RADIOTERAPI

Radiasi Eksternal
Radiasi jenis ini bisa menghancurkan hampir semua jenis kanker dan bisa dijalani oleh pasien
rawat jalan (tidak perlu opname). Juga bisa digunakan untuk menghilangkan nyeri dan gangguan
lain yang lazim dialami oleh penderita kanker yang sudah metastase (menyebar).
Kadang diberikan bersamaan dengan operasi/pembedahan, yaitu kalau kankernya belum
menyebar tetapi tidak bisa diangkat seluruhnya, atau dikhawatirkan akan tumbuh lagi di
sekitarnya. Tindakan dilakukan setelah jaringan utama kanker diangkat, sebelum luka bedah
ditutup kembali lokasi bekas kanker diradiasi. Cara yang disebut intraoperative radiation therapy
(IORT) ini terutama digunakan pada kanker thyroid, usus, pankreas, dan rahim (termasuk indung
telur, leher rahim, mulut rahim, dan sekitarnya).
Radiasi eksternal juga diberikan sebagai pencegahan (prophylactic cranial irradiation, PCI),
misalnya pada penderita kanker paru radiasinya diarahkan ke otak supaya sel kanker tidak
menjalar ke otak.
Terapi radiasi eksternal tidak membuat penderita menjadi radioaktif (memancarkan radiasi ke
sekitarnya). Jadi tidak berbahaya bagi orang-orang di sekitarnya.
Radiasi Internal (Brachytherapy)
Sumber radiasi berupa susuk/implant berbentuk seperti kabel, pita, kapsul, kateter, atau butiran
kecil berisi isotop radioaktif iodine, strontium 89, fosfor, palladium, cesium, iridium, fosfat, atau
cobalt, yang ditanamkan tepat di jaringan kanker atau di dekatnya. Cara ini lebih efektif
membunuh sel kanker sekaligus memperkecil kerusakan jaringan sehat di sekitar sasaran radiasi.
Radiasi internal sering digunakan untuk mengobati kanker di daerah kepala dan leher, thyroid,
prostat, leher rahim, kandungan, payudara, sekitar selangkangan, dan di saluran kencing.
Susuk radioaktif ini ada yang ditanam selama beberapa menit saja (dosis tinggi), ada yang
selama beberapa hari (dosis rendah), ada juga yang dibiarkan di dalam tubuh tanpa diangkat lagi.
Selama menjalani terapi ini penderita sedikit radioaktif, khususnya di sekitar lokasi susuk, tetapi
secara keseluruhan tubuh penderita tidaklah radioaktif. Untuk mencegah hal-hal yang tidak
diinginkan, penderita perlu menjalani rawat inap dengan beberapa batasan. Misalnya, dirawat di
ruang tersendiri. Pendamping boleh melayani penderita, tetapi tidak terus-menerus berada di
sisinya. Begitu juga tamu yang bezuk dibatasi waktunya. Wanita hamil dan anak-anak di bawah
usia 18 tahun tidak boleh berkunjung. Tetapi setelah implant radioaktif ini diambil lagi, penderita
sama sekali tidak radioaktif.
Radiasi Sistemik

Pada radiasi sistemik, bahan radioaktif sebagai sumber radiasi ditelan seperti obat atau
disuntikkan, yang kemudian mengikuti aliran darah ke seluruh tubuh. Radiasi ini digunakan
untuk mengobati kanker thyroid dan non-Hodgkins lymphoma.
Sisa-sisa bahan radioaktif yang tak terpakai keluar dari tubuh melalui air liur, keringat, dan air
kencing. Dalam kurun waktu tertentu cairan ini bersifat radioaktif, tetapi sesudahnya tidak lagi.
Itu sebabnya penderita yang menjalani radiasi sistemik perlu menjalani rawat inap.

RADIOLOGI
A
Konvensional
.
Pemeriksaan radiologi tanpa bahan kontras.
Jenis pemeriksaan:
1. Thorax
Pemeriksaan secara radiologi organ thorax
2. Kepala
Pemeriksaan secara radiologi organ kepala
3. Extermitas
Pemeriksaan secara radiologi organ ektermitas
4. Vetebrae
Pemeriksaan secara radiologi organ vetebrae; vetebrae cervical,vetebrae thoraxal,
vetebrae lumbal, vetebrae sacral, coccigius.
5. Mamography
Pemeriksaan secara radiologi organ payudara dengan menggunakan pesawat
khusus mammography dengan kapasitas kilo volt rendah dan waktu expose
panjang
B.Pemeriksaan Khusus
Pemeriksaan radiologi dengan bahan kontras.
Jenis pemeriksaan:
1. Oesophagus
Pemeriksaan secara radiologi organ traktus digestivus pada daerah oesofhagus
dengan menggunakan bahan kontras melalui oral ( barium sulfat yang dilarutkan

dalam air 1:1 )

2. Maag Duedonum
Pemeriksaan secara radiologi pada organ lambung dengan menggunakan bahan
kontras melalui oral ( barium sulfat yang dilarutkan dalam air )
3. Follow Through
Pemeriksaan secara radiologi pada organ usus halus dengan menggunakan bahan
kontras melalui oral ( barium sulfat yang dilarutkan dalam air )
4. Intra Vena Pyelography ( IVP )
5. Pemeriksaan secara radiologi pada organ traktus urinarius ( ginjal ,urether, buli
buli dengan menggunakan bahan kontras melalui penyuntikan intravena
6. Appendikogram
Pemeriksaan secara radiologi pada daerah appendik dengan menggunakan bahan
kontras barium sulfat yang di larutkan dalam air yang kemudian di minum.
7. Retrograde Pyelography ( RPG )
Pemeriksaan secara radiologi pada organ traktus urinarius ( ginjal, urether, buli
buli ) dengan menggunakan bahan kontras yang dimasukan melalui kateter
kedalam ginjal dan salurannya. Pemasangan kateter tersebut dilakukan di kamar
operasi
8. Bipoler Uretrogram
Pemeriksaan secara radiologi pada organ traktus urinarius ( ginjal, uretra, buli
buli ) dengan menggunakan bahan kontras yang dimasukan melalui kateter
sistomi kedalam buli buli dan secara retrograde melalui urether.
9. Hystero Salvingography ( HSG )
Pemeriksaan secara radiologi pada organ genitalia wanita dengan menggunakan
bahan kontras yang dimasukan melalui uterus dan tuba uterine
10. Myelography
Pemeriksaan secara radiologi pada organ. canalis medulla spinalis dengan
menggunakan bahan kontras yang dimasukan melalui lumbal fungsi.
11. Fiestelography
Pemeriksaan secara radiologi untuk fistel ( kedalaman, hubungan dengan organ
lain ) dengan menggunakan bahan kontras dimasukan melalui fistel tersebut.
C
CT. SCAN
.
a. Pemeriksaan CT Scan tanpa kontas

1. CT Scan Kepala
Pemeriksaan secara radiologi dengan cara komputed Tomography pada organ
kepala dan jarinagn otak
2. Ct San Thorax
Pemeriksaan secara radiologi dengan cara komputed Tomography pada organ
thorax ( mediastinum, jantung, paru )
3. CT Scan Upper Abdomen
Pemeriksaan secara radiologi dengan cara komputed Tomography organ
abdomen ( diapragma crista illiaca ).
4. Ct San Lower abdomen / whole abdomen
Pemeriksaan secara radiologi dengan cara komputed Tomography pada organ
lower abdomen ( crista illiaca rectum ), whole abdomen dari diapragma
sampai dengan rectum.
5. Sinus paranasal, nasopharynx, larynk, thyroid, orbita
Pemeriksaan dengan cara komputed tomography pada organ sinus paranasal,
nasopharynx, larynk, thyroid dan orbita.
6. Vertebrae
Pemeriksaan dengan cara komputed tomography pada organ vetebrae (
corpus dan discus ) .
7. Trans Thoracal Biopsi (TTB )
Biopsi jaringan paru melalui thoracal yang dituntun dengan CT Scan.
b. Pemeriksaan ct scan dengan kontras
1. CT Scan Kepala
Pemeriksaan secara radiologi dengan cara komputed tomography pada organ
kepala dilakukan dengan CT Scan kepala tanpa kontras terlebih dahulu
kemudian memasukan bahan kontras melalui Intra Vena, setelah itui dilakukan
CTScan kembali .

2. Ct Scan sinus paranasal, nasopharynx, larynx, thyroid dan orbita

Pemeriksaan secara radiology dengan cara komputed tomography pada organ
sinus paranasal, nasopharynx, larynx, thyroid, orbita dilakukan dengan CT
Scan masing masing organ tersebut diatas tanpa kontras terlebih dahulu
kemudian memasukan bahan kontras melalui intra vena, setelah itu dilakukan
CTScan kembali .
3. CT Scan Upper Abdomen
Pemeriksaan secara radiologi dengan cara komputed Tomography pada organ
upper abdomen tanpa kontras kemudian diberi minum bahan kontras dan
disuntikan bahan kontras melalui intra vena kemudian dilakukan Ct Scan
upper abdomen kembali.
4. CT Scan lower abdomen /whole abdomen
Pemeriksaan secara radiologi dengan cara komputed tomography pada organ
lower abdomen / while abdomen dilakukan Ctscan tanpa kontras terlebih
dahulu, kemudian di berikan minum bahan kontras dan juga di berikan cairan
bahan kontras untuk mengisi usus usus besar melalui rectum serta disuntikan
juga kontras secara intra vena . Setelah itu dilakukan Ct scan kembali.
Sumber : Sapardi, BSc

What Is Mastectomy?
Last modified on May 16, 2013 at 4:05 PM
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Mastectomy is the removal of the whole breast. There are five different types of mastectomy:
"simple" or "total" mastectomy, modified radical mastectomy, radical mastectomy, partial
mastectomy, and subcutaneous (nipple-sparing) mastectomy.
"Simple" or "total" mastectomy
Simple or total mastectomy concentrates on the breast tissue itself:

The surgeon removes the entire breast.

The surgeon does not perform axillary lymph node dissection (removal of lymph nodes in
the underarm area). Sometimes, however, lymph nodes are occasionally removed because
they happen to be located within the breast tissue taken during surgery.

No muscles are removed from beneath the breast.

Simple MastectomyLarger Version

Who usually gets simple or total mastectomy?
A simple or total mastectomy is appropriate for women with multiple or large areas of ductal
carcinoma in situ (DCIS) and for women seeking prophylactic mastectomies that is, breast
removal in order to prevent any possibility of breast cancer occurring.

Modified radical mastectomy

Modified radical mastectomy involves the removal of both breast tissue and lymph nodes:

The surgeon removes the entire breast.

Axillary lymph node dissection is performed, during which levels I and II of underarm
lymph nodes are removed (B and C in illustration).

No muscles are removed from beneath the breast.

Modified radical mastectomyLarger Version

Who usually gets a modified radical mastectomy?
Most people with invasive breast cancer who decide to have mastectomies will receive modified
radical mastectomies so that the lymph nodes can be examined. Examining the lymph nodes
helps to identify whether cancer cells may have spread beyond the breast.

Radical mastectomy
Radical mastectomy is the most extensive type of mastectomy:

The surgeon removes the entire breast.

Levels I, II, and III of the underarm lymph nodes are removed (B, C, and D in
illustration).

The surgeon also removes the chest wall muscles under the breast.

Radical mastectomyLarger Version

Who usually gets a radical mastectomy?
Today, radical mastectomy is recommended only when the breast cancer has spread to the chest
muscles under the breast. Although common in the past, radical mastectomy is now rarely

performed because in most cases, modified radical mastectomy has proven to be just as effective
and less disfiguring.

Partial mastectomy
Partial mastectomy is the removal of the cancerous part of the breast tissue and some normal
tissue around it. While lumpectomy is technically a form of partial mastectomy, more tissue is
removed in partial mastectomy than in lumpectomy.

Subcutaneous ("nipple-sparing") mastectomy

During subcutaneous ("nipple-sparing") mastectomy, all of the breast tissue is removed, but the
nipple is left alone. Subcutaneous mastectomy is performed less often than simple or total
mastectomy because more breast tissue is left behind afterwards that could later develop cancer.
Some physicians have also reported that breast reconstruction after subcutaneous mastectomy
can result in distortion and possibly numbness of the nipple. Because subcutaneous mastectomy
is still an area of controversy among some physicians, your doctor may recommend simple or
total mastectomy instead.
Chemotherapy for breast cancer in women
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Cytotoxic means toxic
to cells. These drugs disrupt the way cancer cells grow and divide but they also affect normal
cells.
On this page

When you have chemotherapy

How you have chemotherapy

The drugs used

Side effects

When you have chemotherapy Back to top

Your cancer specialist may recommend you have chemotherapy after surgery to reduce the risk
of breast cancer coming back. This is called adjuvant chemotherapy. Your doctor or nurse will
explain the benefits of this to you and the likely side effects.

You are usually offered chemotherapy if the cancer is:

large

high-grade

has spread to the lymph nodes

triple negative

HER2 positive

Some women have chemotherapy before surgery to shrink a large cancer (neo-adjuvant
treatment). If it works well, you may only need part of the breast removed instead of
a mastectomy. Women with inflammatory breast cancer usually have chemotherapy before their
surgery.
Your cancer specialist may ask you to take part in a research trial that compares different types of
chemotherapy.
How you have chemotherapy Back to top
You usually have chemotherapy in the chemotherapy day unit and go home after it. The drugs
are usually given into a vein (intravenously) and some are taken as tablets.
When you have intravenous chemotherapy, the nurse will give you the drugs into a vein by
injection or as a drip (infusion).
You usually have them through a small tube (cannula) in your hand or arm. Sometimes they are
given through a soft plastic tube called a central line or PICC line. These lines go into a large
vein in your chest. Chemotherapy can also be given into a thin, soft plastic tube with a rubber
disc (port), under the skin on your upper chest.
Chemotherapy is given into the vein as one or more sessions of treatment. Each session takes a
few hours. After the session, you will have a rest period of a few weeks. The chemotherapy
session and the rest period is called a cycle of treatment.
The length of a cycle depends on the chemotherapy drugs youre taking, but most cycles are 13
weeks long. Your doctor or nurse will explain more about this. Most, but not all, courses of
chemotherapy consist of six cycles.
The drugs used Back to top

You will have a combination of different chemotherapy drugs. Some commonly used
combinations include:

FEC fluorouracil (5FU), epirubicin and cyclophosphamide

FEC-T FEC followed by docetaxel (Taxotere)

AC or EC doxorubicin (Adriamycin) and cyclophosphamide or epirubicin and

cyclophosphamide

CMF cyclophosphamide, methotrexate and 5FU

E-CMF epirubicin and CMF.

Adjuvant chemotherapy for breast cancer usually includes an anthracycline drug, such as
epirubicin or doxorubicin. If there is a higher risk of the cancer coming back, docetaxel is also
usually included. Your doctor may offer you a choice of chemotherapy treatments.
If you have HER2 breast cancer, you may have trastuzumab (Herceptin) along with your
chemotherapy.
Side effects Back to top
Chemotherapy drugs can cause side effects. Many of these can be controlled well with medicines
and will usually go away when your treatment finishes. Your doctor or nurse will tell you more
about what to expect. Always tell them about your side effects, as there are usually ways in
which they can be controlled.
Risk of infection
Chemotherapy can reduce your number of white blood cells, which help fight infection. If the
number of white blood cells is low, youll be more prone to infections. A low white blood cell
count is called neutropenia.
Always contact the hospital immediately on the 24-hour contact number youve been given and
speak to a nurse or doctor if:

you develop a high temperature, which may be over 37.5C (99.5F) or over 38C
(100.4F) depending on the hospitals policy follow the advice that you have been given
by your chemotherapy team

you suddenly feel unwell, even with a normal temperature

you feel shivery and shaky

you have any symptoms of an infection such as a cold, sore throat, cough, passing urine
frequently (urine infection) or diarrhoea.

If necessary, youll be given antibiotics to treat an infection.

Youll have a blood test before each cycle of chemotherapy to make sure your white blood cells
have recovered. Occasionally, your treatment may need to be delayed if your number of white
blood cells is still low.
Your nurse may give you injections of a drug called G-CSF under the skin. It encourages the
bone marrow (where blood cells are made) to make more white blood cells.
Bruising and bleeding
Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the
blood to clot. If you develop any unexplained bruising or bleeding such as nosebleeds, bleeding
gums, blood spots or rashes on the skin, contact your doctor or the hospital straight away.
Anaemia (low number of red blood cells)
Chemotherapy may reduce the number of red bloods cells (haemoglobin) in your blood. A low
level of red blood cells is known as anaemia, which can make you feel very tired and lethargic.
You may also become breathless. Let your doctor know if you get these effects.
Feeling sick (nausea)
Some chemotherapy drugs can make you feel sick (nauseated) or possibly be sick (vomit). Your
cancer specialist will prescribe anti-sickness (anti-emetic) drugs to prevent this. Let your doctor
or nurse know if your anti-sickness drugs are not helping, as there are several different types you
can try. We can send you more information about nausea and vomiting.
Tiredness (fatigue)
Youre likely to become tired and have to take things more slowly. Try to pace yourself and save
your energy for things that you want to do or that need doing. Balance rest with some physical
activity. Even just going for a short walk will help increase your energy.
Hair loss
This is a common side effect of the drugs used to treat breast cancer. Ask your nurse what you
should expect. Some women may lose all their body hair including eyelashes and eyebrows. If

you do experience hair loss, your hair should start to grow back about 36 months after
treatment.
Your nurse can give you advice about coping with hair loss and how to look after your scalp.
They will let you know if scalp cooling a way of reducing hair loss during chemotherapy
would be appropriate.
Loss of appetite
Some people lose their appetite while theyre having chemotherapy. This can be mild and may
only last a few days. If you dont feel like eating during treatment, you could try replacing some
meals with nutritious drinks or a soft diet. If it doesnt improve, you can ask to see a dietitian.
Sore mouth
Your mouth may become sore (or dry), or you may notice small ulcers during treatment.
Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush,
can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these
problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Diarrhoea
Some chemotherapy drugs can cause diarrhoea. This often starts several days after treatment. If
youre taking chemotherapy tablets or capsules at home, its important to let your doctor or nurse
know if you have diarrhoea, as your treatment may need to be interrupted. Medicine can be
prescribed to help. Its important to drink plenty of fluids if you have diarrhoea.
Effects on the nerves
Some chemotherapy drugs can affect the nerves in your hands or feet. This can cause tingling or
numbness, a sensation of pins and needles or muscle weakness (peripheral neuropathy).
Its important to let your doctor know if this happens. They may need to change the
chemotherapy drug if it gets worse. Usually, peripheral neuropathy gradually gets better when
chemotherapy is over, but sometimes its permanent. We can send you more information about
peripheral neuropathy.
Contraception
Your doctor will advise you not to get pregnant while having chemotherapy. This is because the
drugs may harm an unborn baby. Its important to use effective contraception during your
treatment.

Sex
Youre usually advised to use condoms if you have sex within the first 48 hours after
chemotherapy. This is to protect your partner from the drugs in case theyre present in the
vaginal fluid.
Early menopause
Younger women may find chemotherapy brings on an early menopause, which can be difficult to
cope with.
Infertility
If youre worried about the effect chemotherapy may have on your fertility, its important to talk
this over with your cancer specialist before treatment starts.
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Breast/Treatingbreastcancer/Chem
otherapyforbreastcancer.aspx
Chemotherapy for breast cancer
Chemotherapy (chemo) is treatment with cancer-killing drugs that may be given intravenously
(injected into a vein) or by mouth. The drugs travel through the bloodstream to reach cancer cells
in most parts of the body. Chemo is given in cycles, with each period of treatment followed by a
recovery period. Treatment usually lasts for several months.
If youd like more information on a drug used in your treatment or a specific drug mentioned in
this section, see our Guide to Cancer Drugs , or call us with the names of the medicines youre
taking.
When is chemotherapy used?
There are several situations in which chemo may be recommended.
After surgery (adjuvant chemotherapy): When therapy is given to patients with no evidence
of cancer after surgery, it is called adjuvant therapy. Surgery is used to remove all of the cancer
that can be seen, but adjuvant therapy is used to kill any cancer cells that may have been left
behind but can't be seen. Adjuvant therapy after breast-conserving surgery or mastectomy
reduces the risk of breast cancer coming back. Radiation, chemo, targeted therapy, and hormone
therapy can all be used as adjuvant treatments.
Even in the early stages of the disease, cancer cells may break away from the primary breast
tumor and spread through the bloodstream. These cells don't cause symptoms, they don't show up

on imaging tests, and they can't be felt during a physical exam. But if they are allowed to grow,
they can establish new tumors in other places in the body. The goal of adjuvant chemo is to kill
undetected cells that have traveled from the breast.
Before surgery (neoadjuvant chemotherapy): Chemo given before surgery is called
neoadjuvant chemotherapy. Often, neoadjuvant therapy uses the same treatments that are used as
adjuvant therapy, only they are given (or at least started) before surgery instead of after. In terms
of survival, there is no difference between giving chemo before or after surgery. The major
benefit of neoadjuvant chemo is that it can shrink large cancers so that they are small enough to
be removed with less extensive surgery. The other advantage of neoadjuvant chemo is that
doctors can see how the cancer responds to the chemo drugs. If the tumor does not shrink with
the first set of drugs, your doctor will know that other chemo drugs are needed.
Some breast cancers are too big to be surgically removed at the time of diagnosis. These cancers
are referred to as locally advanced and have to be treated with chemo to shrink them so they can
be removed with surgery.
For advanced breast cancer: Chemo can also be used as the main treatment for women whose
cancer has spread outside the breast and underarm area, either when it is diagnosed or after initial
treatments. The length of treatment depends on whether the cancer shrinks, how much it shrinks,
and how a woman tolerates treatment.
How is chemotherapy given?
In most cases (especially adjuvant and neoadjuvant treatment), chemo is most effective when
combinations of more than one drug are used. Many combinations are being used, and it's not
clear that any single combination is clearly the best. Clinical studies continue to compare today's
most effective treatments against something that may be better.
The most common chemo drugs used for early breast cancer include the anthracyclines (such as
doxorubicin/Adriamycin and epirubicin/Ellence) and the taxanes (such as paclitaxel/Taxol and
docetaxel/Taxotere). These may be used in combination with certain other drugs, like
fluorouracil (5-FU) and cyclophosphamide (Cytoxan).
Some of the most commonly used drug combinations for early breast cancer are:

CAF (or FAC): cyclophosphamide, doxorubicin (Adriamycin), and 5-FU

TAC: docetaxel (Taxotere), doxorubicin (Adriamycin), and cyclophosphamide

AC T: doxorubicin (Adriamycin) and cyclophosphamide followed by paclitaxel

(Taxol) or docetaxel (Taxotere).

FEC: T, 5-FU, epirubicin, and cyclophosphamide followed by docetaxel (Taxotere) or

paclitaxel (Taxol)

TC: docetaxel (Taxotere) and cyclophosphamide

TCH: docetaxel, carboplatin, and trastuzumab (Herceptin) for HER2/neu positive tumors

Other combinations that are less often used include

CMF: cyclophosphamide (Cytoxan), methotrexate, and 5-fluorouracil (fluorouracil, 5FU)

A CMF: doxorubicin (Adriamycin), followed by CMF

EC: epirubicin (Ellence) and cyclophosphamide

AC: doxorubicin (Adriamycin) and cyclophosphamide

The targeted drug trastuzumab (Herceptin) may be given along with chemo for early stage breast
cancer when the cancer cells test positive for HER2 (this drug is discussed in the section about
targeted therapy).
Many other chemo drugs are useful in treating women with breast cancer, such as:

Platinum agents (cisplatin, carboplatin)

Vinorelbine (Navelbine)

Capecitabine (Xeloda)

Liposomal doxorubicin (Doxil)

Gemcitabine (Gemzar)

Mitoxantrone

Ixabepilone (Ixempra)

Albumin-bound paclitaxel (Abraxane)

Eribulin (Halaven)

Targeted therapy drugs such as trastuzumab and lapatinib (Tykerb) may be used with these
chemo drugs for tumors that are HER2-positive (these drugs are discussed in more detail in the
"Targeted therapy for breast cancer" section).
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the
body time to recover from the effects of the drugs. Chemo begins on the first day of each cycle,
but the schedule varies depending on the drugs used. For example, with some drugs, the chemo
is given only on the first day of the cycle. With others, it is given every day for 14 days, or
weekly for 2 weeks. Then, at the end of the cycle, the chemo schedule repeats to start the next
cycle. Cycles are most often 2 or 3 weeks long, but they vary according to the specific drug or
combination of drugs. Some drugs are given more often. Adjuvant and neoadjuvant chemo is
often given for a total time of 3 to 6 months, depending on the drugs that are used. Treatment
may be longer for advanced breast cancer and is based on how well it is working and what side
effects the patient has.
Dose-dense chemotherapy: Doctors have found that giving the cycles of certain chemo agents
closer together can lower the chance that the cancer will come back and improve survival in
some women. This usually means giving the same chemo that may be given every 3 weeks (such
as AC T), but giving it every 2 weeks. A drug (growth factor) to help boost the white blood
cell count is given after chemo to make sure the white blood cell count returns to normal in time
for the next cycle. This approach can be used for neoadjuvant and adjuvant treatment. It can lead
to more side effects and be harder to take, so it isnt for everyone.
Possible side effects
Chemo drugs work by attacking cells that are dividing quickly, which is why they work against
cancer cells. But other cells in the body, like those in the bone marrow, the lining of the mouth
and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected
by chemo, which can lead to side effects. Some women have many side effects; others may only
have few.
Chemo side effects depend on the type of drugs, the amount taken, and the length of treatment.
Some of the most common possible side effects include:

Hair loss

Mouth sores

Loss of appetite or increased appetite

Nausea and vomiting

Low blood cell counts

Chemo can affect the blood forming cells of the bone marrow, which can lead to:

Increased chance of infections (from low white blood cell counts)

Easy bruising or bleeding (from low blood platelet counts)

Fatigue (from low red blood cell counts and other reasons)

These side effects usually last a short time and go away after treatment is finished. It's important
to tell your health care team if you have any side effects, as there are often ways to lessen them.
For example, drugs can be given to help prevent or reduce nausea and vomiting.
Other side effects are also possible. Some of these are more common with certain chemo drugs.
Your cancer care team will tell you about the possible side effects of the specific drugs you are
getting.
Menstrual changes: For younger women, changes in menstrual periods are a common side
effect of chemo. Premature menopause (not having any more menstrual periods) and infertility
(not being able to become pregnant) may occur and may be permanent. Some chemo drugs are
more likely to cause this than others. The older a woman is when she receives chemotherapy, the
more likely it is that she will become infertile or go through menopause as a result. When this
happens, there is an increased risk of bone loss and osteoporosis. There are medicines that can
treat or help prevent problems with bone loss.
Even if your periods have stopped while you were on chemo, you may still be able to get
pregnant. Getting pregnant while receiving chemo could lead to birth defects and interfere with
treatment. This is why its important that women who are pre-menopausal before treatment and
are sexually active discuss using birth control with their doctor. Patients who have finished
treatment (like chemo) can safely go on to have children, but it's not safe to get pregnant while
on treatment.
If you are pregnant when you get breast cancer, you still can be treated. Certain chemo drugs can
be given safely during the last 2 trimesters of pregnancy. This is discussed in detail in the section,
Treatment of breast cancer during pregnancy.
If you think you might want to have children after being treated for breast cancer, talk with your
doctor before you start treatment. You can read our document Fertility and Women With Cancer
for more information.

Neuropathy: Many drugs used to treat breast cancer, including the taxanes (docetaxel and
paclitaxel), platinum agents (carboplatin, cisplatin), vinorelbine, erubulin, and ixabepilone, can
damage nerves outside of the brain and spinal cord. This can sometimes lead to symptoms
(mainly in the hands and feet) like numbness, pain, burning or tingling sensations, sensitivity to
cold or heat, or weakness. In most cases this goes away once treatment is stopped, but it might
last a long time in some women. Neuropathy is discussed in more detail in our document,
Peripheral Neuropathy Caused By Chemotherapy.
Heart damage: Doxorubicin, epirubicin, and some other drugs may cause permanent heart
damage (called cardiomyopathy). The risk of this occurring depends on how much of the drug is
given, and is highest if the drug is used for a long time or in high doses. Doctors watch closely
for this side effect. Most doctors check the patients heart function with a test like a MUGA or an
echocardiogram before starting one of these drugs. They also carefully control the doses, watch
for symptoms of heart problems, and may repeat the heart test to monitor function. If the heart
function begins to decline, treatment with these drugs will be stopped. Still, in some patients,
heart damage takes a long time to develop. Signs might not appear until months or years after
treatment stops. Heart damage from these drugs happens more often if the targeted therapy drug
trastuzumab is used as well, so doctors are more cautious when these drugs are used together.
Hand-foot syndrome: Certain chemo drugs, such as capecitabine and liposomal doxorubicin,
can irritate the palms of the hands and the soles of the feet. This is called hand-foot syndrome.
Early symptoms include numbness, tingling, and redness. If it gets worse, the hands and feet can
become swollen and uncomfortable or even painful. The skin may blister, leading to peeling of
the skin or even open sores. There is no specific treatment, although some creams may help.
These symptoms gradually get better when the drug is stopped or the dose is decreased. The best
way to prevent severe hand-foot syndrome is to tell your doctor when early symptoms come up,
so that the drug dose can be changed. This syndrome can also occur when the drug 5-FU is given
as an IV infusion over several days (this is not commonly given to treat breast cancer).
Chemo brain: Another possible side effect of chemo is "chemo brain." Many women who are
treated for breast cancer report a slight decrease in mental functioning. They may have some
problems with concentration and memory, which may last a long time. Although many women
have linked this to chemo, it also has been seen in women who did not get chemo as a part of
their treatment. Still, most women function well after treatment. In studies that have found
chemo brain to be a side effect of treatment, the symptoms most often go away in a few years.
For more information, see our document, Chemo brain.
Increased risk of leukemia: Very rarely, certain chemo drugs can permanently damage the bone
marrow, leading to a disease called myelodysplastic syndrome or even acute myeloid leukemia, a
life-threatening cancer of white blood cells. When this happens it is usually within 10 years after

treatment. In most women, the benefits of chemo in preventing breast cancer from coming back
or in extending life are likely to far exceed the risk of this rare but serious complication.
Feeling unwell or tired: Many women do not feel as healthy after receiving chemo as they did
before. There is often a residual feeling of body pain or achiness and a mild loss of physical
functioning. These may be very subtle changes that are only revealed by closely questioning
women who have undergone chemo.
Fatigue is another common (but often overlooked) problem for women who have received
chemo. This may last up to several years. It can often be helped, so it is important to let your
doctor or nurse know about it. For more information on what you can do about fatigue, see our
document, Fatigue in People with Cancer. Exercise, naps, and conserving energy may be
recommended. If there are sleep problems, they can be treated. Sometimes there is depression,
which may be helped by counseling and/or medicines.
For more information about chemotherapy, see our document, Understanding Chemotherapy: A
Guide for Patients and Families.
http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-chemotherapy

Radiotherapy
The information in this part of the website has been written to help you understand more about
radiotherapy treatment. Based on one of our patient information booklets, it contains general
information about radiotherapy and what you can expect during treatment.

Is radiotherapy an option for me?

My radiotherapy treatment

Types of radiotherapy

Planning your treatment

Preparing for your treatment

Receiving radiotherapy

Side effects of radiotherapy

After radiotherapy

Questions you may wish to ask

Guide for children and families

Sources of information and support

Radiotherapy at The Royal Marsden

If your doctor recommends radiotherapy for you they will explain why and what your treatment
will involve. If you have any questions or want more information, please ask. It can often be
difficult to know what to ask or to remember your questions, so you might want to think about
and write them down in advance or see this list of suggested questions.
What is radiotherapy?

Radiotherapy is a treatment for cancer using high -energy radiation, usually X-rays. The type and
amount of radiation that you receive is carefully calculated to damage the cancer cells, which are
abnormal cells. This stops the cells from dividing properly and as a result they are destroyed.
Your treatment is planned to avoid as much healthy tissue as possible. However some healthy
tissue is affected which causes side effects.
Find out more about the different types of radiotherapy.
What are the benefits of radiotherapy?

The purpose of radiotherapy is to destroy cancer cells while causing as little damage as possible
to normal cells. It can be used to treat many kinds of cancer in almost any part of the body.
Curative treatment, which is sometimes called radical treatment, aims to give long-term benefits
to people. Sometimes radiotherapy is given on its own or it may be given alongside other
treatment. Radiotherapy may be given before surgery to shrink a tumour or after surgery to stop
the growth of cancer cells that may remain. It can also be given before, during or after
chemotherapy or hormone treatment to improve overall results.
Palliative treatment aims to shrink tumours and reduce pain or relieve other cancer symptoms.
Palliative radiotherapy may also prolong life.
What are the risks of radiotherapy?

Radiotherapy can damage or destroy normal cells as well as destroying cancer cells and cause
treatment side effects. Most side effects are temporary.
Your doctor will not advise you to have any treatment unless the benefits control of disease and
relief from symptoms are greater than the known risks.

Any side effects which occur during treatment are usually temporary. There may be a small risk
of long-term, or late, permanent effects from radiotherapy. However, side effects are rarely
severe. Your doctor will tell you about your treatment, how it may affect you and any possible
late effects. You may be given additional written information.
If you have any questions or concerns, please ask your doctor. See a list of suggested questions.
You should not become pregnant before or during radiotherapy because radiotherapy may injure
the foetus, especially in the first three months of a pregnancy. Please discuss with your doctor if
you think you may be pregnant. Your doctor will also be able to advise you on how long you
should wait after radiotherapy before becoming pregnant.
Some doctors advise men against fathering a child during radiotherapy and for a few months
afterwards. Again, your doctor will be able to discuss this with you.
http://www.royalmarsden.nhs.uk/cancer-information/treatment/pages/radiotherapy.aspx

Types of radiotherapy
There are two main types of radiotherapy:
External radiotherapy where the radiation comes from a machine outside the body.
Internal radiotherapy where the radiation comes from implants or liquids placed inside the
body.
External radiotherapy

External radiotherapy is the most common type of radiotherapy used. It is usually given as a
course of several treatments over days or weeks.
External radiotherapy is usually given during outpatient visits to a hospital cancer centre. A
machine directs the high-energy radiation, usually X-rays, at the cancer site and a small area of
normal tissue surrounding it. You will be positioned carefully on a treatment couch and then the
machine will be directed exactly at the area to be treated, often from different angles. Treatment
takes several minutes and is painless.
Before you start your course of radiotherapy you will usually need to attend the hospital for
treatment planning.

The CyberKnife is a sophisticated robotic external radiotherapy system given over a shorter
period of time. However, it is not suitable for all tumours and you can ask your doctor if your
case is suitable.
External radiotherapy doesnt make you radioactive and you can safely mix with other people,
including children, at any time during your treatment.
Internal radiotherapy

Internal radiotherapy can be given in several ways.

Brachytherapy is treatment in which solid radioactive sources are placed inside a body cavity or
needles are placed in the tumour. This is usually given on an outpatient basis but may involve
staying in hospital for a few days until the radioactive source has been removed.
Another type of internal radiotherapy involves using a liquid source of radiation and is called
radionuclide (radioisotope or unsealed source) therapy. It can either be taken by mouth or given
as an injection into a vein. For this type of treatment, you will need to stay in hospital for a few
days until most of the radioactivity has disappeared from your body.
If you are going to have internal radiotherapy, your doctor will discuss this with you and give
you further information.
Occasionally, with radioactive treatment or with treatment with radioactive seeds, you will be
emitting a certain amount of radioactivity for a few days. This is why there may be temporary
restrictions on your movements and visitors. This will be carefully explained to you.

What happens after radiotherapy is finished?

When treatment finishes, many people look forward to life returning to normal. However you
may find yourself feeling a bit low. This is normal you will have become used to a new routine
of hospital visits during radiotherapy treatment. Ending treatment will also bring about changes
that you will need to adjust to.
Most side effects only last a few days or weeks but some of the effects of radiotherapy, such as
tiredness, may continue for a couple of months after the end of your treatment. However, any
effects should gradually improve if you have enough rest and eat well. See after treatment for
more information.
Follow-up appointments

When you have finished your treatment, you will be given a clinic appointment so that the doctor
can check your progress. The appointments will probably become less frequent as time passes. If
you are worried about anything at all, you should phone for an earlier appointment.
Your family doctor will be sent a complete report about your treatment.