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A practical guide to tests and treatments
bReASTside effects
radiotheRApy –possible Long-term
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Breastradiotherapy–possiblelong-termsideeffects
Contents
AboutBreast radiotherapy – possible long-term side effects 3
Radiotherapy 4
Sideeffectsofradiotherapyforbreastcancer 6
Possibledelayedsideeffects 8
Breastchanges 8
Restrictedarmandshouldermovement 11
Changesinthewayyourheartworks 12
Lungproblems 14
Effectonthebones 15
Lymphoedemainthearm 16
Numbness,painandweaknessinthearm 18
Radiation-inducedsecondcancers 20
Yourfeelings 21
Howwecanhelpyou 23
Otherusefulorganisations 27
Furtherresources 30
Questionsyoumightliketoaskyourdoctorornurse 33
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Breastradiotherapy–possiblelong-termsideeffects
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AboutBreast radiotherapy – possible long-term side effects
About Breast radiotherapy –possible long-term side effectsThis booklet gives information about the possible long-term (delayed) side effects of radiotherapy to the breast. Thesesideeffectsarerareandhavebecomelesscommonasradiotherapyplanningtechniqueshaveimproved.We’veincludedallofthepossibledelayedsideeffectssothatyoucanbeawareofthem.Butit’simportanttorememberthatyou’reunlikelytogetallofthesideeffectsmentionedhere.Manywomenonlyhavemild,short-termsideeffects.
Wehopethisbookletanswerssomeofyourquestionsaboutdealingwithlong-termsideeffectsofradiotherapy.Itmayhelptoreadthisinformationalongsideourinformationaboutbreastcancerandradiotherapy.
Asthemainaudienceforthisinformationiswomenweusethetermwomenthroughoutthetext,butit’salsoappropriateformenwhohavebeentreatedforbreastcancer.
Wecan’tadviseyouaboutthebesttreatmentforyourself.Thisinformationcanonlycomefromyourowndoctor,whoknowsyourfullmedicalhistory.
Ifyou’dliketodiscussthisinformation,calltheMacmillanSupportLinefreeon0808 808 00 00,Monday–Friday,9am–8pm.Ifyou’rehardofhearingyoucanusetextphone08088080121,orTextRelay.FornonEnglishspeakers,interpretersareavailable.Alternatively,visitmacmillan.org.uk
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Breastradiotherapy–possiblelong-termsideeffects
Turntopages27–32forsomeusefuladdressesandwebsites,andpage33towritedownquestionsforyourdoctororbreastcarenurse.
Ifyoufindthisbooklethelpful,youcouldpassitontoyourfamilyandfriends.Theymayalsowantinformationtohelpthemsupportyou.
Radiotherapy
Radiotherapytreatscancerbyusingtargetedhigh-energyraystodestroycancercells,whiledoingaslittleharmaspossibletonormalcells.Radiotherapyisacommonpartofthetreatmentofmanycancersandcancuresomecancersorhelpreducetheriskofthemcomingbackaftersurgery.Radiotherapymayalsobegiventohelprelievesymptoms.
Radiotherapyisoftenusedaspartofyourtreatmentforbreastcancer.It’sgiven:
• After surgery:It’scommonlygivenaftersurgerythatremovesthebreastlumpandsomeofthebreasttissuesurroundingit(lumpectomyorawidelocalexcision),andsometimesafterremovalofthewholebreast(mastectomy).
• Before surgery:Occasionallyradiotherapyisgivenbefore,orinsteadof,anoperation.
• To the lymph nodes:Sometimesradiotherapyisgiventothelymphnodesintheunderarm(axilla).
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Radiotherapy
• To the lymph nodes behind and above the collarbone (the supra clavicular nodes):Radiotherapymayalsobegiventothelymphnodesinthisareaifit’sthoughtthereisarisktheymightcontaincancercells.
Externalradiotherapyisthemaintypeofradiotherapyusedtotreatbreastcancer.Lesscommonlyatypeofinternalradiotherapy(alsocalledbrachytherapy)isused.Thisplacesaradioactivesourceclosetothetumour.Ourcancersupportspecialistscangiveyoumoreinformationaboutthis.
Externalradiotherapyisnormallygivenasaseriesofshortdailytreatmentsintheradiotherapydepartmentatthehospital,usingamachinecalleda Linear Acceleratorwhichproduceshigh-energyx-rays.Treatmentisusuallygivenover3–6weeks,onceadayMonday–Friday,witharestatweekends.Treatmenttakesseveralminuteseachdayandispainless.Itwon’tmakeyouradioactiveanditissafeforyoutobearoundotherpeople,includingchildren.Treatmentisusuallygivenasanoutpatient.
Somewomenarealsogivena‘boost’doseofradiotherapytothepartofthebreastwherethecancerwaslocated(knownasthetumour bed).Thisisusuallygivenafterthemaincourseofradiotherapyhasfinished.
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Breastradiotherapy–possiblelong-termsideeffects
Side effects of radiotherapy for breast cancer
Althoughradiotherapycandestroycancercells,itcanalsoaffectsomeofthenormalcellsinthetreatmentarea.Yourdoctorswilldecidewhetherornottorecommendaparticularradiotherapytreatmentbyweighingupthelikelybenefitsoftreatingthecanceragainstthepossiblerisksandsideeffects.
The benefits of the treatment usually outweigh the risk of developing delayed side effects.
Youshouldbegiventhechancetodiscussanypossiblesideeffectswithyourdoctor.Asthere’softenalotofinformationtotakein,itmayhelptotakearelativeorfriendwithyouwhenyouseethedoctor.
Radiotherapyaffectspeopleindifferentways,soitcanbedifficulttopredictwhetheryouwilldevelopanylong-termproblems.Mostsideeffectsofradiotherapytothebreastaretemporaryanddisappearoverafewweeksormonthsoncetheradiotherapyhasfinished.Forasmallnumberofwomenthesideeffectscanbecomelong-termproblemsthatmaydevelopmonths,orevenyears,later.
Developmentsinthewaythatradiotherapyisgivenhavereducedtheriskofsideeffects,andseriouslong-termproblemsarenowveryrare.However,becausebreastcancerisbecomingmorecommon,andtreatmentisnowverysuccessful,morewomenarelivinglongeraftertreatment.Asaresult,thenumberofwomenwithalong-termproblemhasslightlyincreased.
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Sideeffectsofradiotherapyforbreastcancer
Mostwomenwillonlyneedtohaveradiotherapytothebreastarea,whichmakestheriskofdevelopingseriousdelayedsideeffectsverysmallindeed.However,somewomenwillalsoneedtohaveradiotherapytotheareaunderthearm(axilla)whichcanincreasetheriskoflong-termproblems.Long-termproblemsaremorelikelyifradiotherapyiscombinedwiththeremovalofall,oralargenumberof,thelymphnodesfromunderthearm.
Thisinformationisaboutthepossibledelayedsideeffectsthatmayoccurmonths,oryears,aftertreatment.
Radiotherapy can also cause some general side effects during treatment, such as tiredness or redness of the skin. These are discussed in our booklet Understanding breast cancer.
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Breastradiotherapy–possiblelong-termsideeffects
Possible delayed side effects
Ifyoudevelopanynewsymptomsafteryourtreatmentisover,orifyou’reconcernedthatthesideeffectsyoudevelopedduringyourtreatmentaren’tgettingbetter,youshouldcontactyourdoctor,radiographerorbreastcarenurseatthehospitalforadvice.Thereisoftenasimpleexplanationforthesesymptomsandtheydon’tnecessarilymeanthatyouaredevelopinglong-termsideeffects.
Yourdoctorwillprobablywanttodoteststofindthepossiblecauseofyoursymptoms.Thesemayincludex-rays,scansandspecialistinvestigations,dependinguponyourparticularsymptoms.Youmaybereferredtoadoctorwhospecialisesintreatinglong-termsideeffectsofradiotherapy.Thesespecialistdoctorsaren’tavailableineveryhospital,soyoumayneedtotraveltoseeone.
Themainlong-termsideeffectsarecoveredonthefollowingpages(8–20).
Breast changes
Mostwomenwilldevelopchangesinthelookandfeeloftheirtreatedbreastafterradiotherapy,althoughformanythesechangesareveryslight.
Changes to the skinDuringtreatmentsomewomendevelopaskinreactionsimilartosunburn,knownaserythema.Theskinmaybecomeredanditchy,andifyouhavedarkskinitmayappeardarkerwithablueorblacktinge.Usuallythissideeffectwillsettledown2–4weeksafterradiotherapy,butsometimesitcancontinue.
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Possibledelayedsideeffects
Afewwomenfindthattheiroperationscarremainstenderorsensitiveforsometimeafterradiotherapy.
Somewomenmaydevelopchangeswhichcanincludesmallredblotchesonthebreastcausedbydilatedbloodvesselsundertheskin.Thisconditionisknownastelangiectasia.Althoughthisaffectshowthebreastlooks,itshouldn’tcauseanyotherproblems.
Skin careIfyouhaveaskinreaction,yourdoctor,nurseortheradiographerwillgiveyouadviceonhowtolookafteryourskin.Thefollowingtipsmaybehelpful:
• Avoidusingperfumedsoaps,talcumpowderanddeodorants/antiperspirantsuntilthereactionhassettled.
• Avoidshavingunderyourarmontheaffectedside.
• Showersarebetterthanbaths,andyoushouldavoidsoakingtheaffectedareafortoolongifyouhaveabath.
• Afterwashing,pattheareadryratherthanrubbingitwithatowel,ordryitwithahairdryeronacoolsetting.
• Looseclothingmaybemorecomfortabletowear.
• Avoidexposingtheareatostrongsunlightforatleastayear,asyourskinwillcontinuetobemoresensitive.Ifyoudogooutinthesun,applysunblocktotheskinwhichhasbeentreatedbyradiotherapy.
Breast swellingAfewwomenwilldevelopswellingofthebreastareaduring,orshortlyaftertreatment.Thisswellingisknownasoedema,andusuallygoesawayacoupleofmonthsaftertreatmenthas
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Breastradiotherapy–possiblelong-termsideeffects
finished,althoughinsomewomenitmaypersistformonthsoryears.
Sometimes,adifferenttypeofswellingcalledlymphoedemacandevelop.Thiscanoccurifthelymphnodeshavebeenremovedoraredamagedbyradiotherapy,causingabuild-upoflymphfluid.Itmorecommonlyaffectsthearm(seepage16),butcanalsocauseswellingofthebreast.
Lymphoedemacandevelopmanymonthsoryearsaftertreatmenthasfinished.Talktoyourbreastcarenurseordoctorifyouthinkyouhavelymphoedema.Ifnecessarytheycanreferyoutoalymphoedemaspecialist.
There is more information about lymphoedema in our booklet Understanding lymphoedema, which includes tips to help you avoid it and advice on how to reduce its effects.
Soreness or painManywomenfindthattheareainthebreastthathasbeentreatedfeelsuncomfortableorsore.Thistendstobecomelessofaproblemyearafteryear.Ifthishappensandiscausingyouaproblem,yourdoctorcanprescribepainkillerstohelprelieveanypain.Somewomenfindthatthepaincanberelievedbywearingasupportbra.Itcanalsohelptowearasoftbraatnight,butmakesurethebrahasnounderwire.
Shrinking of the breastIt’sfairlycommonforthebreasttoshrinkslightlyovertime,butforittofeelthesame.Afewwomendevelopahardeningorthickeningofthebreasttissue(fibrosis).Thiscancausethebreasttobecomeharderandsmallerthanitwas,althoughtheeffectismostlyverymild.Inseverecasesthiscanmakethebreastslookdifferenttoeachother.
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Possibledelayedsideeffects
Somewomenfindthatastheygetoldertheirbreaststendtogetbigger.Breastscanalsogetbiggerasaresultofgainingweight.Abreastthathasbeentreatedwithradiotherapymaynotincreaseinsizeasmuchastheuntreatedbreast.Ifthisisaproblemforyou,talktoyourdoctororbreastcarenurse,asasiliconeshell(partialprosthesis)canbefittedtoyourbra.Surgerycanalsosometimesbedonetocorrectanimbalanceinsize.
Restricted arm and shoulder movement
Radiotherapycanaffecthowwellyoucanmoveyourarmandshoulder.It’sfairlycommonforwomenwhohaveradiotherapytotheareaunderthearmtoexperiencesomerestrictioninmovement,especiallyifthey’vehadsurgerytotheirunderarmareaaswell.Thismaymakeitdifficulttocarryheavybagsanddohouseholdchoresorsometypesofexercise,suchasswimming.
Beforesurgery,aphysiotherapistshouldshowyouexercisestohelpimprovethemovementofthearmandshoulder.It’sagoodideatocontinuetheexercisesforacoupleofyears–yourphysiotherapistcantellyouhowfrequentlytodothem.Anyrestrictionsinmovementshouldgraduallyimproveaftertreatment,butsomewomencontinuetohaveproblems.Ifyouhaveproblems,asktoseeaphysiotherapistagainforadvice.
Ifthearmandshoulderarepainful,itcanhelptotakepainkillersbeforedoinganyexercises.Somewomenfindthatcomplementarytherapiesarehelpful.There’smoreinformationinourbookletUnderstanding complementary therapies.
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Breastradiotherapy–possiblelong-termsideeffects
Changes in the way your heart works (cardiac complications)
Thereisaverysmallriskofdamagetotheheartmuscleorthemajorbloodvesselsaroundtheheart.Thisisonlyapotentialproblemifyouhavehadcancerinyourleftbreast,astheheartisontheleftsideofthechest.Radiotherapyisnowverycarefullyplanned,sothattheheartiseithernotwithintheradiationareaoronlyasmallamountoftheheartwillreceiveanyradiation.Asaresult,theriskofdevelopinganyheartproblemsisnowverylow.
Ifyourhearthasbeendamagedbyradiotherapyyoumayfindthatyougettiredveryeasilyorgetbreathlessonexertion,forexamplewhenclimbingthestairs.Youmayalsonoticethatyousometimesfeeldizzyorgetchestpains.It’simportanttorememberthatthesesymptomscanbecausedbymanythingsandtheyaren’talwaysaresultofdamagetotheheart.
Treatment for heart changesThetreatmentwilldependuponthepartoftheheartthathasbeendamagedandhowit’saffectingyou.Youmayjustbeadvisedtoavoidthingsthatcouldcausefurtherdamage,suchasalcohol,smokingandstress,ortoimproveyourdiet.
Treatmentmayincludemedicinestoimprovetheheartrhythm(anti-arrhythmics),orimprovethebloodflowaroundthehearttohelpreducechestpain(anti-anginals).
Yourdoctorornursewillexplainmoreaboutthetreatmentthatyouneedandcanansweranyquestionsyouhave.
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Breastradiotherapy–possiblelong-termsideeffects
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Breastradiotherapy–possiblelong-termsideeffects
Lung problems
Asmallnumberofwomen(around1in50)developsymptomssuchasbreathlessness,adrycoughorchestpain.Thesemayoccurbecausetheradiotherapycandamagethecellsliningthelungs,causinginflammationorahardeningandthickening(fibrosis).Thisproblemappearstobeslightlymorelikelyifyou’vehadcertainchemotherapydrugsatthesametime.
Thesesymptomscandevelop2–3monthsaftertheradiotherapyhasfinished,orsometimesuptoayearlater.Thechangesareusuallytemporary,lastingamonthortwo,butoccasionallycanbecomealong-termsideeffect.
Yourriskofdevelopinglungproblemsisslightlyhigherif:
• radiotherapyisalsogiventothelymphnodesinthechestarea
• you’vehadchemotherapy.
Thesesymptomsmaybemadeworseifyoualreadyhavealungproblemsuchasasthma,orifyousmoke.
Treatment for lung problemsMostlungproblemsaretreatableandit’sunusualforthemtocontinueovertime.Treatmentdependsonexactlywhatiswrongwithyourlungsandmaysimplyinvolveadviceoncuttingdownorgivingupsmoking,andmaintainingahealthyweight.
Youmaybegiveninhalersthatcontaindrugstohelpopenuptheairways(bronchodilators).Steroidscanbegivenastabletsorinhalerstoreduceinflammation.Youmaybegivenantibioticsifyouhaveaninfectioninthelung.
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Possibledelayedsideeffects
Yourdoctorornursewillexplainmoreaboutthetreatmentyouneedandwillteachyouhowtouseaninhalerifnecessary.
Effect on the bones
Ararelatesideeffectofradiotherapytothebreastisdamagetothebones,especiallytheribs.Thisaffectsfewerthan1in100womenandisslightlymorelikelyifyou’vehadcertainchemotherapydrugsatthesametime.Thebonescanbecomethinnerandmorebrittle.Ifthishappens,itcancausepainandmakeithardforyoutoliftheavyobjectsortoexercise.
It’simportanttobeawarethatthisproblemcanhappen,sothatifyouhaveanysymptomsyoucangetthemcheckedbyyourdoctor.Radiotherapydamagetothebonesisveryuncommonsoit’slikelythatifyouhaveanysymptomstherewillbeanothercause.
Treatment for bone damageTreatmentrelievesanysymptomsthatoccur.Thismayinvolvetakingpainkillersoranti-inflammatorydrugs.Sometimescalciumsupplements,vitaminD,ordrugscalledbisphosphonates,whichcanhelptostrengthenthebones,maybehelpful.
Ifyouhavepain,thiscanusuallybecontrolledwithpainkillers.Youmayalsoneedtoseeaphysiotherapistoroccupationaltherapist(OT)ifthedamagedboneismakingitdifficulttocarryoutdailyactivities.Veryoccasionally,surgerymaybesuggestedtoremovethedamagedribs.
Veryrarely,ifthebonehasbeenseverelydamaged,atreatmentknownashyperbaric oxygen therapy mayhelptopreventfurtherweakeningoftheboneandimprovesymptoms.
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Breastradiotherapy–possiblelong-termsideeffects
Thisisanewertypeoftreatmentandtheexactbenefitsarestillbeingresearched.It’snotavailableinmanyplacesintheUK.
We can send you information about controlling cancer pain and hyperbaric oxygen therapy.
Lymphoedema in the arm
Lymphoedemaisatypeofswelling.Itcanoccuriflymphnodesinthearmpithavebeenremovedoraredamagedbyradiotherapy.Lymphfluidnormallyflowsalongthelymphvesselsandthroughthelymphnodes.Ifthelymphvesselsaredamaged,excessfluidmaybuildupinthearmcausingittoswell.
Lymphoedemacanoccurinwomenwhohadradiotherapytothearmpitaspartoftheirtreatmentforbreastcancer.It’smorecommoninwomenwho’vehadsurgerytoremovemost,orall,ofthelymphglandsintheareaunderthearmaswellasradiotherapytotheunderarm.
Lymphoedemainthearmcanalsooccurafterradiotherapytothebreastandchestwall,butthisisveryrare.
Ifyourarmisswollenbecauseoflymphoedemaitmaybecomestiff,uncomfortableandawkwardtomove.Thiscanmakedailyactivitieslikedressingdifficult.Theskinofyourarmmaybecometightandstretched.Oncelymphoedemaoccursitcanneverbecompletelycured.However,manythingscanbedonetohelpreducetheswellinganddiscomfortandallowwomentousetheirarmnormally.
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Possibledelayedsideeffects
Preventing lymphoedemaIfyou’reatriskofdevelopinglymphoedema,itmayhelpnottoputtoomuchstrainonyourlymphaticsystem.Thismeanstryingtoavoidanyinfectionorinflammation,asthesecancausemorelymphfluidtobeproducedandincreasetheriskoflymphoedema.It’simportanttoavoidgettinganycutsorgrazesonyourarm.Ifyoudogetthem,useantisepticandplastersstraightawayandusemoisturisertokeepyourskinsupple.
Treating lymphoedemaIfyoudeveloplymphoedema,youwillusuallybereferredtoalymphoedemaspecialistfortreatmentandadvice.Thismaybeanurse,physiotherapistordoctor.Thetreatmentwilldependuponhowmuchlymphoedemayouhave,andaimstohelpreducetheswelling,preventfurtherswellingandrelieveanydiscomfort.Therearefourmaintypesoftreatment:
• skincare
• supportingthearmusingcompressionstockingsorbandages
• positioningandmovement,orexercisingthearm
• aparticulartypeofmassagecalledmanuallymphaticdrainage(MLD)orsimplelymphaticdrainage(SLD).
Our booklet Understanding lymphoedema has more detailed information about preventing and treating lymphoedema.
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Breastradiotherapy–possiblelong-termsideeffects
Numbness, pain and weakness in the arm
About1in100womenwhohaveradiotherapytotheunderarmwilldevelopsomenumbnessandtinglinginthehand,weaknessinthehand,orpainaroundtheshoulder,armorhand.Thesesymptomswillusuallybemildbutveryoccasionallymaybemoresevereandtroublesome.
Thesymptomsareduetodamagetothenervesgoingintothearm,whichcansometimesoccurafterradiotherapytothearmpit.Thesenervesareknownasthebrachialplexusandthelong-termsideeffectisoftencalled radiation-induced brachial plexus neuropathy or brachial plexopathy.
Treating brachial plexopathyUsuallythisisamildsymptom.But,ifseverebrachialplexopathydevelopsitcan’tbereversed.However,treatmentscanhelptocontrolsymptomssuchaspain,andmakethepracticalaspectsoflifeeasier.
Oneoftheprioritiesoftreatmentistofindthebestwayofcontrollingthepain.Peopleoftendescribethepainas‘shooting’or‘burning’,butyoumayalsohavepinsandneedles,numbnessortightness.Therearevariouspainkillersthatmaybehelpful,dependinguponhowseverethepainis,andyourdoctorcanadviseyouaboutthese.Theymayprescribelow-doseantidepressantsorantiepilepticdrugs,asthesecanbeeffectiveincontrollingnervepain.Youmaybereferredtoaspecialistpainclinicforfurtheradvice.
Yourdoctorsmayalsosuggestothertreatments,suchasmassageorapplyingheatandcoldtothepainfulareas.AnotherpossibilityisusingaTENS(transcutaneouselectricalnervestimulation)machine.Thiscanbeveryeffectiveat
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Possibledelayedsideeffects
relievingpain.Itinvolvesplacingstickypadsthatcontainelectrodesontoyourskin.Aweakelectricalcurrentispassedthroughthepads.Theelectricalcurrentcanmakethebodyreleaseitsownnaturalpainkillers(endorphins),whichcanhelpcontrolpain.
Somewomenfindacupuncturehelpful,andsomeGPorhospitalclinicsnowofferthis.Othercomplementarytherapiesmayalsobeuseful,butyoushouldalwaysdiscussthesewithyourdoctorfirst.
We can send you a booklet about cancer and complementary therapies.
Youmaybereferredtoaphysiotherapistandanoccupationaltherapist(OT).Aphysiotherapistwillhelpyoukeepyourarmasmobileandstrongaspossible.Thiswillinvolveexercisestostrengthenthemusclesandkeepthemsupple.Theywillalsobeabletoshowyouhowtouseslingsorsplintstosupportyourarm.TheOTwillassesshowthenervedamagehasaffectedtheuseofyourarm,andlookathowthisinterfereswithyourdailylife.ThephysiotherapistandOTcanthensuggestpracticalwaystohelpyoucarryonasnormallyaspossible.
Ifyouaren’tabletoworkbecauseofthedamagetoyourarm,youmaybeentitledtosomebenefits.Asocialworker,eitheratthehospitalorinthecommunity,oryourlocalJobcentrePlusofficecanadviseyouaboutthis.YoucanfinddetailsofyourlocalJobcentrePlusofficeandgetmoreinformationaboutbenefitsontheDepartmentforWorkandPensionspublicserviceswebsitedirect.gov.uk
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Breastradiotherapy–possiblelong-termsideeffects
Our booklets, Work and cancer and Self-employment and cancer have helpful information about work, disability and financial issues. We can also send you a copy of Help with the cost of cancer.
Radiation-induced second cancers
Thisisaveryrarelong-termproblemfollowingradiotherapyforsometypesofcancer,includingcancerofthebreast.Lessthan1in1,000womenwilldevelopasecondcancer,suchasasarcoma,withinthetreatmentarea.Thiscanoccurmanyyearslater.Secondcancersareveryrarebutanynewsymptomsshouldalwaysbecheckedwithyourdoctor.
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Yourfeelings
Your feelings
Youmayhaveallkindsofemotionsifyouarediagnosedashavingdamagecausedbyyourradiotherapytreatment.Radiotherapydamageisuncommonanditcantakealongtimetofindoutthattheproblemisrelatedtoradiotherapy.Youmayfeelangryaboutthis.Youmayberelievedthatyounowknowthereasonsforyoursymptoms,orfeelcheatedthatyouhavesurvivedcanceronlytobedamagedbythetreatment.Youmaybeworriedabouthowyouwillcopewithanydisability,orworriedaboutmoneyproblemsifyouhavetogiveupwork.
Theseareallnormalreactionsandpartoftheprocessthatmanywomengothrough.Everyonehastheirownwayofcoping.Somewomenfindithelpfultotalktofriendsorfamilymembers,whileothersprefertoseekhelpfrompeopleoutsidetheirsituation,suchascounsellors.Manypeoplefindsupportthroughonlineforumswheretheycanshareexperienceswithothersinasimilarsituation.Othersprefertokeeptheirfeelingstothemselves.Thereisnorightorwrongwaytocope,buthelpisthereifyouneedit.
Anumberoforganisationsandsupportgroupscanhelpandsupportyou.Ourcancersupportspecialistscangiveyoudetailsofthosethatarelocaltoyou.
Our booklet The emotional effects of cancer discusses the feelings you may experience and has advice on how to cope with them.
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Breastradiotherapy–possiblelong-termsideeffects
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Howwecanhelpyou
Canceristhetoughestfightmostofuswilleverface.Butyoudon’thavetogothroughitalone.TheMacmillanteamiswithyoueverystepoftheway.
Get in touch
Macmillan Cancer Support 89AlbertEmbankment,LondonSE17UQQuestions about cancer? Callfreeon0808 808 00 00 (Mon–Fri,9am–8pm)www.macmillan.org.ukHard of hearing?Usetextphone08088080121orTextRelay.Non-English speaker? Interpretersareavailable.
Clear, reliable information about cancer
Wecanhelpyoubyphone,email,viaourwebsiteandpublicationsorinperson.Andourinformationisfreetoeveryoneaffectedbycancer.
Macmillan Support Line Ourfree,confidentialphonelineisopenMonday–Friday,9am–8pm.Ourcancersupportspecialistsprovideclinical,financial,emotionalandpracticalinformationandsupporttoanyoneaffectedbycancer.Calluson0808 808 00 00 oremailusviaourwebsite,macmillan.org.uk/talktous
Information centresOurinformationandsupportcentresarebasedinhospitals,librariesandmobilecentres,andofferyoutheopportunitytospeakwithsomeoneface-to-face.Findyournearestoneatmacmillan.org.uk/informationcentres
How we can help you
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Breastradiotherapy–possiblelong-termsideeffects
PublicationsWeprovideexpert,up-to-dateinformationaboutdifferenttypesofcancer,testsandtreatments,andinformationaboutlivingwithandaftercancer.Wecansendyoufreeinformationinavarietyofformats,includingbooklets,leaflets,factsheets,andaudioCDs.WecanalsoprovideourinformationinBrailleandlargeprint.
Youcanfindallofourinformation,alongwithseveralvideos,onlineatmacmillan.org.uk/cancerinformation
Review our informationHelpusmakeourresourcesevenbetterforpeopleaffectedbycancer.Beingoneofourreviewersgivesyouthechancetocommentonavarietyofinformationincludingbooklets,factsheets,leaflets,videos,illustrationsandwebsitetext.
Need out-of-hours support? Youcanfindalotofinformationonourwebsite,macmillan.org.ukFormedicalattentionoutofhours,pleasecontactyourGPfortheirout-of-hoursservice.
Someone to talk to
Whenyouorsomeoneyouknowhascancer,itcanbedifficulttotalkabouthowyou’refeeling.Youcancallourcancersupportspecialiststotalkabouthowyoufeelandwhat’sworryingyou.
Wecanalsohelpyoufindsupportinyourlocalarea,soyoucanspeakface-to-facewithpeoplewhounderstandwhatyou’regoingthrough.
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Howwecanhelpyou
Professional help
OurMacmillannurses,doctorsandotherhealthcareandsocialcareprofessionalsofferexperttreatmentandcare.Theyhelpindividualsandfamiliesdealwithcancerfromdiagnosisonwards,untiltheynolongerneedthishelp.
YoucanaskyourGP,hospitalconsultant,districtnurseorhospitalwardsisterifthereareanyMacmillanprofessionalsavailableinyourarea,orcallus.
Support for each other
Nooneknowsmoreabouttheimpactcancerhasonaperson’slifethanthosewhohavebeenaffectedbyitthemselves.That’swhywehelptobringpeoplewithcancerandcarerstogetherintheircommunitiesandonline.
Support groupsYoucanfindoutaboutsupportgroupsinyourareabycallingusorbyvisitingmacmillan.org.uk/selfhelpandsupport
Online communityYoucanalsoshareyourexperiences,askquestions,getandgivesupporttoothersinouronlinecommunityatmacmillan.org.uk/community
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Breastradiotherapy–possiblelong-termsideeffects
Financial and work-related support
Havingcancercanbringextracostssuchashospitalparking,travelfaresandhigherheatingbills.Somepeoplemayhavetostopworking.
Ifyou’vebeenaffectedinthisway,wecanhelp.CalltheMacmillanSupportLineandoneofourcancersupportspecialistswilltellyouaboutthebenefitsandotherfinancialhelpyoumaybeentitledto.
Wecanalsogiveyouinformationaboutyourrightsatworkasanemployee,andhelpyoufindfurthersupport.Macmillan Grants Moneyworriesarethelastthingyouneedwhenyouhavecancer.AMacmillanGrantisaone-offpaymentforpeoplewithcancer,tocoveravarietyofpracticalneedsincludingheatingbills,extraclothing,oramuchneededbreak.
Findoutmoreaboutthefinancialandwork-relatedsupportwecanofferatmacmillan.org.uk/financialsupport
Learning about cancer
Youmayfinditusefultolearnmoreaboutcancerandhowtomanagetheimpactitcanhaveonyourlife.
YoucandothisonlineonourLearnZone–macmillan.org.uk/learnzone–whichoffersavarietyofe-learningcoursesandworkshops.There’salsoasectiondedicatedtosupportingpeoplewithcancer–idealforpeoplewhowanttolearnmoreaboutwhattheirrelativeorfriendisgoingthrough.
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Otherusefulorganisations
Breast Cancer Care5–13GreatSuffolkStreet,Southwark,LondonSE10NSHelpline08088006000(Mon–Fri,9am–5pm,Sat,9am–2pm)Tel (admin)08450920800Tel (text)08088006001Emailinfo@breastcancercare.org.ukwww.breastcancercare.org.ukProvidesinformation,practicalhelpandemotionalsupporttoanyoneaffectedbybreastcancer.Specialistbreastcarenursesrunthehelpline.TheLavenderTrustalsorunsfromBreastCancerCare,offeringinformationandsupportspecificallyforyoungerwomenwithbreastcancer.
Lymphoedema Support NetworkStLuke’sCrypt,SydneyStreet,LondonSW36NHInfo and support line 02073514480Email [email protected]
www.lymphoedema.orgAnationalcharitythatprovidesinformationandsupporttopeopleaffectedbylymphoedema.
RAGE (Radiotherapy Action Group Exposure)Tel01892557804Email janice.millington@btinternet.comwww.rage.webeden.co.ukForwomenwhohavesurvivedbreastcancerbuthavebeendamagedbyradiotherapytreatment.
General cancer and support organisations
Cancer Black Care 79ActonLane,LondonNW108UTTel02089614151(Mon–Fri,9.30am–4.30pm)Email [email protected] Offersarangeofinformationandsupportforpeoplewithcancerfromethnic
Other useful organisations
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Breastradiotherapy–possiblelong-termsideeffects
communities,theirfriends,carersandfamilies.WelcomespeoplefromdifferentethnicgroupsincludingAfrican,Asian,TurkishandWestIndiancommunities.
Irish Cancer Society43–45NorthumberlandRoad,Dublin4,IrelandCancer Helpline1800200700(Mon–Thurs,9am–7pm,Fri,9am–5pm)[email protected] OperatesIreland’sonlyfreephonecancerhelpline,whichisstaffedbyqualifiednursestrainedincancercare
Maggie’s Centres 8NewtonPlace,GlasgowG37PRTel03001231801Emailenquiries@maggiescentres.orgwww.maggiescentres.org Locatedthroughoutthecountry,Maggie’sCentresareplacestoturntoforanyoneaffectedbycancer.Youcanaccessinformation,benefitsadvice,andemotionalorpsychologicalsupportfree
ofchargeandunderoneroof.Youdon’thavetomakeanappointmentorbereferred.
Tak Tent Cancer Support – Scotland Flat5,30ShelleyCourt,GartnavelComplex,GlasgowG120YNTel01412110122Emailtaktent4u@gmail.comwww.taktent.org Offersinformationandsupportforcancerpatients,families,friendsandhealthprofessionals.RunsanetworkofmonthlysupportgroupsacrossScotland.Alsoprovidescounsellingandcomplementarytherapies.Tenovus9thFloor,GleiderHouse,TyGlasRoad,Llanishen,CardiffCF145BDFreephone helpline [email protected] BasedinWales,Tenovusprovidesarangeofservicestopeoplewithcancerandtheirfamilies,including
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Otherusefulorganisations
counsellingandafreephonecancerhelpline.
The Ulster Cancer Foundation 40–44EglantineAvenue,BelfastBT96DXFreephone helpline08007833339Helpline [email protected]@ulstercancer.orgwww.ulstercancer.org Providesarangeofservicestopeoplewithcancerandtheirfamilies,includingafreetelephonehelpline,whichisstaffedbyspeciallytrainednurseswithexperienceincancercare.
Support for carers
Carers UK 20GreatDoverStreet,LondonSE14LXTel02073784999Carers line 08088087777(WedandThurs,10am–12pmand2–[email protected]
Offersinformationandsupporttocarers.Canputpeopleincontactwithsupportgroupsforcarersintheirarea.HasnationalofficesforScotland,WalesandNorthernIreland:
Carers Scotland TheCottage,21PearceStreet,GlasgowG513UTTel01414453070Emailinfo@carerscotland.orgwww.carerscotland.org
Carers Wales RiverHouse,YnsbridgeCourt,Gwaelod-y-Garth,CardiffCF159SSTel02920811370Emailinfo@carerswales.orgwww.carerswales.org
Carers Northern Ireland 58HowardStreet,BelfastBT16PJTel02890439843Emailinfo@carersni.orgwww.carersni.org
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Financial and legal advice
Benefit Enquiry Line2ndFloor,RedRoseHouse,LancasterRoad,Preston,LancsPR11HBTel0800882200Textphone0800243355EmailBEL-Customer-Services@dwp.gsi.gov.ukwww.direct.gov.uk/en/Dl1/Directories/DG_10011165 Providesadviceaboutbenefits,andcanalsoprovidehelptocompletesomedisabilityrelatedclaimpacks.
Citizens Advice Bureau Findcontactdetailsforyourlocalofficeinthephonebookoratcitizensadvice.org.uk FindadvicefortheUKonline,inarangeoflanguages,atadviceguide.org.ukCitizensAdviceBureausprovidefree,confidential,independentadviceonavarietyofissuesincludingfinancial,legal,housingandemployment.Citizens Advice Scotlandwww.cas.org.uk
Further resources
Audiotapes and CDs
Ourhigh-qualityaudiomaterials,basedonourrangeofbooklets,includeinformationaboutcancertypesanddifferenttreatments.Theyalsogiveadviceaboutlivingwithcancer.
ToorderyourfreeCDortapevisit be.macmillan.org.ukorcall0808 808 00 00.
Useful websites
Alotofinformationaboutcancerisavailableontheinternet.Somewebsitesareexcellent,othershavemisleadingorout-of-dateinformation.Thesiteslistedonthefollowingpagesareconsideredbynursesanddoctorstocontainaccurateinformationandareregularlyupdated.
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Furtherresources
Macmillan Cancer Support www.macmillan.org.uk Findoutmoreaboutlivingwiththepractical,emotionalandfinancialeffectsofcancer.Ourwebsitecontainsexpert,accurateandup-to-dateinformationoncanceranditstreatments,including:
• our100+booklets,300+factsheets,andcancerQ&As
• howMacmillancanhelp,theservicesweofferandwheretogetsupport
• howtocontactourcancersupportspecialists,includinganemailformforsendingyourquestions
• localsupportgroupssearch,linkstoothercancerorganisationsandadirectoryofinformationmaterials
• ahugeonlinecommunityofpeopleaffectedbycancersharingtheirexperiences,adviceandsupport.
www.cancer.gov (National Cancer Institute – National Institute of Health – USA)Givescomprehensiveinformationoncancerandtreatments.
www.cancer.org (American Cancer Society)Nationwidecommunity-basedvoluntaryhealthorganisationdedicatedtoeliminatingcancerasamajorhealthproblem.Itaimstodothisthroughresearch,education,advocacyandservice.
www.cancerhelp.org.uk (Cancer Research UK)Containspatientinformationonalltypesofcancerandhasaclinicaltrialsdatabase.
www.healthtalkonline.org www.youthhealthtalk.org (site for teens and young adults) Bothwebsitescontaininformationaboutsomecancersandhavevideoandaudioclipsofpeopletalkingabouttheirexperiencesofcanceranditstreatments.
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Breastradiotherapy–possiblelong-termsideeffects
www.nhs.uk (NHS Choices)NHSChoicesistheonline‘frontdoor’totheNHS.Itisthecountry’sbiggesthealthwebsiteandgivesalltheinformationyouneedtomakechoicesaboutyourhealth.
www.nhsdirect.nhs.uk (NHS Direct Online)NHShealthinformationsiteforEngland–coversallaspectsofhealth,illnessandtreatments.
www.nhsdirect.wales.nhs.uk (NHS Direct Wales)
www.nhs24.com (NHS 24 in Scotland)
www.patient.co.uk (Patient UK)Aimstoprovidenon-medicalpeopleintheUKwithgood-qualityinformationabouthealthanddisease.Includesevidence-basedinformationleafletsonawiderangeofmedicalandhealthtopics.Alsoreviewsandlinkstomanyhealthandillnessrelatedwebsites,someofwhichareoverseas.
www.riprap.org.uk (Riprap) Developedespeciallyforteenagerswhohaveaparentwithcancer.
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Breastradiotherapy–possiblelong-termsideeffects
Questions you might like to ask your doctor or nurse
Youcanfillthisinbeforeyouseethedoctorornurse,andthenuseittoremindyourselfofthequestionsyouwanttoask,andtheanswersyoureceive.
1.
Answer
2.
Answer
3.
Answer
4.
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5.
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6.
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Breastradiotherapy–possiblelong-termsideeffects
Disclaimer
Wemakeeveryefforttoensurethattheinformationweprovideisaccuratebutitshouldnot
bereliedupontoreflectthecurrentstateofmedicalresearch,whichisconstantlychanging.
Ifyouareconcernedaboutyourhealth,youshouldconsultadoctor.Macmillancannot
acceptliabilityforanylossordamageresultingfromanyinaccuracyinthisinformationor
thirdpartyinformationsuchasinformationonwebsitestowhichwelink.Wefeaturereallife
storiesinallofourarticles.Somephotographsareofmodels.
Thanks
Thisbooklethasbeenwritten,revisedandeditedbyMacmillanCancerSupport’s
informationdevelopmentnursesandeditorialteam.Ithasbeenapprovedbyourmedical
editor,DrTerryPriestman,ConsultantClinicalOncologist.Withthanksto:MorvenAngus,
BreastSpecialistNurse;ProfessorMichaelDixon,ConsultantSurgeonandSeniorLecturer;
VickiHarmer,SpecialistBreastCareAdvisor;DrDavidMorgan,ConsultantClinical
Oncologist;andthepatientreviewers.
Sources
FaithfullS,WellsM.Supportive Care in Radiotherapy. 2003. ChurchillLivingstone.
Chaoetal.Radiation Oncology: Management Decisions. 2ndedition.2002.Lippincott
WilliamsandWilkins.
DoneganWL,SprattJS.Cancer of the Breast. 5thedition. 2002. WBSaunders.
UpToDateOnline.Techniquesandcomplicationsofbreastandchestwallirradiationfor
earlystagebreastcancer.www.uptodate.com(accessed5May2010).
UpToDateOnline.Cardiotoxicityofradiationtherapyformalignancy.www.uptodate.com
(accessed5May2010).
5 waysyou can hElP
somEonE withcancer
Share your cancer experience Supportpeoplelivingwithcancerbytellingyourstory,online,inthemediaorface-to-face.
Campaign for change Weneedyourhelptomakesureeveryonegetstherightsupport.Takeanaction,bigorsmall,forbettercancercare.
Help someone in your community Alifttoanappointment.Helpwiththeshopping.Orjustacupofteaandachat.Couldyoulendahand?
Raise money Whateveryoulikedoing,youcanraisemoneytohelp.Takepartinoneofoureventsorcreateyourown.
Give money Bigorsmall,everypennyhelps.Tomakearegularorone-offdonation–seeover.
Call us to find out more
0300 1000 200macmillan.org.uk/getinvolved
Can you do something to help?We hope this booklet has been useful to you. It’s just one of our many publications that are available free to anyone affected by cancer. They’re produced by our cancer information specialists who, along with our nurses, benefits advisers, campaigners and volunteers, are part of the Macmillan team. When people are facing the toughest fight of their lives, we’re there to support them every step of the way.
We want to make sure no one has to go through cancer alone, so we need more people to help us. When the time is right for you, here are some ways in which you can become a part of our team.
Pleasecutoutthisformandreturnitinanenvelope(nostamprequired)to:SupporterDonations,MacmillanCancerSupport,FREEPOSTLON15851,89AlbertEmbankment,LondonSE17UQ
Please fill in your personal details Mr/Mrs/Miss/Other
Name
Surname
Address
Postcode
Phone
Pleaseacceptmygiftof£
(Pleasedeleteasappropriate)Iencloseacheque/postalorder/CharityVouchermadepayabletoMacmillanCancerSupport
ORdebitmy:Visa/MasterCard/CAFCharityCard/Switch/Maestro
Cardnumber
££££ ££££££££ ££££Validfrom Expirydate
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Don’t let the taxman keep your moneyDoyoupaytax?Ifso,yourgiftwillbeworthalmostathirdmoretous–atnoextracosttoyou.Allyouhavetodoiswriteyournamebelow,andthetaxofficewillgive25pforeverypoundyougive.
£IamaUKtaxpayerandIwouldlikeMacmillanCancerSupporttotreatalldonationsIhavemadeforthesixyearspriortothisyearandalldonationsImakeinfutureasGiftAiddonations,untilInotifyyouotherwise.
I understand that I must pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April one year to 5 April the next) that is at least equal to the amount of tax that Macmillan will reclaim on my gifts for that tax year.
Macmillan Cancer Support and our trading companies would like to hold your details in order to contact you about our fundraising, campaigning and services for people affected by cancer. If you would prefer us not to use your details in this way please tick this box. o
In order to carry out our work we may need to pass your details to agents or partners who act on our behalf.
If you’d rather donate online, go to macmillan.org.uk/donate
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Cancer is the toughest fight most of uswill ever face. If you or a loved one hasbeen diagnosed, you need a team ofpeople in your corner, supporting youevery step of the way. That’s who we are.
We are the nurses and therapists helping you through treatment. The experts on the end of the phone. The advisers telling you which benefits you’re entitled to. The volunteers giving you a hand with the everyday things. The campaigners improving cancer care. The community supporting you online, any time. The fundraisers who make it all possible.
You don’t have to face cancer alone.We can give you the strength to get through it. We are Macmillan Cancer Support.
Questions about living with cancer? Call free on 0808 808 00 00 (Mon–Fri, 9am–8pm)
Alternatively, visit macmillan.org.uk
Hard of hearing? Use textphone 0808 808 0121, or Text Relay. Non-English speaker? Interpreters available.
© Macmillan Cancer Support, 2010. 3rd edition. MAC11681. Next planned review 2012. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604).
Printed using sustainable material. Please recycle.