FAQs about Radiation

This content has been reviewed and approved by

William J. Gradishar, MD FACP
Director, Breast Medical Oncology, Professor of Medicine
Robert H. Lurie Comprehensive Cancer Center
Northwestern University Feinberg School of Medicine

Does everyone need radiation therapy after surgery? 

Not everyone needs radiation after surgery. However, most patients who only have their lump removed will need radiation to the remainder of their breast.
Some patients will need it even after a complete removal of the breast if the tumor size was large or if numerous lymph nodes were involved, or if a cancer deposit had broken through the capsule of the lymph nodes.

This decision is complex and is individualized for a given patient by the team of radiation oncologist, medical oncologist, and surgeon taking care of that patient. The purpose of the radiation is to decrease the risk of breast cancer returning within the same breast or the same part of the chest wall. Some other patients with smaller tumors may also be able to avoid radiation.

The preferred way to give radiation and the standard practice is to give you radiation after completion of postoperative chemotherapy, although both approaches have been looked at. Chemotherapy goes through the blood stream to all parts of your body, including the breast. Radiation is given as an additional therapy in and around the area of the operation because there is a higher likelihood of having some residual cancer cells there. Although radiation is the local treatment, chemotherapy is a total body treatment and you may need both. Most experts agree that giving chemotherapy before radiation is the best approach.

This treatment—called "brachytherapy" (radiation traveling for short distances)—is a more convenient way to receive radiation, and you get done a lot sooner. It is, however, suited for patients with smaller tumors, and not everyone may be a candidate for this treatment. It is very important to discuss this with your radiation oncologist and see what type of experience that facility has with this type of radiation.

It has not been compared in a large randomized trial with regular radiation, and some caution is necessary. It should also be kept in mind that there is some evidence in medical literature to support skipping radiation altogether in women older than 70 who have small tumors and hence a low likelihood of recurrence of cancer in the same area. You should discuss this aspect with your doctor as well.

We generally finish all chemotherapy before starting radiation to the breast, but this only applies to the initial therapy of operable breast cancer. If your situation is different or if there are special considerations, you should discuss this with your doctor. Ultimately, your oncologist and radiation oncologist will decide whether you need chemotherapy during radiation or not.

The most common side effects related to postoperative breast radiation are those affecting your skin, which may appear sunburned. In some cases, the effect may be more severe, causing laceration of the skin. It does not happen right away, it takes a few weeks to develop and a few weeks to go away. The skin may remain darker than the normal tissue. There may be some contraction or scarring of the breast tissue. Occasionally, there are other side effects, which are less common. You should discuss this with your radiation oncologist in more detail.

It varies a lot by your definition of normal. Most people continue their normal activities even during radiation. If you do not have any significant skin reaction, you will be able to carry out most of your activities. There are remedies for the skin reaction that you can discuss with your radiation oncologist.

As most women undergo postoperative chemotherapy, they still feel some residual side effects of fatigue, tiredness, etc. Likewise, as they undergo radiation, they may not feel completely normal. Soon after finishing your radiation, you are normally more than 2 months out from chemotherapy and your hair should be coming back. Your fatigue should have improved significantly. It is important to emphasize that every individual's reaction to therapy is different. There is no standard time frame that should apply to all patients.