your radiotherapy
You will need to have a CT scan so we can plan your
radiotherapy treatment. This scan will give your doctor a
detailed picture of area that needs treatment. We will send
you an appointment to come to the planning department
which is located at the front of the hospital.
You may see your doctor during this appointment if you
have not signed a consent form for treatment, the doctor will
explain the benefits and risks of radiotherapy, it is your
decision to go ahead with treatment, please discuss any
concerns you have before signing your consent form.
If you have already signed your consent form for treatment
during your outpatient appointment you may only see the
planning radiographers. They will explain everything that is
going to happen to you.
We will ask you to take off your top clothing but we will keep
you covered up as much as possible. You will lie on the
couch which is quite hard, with your arms up. Please tell the
radiographers if you feel uncomfortable because you will
need to keep this position, while we do the scan and also
each day of your treatment.
You will not see or feel anything during the scan. When the
radiographers are ready to leave the room to turn the
scanner on they will ask you to lie still and breath normally.
When they are outside the room they will be watching you
through a large window. The scan will only take a few
minutes, but you will be in the room for about 10-20
minutes.
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Picture of CT scanner
We will need to draw small pen marks on your skin, we will
mark the side we will be treating and also the opposite side,
this will make sure you are lying straight during your
treatment. We will ask if you are happy for us to make tiny
permanent dots of these marks. To make these dots we use
the tip of a sterile needle to place black ink just under your
skin. The permanent marks are as tiny as a freckle. This
means we have accurate marks to position you for your
treatment each day, so you are able to wash during
treatment.
A picture of a permanent ink mark
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Starting your treatment
There can be a few weeks in-between your planning scan
and the start of your treatment. This is due to the time
needed to plan your treatment and when the next free slot
on your treatment machine.
At your planning appointment you will be asked your
preferred treatment appointment time. We will try to match
your appointments to this time but we cannot guarantee this.
Please tell us if you have any special needs that may affect
your appointments, such as:
 needing transport
 having any other treatment (chemotherapy for example)
 personal difficulties (such as caring responsibilities)
We will send you a letter or call you with your first
appointment. We will be given the rest of your appointments
when you come for your first treatment.
If you have a problem with this appointment, please phone
the radiotherapy booking clerk as soon as possible. The
phone number is on page 15. If the answer machine comes
on, please leave your name and phone number slowly and
clearly. We will ring you back as soon as possible.
Your first radiotherapy treatment
Please come to the radiotherapy entrance which is at the
back of the hospital. Give your name and hand your letter to
the receptionist in the radiotherapy waiting room. They will
tell you where to sit and wait or direct you straight to your
treatment machine.
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Your radiographers will talk to you before you go in for your
first treatment. We will explain what will happen during your
treatment and the possible side effects you may experience.
We will give you advice on skin care during your treatment.
Please ask any questions you have regarding your
treatment. You maybe asked to re-sign your consent form
before you have your first treatment.
Occasionally unforeseen machine breakdowns can happen
during your treatment. This may cause delays and
sometimes cancellation of your appointment on that day.
We will explain this to you in more detail on your first day.
There are different types of treatment machines but most
people have their treatment on a Linear Accelerator
(shortened to LA). They each are numbered, so, for
example, you may have your treatment on LA 4 or LA 5.
The LA machines may look and sound different but they all
give the same treatment.
During your radiotherapy treatment
In the treatment room, we will ask you to lie on the couch in
the same position you were for your planning. Please allow
us to move you carefully using the permanent reference
marks in to the correct treatment position you just need to lie
still and breathe normally.
Music will be played in the treatment room; you can bring a
CD with you to listen to in the room.
Your treatment may be delivered from different angles. On
your first day of treatment, the radiographers check your
position at each of these angles before leaving the room to
start your treatment.
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The machine can be controlled and moved to different
angles by the radiographers outside the room. When the
machine is moving, it may come close to you but it will not
touch you. When the machine is switched on you won’t feel
anything, but you may hear a buzzing noise.
The radiographers will watch you carefully on television
monitors. If you feel uncomfortable while the machine is on
please wave your hand. We can switch the machine off and
restart the treatment when you are comfortable again.
Usually on your first day of treatment and at regular points
afterwards, we will take pictures or scan the area that is
being treated; you may be lying on the couch for a few extra
minutes whilst this is done. The images are only used to
help us check you are in the correct position for your
treatment.
How you will lie on the treatment machine
You need to lie still on the treatment couch for about 10-15
minutes, but the treatment itself (when you hear the buzzing
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noise) usually only take a few minutes. When your treatment
is finished, the radiographers will come back into the room,
as the couch you are laying on is usually quite high please
stay still until we tell you it is safe to get off, then you are
able to leave the treatment room, the treatment procedure is
the same everyday.
Short term side effects of radiotherapy treatment
Any side effects normally start to develop after about 8 to 10
treatments, although this may vary from person to person.
Side effects only affect the area of the body that we are
treating. We will give you lots of support and advice to
manage these effects.
Radiotherapy continues to work inside your body for up to
10 days after you have finished your treatment. Therefore
any side effects you experience will continue for this time
also. After 10 days you will start to feel better, everybody’s
recovery time is different.
Tiredness
Radiotherapy can make you feel more tired than usual. You
should listen to your body and rest if you need to but
continue your normal activities if you feel able. Some people
find a little exercise, drinking plenty of water and eating a
healthy diet can help their tiredness.
Skin reactions
Your skin within the treatment area may turn pink, feel warm
and tender; also can be dry and itchy. We encourage you to
continue your normal skin care routine during treatment; we
will discuss skincare with you on your first treatment.
Usually most people can continue with their usual skin care
routine.
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Wearing loose cotton clothing and non-wired soft bra maybe
more comfortable. We would encourage you to wear a bra
as this helps support the breast.
During and after your radiotherapy treatment you should
avoid exposing the treated area to the sun. This area of skin
will always be more sensitive to the sun so you should use a
high factor sun block (at least factor 30).
Sore and tender breast
Your breast may feel slightly sore, tender and maybe
become swollen during the treatment. You may notice
occasional shooting pains through the breast which are
normal, you will recover from this after treatment.
Using deodorants
During your radiotherapy you may continue to use a
deodorant on the side you are having treatment.
Arm stiffness and loss of feeling in the armpit
Your arm and armpit may feel stiff, numb or tingly after
surgery. Please carry on doing the exercises you have been
shown. Radiotherapy can temporarily interfere with the
healing process so your arm or armpit may become
uncomfortable during the treatment but will improve after
your treatment has finished.
Sore throat
If you are having treatment to the small area above your
collar bone you may get a dry, sore throat. This may feel like
a lump when you swallow or indigestion. Please speak to
the review team about this as there are medications that can
help.
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Nausea
Some people may feel slightly sick at the start of their
treatment. This usually disappears as you go through your
treatment. If this continues and is affecting your eating we
can give you medication to help, please speak to the review
team about this.
Long term side effects
Any long term side effects are very rare, they can develop
months or even years after the treatment has finished. Your
doctor will discuss these with you. Radiotherapy to the
breast can cause some changes or thickening of breast
tissue (this is called fibrosis). It is likely you will not notice
any changes but some changes could include:
 Change of skin colour of your breast
 Tiny blood vessels becoming more obvious
 Your breast becoming smaller
 Your breast becoming firmer
 Swelling of your breast
 Pain and tenderness in your breast
Radiotherapy is accurately planned to ensure only a small
amount of healthy tissue is treatment. A very small part of
lung tissue may be treated which may cause some scarring
to form. This should not affect your daily life. But you may
notice you are slightly more breathless after heavy exercise.
When treating the left breast the treatment is planned to
avoid the heart muscle as much as possible, if a very small
part of heart muscle is treated some scarring could form but
it should not affect your daily life.
Very rarely the ribs underlying the breast we have treated
can become brittle which may become at risk of fracture.
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A very rare late effect of radiotherapy to the breast is the
risk of developing a second cancer (<0.1%).
Breast boost treatment
Some ladies will need an extra top up treatment to the scar
area after treatment to the whole breast. You will lie flat on
the bed with your arms up; the machine will have a special
applicator attached to it. This applicator will not touch you
but will come close to you. You will not feel anything during
the treatment; you will hear the machine buzzing.
Lymphoedema advice
It is important that you look after your arm on the side you
had surgery, as there may be a risk of swelling of the hand
and arm (called lymphoedema). Try to avoid cuts, burns or
bites to that arm and hand by; for example, wearing gloves
when gardening. If you need to have your blood pressure
checked or blood taken make sure the doctor or nurse uses
the other arm.
Finishing your treatment
Towards the end of your treatment we will give you an
appointment for a follow up clinic with your doctor or breast
care nurse. This can be between a few months to up until a
year after finishing your treatment, depending on your
individual case and the doctor you see.
The follow up leaflet you will be given will have the details of
your appointment, with the telephone number of the review
team to ring if you are worried about any of your side
effects. Also your doctor's secretary number will be given in
case you need to change your follow up appointment.
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Contact phone numbers
Velindre hospital
029 2061 5888
Radiotherapy booking clerks
029 2019 6836
Information, Support
and Review Radiographers 029 2061 5888 ext 6421
Physiotherapy department
029 2061 5888 ext 6340
Transport from Bridgend
Sandville
01656 743344
Transport from Merthyr
Cancer Aid Merthyr
01685 379633
Transport from Aberdare
The Rowan Tree Cancer Care 01443 479369
Helplines and websites
Breast Cancer Care
Helpline:
0808 800 6000 Mon - Fri 9 – 5pm, Sat 9 - 2pm
Website:
www.breastcancercare.org.uk
Macmillan cancer support
Helpline:
0808 800 0000 Mon - Fri 9 – 8pm
Textphone: 0808 808 0121
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Email:
Website:
Tenovus
Helpline:
Website:
F.PI 12
[email protected]
www.macmillan.org.uk
0808 808 1010 Mon - Fri 8am-8pm (answer
machine available)
www.tenovus.com
Issue 17
16
Dec 2014