Radiotherapy after Breast Cancer

My Uncle suffered from colon cancer and had told me that radiotherapy was not nearly as difficult to bear as chemotherapy. However, when I came to receive radiotherapy for my breast cancer, I came to disagree with him. Radiotherapy treatment is planned and delivered by specially trained professionals called therapy radiographers. It is given by a machine called a linear accererator. Breast cancer patients are usually treated for between 3 to 6 weeks.

The treatment only lasts a few seconds, but to get prepared and settled on the machinery, the period each patient is in the room is about 10 minutes. I needed four weeks treatment. It is given on week days, every week day except for public holidays, for the stated period, so I had to go for treatment 5 days a week for four weeks.

The treatment, at least at first, is painless. Still, reasons that I did not agree with my uncle were that the journey to the hospital that delivers the treatment is an hour’s drive from where I live, and an hour’s drive back. Given that and the wait for treatment at the beatsonhospital could mean a 3-4 four round trip. That was terribly tiring. Also, the treat ment is given in a large room that contains nothing but a chair to place my cloths on, a screen for the radiographers to stand behind as they deliver treatment and the machine, itself.

Patients are not treated by the same radiographers each day and students, male or female, may be amongst the team. I should have been asked if I was willing to have a student present , but I never was. Like many who suffer from breast cancer, I come from a generation that is not used to displaying my body to other people, especially much younger men. I was simply told to take off the clothes on my top half and come over to the machine. It was embarrassing and demeaning. I was just given a piece of paper towel to cover my modesty. Needless to say, that did not work!

The way this treatment was delivered was embarrassing and demeaning. The journey to get the treatment was long and tiring. During treatment I had to lie in a specific position so that the radiotherapy could be delivered most accurately. The radiographers dimmed the lights for a short time while they positioned the machine. They then stood behind the b machinescreen while the treatment was delivered.Once or twice the treament given was slightly different in that it was a boost to my scar area. However, the method of delivery and the lack of attention to personal sensitivities was the same as ever.

The treatment results in a cumulative effect to the cancer and side effects. At first, I felt no different after treatment. It was only after two weeks or so that I bagan to feel side effects and so terribly tired, weary, as a result of the treatment. It also caused burning on and in the flesh around my breast. The hospital provded aqueous cream to soothe that.

I needed the radiotherapy to help beat the cancer, but it was difficult to bear.

Valerie Penny

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Risk of Recurrence of Breast Cancer

herceptin_drugMy body has endured surgery, chemotherapy and radiotherapy. As a result of this I have lost my hair and my energy. Still, that tumour the size of a baked bean is perceived as a threat. Its return must be further discouraged. My oncologist therefore insists on mammograms every six months and prescribes Letrozole. I must take one 2.5mg tablet each day for 5 years.

Breast cancer is often discussed as a general condition, but there are several different types that require different treatments. One way to distinguish breast cancer cells is through your genes. When you are diagnosed with breast cancer, your doctor will test the cancerous cells to determine their genetic makeup. My tumour had more of the HER2 protein in it than it should have had. HER2 is a protein that stimulates the growth of breast cancer cells. It can be found in your blood and urine. Sometimes it is referred to as a tumour marker. Tumor markers like HER2 cannot be used for cancer diagnosis, but they can provide other important information and the presence of HER2 helps the doctor predict how likely the breast cancer is to respond to treatment.

It is estimated that about 20 percent of breast cancers are HER2-positive. Younger women are more likely to be her_2_geneHER2-positive than older women. HER2-positive breast cancer tends to be more aggressive and to spread more quickly than other cancers. That is why it is important to find out if the cancer cells in your body contain this protein. If your breast cancer is HER2-positive, you have a much better chance of successful treatment with methods that target the HER2 protein specifically. Results show that those who tested positive for HER2 at an early stage of the condition (with tumours 1 centimeter or smaller) had a higher risk of recurrence. Researchers have also found that HER2-positive patients had a 77.1 percent five-year survival rate, with no recurrence. However, they also are
around five times more likely to suffer recurrence than those who were HER-2 negative and have close to three times the risk of recurrence of those who tested negative for HER2. So I am absolutely sure I want to discourage recurrence.

Tumours that are HER2-positive are more often associated with factors that increase recurrence rates. For example, HER2 tumours are more likely to occur in younger women and have higher nuclear grade. Generally, the higher the nuclear grade, the more aggressive the tumour. HER2 tumours are also more likely to show positive margins during breast surgery. Positive margins occur when cancer cells extend beyond the edge of tissue that is removed. HER2 tumours also have a higher likelihood of residual disease being found when additional tissue is removed. Up to 70 percent of patients with HER2-positive breast cancer respond to treatment. However, total remission for the condition occurs only in around 7 to 8 percent of patients. Targeted treatments (medicines that target the HER2 protein, like the Herceptin I was treated with) have improved the prognosis for HER2-positive patients. Remissions can also be lengthy, offering another bright spot in prognosis and reports show that remission can last more than 15 years for some patients.

tabletI was diagnosed HER2-positive and this brings special challenges in my recovery from breast cancer. The HER2 protein can make the breast cancer more aggressive. It can also make it harder to treat with hormone treatments used for other types of breast cancer. However, drugs like trastuzumab (Herceptin) target HER2 directly and effectively. This drug, when used in combination with other drugs, shows some very promising results for improving prognosis and survival rates for patients with HER2 cancer. However, there is a small but real risk of heart damage and possible lung damage. Scientists are still studying how long women should take Herceptin for the greatest benefit. I am not ashamed to tell you that I hope their studies are successfully concluded soonest. I have a vested interest in this, as my tumour was HER-2 positive.

All in all, having made the decision to stay alive long enough to thoroughly embarrass my children, when the oncologist tells me that I must take one 2.5mg tablet of Letrozole each day for the next five years, I will do just that. Letrozole has side effects but I have decided that whatever they are, they have to be better than allowing the tumour to return.

Valerie Penny

After Radiotherapy

It is hard to imagine a treatment that only lasts a few seconds, minutes if you count the set up time, causing after effects.  Believe me when I tell you that it does.  There are side effects of any medical treatments, of course.  With radiotherapy these can be quite frightening.  There is some concern that after treating the brain (particularly if combined with chemotherapy) the patient may develop memory problems.

Radiation therapy works by damaging the DNA (genes) of tumour cells.  DNA damage stops tumour cells from dividing, growing and spreading.  Radiotherapy is a useful tool for treating cancer because cancer cells grow and divide more rapidly than most normal cells around them.  Although some normal cells are affected by radiation, most normal cells appear to recover more fully from the effects of radiation than do cancer cells. Radiation oncologists carefully limit the intensity of treatments and the area being treated so that the cancer will be affected more than the normal tissues.  This is why the set up for the treatment often lasts longer than the treatment itself.

Modern radiotherapy has advanced dramatically over the recent years.  It is now possible to focus radiotherapy with extreme precision. This allows the radiation dose to be targeted to the areas of tumour while sparing most adjacent normal tissues even in seemingly complicated and difficult parts of the body.

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Radiotherapy affects different people to greater or lesser extents.  My friend Ismay, who is a real inspiration to me, is facing terminal cancer with and bravery that is awe-inspiring.  She found the radiotherapy to her head (to shrink a brain tumour) really difficult.  She was left with burns to her scalp.  Her hair that had grown back after chemotherapy, was lost again and the burns to her head made it impossible to wear her wig for weeks.  The pain and distress were hard to bear: but bear it she did. along with some forgetfulness, with her relentless courage and humour.

My treatment was to my right breast.  It was targeted to the area from which my tumour had been removed.  I had been told the radiotherapy would make me feel tired.  I had also been told the effect was cumulative. Unsurprisingly, me being me, when I felt no particular effects after the first dose or so, I felt I had beaten the system.  I had been told the cumulative effects would also include burning to my skin.  Again, initially, I deduced my skin was different to everybody else’s.  It is    not.  However, the effects do not kick in immediately, but do last a long time after the treatment has finished.  Radiation_breast

I have found the after effects of the radiotherapy quite depressing.  The burning under my breast was soothed by aqueous cream but the skin burnt and peeled the way it might with sunburn.  I am now six moths out after radiotherapy has finished.  The burns are healed but my breast still looks tanned compared to the other and I still find I get tired far faster than I expected this far on.  I still cannot walk as far as I used to.  One of my favourite hobbies is dancing, but I cannot dance for as long or as energetically as I did before my treatment.

I continue to find it difficult to concentrate for prolonged periods and the exhaustion is debilitating.  I was becoming increasingly upset about this and was speaking to my friend Margaret.  Margaret survived breast cancer and got her all clear about eighteen months ago.  She has been immensely supportive during my cancer journey.  The wonderful Margaret told me that, even yet, she gets bone tired sometimes.  It is not like the tiredness you feel after a busy day or a late night.  It is a wave of weariness that is all encompassing.  The big problem is it can arrive, unannounced, at any time.  So I have no confidence that, if I start a long or complicated task, I will have the energy to finish it.  This is what I find most exasperating.

However, the side effect that I had feared most was depression.  When the radiotherapy comes to an end, you come off the treatment merry-go-round.  All the attention stops and this can cause the depression the doctors and nurses warned me about.  I suppose when you have been using all your energies to defeat this disease, when it comes to an end so suddenly, it can result in an emotional vacuum.  I have mental health problems anyway and I really feared this problem.  I was lucky, it did not happen to me.  Other friends were not so lucky.  They did feel the sudden stop of treatment and attention left a void that led to depression.

Now I am at the stage where I get check up appointments with the consultant approximately every three months. Before I see the consultant I go to the hospital for an echo scan.  It is also called an echo-cardiogram is an ultrasound scan of the heart. It is sometimes just called an ‘ECHO’. Ultrasound is a very high-frequency sound that you cannot hear, but it can be emitted and detected by special machines. The scan can give accurate pictures of the heart muscle, the heart chambers, and structures within the heart such as the valves.  An ECHO can be carried out for many different reasons.   I have it done to check how well your heart is working after the radiotherapy and to look at how well the valves are moving inside the heart.   An ECHO can also help to see any fluid that may have collected around the heart.  So far my heart is holding up well.

I need to undress to the waist and lie on the couch. A probe is placed on my chest (it is a bit like a very thick blunt pen).   Also, lubricating jelly is put on the probe so it makes good contact with the skin.   The probe is connected by a wire to the ultrasound machine and monitor.   Pulses of ultrasound are sent from the probe through the skin towards your heart. The ultrasound waves then echo (‘bounce back’) from the heart and various structures in the heart.  They make a sort of swooshing noise.

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The consultant also arranges for my blood to be checked to make sure my calcium and haemoglobin levels are high enough.  So far, so good.  This is especially important because for the next five years I require to take a medication known as letrozole.   Amongst the more common side effects of letrozole are hot flushes, hair loss, joint and bonepain, muscle pain, tiredness, unusual sweating, nausea, diarrhea, dizziness, and trouble sleeping.  I have certainly suffered the tiredness as well as the joint, bone and muscle pain.   I was told by other patients it should lessen after 8-10 months.  The doctors have not confirmed this!

So I have complained about my difficulties and honestly reported my progress.  I am aware that I am very lucky. The disease was diagnosed early after a mammogram.  The necessary surgery was carried out quickly.  I am to get another mammogram later this month to confirm that I continue to survive breast cancer now.

Valerie Penny

 

 

 

Radiotherapy After Breast Cancer Surgery

So here I am, the beginning of my radiotherapy, four weeks of travelling up and down from the Beatson Hospital in Glasgow, Scotland.  The journey takes more than an hour each way and while the treatment only takes ten minutes, it rarely starts on time. Image When I eventually get called through I have to walk along a lengthy corridor with a large room at the end of it.  Two technicians were there setting the machine up for me.  It has to be changed and cleaned after each patient and that was still being done as I entered the room.  There is no where take off my clothes but in the room in the full view of the technicians.  Now, I appreciate there is nothing special about me, however I am, by nature quite reserved.  I am not given to disrobing readily and I was quite embarrassed when I was told just to strip to the waist and put my clothes on the chair near the entry to the room.  I was handed a paper towel with which to cover my modesty as I walked from the chair to the machine. This was horrid.  The paper was not wide enough to cover both my breasts at once and as often as not fell to the floor as soon as I got on to the machine. radio_treatment         On the occasion of my first treatment the technicians introduced themselves.  I believe they should have done this on each occasion that I had different people treating me.  That did not happen.  Indeed, even when there was a student present, whether male or female, I was neither asked for permission to have the student present, nor introduced, nor told that a male member of staff would be present. Now, I am being treated for breast cancer.  I am of an age and disposition that does not readily strip off in the presence of strangers. The stress is appalling anyway, and being treated like cattle, or meat, certainly not as a valuable patient, was very upsetting. It added to my tension rather than easing it. There was no consistency of times for appointments either.  I was fortunate that most of my appointments were between 11.00 and 12.00 each day.  However, speaking to other patients that was unusual.  Having to go to hospital each day is difficult enough, but if it is at around the same time of day you can get into a routine of sorts.  I found radiotherapy even more difficult to cope with than chemotherapy for these reasons.  It definitely intrudes into “real life”. Of course, I had heard that radiotherapy would make me tired and I would suffer from burns around the area being treated.  I had no such effects initially and, if you have read the rest of this blog, it will not surprise you to know that I believed none of this would happen to me. Neither will it surprise you to know that I was wrong again. MRSA After six or seven treatments I began to feel so very tired. Tired and bone weary. Getting up in the morning was increasingly difficult, although I always did.  However, I often needed to go for an afternoon nap when I  got home from radiotherapy.  The feelings of tiredness increased.  I could not work out whether this was due to the travelling or the treatment.  In the end I decided it was both, exacerbated by the chemotherapy that I had already received.  
Tiredness caused by the radiotherapy treatment itself, is thought to be due in part to the type of toxins released during the breakdown of some of the cells within the treatment area. Drinking fluids to keep hydrated,appears to help flush these toxins out of your system. Eating regularly throughout the day, and not missing meals, will also help to maintain your energy levels.   In addition my skin around the area getting treated by radiotherapy was becoming increasingly red and sore. Th radiotherapy is very precisely applied to the exact same area each day.  My breast around my operation scar became increasingly sore but the burning was worst underneath my breast.   Most patients will notice a reddening,  darkening, or burning of the skin within the treatment area, this is called erythema.   This reddening is sometimes likened to a mild sunburn. 220px-Aqueous_cream_B.P. There are some occasions for example when the doctor wishes to treat close to the skin’s surface.   In these instances the reddening may be worse, but you will have been informed about this in the initial consultation. Most patient’s will only have a very mild reaction.   The hospital prescribed aqueous cream and pain killers.   You can help reduce skin reactions by looking after your skin.   It is clear that skin that is well moisturised has less significant side effects than skin that is not. During my radiotherapy treatment I kept my skin well moisturised, and regularly applied (2-3 times per day) the Aqueous Cream provided by the hospital.  This is a pure water based moisturiser. Four weeks, or 19 sessions after it started my radiotherapy was over.  I walked out of the hospital and the routine I had built up during the period of radiotherapy was terminated.  The medical attention and support I had been receiving for months was brought to an end. What a strange feeling.

Valerie Penny

Cancer Treatment After Chemotherapy

My chemotherapy lasted 18 weeks.  The treatments were every 3 weeks.  At first, I really thought I had beat the system and that, with the help of the cool cap, my hair would not fall out.  I was wrong, it did.  I had thought I would not want a wig, what does it matter if I am bald or not?  I was wrong, I did.

The wig was useful for three reasons: first, it keeps your head warm!  Second, it makes things easier for loved ones who do not want to think of you as really ill, even when they know you are.  Last, it helped me to feel “normal” and not to advertise my illness.  I do not want to be defined by any one aspect of my life, especially cancer.

I had also thought, somewhat conceitedly, that I would not get so very tired from the chemotherapy and life would go on as normal, just punctuated by the treatments.  Guess what?  I was wrong again!  The chemotherapy builds up over the period of time and I got bone tired sometimes.  I was so tired that getting up was an effort and I accomplished very little some days.  However, every day I got up, I got dressed and I did something, even if it was just make a cup of tea, write my diary or phone a friend.  Some days I needed a nap and others I felt so good I would bake a cake, clean the bathroom and present my writing class.  Believe me when I tell you I paid for those days for 2 or 3 days afterwards.

Bearing in mind the number of times I had been wrong before, it will not surprise you that I was wrong again when I considered the 5 week break between chemotherapy and the beginning of my radiotherapy was unnecessary.  That period allowed me to be just a little less tired each day and my husband and I did a few things together that I could not have contemplated if I had gone directly from one form of treatment to the next.

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My husband took me to the Ayr Flower Show. We were only there for 3 hours, but it was lovely to see the flowers and stalls where the vendors had some useful things on sale.  Some fine plants and pretty accessories available too.  There was a stand showing birds of prey that was really interesting.  I was also surprised at the wide variety of stalls providing food and snacks.  We particularly enjoyed looking at the Bonsai Trees.

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All too soon the weeks of freedom came to an end.  My radiotherapy started.  There was one big difference between the chemotherapy and the radiotherapy.  I had to attend hospital every week day for 19 days to complete the required radiotherapy.

My sessions started on a Tuesday so for the next 4 weeks I must endure the 70 minute drive to and from home to the hospital  for my 10 minute radiotherapy sessions.  It was a huge intrusion into the day.  It was also difficult to lead any semblance of a normal life during this period because my days from 10.00 to about 1.30 were taken up by the daily trips to The Beatson West of Scotland Cancer Centre. It is a specialised cancer care centre in Glasgow, Scotland. I was lucky because there is a local charity, North Ayrshire Cancer Care, that provides volunteer drivers to drive people to and from cancer treatments.  This makes a big difference.  Patients are advised against driving after treatment and it would be difficult to find family and friends able to make the trip daily for such a long period of time.  There is such a time commitment each day.

So, radiotherapy, here I come.

Valerie Penny

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