What Are Clinical Trials
Cancer specialists regularly conduct studies to test new treatments. These studies are called clinical trials. Clinical trials are available through cancer doctors everywhere- not just in major cities or in large hospitals.
Some clinical studies try to determine if a therapeutic approach is safe and potentially effective. Many large clinical trials compare the more commonly used treatment with a treatment that cancer experts think might be better. Patients who participate in clinical trials help doctors and future cancer patients find out whether a promising treatment is safe and effective. All patients who participate in clinical trials are carefully monitored to make sure they are getting quality care. It is important to remember that clinical trials are completely voluntary. Patients can leave a trial at any time. Clinical trials testing new treatments are carried out in phases:
Only you can make the decision about whether or not to participate in a clinical trial. Before making your decision, it is important to learn as much as possible about your cancer and the clinical trials that may be available to you. Your radiation oncologist can answer many of your questions if you are considering taking part in a trial or contact the National Cancer Institute at 1-800-4-CANCER or www.cancer.gov.
Side Effects Of Radiation Therapy To Your Breast Or Chest Wall
You may have side effects from radiation therapy. The type and how strong they are depends on many things. These include the dose of radiation, the number of treatments, and your overall health. The side effects may be worse if youre also getting chemotherapy.
You may start to notice side effects about 2 weeks after you start radiation therapy. They may get worse during your radiation therapy, but theyll slowly get better over 6 to 8 weeks after your last treatment. Some side effects may take longer to go away. Follow the guidelines in this section to help manage your side effects during and after your radiation therapy.
When And Where Skin Symptoms Show Up
These types of side effects usually show up within the first 2 weeks of starting radiation therapy and may continue to develop throughout the treatment. Once the treatment is over, the skin will take a while to heal, but will eventually get better. The darkening, however, may last longer than that, up to several months. Sometimes there will be some lasting and permanent color changes.
Some areas of the skin may also react more than others:
- The skin in the upper inner corner of the breast, for example, may become more red or irritated than other areas depending on the angle of the radiation beam.
- The armpit can become irritated because the arm rubs back and forth against the skin there, and because of sweat and hair.
- Most bras rub on the fold under the breast, which can cause irritation and redness.
Some people dont experience any skin reactions to treatment, others have mild reactions, and still others may have more severe reactions. The risk of skin side effects increases if:
- You have a fair complexion.
- You have large breasts.
- Youve had recent chemotherapy.
- Youre receiving radiation after mastectomy, and the treatment is a high dose.
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How Radiation Treatments Affect The Skin
Radiation therapy uses high-energy particles or waves to destroy cancer cells. It damages the DNA inside those cells, killing them off so they can no longer cause problems.
Unlike chemotherapy, radiation doesnt cause skin and hair problems all over, but it can affect the skin where the radiation treatment occurs. It has to pass through the skin to reach the area where the cancer lives, which means the skin may suffer some ill effects.
Common side effects of radiation treatment on the surrounding skin include the following:
- Skin color changes, usually darker or tanned looking
- Burning sensation
Sexual And Reproductive Health
You can be sexually active during your radiation therapy unless your radiation oncologist gives you other instructions. You wont be radioactive or pass radiation to anyone else. If you or the person youre sexually active with can get pregnant, its important to use birth control during your radiation therapy.
You may have concerns about how cancer and your treatment can affect your sex life. Radiation therapy can affect your sexual health physically and emotionally. Talking with your radiation oncologist or nurse about your sexual health can be hard, but its an important conversation to have. They may not bring it up unless you share your questions and concerns. You may feel uncomfortable, but most people in cancer treatment have similar questions. We work hard to make sure everyone in our care feels welcome.
Sexual health programs
We also offer sexual health programs. These programs can help you manage the ways your cancer or cancer treatment affect your sexual health or fertility. Our specialists can help you address sexual health or fertility issues before, during, or after your treatment.
- For information about our Male Sexual & Reproductive Medicine Program or to make an appointment, call .
- For information about our Cancer and Fertility Program, talk with your healthcare provider.
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Possible Skin Changes From Radiation
Not everyone will experience skin-related side effects of radiation therapy, but many people will. The most common reaction is called radiation dermatitis, which includes these symptoms:
- Blisters and wet, peeling skin
- Darkened areas of skin
These effects range from mild to severe, with the severity depending on how many radiation doses you receive and how frequently you receive them. The reaction is much like a sunburn, with the changes happening gradually over the course of treatment.
Fortunately, most of these effects will go away within a few weeks of completing your treatment. In some cases, the irradiated area may be slightly darker, thinner, or dryer than it was before.
Because these types of side effects can create interruptions in treatmentand because they can cause long-term changes in the skinits important to manage them as best you can.
During Your Radiation Therapy
On the day of your first radiation treatment, youll start putting triamcinolone 0.1% ointment on your skin in the treatment area. This is a prescription ointment that will help protect your skin. Youll use it every day, once in the morning and once in the evening. This includes the days you dont have treatment. Your radiation nurse will give you more information about it before your first treatment.
Your radiation oncologist may also recommend using Mepitel® Film to protect your skin in the treatment area. If they do, put it on your skin in the treatment area before your first treatment. Keep it on until the edges start to peel up.
Youll stay in one position for about 10 to 20 minutes during each of your radiation treatments, depending on your treatment plan. If you think youll be uncomfortable lying still, you can take acetaminophen or your usual pain medication 1 hour before your appointments.
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How Is Radiation Dermatitis Treated
Healthcare providers may recommend creams to ease symptoms like dry, itchy skin. They also may prescribe special creams to treat severe radiation dermatitis or radiation burns. For example, if youre being treated for breast cancer, your provider may prescribe a steroid cream to reduce your risk of developing radiation dermatitis. Talk to your provider before using any cream or other moisturizer. They will let you know what creams are safe and the best ways to use them.
How long does it take for radiation burn symptoms to heal?
Most mild radiation burn symptoms subside a few weeks after you finish your treatment. Ask your healthcare provider if your radiation therapy might cause delayed radiation dermatitis symptoms.
Will I need to stop radiation therapy if I have radiation burn?
No, most people dont need to stop radiation treatment because they develop radiation dermatitis. But your healthcare provider may adjust your treatment so your current symptoms dont get worse or so you don’t develop new symptoms.
Are there other steps I can take to help my skin heal or reduce symptoms?
Here are some ways you can protect your skin and ease your radiation burn symptoms:
Is Radiation Therapy Safe
Some patients are concerned about the safety of radiation therapy. Radiation has been used successfully to treat patients for more than 100 years. In that time, many advances have been made to ensure that radiation therapy is safe and effective.
Before you begin receiving radiation therapy, your radiation oncology team will carefully tailor your plan to make sure that you receive safe and accurate treatment. Treatment will be carefully planned to focus on the cancer while avoiding healthy organs in the area. Throughout your treatment, members of your team check and re-check your plan. Special computers are also used to monitor and double-check the treatment machines to make sure that the proper treatment is given. If you undergo external beam radiation therapy, you will not be radioactive after treatment ends because the radiation does not stay in your body. However, if you undergo brachytherapy, tiny radioactive sources will be implanted inside your body, in the tumor or in the tissue surrounding the tumor, either temporarily or permanently. Your radiation oncologist will explain any special precautions that you or your family and friends may need to take.
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What Happens Before During And After Treatment
Once the diagnosis has been made, you will probably talk with your primary care physician along with several cancer specialists, such as a surgeon, a medical oncologist and a radiation oncologist, to discuss your treatment choices. These specialists will work together to help recommend the best treatment for you. In some cases, your cancer will need to be treated by using more than one type of treatment. For example, if you have breast cancer, you might have surgery to remove the tumor , then have radiation therapy to destroy any remaining cancer cells in or near your breast . You also might receive chemotherapy to destroy cancer cells that have traveled to other parts of the body.
Your radiation oncologist may request that special blocks or shields be made for you. These blocks or shields are put in the external beam therapy machine before each of your treatments and are used to shape the radiation to your tumor and keep the rays from hitting normal tissue. Multileaf collimators may also be used to shape the beam and achieve safe delivery of your radiation treatment.
The radiation therapy team carefully aims the radiation in order to reduce the dose to the normal tissue surrounding the tumor. Still, radiation will affect some healthy cells. Time between daily treatments allows your healthy cells to repair much of the radiation effect, while cancer cells are not as likely to survive the changes.
How To Care For Skin After Radiation Treatment For Breast Cancer
Cancer treatments can be very hard on the skin. Whereas chemotherapy may cause dryness, flakiness, and hair loss, radiation can lead to side effects that are similar to those caused by sun damage.
Every patient is different, and treatments often vary too, so how your skin reacts may be different from how someone elses skin does.
But in honor of National Breast Cancer Awareness month, we wanted to remind you of the steps you can take to support your skin while undergoing radiation for breast cancer.
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Use Cool Compresses After Each Treatment To Speed Skin Recovery
Just as you would treat a regular burn with a cold compress, you can do the same with radiation burns. After each treatment, apply a cool compress to the treated area. This will help reduce the swelling and redness that may result.
Do be sure anything you apply to the skin is clean and free of bacteria . Also, dont use extreme cold. Ice packs are out. Instead, try cold water packs or packages of frozen veggies through a moist cloth.
Soothing hydrogel sheets and packs are also available from medical and home health suppliers. Theyre sterile and hydrating and are easy to work with.
When To Call Your Radiation Oncologist Or Nurse
- You have a fever of 100.4 °F or higher.
- You have chills.
- Your skin is painful, peeling, blistering, moist, or weepy.
- You have discomfort in the treatment area.
- Your breast, underarm , or arm is getting more swollen.
- You have any new or unusual symptoms.
Many people find that counseling helps them. Our counseling center offers counseling for individuals, couples, families, and groups. We can also prescribe medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.
Integrative Medicine Servicewww.mskcc.org/integrativemedicineOur Integrative Medicine Service offers many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. To schedule an appointment for these services, call .
You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call .
Nutrition ServicesOur Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. To make an appointment, ask a member of your care team for a referral or call the number above.
Tobacco Treatment Program
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Direct Correlation Between Severity Of Skin Problems And Pain At Treatment Site
On the local Symptom Inventory questionnaire, the cancer patients were asked to rate their skin problems and pain at the site of treatment, as opposed to rating any generalised skin problems or pain, which was asked in the nationwide Symptom Inventory. Overall, the severity of skin problems at treatment site reported after 5 weeks of radiation therapy directly correlated with the severity of pain at the treatment site by Pearson’s correlation . However, when correlative analysis was performed based on race, the severity of pain at treatment site did not significantly correlate with severity of skin problems at treatment site in black patients . Regression analysis using one-way ANOVA showed that the report of pain at treatment site is a potential predictor of the report of skin problems at treatment site in white , but not black patients . Additionally, we examined the influence of total radiation exposure on the report of skin problems at the treatment site. No correlation was observed between total radiation dose and reported skin problems at treatment sites by white or black patients . Regression analysis by one-way ANOVA confirmed that total radiation dose is not a potential predictor of reported skin problems at the treatment site for white or black patients .
General Management Of Radiation Dermatitis
Patients with acute radiation dermatitis should be carefully assessed.
- Check that the radiation dose and distribution are correct
- Consider discontinuing the concomitant medication that may have contributed to the reaction.
- Consider alternative explanations for the skin changes, such as contact dermatitis or infection.
Patients may wash the affected skin with a gentle non-soap cleanser and dry it with a soft, clean towel before each irradiation session. Emollients, moisturisers, gels, emulsions and dressings applied after treatment may reduce discomfort.
Topicalcorticosteroids may be prescribed for radiation dermatitis for 2 to 4 weeks. It is uncertain whether these are of benefit.
Patients receiving radiation therapy should be advised to avoid:
- sun exposure by covering the treated area with protective clothing or SPF 50+ broad-spectrum sunscreen
- topical skin irritants, such as perfumes, deodorants and alcohol-based lotions
- scratching of the skin in the affected area.
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Taking Care Of Your Skin
Here are some tips on dealing with skin issues during and after radiation therapy:
Know what skin changes to expect. To help prepare yourself, ask your doctor ahead of time what skin changes you may expect during radiation therapy. Plan how you will deal with skin reactions. Also, remember that many skin changes are temporary and may go away when treatment ends.
Keep your skin clean and dry. When washing irradiated skin, use lukewarm water and mild, non-perfumed soap. Don’t rub or scrub your skin. Instead, let the water run over the treated area. Rinse the area thoroughly and gently pat dry with a soft towel. Be careful not to wash off any ink markings needed for treatment.
Use skin products wisely. While you are undergoing radiation therapy, consult with your doctor first before using any skin care products. Your doctor may prescribe cleansing, protective, moisturizing, drying, anti-itch, or anti-inflammatory agents. Your doctor may also advise you to avoid skin care products for at least four hours before treatment.
Avoid irritants. Avoid perfumes, body oils, bubble bath, scented lotions, cosmetics, or products containing alcohol. Your doctor may recommend non-allergenic products.
Wear loose-fitting clothing. Avoid clothes that are tight-fitting, such as collars, bras, girdles, and pantyhose. Avoid irritating or scratchy fabrics, such as wool, that may rub your skin. Instead, try soft cotton clothes and bed sheets. Wash your clothes in mild, gentle detergents.
What Are Additional Treatment Options
Systemic Radiation Therapy
Certain cancers may be treated by swallowing radioactive pills or receiving radioactive fluids in the vein . This type of treatment is called systemic radiation therapy because the medicine goes to the entire body. For example, radioactive iodine capsules are given to treat some types of thyroid cancer. Another example is the use of intravenous radioactive material to treat pain due to cancer that has spread to the bone. Radiolabeled antibodies are monoclonal antibodies with radioactive particles attached. These antibodies are designed to attach themselves directly to the cancer cell and damage it with small amounts of radiation.
Cancer doctors now know much more about how cancer cells function. New cancer therapies use this information to target cancer cell functions and stop them. Called targeted therapies, they can be more specific in stopping cancer cells from growing and may make other treatments work better. For example, some medicines work to prevent cancers from growing by preventing the growth of new blood vessels that would nourish the cancer. Other targeted therapies work more directly on cancer cells by blocking the action of molecules on the surface of cancer cells called growth factors.
Some medicines called radioprotectors can help protect healthy tissue from the effects of radiation.
Intraoperative Radiation Therapy
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