Why Do I Need Radiotherapy?

One step at a time: that's been my philosophy for getting through my cancer treatment.  My doctors have wisely taken the same approach, giving me just enough information to get through each stage without overloading me with information.

But now that the mastectomy and chemo are over, it is finally time to turn my attention to radiotherapy.  I have been prescribed 25 sessions, so that means going to hospital every week day for five weeks plus an initial week with two preparatory appointment.  That's when they will decide how I will be positioned and mark me with small tattoos so that they can recreate that position exactly for each session.

Last week I met my radiologist and I had various questions for him, starting with - why do I need radiotherapy at all?  After all, the operation removed my entire breast and the infected lymph nodes, then the chemo supposedly killed off any cancer cells that had escaped in my body.  Hormone therapy should hopefully prevent any new cancers, so what is the point of radiotherapy?

First, he explained the criteria for prescribing radiotherapy.  If my tumour had been small and contained in the breast, then the mastectomy would have been enough.  But if the cancer is also in the lymph nodes (yup) or there is more than one tumour (yup) or there is one tumour larger than 5cm (my two tumours had joined to create one 5cm monster so I guess that's another yes) - then radiotherapy is prescribed.

That's because surgery cannot reach all the problem areas.  A mastectomy cannot remove absolutely all breast tissue and there are lymph nodes in places that would be too invasive to reach with a knife.   And in theory chemo should take care of anything left behind by surgery but in practice it isn't 100% effective, particularly around the breast area, possibly because the surgery removes the routes the chemicals need to travel.

So, where will I need radiotherapy?  They will blast areas where localised cancer cells might still be lurking i.e. the chest wall and the lymph nodes hidden behind the sternum and the clavicle.  And finally they will blast the armpit where first-level nodes have already been removed but, unlike surgery, the radiotherapy will be able to reach the second or third level.

If I wasn't yet convinced, the statistics helped me see that it is worth making the trip to hospital every day for six weeks.  Without radiotherapy, there's a 15% chance of localised recurrence.  Radiotherapy reduces that to only 2% after a lumpectomy.  For me, post mastectomy, radiotherapy will reduce my chance to 1%.  Those are odds I like.

And how does radiotherapy work? They will blast me with high energy x-rays in small doses that will break down the DNA in all cells.  Healthy cells have a repair mechanism so will have repaired themselves before the next session.  But abnormal cells and cancer cells don't have this ability, so will be unable to reproduce and will die by the end of the 25 sessions. 

That sounded like a good result but not much fun for my healthy cells.  So my next question was - Won't it hurt?  My radiologist promised that I will feel no pain during the sessions and, in fact, will have no side effects at all until the last couple of weeks.  By then I may get some dryness and redness on the skin but no burning (large breasted women can burn where the skin folds but, as I have had a mastectomy, I should be fine).  There might also be some fatigue towards the end...but not as bad as chemo-exhaustion.

Well okay, but shouldn't I buy some protective creams?  He almost rolled his eyes at this one, clearly he despairs of the advice people receive.  Ignore what everyone says, he pleaded, don't use cream or oils, soap or deodorant.  Just wash with water.  To keep yourself comfortable, avoid wearing your bra or prosthesis if possible and wear white cotton T shirts next to the skin.  I have, of course, been advised to buy a 'wonder cream' that a friend (who survived radiotherapy unscathed) swears by.  I'm hesitating...but I think I'll stick with my radiologist's advice for now.

Finally he explained that I should have four weeks recovery time between the end of chemo and the start of radiotherapy.   But my last question was, can I wait a couple of weeks longer?  You see, I told him, the kids have a week's holiday and I really don't want to come to hospital every day when they are not at school...  He agreed, though the gap couldn't be any longer.  So now we can go on a family holiday during the break and get a week's rest and relaxation before the next phase starts. 

One step at a time.