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What do you need to know?

At the Spire Specialist Care Centre in Chelmsford, we understand how daunting a cancer diagnosis can be. We are dedicated to helping you, whatever stage you are, from screening through to tailored treatment solutions all within Spire Healthcare. Our breast cancer care is bespoke to you and your needs, we have the facilities and expertise to offer screening, genetic testing for the BRCA 1 and 2 genes linked to the disease, lump investigation and a breast risk health assessment – without the worry and uncertainty of waiting.

Screening services and surgery

Is breast screening right for you?

Breast cancer is the most common cancer among women in the UK, with more than 40,000 new cases diagnosed each year. Clinical sources tell us that one in eight women in the UK will develop breast cancer in their life, a fact that makes screening so important.

The good news is that the number of people dying from breast cancer is reducing sharply, due to a combination of improved treatments and earlier detection. Although the risk of breast cancer increases with age, about one in seven cancers are diagnosed in women under the age of 50.

It is generally recommended that all women should have a mammogram at regular intervals. Mammograms can help spot cancer in the breast that is too small to be seen or felt. A breast cancer genetic test and a breast health risk assessment can provide added reassurance – particularly if you have a family history of breast cancer. Recent health statistics estimate that breast screening saves 1,500 lives a year.

What is available:

  • Breast lump investigation
  • Breast lump removal
  • Breast reconstruction following mastectomy
  • Mammogram (mammography)
  • Mastectomy

Having breast cancer treatment - radiotherapy

When you first attend the Spire Specialist Care Centre, a Therapy Radiographer will explain the treatment process and will discuss any possible side effects and their management during and after radiotherapy.

Your first appointment at the centre will be for a CT scan to aid the planning of your radiotherapy treatment.

The Therapy Radiographers will give you some small permanent skin marks called tattoos that allow your position to be replicated for treatment daily.

Following this, your next appointment will be for your first radiotherapy treatment. The subsequent number of treatments will have been defined by your Oncologist as indicated on your appointment list.

You may have been given a gown to wear for your treatment sessions, it is your choice to wear this or not. Please inform the radiographers if you do not wish to wear one.

The Therapy Radiographers will ask you to lie on the couch in the same position you were at the CT planning appointment. They will use your skin marks (tattoos) to accurately align you for treatment. When you are in the correct position, the Therapy Radiographers will inform you that they are leaving the room. You will be asked to remain as still as possible and breathe normally.

The Therapy Radiographers will be observing you on CCTV and can speak to you via an intercom system.

The radiotherapy machine will move around you, it will not touch you and there is nothing to feel or see whilst the radiotherapy treatment is taking place.The average treatment appointment takes approximately 20-30 minutes.

You will be given time to discuss any questions or concerns you may have with the Therapy Radiographers before you start the treatment.

Having breast cancer treatment - chemotherapy

When is chemotherapy used?

Chemotherapy can be used in the following ways:

  • Neo-adjuvant treatment: chemotherapy given prior to surgery, to try to shrink the tumour.
  • Adjuvant treatment: chemotherapy given after surgery, when there are no visible signs of cancer. It aims to reduce the risk of cancer returning in the future.
  • Chemoradiation or chemoradiotherapy: chemotherapy given at the same time as radiotherapy.
  • Curative chemotherapy: chemotherapy given to try and completely eradicate the cancer.
  • Palliative chemotherapy: chemotherapy that aims to shrink the cancer, slow its growth or reduce the rate of spread. It may also help reduce any symptoms caused by the cancer.

Preparing for radiotherapy treatment

Planning Appointment

Your first appointment at the centre will be for a CT scan to aid the planning of your radiotherapy treatment.

When you arrive at the centre, a Therapy Radiographer will guide you through the preparation needed for the planning CT scan.

For one week prior to your CT planning scan you will need to do the following to prepare your bowel:

  • Have frequent small meals
  • Try to drink between 1.5-2 litres of non-caffeine drinks daily
  • Take light exercise
  • Visit your GP if you have prior problems with constipation
  • Eat a normal balanced diet but avoid foods that cause excess wind or bloating

The Therapy Radiographer will be able to answer any questions and address any concerns you may have.

Preparing for chemotherapy treatment

The following is some general advice to make it easier for you to receive chemotherapy comfortably:

• Try and eat breakfast and/or lunch before you attend
• Drink plenty of fluids and keep your hands and arms warm. This ‘plumps’ up your veins and can make it easier to insert a cannula, which may be used to give your chemotherapy
• Buy a thermometer to use at home
• Wear comfortable, loose clothing
• To help pass the time you can bring something to read, listen to or write on.

Wi-Fi is available and you can use mobile phones and laptops in the CDU however, please be considerate to your fellow patients particularly when using your mobile phone. The unit has coffee making facilities and lunch is provided if you are having treatment during the lunchtime period.

Skin care during radiotherapy

Radiotherapy may cause a change to your skin in the treatment area. This normally occurs 10-12 days after starting the radiotherapy treatment. Everyone is different in how they react to the radiotherapy treatment.

Skin reactions are not a common side effect when having treatment to the pelvis, but they can happen. Your skin will be monitored daily by your team of radiographers. Some women find that their pubic hair falls out during or shortly after their radiotherapy – this usually grows back after the course of treatment has finished.

Some people find that the ink marks put on the skin during treatment can rub off onto clothing. These should wash off but it may be advisable to wear older clothes during your treatment.

Washing

You are advised to bath or shower as normal during the radiotherapy treatment course. It is fine to wash the area being treated but wash with tepid water as very hot or cold water may irritate your skin.

Use mild non-perfumed soap such as Simple or baby soap. The Therapy
Radiographers are happy to advise you on suitability of skin care products if you have other preferences. If you wish to have a bath during treatment it is best to avoid bubble bath products as this may irritate your skin.

When drying your skin after washing, it is advised to pat the area dry. We do not recommend using talcum powder in the treatment area.

Clothing

It may be more comfortable to wear loose clothing made of natural fibers around the skin that is being treated.

Sun exposure

Your skin in the treatment area will always be more sensitive to the sun even after the radiotherapy treatment has finished.

It is best to avoid sun exposure to the treatment area whilst you are undergoing radiotherapy. Please do not put any sun protection creams on your skin whilst having treatment.

After you have finished your course of radiotherapy and any skin reaction has settled it is recommended to cover the area of treatment that may be exposed to the sun or use a sun block with SPF 50. 

It is important to do this for at least six months after completing radiotherapy.

Skin care during chemotherapy

Can I go on holiday while on chemotherapy?

We strongly advise against travelling abroad. If you have already booked a holiday please discuss this with your doctor or nurse as soon as possible. It is also best to wait for at least a month after your last treatment before planning a holiday.

You will also need to make sure that you have travel insurance before going abroad.

Macmillan Cancer Support have up-to-date specialist travel insurance information. Macmillan Cancer Support Direct (Mon-Fri 9am-8pm) can be contacted on 0808 808 0000 or visit www.macmillan.org.uk

When I’m on chemotherapy do I need to stay out of the sun?

You should protect yourself from the sun. Chemotherapy makes your skin much
more sensitive and you can get sunburn more quickly than before. You may find the following guidelines useful:

Choose your sunscreen wisely

• Choose one that protects you from both UV-A and UV-B rays. UV-B rays cause
sunburn, but UV-A rays also increase your risk of skin cancer
• Use SPF or at least 30:SPF stands for Sun Protection Factor. SPF:30 absorbs about 97% of the sun’s burning rays, while SPF:45 absorbs about 98%. No sunscreen or SPF will completely protect you from the sun.
Apply sunscreen liberally Apply sunscreen, about the size of a ping pong ball, to every part of your body exposed to the sun. Don’t forget your ears, feet, behind your neck, and at the top of your head if you have hair loss. Your skin can take up to 30 minutes to absorb sunscreens, so be sure to put it on about 30 minutes before you go outside.

In addition to wearing sunscreen, you should:

• avoid outdoor activities when the sun’s rays are strongest
• seek shade whenever possible wear protective clothing and accessories, such as wide-brimmed hats and sunglasses.
• follow the “Shadow Rule” - if your shadow is shorter than you are, the sun’s damaging rays are at their strongest and you are likely to burn
• avoid tanning beds

Short term side effects of radiotherapy

Radiotherapy side effects can depend on how each individual reacts to the treatment and any side effects normally start to become noticeable approximately half way through your course of treatment.

Cystitis

Radiotherapy treatment can cause the lining of the bladder to become irritated. This can result in the feeling of needing to pass urine more frequently during the day and at night. You may experience pain; this can be due to the inflammation caused or by a possible infection so please advise your Therapy Radiographer if you are experiencing any of these symptoms.

Increasing your fluid intake, in particular barley water and cranberry juice can relieve the symptoms of cystitis. Patients on Warfarin should speak with the Therapy Radiographers as they will need to limit the amount of cranberry juice consumed due to possible interactions with the Warfarin medication. Try to avoid too many caffeinated drinks or alcohol throughout the day to avoid irritation to your bladder.

Diarrhoea

Radiotherapy can affect your bowels bymaking them work faster. This can lead to you requiring opening your bowels more frequently. Sometimes this can progress to diarrhoea like symptoms, where motions may become loose and with a sense of urgency. It is advised to tell the Therapy Radiographers looking after you if you get an onset of loose motions. They will be able to advise you about the possible change to your diet or medication to help manage these symptoms. It is important to drink plenty of fluids to help replace the fluids lost by opening your bowels frequently. Occasionally you may pass some blood in your stools, again please let the Therapy Radiographers know if this is a symptom you experience.

Haemorrhoids (piles)

For those that have pre-existing problems with haemorrhoids or piles, radiotherapy may aggravate this and cause them to flare up. Do not use any existing medicated cream until you have been advised by the Therapy Radiographer as some creams may interfere with the radiotherapy and cause irritation. Others find that the radiotherapy may cause some soreness inside the back passage, which can make it sore or uncomfortable to open your bowels. Please mention to the Therapy Radiographers if any of these symptoms occur.

Sexual Changes

It is natural to be anxious about resuming intercourse if you are sexually active. Many women feel the same and you are not alone. Sexual intercourse after radiotherapy is perfectly safe. 

It will not make the cancer return and you cannot pass on cancer to your partner. However, radiotherapy can make the vagina more sensitive, tender and possibly a bit dry. 

We suggest the use of a lubricant. You may find that once you have finished treatment it could take about four weeks before it feels comfortable to resume sexual intercourse.

Initially intercourse can be uncomfortable and it is possible that you may notice some spots of blood afterwards. This is normal and nothing to be concerned about. Any prolonged or heavy bleeding should be reported to your doctor.

After radiotherapy you may not have much energy or desire for sex. If these problems continue for months after treatment, please discuss this with your doctor at your follow up appointments,as we would like to help you get back to your normal lifestyle.

Short term side effects of chemotherapy

Different chemotherapy drugs cause different side effects. Everyone is individual and will react to chemotherapy differently. Some people have very few side effects and others may have more. You will be carefully assessed by your nurse who will ask you about side effects before each cycle of treatment to make sure that we know about them. This assessment and the results of your blood tests helps your nurse to know if it is safe for you to have treatment.

Your nurse will talk about specific side effects of the treatment before your treatment starts.

In case you have a problem while receiving treatment you will be given 24-hour contact details for the unit. We use a telephone triage system to deal with enquiries. Before calling it is helpful if you can have the following information available:

  • your diagnosis
  • the names of the chemotherapy drugs you are on
  • the last date you received treatment
  • the name of your consultant
  • your current temperature.

It is very important that, wherever possible, we speak directly to the patient. This allows us to give you the correct advice that you need. We will also ask a number of questions that may seem unrelated to the reason for your call, but these allow us to make sure we give you the correct advice.

Please do not use this number if you are not on treatment. 

Infection 

Chemotherapy can make it more difficult for you to fight infection. Because of this, what seems a minor illness can develop into a more serious or even life threatening illness. You must get in touch with us if you feel unusually hot or cold, shivery or more unwell than you would expect at any stage in your treatment. It is important to check your temperature. You can buy a digital thermometer from your local pharmacy. A normal temperature is between 36-37°.

If your temperature is above 37.5° it is essential that you are assessed urgently.
Please be aware you can have a normal temperature and still have an infection so if you feel unwell you should contact us even if your temperature is normal.

Other considerations during your radiotherapy treatment

Fatigue

Some people can experience tiredness during their course of radiotherapy. Some people manage to continue working whilst they are having radiotherapy whilst others find that they are too tired. It is best to listen to your body and do as much as you feel capable, resting
when necessary.

Light exercise can help with energy levels. It is advised to drink plenty of fluids as this can help combat tiredness – 2 litres (3-4 pints) is recommended for your daily intake, try to consume caffeinated drinks in moderation as these can dehydrate you. Your Radiotherapy team will be able to advise you of ways to help manage tiredness if this becomes an issue for you.

Eating well

It is recommended that you follow a balanced healthy diet during treatment. We will advise you if you need to change your diet during radiotherapy. Drinking plenty of fluids is also advised.

Swimming

If you wish to swim whilst having radiotherapy treatment, you can swim in any type of water but it is important to carefully wash and moisturise the area afterwards. If you find swimming irritates your skin you may need to stop whilst you’re having treatment. The Therapy Radiographers will advise you if it is best to avoid swimming all together.

Emotional effects

A cancer diagnosis can bring with it many feelings of fear, anxiety, low mood and depression.

We understand that going through diagnosis and cancer treatment can be both difficult for you and your friends and family. At the centre we are here to provide a supportive environment. Please talk to the Therapy Radiographers if you feel you need any additional support.

Other considerations during your chemotherapy treatment

Practicalities of Life...
Frequently Asked Questions

Will I be able to continue working while I’m on chemotherapy?

Some people work throughout their treatment. Others prefer to take time off or may be advised to take time off based on what they do. You should discuss this with your nurse or consultant. Chemotherapy side effects can build up with each cycle.

You should tell your employer as soon as possible that you will be on chemotherapy and that this will mean that you will need to take time off to come for appointments and that you may need time off without warning if you are feeling unwell. You and your employer can then decide what works best for both of you.

If I can’t work, is there any financial support that I can get?

You may be able to get financial assistance while you are unable to work. Please speak to your nurse if you have any worries about money. Macmillan Cancer Support also offer financial advice. Their contact details are at the back of this booklet.

Will I lose my hair?

This will depend on the chemotherapy drugs you are on. You will be told before you start treatment if you are likely to lose your hair so that you can prepare for this. If you do lose your hair, it will grow back once you have finished your treatment but it may be a different colour or texture. Your nurse will be able to offer you help and advice on how to care for your hair and scalp when you are on treatment. We may be able to offer you a treatment called ‘scalp cooling’ that might help to prevent or reduce hair loss. However, this can only be offered to patients on certain regimes. If you would like to learn more about this or find out if this would be of use to you please speak to your doctor or nurse.