What to Expect: General

What to Expect: General

Radiation Therapy: What to Expect

Introduction

This information is for patients who are receiving radiation therapy for cancer. It describes what to expect during therapy and offers suggestions for self-care during and after treatment. It explains the two most common types of radiation therapy, external radiation and internal radiation therapy (also called brachytherapy). Information is included about the general effects of treatment and how to deal with specific side effects.

You may not want to read everything on this page at one time. Browse through it, read the sections that are of interest to you right now, and look at the others as needed. Because your doctor will plan the treatment specifically for you and the type of cancer you have, some information may not apply to you.

Radiation therapy may vary somewhat among different doctors, hospitals, and treatment centers. Therefore, your treatment or the advice of your doctor (the radiation oncologist) may be different from what you read here. Be sure to ask questions and discuss your concerns with your doctor, nurse, or radiation therapist. Ask whether they have any additional written information that might help you.

Some Important Points:

  • Radiation treatments are painless.
  • External radiation treatment does not make you radioactive.
  • Treatments are usually scheduled every day except Saturday and Sunday.
  • You need to allow 30 minutes for each treatment session although the treatment itself takes only a few minutes.
  • It’s important to get plenty of rest and to eat a well-balanced diet during the course of your radiation therapy.
  • Skin in the treated area may become sensitive, red and easily irritated.
  • Side effects of radiation treatment are usually temporary and they vary depending on the area of the body that is being treated.

Radiation in Cancer Treatment

What Is Radiation Therapy?

Radiation therapy (sometimes called radiotherapy, x-ray therapy, or irradiation) is the treatment of disease using penetrating beams of high energy waves or streams of particles called radiation.

Many years ago doctors learned how to use this energy to “see” inside the body and find disease. You’ve probably seen a chest x-ray or x-ray pictures of your teeth or your bones. At high doses (many times those used for x-ray exams) radiation is used to treat cancer and other illnesses.

The radiation used for cancer treatment comes from special machines or from radioactive substances. Radiation therapy equipment aims specific amounts of the radiation at tumors or areas of the body where there is disease.

 

How Does Radiation Therapy Work?

Radiation in high doses kills cells or keeps them from growing and dividing. Because cancer cells grow and divide more rapidly than most of the normal cells around them, radiation therapy can successfully treat many kinds of cancer. Normal cells are also affected by radiation but, unlike cancer cells, most of them recover from the effects of radiation.

To protect normal cells, doctors carefully limit the doses of radiation and spread the treatment out over time. They also shield as much normal tissue as possible while they aim the radiation at the site of the cancer.

 

What Are the Goals and Benefits of Radiation Therapy?

The goal of radiation therapy is to kill the cancer cells with as little risk as possible to normal cells. Radiation therapy can be used to treat many kinds of cancer in almost any part of the body. In fact, more than half of all people with cancer are treated with some form of radiation. For many cancer patients, radiation is the only kind of treatment they need. Thousands of people who have had radiation therapy alone or in combination with other types of cancer treatments such as chemotherapy, are free of cancer.

Radiation treatment, like surgery, is a local treatment–it affects the cancer cells only in a specific area of the body. Sometimes doctors add radiation therapy to treatments that reach all parts of the body (systemic treatment) such as chemotherapy, or biological therapy to improve treatment results. You may hear your doctor use the term, adjuvant therapy, for a treatment that is added to, and given after, the primary therapy.

Radiation therapy is often used with surgery to treat cancer. Doctors may use radiation before surgery to shrink a tumor. This makes it easier to remove the cancerous tissue and may allow the surgeon to perform less radical surgery. Radiation therapy may be used after surgery to stop the growth of cancer cells that may remain. Your doctor may choose to use radiation therapy and surgery at the same time. This procedure is known as intraoperative radiation.

In some cases, instead of surgery, doctors use radiation along with anticancer drugs (chemotherapy) to destroy the cancer. Radiation may be given before, during, or after chemotherapy. Doctors carefully tailor this combination treatment to each patient’s needs depending on the type of cancer, its location, and its size. The purpose of radiation treatmen before or during chemotherapy is to make the tumor smaller and thus improve the effectiveness of the anticancer drugs. Doctors sometimes recommend that a patient complete chemotherapy and then have radiation treatment to kill any cancer cells that might remain.

When curing the cancer is not possible, radiation therapy can be used to shrink tumors and reduce pressure, pain, and other symptoms of cancer. This is called palliative care or palliation. Many cancer patients find that they have a better quality of life when radiation is used for this purpose.

What Are the Risks of Radiation Therapy?

The brief high doses of radiation that damage or destroy cancer cells can also injure or kill normal cells. These effects of radiation on normal cells cause treatment side effects. Most side effects of radiation treatment are well known and, with the help of your doctor and nurse, easily treated. The side effects of radiation therapy and what to do about them are discussed later.

The risk of side effects is usually less than the benefit of killing cancer cells. 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.

 

How Is Radiation Therapy Given?

Radiation therapy can be given in one of two ways: external or internal (brachytherapy). Some patients have both, one after the other.

Most people who receive radiation therapy for cancer have external radiation. It is usually given during outpatient visits to a hospital or treatment center. In external radiation therapy, a machine directs the high-energy rays at the cancer and a small margin of normal tissue surrounding it.

The various machines used for external radiation work in slightly different ways. Some are better for treating cancers near the skin surface; others work best on cancers deeper in the body. The most common type of machine used for radiation therapy is called a linear accelerator. Some radiation machines use a variety of radioactive substances (such as cobalt-60, for example) as the source of high-energy rays. Your doctor decides which type of radiation therapy machine is best for you.

When internal radiation therapy is used, the radiation source is placed inside the body. This method of radiation treatment is called brachytherapy or implant therapy. The source of the radiation (such as radioactive iodine, for example) sealed in a small holder is called an implant. Implants may be thin wires, plastic tubes (catheters), capsules, or seeds. An implant may be placed directly into a tumor or inserted into a body cavity. Sometimes, after a tumor has been removed by surgery, the implant is placed in the ‘tumor bed’ (the area from which the tumor was removed) to kill any tumor cells that may remain.

Another type of internal radiation therapy uses unsealed radioactive materials which may be taken by mouth or injected into the body. If you have this type of treatment, you may need to stay in the hospital for several days.

Who Gives Radiation Treatments?

A doctor who specializes in using radiation to treat cancer — a radiation oncologist — will prescribe the type and amount of treatment that is right for you. The radiation oncologist is the person referred to as "your doctor" throughout this page. The radiation oncologist works closely with the other doctors and health care professionals involved in your care. This highly trained health care team may include:

  • The radiation physicist, who makes sure that the equipment is working properly and that the machines deliver the right dose of radiation. The physicist also works closely with your doctor to plan your treatment.
  • The dosimetrist, who works under the direction of your doctor and the radiation physicist and helps carry out your treatment plan by calculating the amount of radiation to be delivered to the cancer and normal tissues that are nearby.
  • The radiation therapist, who positions you for your treatments and runs the equipment that delivers the radiation.
  • The radiation nurse, who will coordinate your care, help you learn about treatment, and tell you how to manage side effects. The nurse can also answer questions you or family members may have about your treatment.

Your health care team also may include a medical oncologist (chemotehrapy doctor), physician assistant, radiologist, dietitian, physical therapist, social worker, or other health care professional.

 

Is Radiation Treatment Expensive?

Treatment of cancer with radiation can be costly. It requires very complex equipment and the services of many health care professionals. The exact cost of your radiation therapy will depend on the type and number of treatments you need.

Most health insurance policies, including Part B of Medicare, cover charges for radiation therapy. It’s a good idea to talk with your doctor’s office staff or the hospital business office about your policy and how expected costs will be paid.

In some states, the Medicaid program may help you pay for treatments. You can find out from the office that handles social services in your city or county whether you are eligible for Medicaid and whether your radiation therapy is a covered expense.

If you need financial aid, contact the hospital social service office. They may be able to direct you to sources of help.

What Are the Side Effects of Treatment?

External radiation therapy does not cause your body to become radioactive. There is no need to avoid being with other people because you are undergoing treatment. Even hugging, kissing, or having sexual relations with others poses no risk of radiation exposure.

Most side effects of radiation therapy are related to the area that is being treated. Many patients have no side effects at all. Your doctor and nurse will tell you about the possible side effects you might expect and how you should deal with them. You should contact your doctor or nurse if you have any unusual symptoms during your treatment, such as coughing, sweating, fever, or pain.

The side effects of radiation therapy, although unpleasant, are usually not serious and can be controlled with medication or diet. They usually go away within a few weeks after treatment ends, although some side effects can last longer. A commonly emplyed rule of thumb is that after completion of radiation, side effects (if they do occur) usually last for the number of weeks that you received radiation for. Always check with your doctor or nurse about how you should deal with side effects.

Throughout your treatment, your doctor will check on the effects of the treatment, generally once a week. You may not be aware of changes in the cancer, but you probably will notice decreases in pain, bleeding, or other discomfort. You may continue to notice further improvement after your treatment is completed.

Your doctor may recommend periodic tests and physical exams to be sure that the radiation is causing as little damage to normal cells as possible. Depending on the area being treated, you may have routine blood tests to check the levels of red blood cells, white blood cells, and platelets; radiation treatment can cause decreases in the levels of different blood cells.

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