Radiation therapy, or radiotherapy, is the use of various forms of radiation to safely and effectively treat cancer and other diseases. Radiation oncologists may use radiation to cure cancer, to control the growth of the cancer or to relieve symptoms, such as pain. Radiation therapy works by damaging cells. Normal cells are able to repair themselves, whereas cancer cells cannot.
Sometimes radiation therapy is the only treatment a patient needs. At other times, it is only one part of a patient’s treatment. For example, prostate and larynx cancer are often treated with radiotherapy alone, while a woman with breast cancer may be treated with surgery, radiation therapy and chemotherapy. Radiation may also be used to make your primary treatment more effective. For example, you can be treated with radiation therapy before surgery to help shrink the cancer and allow less extensive surgery than would otherwise be needed; or you may be treated with radiation after surgery to destroy small amounts of cancer that may have been left behind. A radiation oncologist may choose to use radiation therapy in a number of different ways. Sometimes the goal is to cure the cancer. In this case, radiation therapy may be used to: -Destroy tumors that have not spread to other parts of your body. -Reduce the risk that cancer will return after you undergo surgery or chemotherapy by killing small amounts of cancer that might remain. Sometimes, the overall goal is to slow down the cancer as much as possible. In other cases, the goal is to reduce the symptoms caused by growing tumors and to improve your quality of life. When radiation therapy is administered for this purpose, it is called palliative care or palliation. In this instance, radiation may be used to: -Shrink tumors that are interfering with your quality of life, such as a lung tumor that is causing shortness of breath. -Relieve pain by reducing the size of your tumor. The locations and types of cancers that can be targeted with radiation including the following locations: -Head and neck – nasal and sinus cancer, nasal cancer, oral cancer, neck cancer, laryngeal cancer, and salivary gland and thyroid cancer -Chest – lung cancer, esophageal cancer, lymphoma, and breast cancer -Abdomen – stomach cancer, liver cancer, pancreatic cancer, kidney cancer, and lymphoma -Lower abdomen – colon cancer, bladder cancer, uterine cancer, cervical cancer, and prostate cancer
-The main advantage of radiotherapy is that it may help to control the growth of the cancer.
-For a small number of people with borderline resectable cancer and locally advanced pancreatic cancer, radiotherapy may help to make surgery possible.
-Each treatment session will take about 30 minutes and you won’t usually need to stay in hospital.
-You may be able to carry on with your daily life, such as going to work, if you feel up to it.
-If you have advanced cancer, radiotherapy can help control symptoms and relieve pain.
-Radiotherapy can cause side effects, including tiredness, sickness and diarrhea
-If you have borderline resectable or locally advanced cancer, you may have to go to hospital five days a week for several weeks for your treatment, although this may vary from person to person.
RADIATION THERAPY TO THE HEAD AND NECK
Radiation to the head and neck is used to treat the following cancers: brain cancer, nasal and sinus cancer, nasal cancer, oral cancer, neck cancer, laryngeal cancer, and salivary gland and thyroid cancer. Treatment with Radiation The patient’s head and neck will be positioned and a plastic mask may be used to hold the head and neck steady during treatment. The doctor will carry out the radiation therapy according to the treatment plan established. The type of radiation and the duration of the treatment will vary depending on the technique used. Radiation therapy takes approximately two to 10 minutes, and including preparing the patient, the procedure can take between 15 to 25 minutes. Radiation therapy is carried out five times a week, lasting a total of five to eight weeks, depending on the type of cancer and the treatment plan created by the doctor. Common Side Effects and Management
RADIATION THERAPY TO THE CHEST
Radiation to the chest is used to treat the following cancers: lung cancer, esophageal cancer, lymphoma and breast cancer. Treatment with Radiation During the radiation treatment the patient must lie still. The patient may be asked to raise their arms over their heads or keep them at their sides. The patient should breathe normally. Radiation therapy takes approximately two to 10 minutes, and including preparing the patient, the procedure can take between 15 to 25 minutes. Radiation therapy is carried out five times a week, lasting a total of five to eight weeks, depending on the type of cancer and the treatment plan created by the doctor.
RADIATION THERAPY TO THE ABDOMEN
Radiation to the abdomen is used to treat the following cancers: stomach cancer, liver cancer, pancreatic cancer, kidney cancer, and lymphoma. Treatment with Radiation During the treatment the patient should lay still and breathe normally. The radiologist will adjust the patient’s position and the location for radiation according to the treatment plan established. Radiation will be administered as per the technique specified in the treatment plan. Radiation therapy takes approximately two to 10 minutes, and including preparing the patient, the procedure can take between 15 to 25 minutes. Radiation therapy is carried out five times a week, lasting a total of five to eight weeks, depending on the type of cancer and the treatment plan created by the doctor.
RADIATION THERAPY TO THE LOWER ABDOMEN
Radiation to the lower abdomen is used to treat the following cancers: colon cancer, bladder cancer, uterine cancer, cervical cancer, and prostate cancer. Treatment with Radiation During the treatment the patient should lay still and breathe normally. The radiologist will adjust the patient’s position and the location for radiation according to the treatment plan established. Radiation will be administered as per the technique specified in the treatment plan. Radiation therapy takes approximately two to 10 minutes, and including preparing the patient, the procedure can take between 15 to 25 minutes. Radiation therapy is carried out five times a week, lasting a total of five to eight weeks, depending on the type of cancer and the treatment plan created by the doctor.
There are 3 general steps that you will have to go through before starting your actual radiation treatment. These include: Meeting With a Radiation Oncologist If you are considering radiation therapy, you must first meet with a radiation oncologist to see if radiation therapy is right for you. During your first visit, your doctor will evaluate your need for radiation therapy and its likely results. This includes reviewing your current medical problems, past medical history, past surgical history, family history, medications, allergies and lifestyle. The doctor will also perform a physical exam to assess the extent of your disease and judge your general physical condition. You may also be seen by a medical student, a resident (radiation oncologist in training), a nurse practitioner, a physician's assistant or a nurse. After reviewing your medical tests, including CT scans, MRI scans and PET scans, and completing a thorough examination, your radiation oncologist will discuss with you the potential benefits and risks of radiation therapy and answer your questions. For a list of questions that you may want to ask, please see the section 'What Questions Should I Ask My Doctor?' on page 20. Simulation To be most effective, radiation therapy must be aimed precisely at the same target or targets each and every time treatment is given. The process of measuring your body and marking your skin to help your team direct the beams of radiation safely and exactly to their intended locations is called simulation. During simulation, your radiation oncologist and radiation therapist place you on the simulation machine in the exact position you will be in during the actual treatment. Your radiation therapist, under your doctor's supervision, then marks the area to be treated directly on your skin or on immobilization devices. Immobilization devices are molds, casts, headrests or other devices that help you remain in the same position during the entire treatment. The radiation therapist marks your skin and/or the immobilization devices either with a bright, temporary paint or a set of small, permanent tattoos. 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. Treatment Planning Once you have finished with the simulation, your radiation oncologist and other members of the treatment team review the information they obtained during simulation along with your previous medical tests to develop a treatment plan. Often, a special treatment planning CT scan is done to help with the simulation and treatment planning. This CT scan is in addition to your diagnostic CT scan. Frequently, sophisticated treatment-planning computer software is used to help design the best possible treatment plan. After reviewing all of this information, your doctor will write a prescription that outlines exactly how much radiation you will receive and to what parts of your body.
During radiation treatment the radiologist will assess the results of the treatment weekly and manage the side effects that occur. Furthermore the patient may need to undergo blood tests as well. Patients with severe side effects from the radiation may need to stop the treatment or be admitted into the hospital for observation or may need medication to alleviate the conditions, depending on the doctor’s recommendation. After radiation therapy is completed the patient must continue to follow the same procedures they did during radiation for at least two to three weeks. Two to four weeks after treatment is completed the doctor will schedule a visit to follow up on the results of the treatment. After that visits will be scheduled every one to three months, depending on the type of treatment and its process. Follow-up visits will then be even farther apart, every four to six months, for five years. If, after five years, the patient shows no signs of the disease, follow-up visits will occur once a year.
Radiation therapy is usually well tolerated and many patients are able to continue their normal routines. However, some patients may eventually develop painful side effects. Be sure to talk to a member of your radiation oncology treatment team about any problems or discomfort you may have. Many of the side effects of radiation therapy are only in the area being treated. For example, a breast cancer patient may notice skin irritation, like a mild to moderate sunburn, while a patient with cancer in the mouth may have soreness when swallowing. Some patients who are having their midsection treated may report feeling sick to their stomach. These side effects are usually temporary and can be treated by your doctor or other members of the treatment team. Side effects usually begin by the second or third week of treatment, and they may last for several weeks after the final radiation treatment. In rare instances, serious side effects develop after radiation therapy is finished. Your radiation oncologist and radiation oncology nurse are the best people to advise you about the side effects you may experience. Talk with them about any side effects you are having. They can give you information about how to manage them and may prescribe medicines or changes in your eating habits to help relieve your discomfort. The side effect most often reported by patients receiving radiation is fatigue. The fatigue patients experience is usually not severe, and patients may be able to continue all or some of their normal daily activities with a reduced schedule. However, treating cancer often requires considerable mental and physical effort. Whenever possible, try to take time during your treatment to rest and relax. Many patients are concerned that radiation therapy will cause another cancer. In fact, the risk of developing a second tumor because of radiation therapy is very low. For many patients, radiation therapy can cure your cancer. This benefit far outweighs the very small risk that the treatment could cause a later cancer. If you smoke, the most important thing you can do to reduce your risk of a second cancer is to quit smoking.
What are the different kinds of radiation?
The goal of radiation therapy is to get enough radiation into the body to kill the cancer cells while preventing damage to healthy tissue. There are several ways to do this. Depending on the location, size and type of cancer, you may receive one or a combination of techniques. Your treatment team will help you to decide which treatments are best for you. Radiation therapy can be delivered in two ways, externally and internally. During external beam radiation therapy, the radiation oncology team uses a machine to direct high-energy X-rays at the cancer. Internal radiation therapy, or brachytherapy, involves placing radioactive sources (for example, radioactive seeds) inside your body.
How safe is radiation therapy?
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.
How should I care for myself during radiation therapy?
1. Ensure that you get plenty of rest. Many patients experience fatigue during radiation therapy, so it is important to make sure you are well rested. If possible, ask friends and family to help out during treatment, by running errands and preparing meals. This will help you get the rest you need to focus on fighting your cancer.
2. Follow you doctor's orders. In many cases, your doctor will ask you to call if you develop a fever of 38°C or higher. Be sure to read your instructions as far as caring for yourself during treatment.
3. Eat a balanced and nutritious diet. A dietitian, nurse or doctor may work with you to make sure you are eating the right foods to get the vitamins and minerals you need. With certain types of radiation, you may need to change your diet to minimize side effects. You should not attempt to lose weight during radiation therapy since you need more calories due to your cancer and treatment.
4. Treat the skin that is exposed to radiation with extra care. The skin in the area receiving treatment may become red and sensitive, similar to getting a sunburn. Your radiation oncology nurse will review specific instructions for caring for your skin with you.