It’s the strangest feeling, lying stock still for the best part of half an hour, on your back, naked from the waist up on a treatment bench in a cold room, with your arms up behind your head on arm rests, a weird snorkel-like breathing control device in your mouth and a nose clip on, holding your breath for periods of up to 20 seconds at a time while a huge machine called a linear accelerator or linac moves around beeping and whirring and zaps you with high doses of radiation (high-energy x-rays) in and around the area where your breast cancer was.
That’s precisely the position I’ve been in 14 times now since starting the radiotherapy part of my breast cancer treatment on 4th February. I just have two more sessions to go. After my final session, on Friday, the hospital-based phase of my treatment – chemotherapy that started back in August last year followed by surgery just before Christmas and now radiotherapy – will be over. That’s a huge milestone in anyone’s book.
The radiotherapy sessions felt very strange to start with but, as with many things over these past six months, I soon got used to them. The team in the radiotherapy department really couldn’t do more to make you feel at ease and you soon started to look forward to the daily chats with whoever was there on the desk when you arrived and the pair of radiographers dealing with you that day. And the breath-holding you have to perform during treatment is actually quite relaxing in a weird kind of way. That said, and despite the knowledge that radiotherapy is an important part of my treatment, I can still easily think of a lot of places I’d rather be than lying on that table in that position being zapped by high-dose radiation.
The aim of radiotherapy in the treatment of breast cancer is to reduce the risk of your cancer recurring by destroying any microscopic cancer cells in or near your breast that may be left in the areas being treated. Where you have it depends on things such as the location, size and grade of your original cancer. I’m having treatment to the right chest wall, the reconstructed breast and, since my cancer had spread to the right axillary lymph nodes, I’m also having it to the right internal mammary chain of lymph nodes and to the lymph nodes above the right collarbone, above where I had lymph nodes removed during surgery.
You may be wondering about the relevance of the breath-hold device. Radiation affects healthy tissue in the area being treated and radiation for breast cancer can cause heart and lung damage. In my case, I hold my breath during treatment to lift the treatment area away from my right lung and to a lesser degree from my heart to minimise the potential damage to those two organs. Even with the breath hold, though, the radiation beam passes through the top of my right lung. You might only find out in later years whether there’s been any damage, so fingers crossed on that front. In terms of the heart, the breath hold is particularly important if you’ve had a left-side mastectomy (Andy, that’s because your heart is on the left). My mastectomy was on the right, so in my case the breath hold is to reduce the amount of “scatter dose” reaching my heart from the radiation beams to the areas being treated.
The longest I have to hold my breath for at a time is 20 seconds, the shortest is about five. I’m zapped seven times in exactly the same places each session, which means I have to hold my breath seven times. I have to inflate my lungs by the same amount each time. The amount was worked out in a lengthy planning session that was carried out a week or so before the sessions themselves started and that involved among other things, a CT scan.
Each radiotherapy session lasts about half an hour. More time is spent making sure you’re in the right position for the delivery of the radiotherapy than is spent actually delivering the treatment. The precise position you need to be in is worked out during the planning session and the radiographers position you using alignment lasers and stickers or tattoos that were placed or marked on you, again during the planning session. The tattoos are indeed permanent marks, usually small dots; I requested no tattoos and got stickers instead.
You’re naked from the waist up while the radiographers (there are always two, one on each side) line you up. This involves them using a little metal ruler to check measurements in the area being treated, drawing lines on me with a felt-tip pen in a couple of places, positioning the treatment bench and moving me into place. Once the radiographers are confident everything matches up, they put a large piece of tissue paper over your upper body and then leave the room. An alarm sounds, a thick steel door closes behind the radiographers, and you’re on your own. The radiographers then talk to you through an intercom and tell you when to hold your breath so they can deliver the treatment. Sometimes before they start treatment they get the machine to take one or two x-ray images so they can check yet again that you’re set up correctly. The treatment itself only lasts a few minutes. The radiographers then come back in, extract you from the breath hold device, help you fasten up the hospital gown you’ve got on and help you off the bench. After a few reassuring words from them, the session’s over.
It feels like it’s been a long three weeks since I started this final phase of treatment, what with the stay in hospital when the infection I developed was at its worst (It went downhill from there). I was also very tired during the first week of treatment. Fatigue is a common side effect of radiation but in my case it could have been caused by any number of reasons. It could have been the radiation, it could have been the infection taking hold, it could have been the travelling up and down to and from Glasgow I’d done in the preceding weeks (and the reason for said travelling: In Glasgow again, but for the saddest of reasons), it could have been that I was still recovering from my surgery in December or it could be the result of having been undergoing treatment for a continual six months. Whatever the cause, I felt exhausted. But we’re nearly at the end of the road now. What an exciting – and daunting – prospect.