This is the transcript for our video about what to expect when having radiotherapy for breast cancer. Watch the video.
[Video title]
Radiotherapy for breast cancer: What to expect
[Text on screen]
You might have lots of questions before you start radiotherapy. This film explains what to expect before, during and after your treatment.
Your clinical team are here for you throughout. If you have any questions or worries, just ask us. We are here for you every step of the way.
[Soft intro music]
[Julie Moss, Patient]
Initially, it made me feel I was worthless but then my positivity kicked back in and went, no, you can fight this.
[Helen Bradsell, Patient]
I kept saying, no, it's not happening to me.
It's like just been like an emotional rollercoaster, to be honest.
[Mary McNeice, Patient]
That was a bit of a shock, but I got over that and you have to stay positive.
[Catherine Holbrook, Patient]
Just started on radiotherapy and I think compared to the other treatments, so far that's been a breeze.
[Helen Bradsell, Patient]
I think the more informed you are, the more you know, the easier it is and the more settled you feel.
[Text on screen]
Understanding breast cancer radiotherapy: What you need to know
[Dawn Ledsom, Consultant Radiographer in Breast Radiotherapy]
Radiotherapy uses high-energy x-rays to destroy cancer cells. It's a common treatment for breast cancer patients.
It can be given to the breast or chest wall after a mastectomy and it can include the surrounding lymph nodes.
The reason why we give radiotherapy is because it reduces the risk of local recurrence.
[Voiceover]
If you have had a diagnosis of breast cancer, you will be discussed at a multidisciplinary team meeting.
[Dr Shaveta Mehta, Consultant Clinical Oncologist]
So, a MDT is a multidisciplinary team and this includes basically everyone who is involved in patient care.
That includes the surgeons, the oncologists, pathologists, radiologists, breast care nurses, radiographers, research nurses and so on.
And in these, with the MDT, we meet very regularly and in these meetings we review each patient's cancer details and depending on that, we make a treatment plan or the MDT recommend a treatment plan, and if it is felt that radiotherapy is important for these patients, we decide that.
[Text on screen]
Your first appointment
[Voiceover]
Your first appointment will be to discuss your recommended treatment.
Your consultant, clinical oncologist, registrar or consultant radiographer will discuss the treatment details with you, including the number of treatments, treatment area and the possible side effects.
Breast cancer radiotherapy treatment is usually given daily over five to 15 consecutive weekdays.
If you agree to have radiotherapy, the next stage is the radiotherapy planning appointment to allow us to plan the treatment specifically for you.
[Text on screen]
Your planning appointment
[Voiceover]
We will schedule this appointment and communicate the dates with you. The appointment will be at one of our Clatterbridge Cancer Centre hospitals.
The appointment will last around 30 minutes and will involve you having a CT scan of the upper body.
[Dr Shaveta Mehta, Consultant Clinical Oncologist]
The purpose of this scan is that it helps us to map out the area which we are going to treat with radiation.
[Voiceover]
The CT scan will be of the upper body. You'll be taken to the changing room and asked to remove all clothing from the waist up and will be provided with a modesty gown.
Next, you'll be asked to lie down on a piece of equipment called a breastboard. This allows us to position you correctly. Each day for your treatment, we will replicate this exact same position.
For your scan, we may ask you to hold your breath for 20 seconds. This is called the deep inspiration breath hold technique.
[Phoebe Croft, Therapeutic Radiographer]
So when you breathe in, it inflates your lungs and it pushes your heart down away from the chest wall and the area that we're treating.
[Voiceover]
The radiographers will position a screen above you. This will allow you to see how deep you need to hold your breath. The box on your chest will be monitoring this.
When we are ready to begin, you'll be on your own in the scanning room, but we can see you and hear you at all times.
[Therapeutic radiographer in treatment control room]
Okay, Mrs Smith, when you're ready, breathe into the green box and hold.
[Voiceover]
Once the scan is done, we will take your permission to put some small permanent marks on your skin called tattoo dots.
There will be three to four of these tattoos on your chest. The radiographers will try to place these in a position that is not visible under your clothing.
[Phoebe Croft, Therapeutic Radiographer]
So when you go for your radiotherapy treatment, we want to get you in the same position each day. So these little tattoo dots allow us to get you back in the same position each day.
[Text on screen]
Treatment
[Voiceover]
Your treatment usually starts around one to two weeks after your planning appointment, details of which will be sent to you.
[Therapeutic radiographer in waiting room]
Mrs Smith?
[Voiceover]
If you've received chemotherapy, please let our planning team know so your radiotherapy can start at the correct time. Certain precautions are necessary at this stage.
[Dr Shaveta Mehta, Consultant Clinical Oncologist]
Following the planning CT scan, it's very important that if any patient needs a fluid drainage - for example, the seroma drainage from the breast or chest wall, or any fluid filling if somebody has an implant - these are not done until they finish the radiotherapy because it can change the shape of the breast and that can affect the accuracy of the treatment they will get.
[Voiceover]
Positions of the treatment machines are chosen to allow the treatment area to be covered whilst avoiding other parts of the body, minimising dose to the surrounding organs, such as heart and lungs.
To enter the treatment room, the radiographers will walk with you down a short angled corridor called a maze.
[Katie Rigby, Therapeutic Radiographer]
So the maze is designed to protect anyone outside of the room from the radiation that's produced in the room. So we have lots of walls for the radiation to bounce off before it reaches the outside of the room, to keep everybody safe.
[Voiceover]
This machine is called the linear accelerator, also known as a 'linac'. Clatterbridge Cancer Centres have 11 such machines, all of which deliver the same treatment.
For your treatment, our radiographers will move you into the same position that you were in for your planning scan. The tattoo dots made during your planning appointment are lined up with laser lights.
Like before, the radiographers will leave the room for treatment, but they can see you and hear you at all times.
During your treatment, the linac machine will move around you, but it will not touch you.
[Dawn Ledsom, Consultant Radiographer in Breast Radiotherapy]
The treatment of radiotherapy is painless and takes approximately two minutes.
During your appointment you will have some check scans which means the appointment time is between 15 to 30 minutes.
These check scans are to ensure that you're always in the right position and that the radiotherapy is accurately delivered to the intended area.
[Therapeutic radiographer in treatment control room]
Okay, Jane, whenever you're ready, take a deep breath in and hold.
[Voiceover]
Once your treatment is complete, your radiographer will re-enter the room and will let you know when it is okay to move again.
After your treatment, you're free to leave the hospital and to continue your day as you normally would.
We recommend you keep hydrated and rest if you need to. You are able to drive during treatment, although you may prefer somebody to drive you.
[Text on screen]
Side effects
[Voiceover]
Radiotherapy is usually well tolerated, but there can be some side effects which can vary from person to person.
[Text on screen]
Short-term side effects
[Dr Shaveta Mehta, Consultant Clinical Oncologist]
Short-term side effects are the ones which happen during or just after radiotherapy and the common things are fatigue or tiredness. People do feel tired after radiation.
Other thing is skin reactions which is quite common but the severity could be very different. It's like a sunburn reaction which can be right from mild redness or just some change in the skin colour to mild irritation. Sometimes people can develop rashes and very rarely blisters or peeling of skin can happen.
But we provide support and advice on how to deal with these side effects, and most patients find that these side effects settle in six to eight weeks after completion of radiotherapy.
[Voiceover]
Whilst you're having treatment, you'll be looked after by the on-treatment radiographers who will provide you with all necessary treatment and advice if you experience any side effects.
You will be provided with a skin care leaflet to advise you how to look after your skin during and after radiotherapy.
[Text on screen]
Long-term side-effects
[Dr Farida Alam, Consultant Clinical Oncologist]
So long-term side effects are rare in breast cancer radiotherapy. However, if they do happen, they are usually permanent. They happen months to years after the radiotherapy has been completed.
The most common ones are related to the breast and would include thickening of the skin, darkening of the skin, sometimes a bit of swelling in the breast. Some people experience some shrinkage in the breast, so those are the main side effects relating to the breast.
Again, in the treatment area, some of the ribs can become weak and there is a small risk of fracture of the rib.
With the arm, there is some risk of shoulder stiffness and people who have their armpit treated can have swelling in the arm which is called lymphoedema.
So these are all monitored and, you know, we advise and manage them if they happen.
Further rare effects would include some risks to the lung, which again is very rare and we try our best to stay away from the lungs, but there is a potential risk of long-term lung side effects.
Then for people who have radiotherapy to the left side, they can experience some late cardiac side effects.
And then, extremely rarely, there is a risk of radiotherapy-induced secondary cancers in the treatment area, but these are again often seen very late and are extremely rare.
[Text on screen]
Follow-up
[Voiceover]
Approximately eight weeks after radiotherapy, you will have a follow-up appointment with a member of your oncology team.
At this appointment, your skin reaction and any other side effects that you may be having from treatment will be assessed and your ongoing follow-up will be discussed.
In this video, we've explained the process from the initial consultation to the planning and delivery of your treatment.
Further information is available on our website (www.clatterbridgecc.nhs.uk) and we're always available to answer any questions and help you throughout every aspect of your process.
[Patient ringing end of treatment bell]
[Julie Moss, Patient]
There's so much support there and it's getting that into your headset that you're not alone. There are others there going through the same thing as you and you'll come out fighting.
[Catherine Holbrook, Patient]
They're always reassuring. If there's ever any problems, then I just need to give them a shout and let them know.
But yeah, the team have been fantastic. From coming through to waiting in reception, to going through having your treatment, I can't praise them enough. They've been great.
[Helen Bradsell, Patient]
Absolutely everybody's been amazing, everybody's been so lovely and supportive and it's just been a fantastic journey.
[Mary McNeice, Patient]
Don't worry, you're well looked after. At the beginning I had sleepless nights wondering what was behind that door of radiotherapy, thinking it was a tunnel.
And really you're only in there for a short while. You're put on the bed. It's all measured up for you and you're in and out and it's all over and done with.
And that treatment you have that first day, you will have that until you're at the end of your treatment.
There's nothing whatsoever to worry about.
[Text on screen with special thanks to participants and production team]
[Text on screen]
Supported by the Innovation Team at The Clatterbridge Cancer Centre and funded by Clatterbridge Cancer Charity
[Logos on screen for The Clatterbridge Cancer Centre NHS Foundation Trust and Clatterbridge Cancer Charity]