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A lumpectomy usually is followed by radiation therapy. During radiation therapy, high-energy x-rays are used to destroy cancer cells that still may be present in the affected breast or in nearby lymph nodes. Radiation therapy is sometimes used to shrink tumors before surgery. Doctors sometimes use radiation therapy along with chemotherapy, before or instead of surgery, to destroy cancer cells and shrink tumors.

Radiation Therapy After Lumpectomy

In radiation therapy after a lumpectomy, a machine delivers radiation to the affected breast and, in some cases, to the lymph nodes under the arm or at the collarbone (clavicle). The usual schedule for radiation therapy is 5 days a week for 5 to 6 weeks. The actual treatment, given by a radiation therapist, takes only a few minutes each day. Sometimes an additional "boost" or higher dose of radiation is given to the area where the cancer was found.

During your first visit for radiation treatment planning, your chest area will be marked with ink or with a few long-lasting tattoos. These marks must stay on your skin during the entire treatment period because they show exactly where the radiation will be given. Your radiation oncologist will plan your specific treatment based on a physical exam, mammograms, pathology and lab reports, and your medical history. Doctors carefully limit both the intensity of each treatment and the area being treated so that the least amount of normal tissue will be affected.

Throughout your therapy, your radiation oncologist will check on the effects of your treatment, and you will have regular physical exams and blood tests to check your general health. To get the full benefit from radiation therapy, you need to complete all your treatments as scheduled.

POSSIBLE PROBLEMS: Feeling more tired than usual; skin problems such as itchiness, redness, soreness, peeling, darkening, or shininess of the skin; or decreased sensation in the breast. Radiation to the breast does not cause hair loss, vomiting, or diarrhea. Long-term changes may include changes in the shape and color of the treated breast or a feeling of heaviness in the breast. Once a breast has been irradiated, it cannot be irradiated again. Any local recurrence or new tumor would have to be treated by mastectomy.

Radiation Therapy After Mastectomy

There are times when radiation therapy is used after a mastectomy. It may be used if:

• The tumor is larger than 2 inches.
• Cancer is found in many lymph nodes under the arm.
• The tumor is close to the rib cage or chest wall muscles.

QUESTIONS TO ASK YOUR RADIATION ONCOLOGIST

• What benefit will I get from radiation therapy?
• What are the side effects? What are the risks?
• When will my treatment begin?
• What is the schedule?
• When will treatment end?
• What should I do to prepare for each treatment?
• Who will give the actual radiation treatment?
• How long will each session take?
• What will happen during each treatment?
• Will I feel anything?
• How do I care for myself during the weeks of therapy?
• What side effects should I report to you?
• How will we know the treatment is working successfully?
• How will my breast look and feel when radiation therapy is completed?
• Will I be able to drive to and from the radiation center alone?
• Are there any restrictions to my normal activities?
• How long will I have to protect the irradiated skin from the sun?
• Will I need follow-up care?
• What if I don't have radiation therapy?