Understanding Radiation Therapy

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Radiation therapy to the breast and chest

Radiation treatment to the chest may cause swallowing problems, cough, or shortness of breath. Be sure to tell your doctor or nurse if you notice any of these side effects.

If you get radiation therapy after surgery for breast cancer, try to go without wearing a bra whenever you can. If this is not possible, wear a soft cotton bra without underwires so that your skin is not irritated. If your shoulders feel stiff, ask your doctor or nurse about exercises to keep your arms moving freely.

Other side effects may include breast soreness and swelling from fluid build-up in the treated area. These side effects most likely will go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem (this is called lymphedema), ask your doctor what steps you can take. You can also call us or visit our Web site for more information on lymphedema.

Skin in the treated area may turn red or get darker. This will most likely fade 1 or 2 months after you finish radiation.

Radiation therapy after breast surgery may cause other long-term changes in the breast. Your skin may be slightly darker, and pores may be larger and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before treatment. Sometimes the size of your breast changes—it may become larger because of fluid build-up or smaller because of scar tissue. Many women have little or no change in breast size. These side effects may last long after treatment.

If your treatment includes internal radiation implants, you might notice breast tenderness or tightness. After the implants are removed, you are likely to have some of the same side effects that happen with external radiation treatment. If so, follow the advice given above and let your doctor know about any problems you notice.

After 12 months, you should not have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, tell your doctor about them right away.

When radiation treatments include the chest area, the lungs can be affected. One early change is a decrease in the levels of surfactant, the substance that helps keep the air passages open. This keeps the lungs from fully expanding, and may cause shortness of breath or cough. These symptoms are sometimes treated with steroids.

Radiation pneumonitis is inflammation of the lungs caused by radiation treatment. It’s linked to radiation treatment to the chest or breast. It may occur from about 6 weeks to up to 6 months after completing external radiation therapy. The risk of developing it depends on the radiation dose, the amount of lung tissue in the treatment field, whether you had radiation in the past, and whether you are getting chemo at the same time. It’s also more likely if you have other lung diseases, like COPD. With treatment, most people recover from radiation pneumonitis without any lasting effects.

Common symptoms include:

  • Shortness of breath that usually gets worse with exercise
  • Chest pain, which is often worse when taking in a deep breath
  • Cough
  • Pink-tinged sputum
  • Low-grade fever
  • Weakness

In some cases, no symptoms are noticed, and radiation pneumonitis is found on a chest x-ray.

Radiation pneumonitis is treated by trying to decrease the inflammation. Steroids, like prednisone, are usually used. It usually gets better with treatment. But if it goes untreated or persists, it can lead to pulmonary fibrosis (stiffening or scarring of the lungs). When this happens, the lungs can no longer fully inflate and take in air. If a large area of the lungs is treated with radiation, these changes can cause shortness of breath and less tolerance for physical activity.

Last Medical Review: 01/24/2013
Last Revised: 01/24/2013