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Radiotherapy to the Chest Wall

Date issued: December 2019

For review: December 2021

Ref: B-440/CW/Radiotherapy/Radiotherapy to the Chest Wall v2

PDF: radiotherapy to the chest wall [pdf] 175KB

Contact Numbers

Plymouth Hospitals NHS Trust: 01752 202082

Radiotherapy Admin Team: 01752 431870

Mustard Tree Support Centre: 01752 430060

Introduction

This information leaflet is for patients receiving Radiotherapy to their chest wall area. The general Radiotherapy Leaflet explains about what treatment involves and common side effects which are more specific to your treatment.

Treatment

After surgery there is still a risk of the cancer returning in the chest wall area. This can happen even when the cancer has been removed completely. Your oncologist or registrar will have discussed the treatment options with you and the reasons why radiotherapy has been recommended.

If it is recommended that you have chemotherapy, then radiotherapy is usually given following the completion of your Chemotherapy.

The Radiotherapy Team comprises of Therapeutic Radiographers, Assistant Practitioners, Radiotherapy Helpers and Our Administration Team. You will meet both male and female Healthcare Professionals whilst in the Radiotherapy department

If you have any concerns about this please speak to one of the Radiographers. We try to be sensitive to your needs so please do not hesitate to discuss any issues with us.

During Treatment

During your treatment you will be asked to lie on a piece of equipment called a breast board. This will be set up in the same way for every treatment you have and will help you lie still and in the same position for treatment.

We will need you to remove clothing from the top half of your body for your planning scan and treatment in order for us to position you correctly. We do have gowns within the department that you can use and you can take one home and bring it in with you for every treatment if you wish.

To help us position you correctly for every treatment we would like to mark several small permanent skin marks (tattoos) on your skin. These help to aid with your positioning for treatment. It is usual for patients receiving treatment to their chest wall to have 3 or 4 tattoos.

Pregnancy

Females aged between 12 and 55 years old will need to sign a form to confirm that there is no possibility that they could be pregnant. You will be asked to take a pregnancy test if there is any uncertainty.

It is important that you take precautions to prevent pregnancy during radiotherapy as radiotherapy can cause miscarriage and foetal abnormalities. If at any time during your radiotherapy you think you may be pregnant it is extremely important that you tell a staff member immediately.

Side Effects

Receiving radiotherapy treatment is painless; however, it does have some side effects that you may experience, gradually building as you continue through treatment. It is rare for an individual to experience all side effects from the treatment. If you do have any worries or problems as you go through treatment please speak to the team of radiographers treating you, your doctor or specialist nurse.

Skin

Radiotherapy can cause a skin reaction. Many will experience a mild pinkness of the skin and others may experience a more pronounced redness and blistering, often worse in the folds of skin on the chest wall and in the armpit.

It is recommended that you use a Sodium Lauryl Sulphate Free (SLS free) moisturiser on your skin during treatment as explained in our General Radiotherapy Leaflet.

Your skin will be assessed during your treatment by the radiographers who have treated you and at medical reviews. If you develop a more pronounced skin reaction the radiographers will assess your skin and provide you with dressing or products if required.

Tiredness

Treatment can make you feel tired and this can continue after treatment. It is really important that you listen to your body and rest if you need too. Ensuring that you are well hydrated as you go through treatment is really important and can help with tiredness. This may require you to increase your fluid intake throughout treatment. This can be in the form of water, diluted squash, flavoured water, and clear liquids. Gentle exercise can also help with this. You can continue working if you feel able.

 

Pain

Some people may experience some pain or discomfort within the treatment area. This can be mild twinges and shooting pains, which can be due to the regrowth of nerves within the area. Treatment can occasionally cause the chest wall to become swollen. If you are in discomfort then it is ok to take your usual pain killers to help with this.

Nausea

Although very uncommon, some people may experience nausea during their treatment. If you do feel nauseous during treatment, eating little and often can help. If you do experience any side effects during your treatment please let the treatment team know and they can give you more advice or refer if required.

Any side effects that you experience during treatment will continue to worsen for around 2 weeks after completing your treatment and will then slowly start to settle after this.

During this time you should continue to follow the advice you have been given until any side effects settle, although once radiotherapy has finished any creams can be used for skin reaction.

Longer Term Side Effects

Long term side effects (Late Effects) can occur months or even years after radiotherapy treatment. Mild effects are common but these do not usually interfere with everyday activities or life style. However a small proportion of patients may develop more marked effects, which may interfere with some aspects of everyday life.

Changes to the Chest Wall

Radiotherapy can cause changes to the appearance of the chest wall. You may notice that your skin feels firmer and that there is a slight change to the colour. You may also notice dilated capillaries (tiny blood vessels) under the skin, this is called telangiectasia.

Lymphoedema

The chest wall may become tender, swollen, and pinker in colour several months after treatment. There may also be short, shooting pains and twinges. If this happens it is important to keep moisturising the chest wall every day.

You may also experience swelling of your arm. This is called arm lymphoedema. This is caused by scar tissue which can form following surgery to the armpit or due to radiotherapy to the armpit and/or neck.

If your chest wall or arm does become swollen it is important that you contact your Specialist Nurse or GP who can advise you. They may decide to refer you to the Lymphoedema clinic for more help and support.

Pain

Very rarely you may experience long term, persistent pain following radiotherapy. If this does occur please speak to your specialist nurse, GP or Consultant for advice.

Shoulder Movement

You may experience a reduction in the movement of your shoulder on the side that you have had surgery and radiotherapy. It is important to continue with the shoulder exercises you were given following surgery. If you are unsure of these exercises please speak to the radiographers or your specialist nurse.

Lung Fibrosis

Radiotherapy can cause lung scarring (fibrosis) to a small area of lung tissue. This can rarely cause breathlessness. If this occurs please contact your GP or Specialist Nurse.

Every effort is made to minimise the amount of lung included in the treatment plan.

Bones

Radiotherapy can make your bones more brittle and therefore more likely to break. For radiotherapy to the breast your ribs are most at risk of fracture. A rib facture is very painful and you should see your GP if you feel you have damaged your rib or if any pain in the rib continues.

Heart

Radiotherapy to the left breast may affect a small amount of cardiac tissue and make you more susceptible to heart disease in the future. If you experience any symptoms please contact your GP and in an emergency please go to your nearest emergency department.

Every effort is made exclude the heart from the treatment area and to minimise the risk. Stopping smoking and avoiding other risk factors of heart disease such as obesity and uncontrolled diabetes will help reduce your risk of problems.

Secondary Malignancy

Radiotherapy is linked to a small risk of developing a secondary malignancy many years after treatment. This can be discussed with your Oncologist and their team. The most common cancers associated with radiotherapy are blood vessel tumours in the skin of the treated breast and lung cancers (especially in patients who smoke).

If you have any questions during your Radiotherapy please speak to the Radiographers when you come for treatment.

Nerve Damage

Your doctor may discuss with you treatment to your armpit and/or neck area. Treatment to this area can potentially damage the nerve supply to your arm, brachial plexus neuropathy, which is a rare and serious side effect. Brachial plexus neuropathy can cause pins and needles, numbness, pain, and weakness in the arm. If you experience these symptoms please contact your medical team.

Useful Links

Bosom Pals Breast Social Group bosompalsplymouth@gmail.com M

eeting held 4th Wednesday of every month.

The Macmillan Support Centre (Mustard Tree) Tel: (01752) 430060

Breast Cancer Care: 0808 800 6000 www.breastcancercare.org.uk

Macmillan Cancer Support: 0808 808 0000 www.macmillan.org.uk

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