After a physical exam and a review of your medical history and test results, your doctor will pinpoint the area to be treated. This is done a few days before starting radiation therapy in a process called simulation. You will be asked to lie still on a table while the radiation therapist uses a special x-ray machine to define your treatment field (also called treatment port). This is the exact place on your body where the radiation beam will be aimed. To ensure the radiation beam is aimed correctly, special molds or immobilization devices may be made to help you be still during your treatment. Based on the simulation, other tests, and your medical background, your doctor and a dosimetrist will decide how much radiation is needed, how it will be given, and how many treatments you should have through a treatment planning process. Your treatment will most likely be given with external radiation therapy and is usually given with a machine called a linear accelerator (linac). Before treatment, you will be asked to sign a consent form giving the doctor permision to treat you with radiation therapy and to do the tests that are needed to plan your treatment. After all the planning for your treatment is complete, you will come in for a verification simulation to prepare you for your first day of radiation treatments.
Q. Is radiation effective? How does radiation work?
A. Radiation therapy is an important and effective cancer treatment. Radiation therapy works by killing or damaging cancerous cells so they can not grow or spread. Some normal cells may be affected by radiation, however most fully recover from the effects of treatment. Sometime radiation therapy is the only treatment option a patient needs and other times it is combined with other treatment options such as surgery or chemotherapy.
Q. How often are my treatments delivered?
A. Radiation therapy treatments are usually delivered on a five day a week basis (Monday-Friday), with a break on the weekend, for about 6-8 weeks. Each day your appointment will take about 15-20 minutes.
Q. Who will plan my radiation treatments?
A. Your radiation treatments will be planned by your radiation oncologist with the help of a team of medical professionals, including a dosimetrist and a medical physicist. Your doctor will decide what type of radiation to use depending on the kind of cancer that you have. The first step to take in the radiation therapy process is an initial consultation with your oncologist. During the initial consultation, the doctor will discuss your type of cancer with you and will inform you of the different treatment options that are available to you. The doctor will also let you know about the length of your treatment, possible side effects that you may have and whether or not you need any further tests before starting. It is recommended that you bring a family member or friend along with you because this is the best time to ask questions about your diagnosis and treatment.
Q. What is meant by a “simulation”?
A. After you have completed your initial consultation with your radiation oncologist, you will begin the treatment planning process. During the simulation, the treatment team, consisting of the radiation therapist and the dosimetrist, will use a CT scanner to start the planning of your treatment. The treatment team may use a special immobilization device to properly position your body. The immobilization device will assist in setting you up in the same position each day. Depending on the type of cancer you have, the oncologist may request that you be given a non-toxic dye, or contrast, that is either given orally or through an IV to enhance the visibility of your internal organs. During the CT simulation, you will be given semi-permanent marks with a sharpie marker, and you may have clear skin tape placed over these marks to help preserve them until your first day of radiation treatments. On your first day these marks will be used to allow the radiation therapist to precisely target the radiation area to be treated. Your semi-permanent marks will change on the first day and will be replaced with permanent markings, or tattoos, that are about the size of a small freckle.
After your simulation, your radiation oncologist will plan your treatment with the dosimetrist and radiation physicist. While planning, they will decide how much radiation is needed and where it will be distributed, depending on the area of your tumor. This all depends on your medical history and the type of cancer you have. Every person’s treatment will be different and initiation of treatment will be different for each person following simulation.
Q. What happens during treatment?
A. If you are receiving external radiation, your course of treatment will be given on a daily basis, excluding weekends, for about 5-8 weeks, depending on your type of cancer. You will be accompanied into the radiation treatment room by a therapist and asked to lie flat on the treatment table, usually with an immobilization device. You will be asked to lie very still and breathe normal, and to try not to help the therapists while they align your body, but instead to lay heavy. When necessary, specially designed blocks may be used to shield your healthy tissue from the radiation. On the first day, x-ray films will be taken to ensure that your treatment positioning is accurate and that these blocks are covering the healthy tissues. Once you are aligned, the therapists will walk out of the treatment room, but they can see you through a closed circuit television and hear you through an intercom. The most important thing to remember is not to move during your treatment. During the course of your treatment, you will be seen by your radiation oncologist once a week to discuss your treatment and any side effects you may be experiencing. When necessary, your oncologist may change your treatment plan by revising the dose or changing the length of your treatment. It is very important to try to make all of your scheduled appointments to get the most benefit from the radiation. Missing or delaying treatments can lessen the effectiveness of your radiation therapy treatments.
Q. Will the radiation treatment hurt?
A. The radiation is painless. You will not feel, see, or hear the radiation.
Q. What happens after I finish my radiation treatments?
A. When you have completed your course of radiation treatments, you will be asked to schedule a 1 month follow-up. It is very important to attend your follow-up appointments with your radiation oncologist. In order to monitor the effects and progress of your treatment, you may be asked to get blood work and / or diagnostic scans or x-rays.
Q. What kinds of side effects occur during radiation therapy?
A. Radiation side effects will vary with each patient depending on their type of cancer and the area being treated. You may experience no side effects, or a few mild ones through the course of your treatment. The most common side effects are fatigue and redness of the skin, similar to a mild sunburn. These can result from radiation to any treatment site, while other side effects may relate to a specific area being treated.
- Plan your day so that you can rest between activities.
- Save energy for doing the things that you feel are most important.
- Take short walks or light exercise (with the permission of your doctor).
- Allow friends and family to help you with daily activities.
- Talk with other cancer patients in a support group.
- Talk to your employer about your work schedule during radiation treatments.
- Schedule treatment times with your workday in mind with the therapist.
- Drink plenty of fluids and eat well.
- Limit caffeine and alcohol intake.
Q. Will I suffer fatigue and be too tired to work?
A. Many patients are able to carry out their daily activities as usual, while others find that they need more rest, and therefore can not do as much. Try to continue doing the things you enjoy, but if you become too tired, try to take it easy.
Q. Will I have skin problems?
A. Skin changes such as redness or irritation, may be noticed after several treatments. It is similar to a mild sunburn, or for some a sun tan. After a few weeks of treatment, the area may become very dry from the radiation. Inform your doctor or therapist about the skin dryness / irritation so that they can give you advice on how to relieve the irritation. They will usually give out a sample of a special skin cream developed for patients undergoing radiation therapy.
Here are some suggestions on how to care for your skin during treatment:
- Avoid irritating the skin in the area being treated.
- Wash with lukewarm water and a mild soap, such as, Dove or Ivory soap.
- Do not scrub off radiation markings; let soap and water run over the area.
- Do not wear tight clothing over the area.
- Avoid placing a cold pack or a heat pack in the treatment area.
- Do not put any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area during treatment and for several weeks after your treatment. Ask your doctor what you can use.
- Do not apply anything in the treatment area 4-6 hours before your scheduled treatment.
- Avoid exposure to the sun, especially in the treatment area.
- These skin reactions will go away over time, although the skin in the area treated may remain darker, and be more sensitive to the sun.
Q. Will I lose my hair?
A. Hair loss can only occur in the area being treated. For example, radiation on your head may cause all or partial hair loss on your scalp. However if you are being treated on your hip, you will not lose hair on your scalp. Partial or full hair loss depends on how much and what kind of radiation you receive; however, some of the hair may grow back after treatments have ended.
Q. Will I lose my appetite or suffer weight loss as a result of radiation therapy?
A. Radiation treatments may interfere with eating, digesting, and absorbing food, and may cause loss of appetite. In order to help tissues rebuild themselves, try to eat a well balanced meal. You may lose 1 to 2 pounds per week, but your weight will be monitored weekly during your treatments.
Q. I have heard that radiation can cause cancer. Will I get cancer from this treatment?
A. The risk of getting an additional cancer from this treatment is very small. It would usually take ten years to develop a secondary cancer from radiation. Right now your greatest risk is dying from the cancer that you have now. The chance that radiation will help you is much more important. Although all treatments have side effects, the good must be out-weighed with the bad.
Q. Will radiation therapy damage normal tissue?
A. Some normal tissues are irradiated temporarily while treating tumor-containing tissue, but this irritation resolves shortly after treatment. Check with your physician for more information.
Q. How many treatments will I be having?
A. Some patients will receive as many as 45 treatments, while others will only receive one. This number will vary with each patient depending on the type of cancer that is being treated. This is a question that should be discussed with your doctor. Keep in mind that this number could change slightly during your course of radiation therapy treatments.
Q. Are there any restrictions on who I may visit, for example, do I have to stay away from children or pregnant women?
A. No, if you are receiving external radiation as an outpatient you will not be radioactive.
Q. Do I become radioactive after a treatment? Will I “glow in the dark”?
A. No, if you are receiving external beam radiation, the radiation will not be in your body after you have left the treatment room. If you are receiving brachytherapy seed implants you may be radioactive for a short period of time. You will not glow in the dark.
Q. When should I call my doctor?
A. You will see the doctor on a weekly basis, but you should also let the doctor or a therapist know when you are experiencing the following symptoms:
- A pain in the same area that will not go away
- Any new or unusual bumps, lumps, or swelling
- Loss of appetite, nausea, vomiting, or diarrhea
- Weight loss
- Shortness of breath
- A cough or fever
- Unusual bruises, bleeding, or rashes
- Any other sign or symptom that you are worried about
If there is anything life threatening remember to go to an emergency room or call 9-1-1.