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What to Expect

Breast Cancer

Fighting cancer is challenging. To help you prepare for the fight, here is a brief outline of what you can expect during treatment with radiotherapy or radiosurgery. The details of some of the steps may differ, depending on your particular case.

Step 1: The Consultation

First, you'll meet with your doctor, a radiation oncologist, to discuss your treatment. Based on your specific case, your radiation oncologist will tell you what type of radiation treatment he or she recommends, whether it will be given alone or in conjunction with other treatment methods, what the specific goals of treatment are, and what side effects you may expect. You can talk to your oncologist about your treatment options and make a decision together. The consultation is also an excellent opportunity for you to ask the doctor whatever questions you may have. Click here for a list of common questions you could ask.

Step 2: Imaging

In order for the radiation oncologist to design your treatment, the exact size and location of the tumor must first be determined. This is usually done by using scans to create a detailed 3-D image of the treatment area. The scans usually include a CT scan, but they can also include an MRI, PET scan, and ultrasound scan. Your oncologist can rotate the image on his computer screen in order to view the tumor from every angle.

It is very important that the position in which you are scanned is reproduced at the time of treatment. Sometimes temporary skin marks or even tiny tattoos (about the size of a freckle) are made on your body to help the radiation therapist (RT) position you correctly each day for treatment. The radiation therapist, or RT, may position you lying on your stomach, using a special couch-top that allows the breast to fall away from the body. You may also be positioned on your back, with a pad to hold your arm above your head out of the beam’s path. You may be asked to hold still in that position for up to 20 minutes each day.

For some cancers of the left breast, radiation oncologists may use respiratory gating technology. To use this treatment technique, your team studies the motion of your chest as you breathe to evaluate the targeted area's movement in and out of the beam's path. The RT can then turn the beam on only when the targeted area is in a specific position. The RT may ask you to hold your breath (if that is comfortable) while a small cube on your chest broadcasts the position of the ribcage to the control room. Holding your breath while your lungs are expanded creates more space between your heart and breastplate, so that the radiation can target the surgical site while minimizing exposure to the heart and lung tissue. If you don't feel comfortable holding your breath, talk to your RT, and ask if it is possible for you to continue to breathe normally. It is often possible, but it may take a little longer for the treatment since the beam will only turn on when your target is in position.

Step 3: Treatment Planning

After imaging is complete, the radiation oncologist will meet with the medical physicist and dosimetrist to design a treatment plan that's been customized for you. After taking into account the location and type of cancer you have, your medical history, lab tests, and other factors, your treatment team will use sophisticated computer software to assist them in prescribing the exact volume to be treated, the total amount of radiation that will be delivered to the tumor, the angles for the radiation beams, how many treatments you should have, and what kind of machine to use.

Step 4: Getting Positioned for Treatment

Before each day's treatment, you may be asked to change into a gown. The radiation therapist (RT) will help you get positioned on the treatment "couch" — a platform designed to work with the radiation machine. The couch will be adjusted so a laser light shines on the mark that was put on your skin, helping to position you correctly. Depending on the type of machine you’re treated on, your treatment team may take a scan immediately prior to treatment, while you are on the couch. The purpose of this new scan is to show if the tumor has changed in size or position since the first one was created during imaging. If it reveals any changes, the RT will make the necessary adjustments to the position of the couch to ensure that you are properly aligned for treatment.

Step 5: Treatment Begins

The radiation is delivered by a machine called a linear accelerator, or linac. Most linacs have a gantry, which is the head of the machine. The gantry houses a device called a multi-leaf collimator that "shapes" the radiation beam so it conforms to the shape of the tumor from any given angle. During your treatment, the gantry will move around you to deliver the radiation. The radiation beam is not visible to the eye, so you will not see it when it leaves the gantry.

Your first two treatments may take 15 minutes or more, as your radiation therapist helps you get into position and takes images to verify that your setup on the machine is the same as the treatment plan. Subsequent treatments, however, are often shorter. In fact, some treatments — from entering the waiting room to leaving the clinic — can take as little as 12 to 30 minutes.

Step 6: Post-Treatment and Follow-Ups

You may experience some side effects from radiotherapy. If you do, they might not begin until after several sessions because the effects of radiation treatment are cumulative. Talk to your radiation oncologist before and during treatment if you have any questions or experience discomfort. Click here to learn more about possible side effects.

After your treatment has ended, your radiation oncologist will recommend a schedule for periodic checkups to monitor the results for your treatment. Checkups typically include mammograms and are scheduled at six-month intervals. If symptoms or clinical circumstances suggest a recurrence, diagnostic tests such as blood tests, ultrasound scans, CT scans, MRIs, chest x-rays (CXR), or bone scans may be needed.