Radiation therapy is a highly targeted, highly effective way to destroy cancer cells that may linger after surgery. This reduces the risk of recurrence.
Radiation is usually given after mastectomy in men with:
- large cancers (5 centimeters or bigger)
- a positive margin of resection (when the cancer comes very close to or is at the edge of the breast tissue removed)
- a significant area of lymphatic or blood vessel involvement
- significant lymph node involvement (four or more positive nodes)
After mastectomy, radiation therapy is usually given 5 days a week for about 5-7 weeks.
Radiation can also be used for men with advanced (metastatic) disease to relieve symptoms or help avoid complications from specific areas of spread. For example, radiation can help relieve painful bone metastases, decrease the risk of breaking a bone that's been weakened by cancer, decrease bleeding from skin involvement, and reduce neurological symptoms if the cancer puts pressure on nerves or the spinal cord.
The main potential side effects of radiation therapy include:
Skin irritation: The skin involved in radiation may become dry, sore, and more sensitive to the touch. The skin can start to peel or blister. Your skin reaction can become more serious if the exposed area is not treated and infection develops. Your radiation oncologist can work with you to help you manage any of these signs or symptoms. Fortunately, the skin irritation caused by radiation is temporary. The effects on your skin may continue to worsen for another week or so after treatment has ended, but then your skin will begin to improve. The deep redness and the sensitivity should go away over the first weeks after treatment. The skin will take somewhat longer to completely return to its natural color. If you are white, you may find that the treated area looks tanned or slightly pinkish for up to 6 months after your last session of radiation. If you are black, your skin may be tanner and less red. Your skin can become very dark.
Fatigue: The fatigue you will feel with radiation therapy is not the kind of tiredness that comes after "overdoing it" and goes away with a good night's sleep. This treatment-related fatigue is an overall, deep-felt lack of energy. To combat the fatigue, try to get rest when you can. Regular, brief "cat naps" during the day can give you more energy and allow you to save your energy for the most important activities of the day. Also, try to exercise a little bit. If you can take a walk or go for a swim you may be able to boost your energy levels.
Chest wall effects: Both during and soon after radiation treatment, you may experience brief shooting pains — something like an electric shock in the wall of your chest. You may have had similar discomfort after surgery. These pains are due to swelling and irritation of the tissues, and can be eased with an anti-inflammatory medication. Soon after treatment is over they will go away on their own. Over the long term, you may feel muscle stiffness in the chest wall area, brought on by extra exertion such as washing your car or doing other chores. You're most likely to notice stiffness in the pectoralis major muscle — the one that connects the front of your shoulder to the front of your chest. The stiffness is caused by scar tissue (a result of the radiation treatment) that makes the muscle less supple. This problem is usually minor, occurs on and off, and improves with over-the-counter pain medications.
Armpit discomfort: Added to surgery, radiation can make your armpit feel even worse, 3 or 4 weeks into the course of your radiation treatment. And the constant rubbing together of your arm against your armpit can further irritate the skin in this area. Sweat adds to the friction. Use cornstarch powder instead of deodorant to reduce friction.
Lung effects: Even with today's state-of-the-art equipment, a small part of the lung just underneath the chest wall is within the area that will receive treatment. Scar tissue can form in this small part of the lung after radiation is over, just like the scar tissue that can occur if you have a bout of pneumonia. This is not dangerous to you, but you should be aware of what happens. That's because if scar tissue does form, it's usually found by a chest X-ray that's done for an unrelated reason. The doctor who reads the X-ray may be concerned that you have pneumonia or a recurrence of tumor. Symptoms, which are uncommon, can include a dry cough that doesn't produce any phlegm and shortness of breath. If the symptoms don't go away on their own, they usually disappear with a short course of steroids taken in pill form.
Skin Care Tips
- Use warm rather than hot water while showering.
- Avoid harsher soaps (such as Ivory, Dial, and Irish Spring); instead use fragrance-free soaps with a moisturizer (such as Dove).
- Moisturize the skin after your daily treatment with an ointment such as A&D, Eucerin, Aquaphor, or Radiacare. Put on a lot at night and wear an old T-shirt so it doesn't get on your bed clothes.
- For mild itching and burning, apply an aloe vera preparation. Or try 1% hydrocortisone cream (available without a prescription at any drugstore). Spread the cream thinly over the affected area three times a day.
- If your skin forms a blister or peels in a wet way, leave the top of the blister alone! The bubble keeps the area clean while the new skin grows back underneath. If the blister opens, the exposed raw area can be painful. Keep the area relatively dry and clean with only warm water. Blot the area dry and then apply a dressing that won't stick (non-adherent), such as Xeroform dressings (laden with soothing petroleum jelly) and "second skin" dressings made by several companies.