Iowa Health Book: Cancer Center
National Cancer Institute
Peer Review Status: Externally reviewed by the
National Cancer Institute
Contents
Acknowledgements
The National Cancer Institute would like to thank the numerous health
professionals and patients who have assisted with the development and
review of this publication.
Introduction
This booklet is for you if you are receiving radiation therapy for
cancer. Its main purpose is to help you know what to expect and how
to care for yourself during your treatment. It describes external
radiation therapy and brachytherapy using radiation implants, the two
most common types of radiation therapy. Information is included on
radiation therapy methods and the general effects of treatment. There
are also some self-help "pointers" for specific side effects.
You may not want to read this whole booklet at one time. Flip through it, read the sections that are of interest to you right now, and look at the others as needed. Because your treatment will be planned specially for you and the type of cancer you have, some sections of the booklet will not apply to you.
Radiation therapy can vary among different doctors and hospitals. Therefore, your treatment program or the advice of your doctor (the radiation oncologist) may differ 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 other booklets that also might help you.
You will find some helpful sections at the back of this booklet. The page labeled "Notes" can be used to write down questions to ask your doctor, nurse, or radiation therapist. Words that relate to radiation therapy and other aspects of cancer care appear in bold throughout this booklet; these words are defined in the "Glossary." Knowing the meanings of words can help you understand more about your illness and the roles of the people involved in your care. The "Resources" section tells you how to get more information about cancer and services for cancer patients from the National Cancer Institute and the American Cancer Society.
Radiation in Cancer Treatment
What is Radiation Therapy?
Radiation is a special kind of energy carried by waves or a
stream of particles. It can come from special machines or from
radioactive substances. 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.
When radiation is used at high doses (many times those used for x-ray
exams), it can be used to treat cancer and other illnesses. Special
equipment is used to aim the radiation at tumors or areas of the body
where there is disease. The use of high energy rays or particles to
treat disease is called radiation therapy. Sometimes it's called
radiotherapy, x-ray therapy, cobalt therapy, electron beam
therapy, or irradiation.
How Does Radiation Therapy Work?
High doses of radiation can kill cells or keep them from growing and
dividing. Radiation therapy is a useful tool for treating cancer
because cancer cells grow and divide more rapidly than many of the
normal cells around them. Although some normal cells are affected by
radiation, most normal cells appear to recover more fully from the
effects of radiation than do cancer cells. Doctors carefully limit
the intensity of treatments and the area being treated so that the
cancer will be affected more than normal tissue.
What Are the Benefits and Goals of Radiation Therapy?
Radiation therapy is an effective way to treat many kinds of cancer
in almost any part of the body. Half of all people with cancer are
treated with radiation, and the number of cancer patients who have
been cured is rising every day. For many patients, radiation is the
only kind of treatment needed. Thousands of people are free of cancer
after having radiation treatments alone or in combination with
surgery, chemotherapy, or biological therapy.
Doctors can use radiation before surgery to shrink a tumor. After surgery, radiation therapy may be used to stop the growth of any cancer cells that remain. Your doctor may choose to use radiation therapy and surgery at the same time. This procedure, known as intraoperative radiation, is explained more fully below. In some cases, doctors use radiation along with anticancer drugs to destroy the cancer, instead of surgery.
Even when curing the cancer is not possible, radiation therapy still can bring relief. Many patients find the quality of their lives improved when radiation therapy is used to shrink tumors and reduce pressure, bleeding, pain, or other symptoms of cancer. This is called palliative care.
Are There Risks Involved?
Like many other treatments for disease, there are risks for patients
who are receiving radiation therapy. The brief high doses of
radiation that damage or destroy cancer cells also can hurt normal
cells. When this happens, the patient has side effects. These side
effects and what to do about them are discussed later in this
booklet. The risk of side effects is usually less than the benefits
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. Although it will be many years before scientists know all of the possible risks of radiation therapy, they now know that it can control cancer.
How Is Radiation Therapy Given?
Radiation therapy can be in either of two forms: external or
internal. Some patients have both forms, one after the other.
Most people who receive radiation therapy for cancer have the external type. It is usually given during outpatient visits to a hospital or treatment center. In external therapy, a machine directs the high-energy rays or particles at the cancer and the normal tissue surrounding it.
One type of machine that is used for radiation therapy is called a linear accelerator. High-energy rays may also come from a machine that contains a radioactive substance such as cobalt-60.
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. Your doctor decides which machine is best for you.
When internal radiation therapy is used, a radioactive substance, or source, is sealed in small containers such as thin wires or tubes called implants. The implant is placed directly into a tumor or inserted into a body cavity. Sometimes, after a tumor has been removed by surgery, implants are put into the area around the incision to kill any tumor cells that may remain.
Another type of internal radiation therapy uses unsealed radioactive sources. The source is either taken by mouth or is injected into the body. If you have this type of treatment, you will probably need to stay in the hospital for several days.
Who Gives Radiation Treatments?
A doctor who has had special training in using radiation to treat
disease - a radiation oncologist - will prescribe the type and
amount of treatment that best suits your needs. The radiation
oncologist is the person referred to as "your doctor" throughout this
booklet.
The radiation oncologist works closely with other doctors involved in your care and also heads a highly trained health care team. Your radiation therapy team may include:
You also may use the services of a dietitian, a physical therapist, a social worker, and other health care professionals.
Is Radiation Therapy 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, the Cancer Information Service, or the local office of the American Cancer Society. They may be able to direct you to sources of help. These organizations are listed in the "Resources" section.
External Radiation Therapy: What to Expect
How Does the Doctor Plan the Treatment
The radiation used in radiation therapy can come from a variety of
sources. Your doctor may choose to use x-rays, an electron
beam, or cobalt-60 gamma rays. Choosing which type of
radiation to use depends on what type of cancer you have and on how
deep into your body the doctor wants the radiation to penetrate.
High-energy radiation is used to treat many types of cancer.
Low-energy x-rays are used to treat some kinds of skin diseases.
After a physical exam and a review of your medical history, the radiation oncologist may need to do some special planning to pinpoint the treatment area. In a process called simulation, you will be asked to lie very still on a table while the radiation therapist uses a special x-ray machine to define your treatment port or field. This is the exact place on your body where the treatment will be aimed. You may have more than one treatment port. Simulation may take from a half hour to about 2 hours.
The radiation therapist often will mark the treatment port on your skin with tiny dots of colored, semipermanent ink to outline the treatment area. Be careful when you bathe because the marks must not be washed off until all of your treatment is over. If they start to fade, tell the therapist who will darken them so that they can be seen easily. Do not try to draw over faded lines at home unless they will be completely gone before your next visit. If you do replace the marks, be sure to tell the therapist at your next visit.
Using the information from the simulation, other tests, and your medical background, your doctor will meet with the radiation physicist and the dosimetrist. Your doctor then decides how much radiation is needed, how it will be delivered, and how many treatments you should have. This process often takes several days.
After you have started the treatments, your doctor will follow your progress, checking your response to treatment and your overall well-being at least once a week. The treatment plan may be revised by your doctor, if needed. It's very important that you have all of your scheduled treatments to get the most benefit from your therapy. Unnecessary delays can lessen the effectiveness of your radiation treatment.
How Long Does the Treatment Take?
Radiation therapy usually is given 5 days a week for 6 or 7 weeks.
When radiation is used for palliative care, the course of treatment
lasts for 2 to 3 weeks. These types of schedules, which use small
amounts of daily radiation, rather than a few large doses, help
protect normal body tissues in the treatment area. Weekend rest
breaks allow normal cells to recover. The total dose of radiation and
the number of treatments you need will depend on the size and
location of your cancer, type of tumor, your general health, and any
other treatments you're receiving.
What Happens During Each Treatment Visit?
Before your treatment is given, you may need to change into a
hospital gown or robe. It's best to wear clothing that is easy to
take off and put on again.
In the treatment room, the radiation therapist will use the marks on your skin to locate the treatment area. You will sit in a special chair or lie down on a treatment table. For each external radiation therapy session, you will be in the treatment room about 15 to 30 minutes, but you will be getting your dose of radiation for only about 1 to 5 minutes of that time. Receiving external radiation treatments is painless, just like having an x-ray taken.
The radiation therapist may put special shields (or blocks) between the machine and certain parts of your body to help protect normal tissues and organs. There might also be plastic or plaster forms to help you stay in exactly the right place. You will need to remain very still during the treatment so that the radiation reaches only the area where it's needed and the same area is treated each time. You don't have to hold your breath - just breathe normally.
The radiation therapist will leave the treatment room before the machine is turned on. The machine is controlled from a small area that is nearby. You will be watched on a television screen or through a window in the control room. Although you may feel alone, keep in mind that you can be seen and heard at all times by the therapist who can talk with you through a speaker.
The machines used for radiation treatments are very large, and they make noises as they move around to aim at the treatment area from different angles. Their size and motion may be frightening at first. Remember that the machines are being moved and controlled by your radiation therapist. They are checked constantly to be sure they're working right. If you are concerned about anything that happens in the treatment room, ask your therapist to explain.
You will not see or hear the radiation, and, most likely, you won't feel anything. If you do feel ill or very uncomfortable during the treatment, tell your therapist at once. The machine can be stopped at any time.
What Is Hyperfractionated Radiation Therapy?
Radiation is usually given once a day in a dose that is based on the
type and location of the tumor. In hyperfractionated radiation
therapy, the daily dose is divided into smaller doses that are given
more than once a day. If more than one treatment is given per day to
an area, the treatments usually are separated by 4 to 6 hours.
Doctors are studying hyperfractionated therapy to see if it is
equally or even more effective than once-a-day therapy. Early results
in certain tumors are encouraging, and hyperfractionated therapy is
becoming a more common way to give radiation treatments.
What is Intraoperative Radiation?
Intraoperative radiation combines surgery and radiation therapy at
the same time. The surgeon removes as much as possible of the tumor;
then a large dose of radiation is given directly to the tumor bed and
nearby areas where cancer cells might have spread. In some hospitals,
there is an operating room right in the radiation therapy department;
in others, the patient is treated in the radiation therapy department
and then returned to the operating room for surgery. Sometimes
high-dose intraoperative radiation is used in addition to external
radiation therapy to give the cancer cells a larger amount of
radiation than would be safe with external radiation alone.
What Are the 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 of your treatment. Even hugging, kissing, or having sexual
relations with others poses no risk to them of radiation exposure.
Side effects of radiation therapy most often are related to the area that is being treated. Your doctor and nurse will tell you about the possible side effects 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 unusual pain. Most side effects that occur during radiation therapy, although unpleasant, are not serious and can be controlled with medication or diet. They usually go away within a few weeks after treatment ends. However, some side effects can last longer. Many patients have no side effects at all. In another section of this booklet, "Managing Side Effects," you will find advice on how to cope with the side effects that might occur during and after your therapy.
Throughout your treatment, your radiation oncologist will regularly check on the effects of the treatment. You may not be aware of changes in the cancer, but you probably will notice decreases in pain, bleeding, or other discomforts you may have had, especially after your treatment is completed. You may continue to notice more improvements with time. Your doctor probably will recommend some tests to be sure that the radiation is causing as little damage to normal cells as possible. You may have routine blood tests to check the levels of white blood cells and platelets, which may be lower than normal during treatment.
What Can I Do To Take Care of Myself During Therapy?
Each patient's body responds to radiation therapy in its own way.
That's why the doctor must plan, and sometimes adjust, your treatment
just for you. In addition, your doctor or nurse will give you advice
for caring for yourself at home that is specific for your treatment
and the side effects that might result.
Nearly all cancer patients receiving radiation therapy need to take special care of themselves to protect their health and help the treatment succeed. Some guidelines to remember are given below:
Internal Radiation Therapy: What To Expect
When Is Internal Radiation Therapy Used?
Your doctor may decide that very intense radiation given to a small
area of your body is the best way to treat your cancer. Internal
radiation therapy places the source of the high-energy rays as close
as possible to the cancer cells so that fewer normal cells are
exposed to radiation. By using internal radiation therapy, the doctor
can give a higher total dose of radiation in a shorter time than is
possible with external treatment. Instead of using a large radiation
machine, the radioactive material is placed directly into (or as
close as possible to) the affected area. Some of the radioactive
substances used for internal radiation treatment include radium,
cesium, iridium, iodine, phosphorus, and palladium.
Internal radiation therapy often is used for cancers of the head and neck, breast, uterus, thyroid, cervix, and prostate. Your doctor may recommend a combination of internal and external radiation therapy.
Implant radiation as used in this booklet means internal radiation treatment. You also may hear the terms interstitial radiation, intracavitary radiation, or brachytherapy; each is a form of internal radiation therapy. Some people use the term "brachytherapy" whenever they are talking about any form of internal radiation therapy.
When interstitial radiation is given, the radiation source is placed right in the affected tissue, usually in small tubes or containers. These implants may be temporary or permanent. When intracavitary radiation is used, a container of radioactive material is placed in a cavity of the body such as the uterus. In brachytherapy, the radioactive source, which is sealed in a small container, is placed on the surface of the body near the tumor or a short distance from the affected area. The radioactive source also may be delivered to the tumor through tubes; this is called remote brachytherapy. Internal radiation also may be given by injecting a solution of radioactive substance into the bloodstream or a body cavity. When the substance is injected, it is not sealed in a container and may be called unsealed internal radiation therapy.
How Is the Implant Placed in the Body?
For most types of implants, you will need to be in the hospital and
have general or local anesthesia while the doctor places the
container for the radioactive material in your body. In many
hospitals, the radioactive material is placed in the container after
you return to your room so that others are not exposed to radiation.
To get the radiation as close as possible to the cancer, doctors may use implants of radioactive material sealed in wires, seeds, capsules, or needles. The type of implant and the method of placing it depend on the size and location of the cancer. Implants may be put right into the tumor, in special applicators inside a body cavity, on the surface of a tumor, or in the area from which the tumor has been taken.
Does the Implant Spread Radiation to Others?
The radioactive substance in your implant may transmit rays outside
your body. While you're receiving implant therapy, the hospital may
require you to stay in a private room. Although the nurses and other
people caring for you will not be able to spend a long time in your
room, they will give you all of the care you need. You should call
for a nurse when you need one, but keep in mind that the nurse will
work quickly and speak to you from the doorway more often than from
your bedside. In most cases, your urine and stool will contain no
radioactivity. However, either one may contain some radioactive
material if you have unsealed internal radiation therapy.
There also will be limits on visitors while your implant is in place. Most hospitals do not let children younger than 18 or pregnant women visit patients who have an implant. Visitors should sit at least 6 feet from your bed and stay for only a short time each day (10 to 30 minutes). Have visitors ask your nurse for specific instructions before they enter your room.
Are There Any Side Effects?
You are not likely to have severe pain or feel ill during implant
therapy. However, if an applicator is holding your implant in place,
it may be somewhat uncomfortable. If you need it, the doctor will
order medicine to help you relax or to relieve pain. Some patients
feel drowsy, weak, or nauseated after having the anesthesia to place
the implant, but these effects do not last long.
Be sure to tell the nurse if you have any side effects such as burning, sweating, or other unusual symptoms. In the section of this booklet called "Managing Side Effects," you will find tips on skin care and what you can do about problems that might occur after implant therapy.
How Long Does the Implant Stay in Place?
The total amount of time that an implant is left in place depends on
the dose (amount) of radioactivity with which the patient is treated.
The implant may be low dose rate and left in place for several days,
or it may be high dose rate and removed after a few minutes.
Generally, low dose rate implants are left in place from 1 to 7 days.
Your treatment schedule will depend on the type of cancer, where it
is, your general health, and other cancer treatments you have had.
Depending on where the implant is placed, you may have to stay in bed
and lie fairly still to keep the implant from shifting.
For some cancer sites, the implant may be left in place permanently. If your implant is permanent, you may need to stay in your room away from other people in the hospital for a few days while the radiation is most active. The implant will lose energy each day, so by the time you are ready to go home, the radiation in your body will be much weaker. Your doctor will advise you if there are any special precautions you need to use at home.
High dose rate remote brachytherapy allows a person to be treated within a few minutes in inpatient or outpatient clinics. With remote brachytherapy, a very powerful radioactive source travels by remote control through tubes, or catheters, to the tumor. The radioactivity remains at the tumor for only a few minutes. This procedure is done by the brachytherapy team, who will watch you on a closed circuit television. They will talk to you through an intercom. In some cases, several remote treatments may be required. Sometimes, the catheter stays in place between treatments and sometimes it is removed, depending on your condition.
High dose rate treatments are short (usually a few minutes) and result in less discomfort than other types of radiation therapy. Because radioactive materials are not left in your body, you can return home soon after you recover. Remote brachytherapy has been used to treat cancers of the cervix, breast, lung, pancreas, prostate, and esophagus.
What Happens After the Implant Is Removed?
Usually there is no need to have an anesthetic to take out the
implant. Most can be taken out right in the patient's hospital room.
If you had to stay in bed during implant therapy, you might have to
remain in the hospital an extra day or so after the implant is
removed. Once the implant is removed, there is no radioactivity in
your body. The nurses and your visitors no longer will have to
observe any special rules.
Your doctor will tell you if you should limit your activities after leaving the hospital. Most patients are allowed to do as much as they feel like doing. You may need some extra sleep or rest breaks during your first days at home, but you will feel stronger quickly.
The area that has been treated with an implant may be sore or sensitive for some time after therapy. Your doctor may advise you to limit sports and sexual activity for a while if they cause irritation in the treatment area.
Managing Side Effects
Are Side Effects the Same for Everyone?
The side effects of radiation treatment vary from patient to patient.
You may have no side effects or only a few mild ones through your
course of treatment. Or you may have more serious side effects. The
side effects that you have depend mostly on the treatment dose and
the part of your body that is treated. Your general health also can
affect how your body reacts to radiation therapy and whether you have
side effects. Before beginning your treatment, ask your doctor and
nurse about the side effects you might experience, how long they
might last, and how serious they might be.
There are two main types of side effects: acute and chronic. Acute, or short-term, side effects occur close to the time of the treatment and usually are gone completely within a few weeks of finishing therapy. Chronic, or long-term, side effects may take months or years to develop and usually are permanent.
The most common side effects are fatigue, skin changes, and loss of appetite. They can result from radiation to any treatment site. Other side effects are related to treatment of specific areas. For example, temporary or permanent hair loss may be a side effect of radiation treatment to the head. This chapter discusses common side effects first. Then side effects involving specific body parts are described.
Fortunately, most side effects will go away in time. In the meantime, there are ways to reduce the discomfort they cause. If you have a side effect that is particularly severe, the doctor may prescribe a break in your treatments or change the kind of treatment you're receiving.
Be sure to tell your doctor, nurse, or radiation therapist about any side effects that you notice. They can help you treat the problems and tell you how to lessen the chances that the side effects will come back. The information in this booklet can serve as a guide to handling some side effects, but it cannot replace talking with your health care team.
Will Side Effects Limit My Activity?
Not necessarily. It will depend on what side effects you have and how
severe they are. Many patients are able to go to work, keep house,
and enjoy leisure activities while they are receiving radiation
therapy. Others find that they need more rest than usual and
therefore cannot do as much. You should try to do the things you
enjoy as long as you don't become too tired.
Your doctor may suggest that you limit activities that might irritate the area being treated. In most cases, you can have sexual relations if you wish. Your desire for physical intimacy may be lower because radiation therapy may cause you to feel more tired than usual. For most patients, these feelings are temporary.
What Causes Fatigue?
During radiation therapy, the body uses a lot of energy healing
itself. Stress related to your illness, daily trips for treatment,
and the effects of radiation on normal cells all may contribute to
fatigue. Most people begin to feel tired after a few weeks of
radiation therapy. Feelings of weakness or weariness will go away
gradually after your treatment is finished.
You can help yourself during radiation therapy by not trying to do too much. If you feel tired, limit your activities and use your leisure time in a restful way. Do not feel that you have to do all the things you normally do. Try to get more sleep at night, and rest during the day if you can.
If you have been working a full-time job, you may want to continue. Although treatment visits are time-consuming, you can ask your doctor's office or the radiation therapy department to help by trying to schedule treatments with your workday in mind.
Some patients prefer to take a few weeks off from work while they're receiving radiation therapy; others work a reduced number of hours. You may want to speak frankly with your employer about your needs and wishes during this time. You may be able to agree on a part-time schedule, or perhaps you can do some work at home.
Whether you're going to work or not, it's a good idea to ask family members or friends to help with daily chores, shopping, child care, housework, or driving. Neighbors may be able to help by picking up groceries for you when they do their own shopping. You also could ask someone to drive you to and from your treatment visits to help conserve your energy.
How Are Skin Problems Treated?
You may notice that your skin in the treatment area may begin to look
reddened, irritated, sunburned, or tanned. After a few weeks you may
have very dry skin from the therapy. Ask your doctor or nurse for
advice on relieving itching or discomfort. With some kinds of
radiation therapy, treated skin may develop a "moist reaction,"
especially in areas where there are skin folds. When this happens,
the skin is wet and it may become very sore. It's important to notify
your doctor or nurse if your skin develops a moist reaction. They can
give you some suggestions on how you can keep these areas dry. Other
helpful tips can be found below.
During radiation therapy you will need to be very gentle with the skin in the treatment area. Avoid irritating treated skin. When you wash, use only lukewarm water and mild soap. Don't wear tight clothing over the area. It's important not to rub, scrub, or scratch any sensitive spots. Also avoid putting anything that is very hot or very cold, such as heating pads or ice packs, on your treated skin. Don't use any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you're being treated or for several weeks afterward (unless approved by your doctor or nurse). Many skin products can leave a coating on the skin that can interfere with radiation therapy or healing.
Avoid exposing the area to the sun during treatment and for at least 1 year after your treatment is completed. If you expect to be in the sun for more than a few minutes you will need to be very careful. Wear protective clothing (such as a hat with a broad brim and a shirt with long sleeves) and use a sunscreen. Ask your doctor or nurse about using sun blocking lotions.
The majority of skin reactions to radiation therapy should go away a few weeks after treatment is finished. In some cases, though, the treated skin will remain darker than it was before.
What Can Be Done About Hair Loss?
Radiation therapy can cause hair loss, also known as alopecia,
but only in the area being treated. For example, if you are receiving
treatment to your hip, you will not lose the hair from your head.
However, radiation to your head may cause you to lose some or all of
the hair on your scalp. Many patients find that their hair grows back
again after the treatments are finished, but accepting the loss of
hair - whether from scalp, face, or body - can be a hard adjustment.
The amount of hair that grows back will depend on how much radiation
you receive and the type of radiation treatment your doctor
recommends. Other types of treatment, such as chemotherapy, also can
affect how your hair grows back. For example, if your radiation
therapy is for palliative care, your hair probably will grow back
slowly. However, if the goal of your radiation therapy is to cure
rather than to relieve the symptoms of your cancer, then your hair
may not grow back, and if it does, it probably will be very fine.
Although your scalp may be tender after the hair is lost, you may want to cover your head with a hat, turban, or scarf while you're in treatment. Also, you should wear a protective cap or scarf when you're in the sun. If you prefer a wig or toupee, be sure the lining does not irritate your scalp. A hairpiece that you need because of cancer treatment is a tax-deductible expense and may be covered in part by your health insurance. If you plan to buy a wig, it's a good idea to select it early in your treatment so that you can match the color and style to your own hair.
What About Side Effects on the Blood?
Sometimes radiation therapy can cause low white blood cell counts or
low levels of platelets. These blood cells help your body fight
infection and prevent bleeding. If your blood tests show this side
effect, your treatment might be delayed for about a week to allow
your blood counts to increase.
What if There Are Eating Problems?
Many side effects can cause problems with eating and digesting food,
but you always should try to eat enough to help damaged tissues
rebuild themselves. It's very important not to lose weight during
radiation therapy. Try to eat small meals often and eat a variety of
different foods. Your doctor or nurse can tell you whether your
treatment calls for a special diet, and a dietitian will have a lot
of ideas to help you maintain your weight.
Coping with short-term diet problems may be easier than you expect. There are a number of diet guides and recipe booklets for patients who need help with eating problems. Another NCI booklet, Eating Hints, tells how to get more calories and protein without eating more food and provides further tips to help you enjoy eating. The recipes it contains can be used for the whole family and are marked for people with special concerns, such as low-salt diets.
If you have pain when you chew and swallow, your doctor may advise you to use a powdered or liquid diet supplement. Many of these products, available at the drugstore without prescription, are made in a variety of flavors. They are tasty when used alone, or they can be combined with other foods, such as pureed fruit, or added to milkshakes. Some of the companies that make diet supplements have produced recipe booklets to help you increase your nutrient intake. Ask your dietitian or pharmacist for further information.
You may lose interest in food during your treatment. Loss of appetite can happen when changes occur in normal cells. Some people just don't feel like eating because of stress from their illness and treatment or because the treatment changes the way foods taste. Even if you're not very hungry, it's important that you make every effort to keep your protein and calorie intake high. Doctors have found that patients who eat well can better handle both their cancer and the side effects of treatment.
The list below suggests ways to perk up your appetite when it's poor and to make the most of it when you do feel like eating.
If you are able to eat only small amounts of food, you can increase the calories per serving by trying the following ideas:
Some people find they can handle large amounts of liquids even when they don't feel like eating solid foods. If this is the case for you, try to get the most from each glassful by having drinks enriched with powdered milk, yogurt, honey, or prepared liquid supplements.
Does Radiation Therapy Affect the Emotions?
Nearly all patients who receive treatment for cancer feel some degree
of emotional upset. It's not unusual to feel depressed, afraid,
angry, frustrated, alone, or helpless. Radiation therapy may affect
the emotions indirectly through fatigue or changes in hormone
balance, but the treatment itself is not a direct cause of mental
distress.
Many patients help themselves by talking about their feelings with a close friend, family member, chaplain, nurse, social worker, or psychologist with whom they feel at ease. You may want to ask your doctor or nurse about meditation or relaxation exercises that could help you unwind and feel better.
American Cancer Society nationwide programs can provide support. Groups such as the United Ostomy Association and the Lost Chord Club offer opportunities to meet with others who share the same problems and concerns. Some medical centers have formed peer support groups so that patients can meet to discuss their feelings and inspire each other.
There are several helpful books and other materials on this subject. The Cancer Information Service can direct you to reading matter and other resources in your area.
What Side Effects Occur With Radiation Therapy to the Head and
Neck Area?
Some people who are having radiation to the head and neck have
redness and irritation in the mouth, a dry mouth, difficulty in
swallowing, changes in taste, or nausea. Try not to let these
symptoms keep you from eating.
Other problems that may occur during treatment to the head and neck are a loss of your sense of taste, earaches (caused by hardening of ear wax), and swelling or drooping of skin under the chin. There may be changes in your skin texture. You also may notice that your jaw feels stiff and that you cannot open your mouth as wide as before your treatment. Jaw exercises may help this problem. Report any side effects to your doctor or nurse and ask what you should do about them.
If you are receiving radiation therapy to the head or neck, you need to take especially good care of your teeth, gums, mouth, and throat. Side effects from treatment to these areas most often involve the mouth, which may be sore and dry.
Here are a few tips that may help you manage mouth problems:
Dental Care
Radiation treatment for head and neck cancer can increase your
chances of getting cavities. Mouth care designed to prevent problems
will be a very important part of your treatment. Before starting
radiation therapy, notify your dentist and arrange for a complete
dental/oral checkup. Ask your dentist to consult with your radiation
oncologist about any dental work you need before your radiation
treatments begin.
Your dentist probably will want to see you often over the course of your radiation therapy. Your dentist can give you very detailed instructions about caring for your mouth and teeth to reduce the risk of tooth decay and will help you deal with possible problems such as soreness of the tissues in your mouth. It is important to your total well-being that you follow the dentist's advice while you're receiving radiation therapy. Most likely, you will be advised to:
Your dentist can explain how to use disclosing tablets, how to mix the salt and baking soda mouthwash, and how to use the fluoride treatment method that best suits your needs. Most likely you can get printed instructions for proper dental care at the dentist's office.
Handling Mouth or Throat Problems
Soreness in your mouth or throat may appear in the second or third
week of external radiation therapy. It is likely to decrease from the
fifth week on and end a month or so after your treatment ends. You
may have trouble swallowing during this time because your mouth feels
dry. Your doctor or dentist can prescribe medicine for mouth
discomfort and advise you about methods to relieve other mouth
problems.
If you wear dentures you may notice that they no longer fit well. This may happen if the radiation causes swelling in your gums. It's important not to let your dentures cause gum sores that may become infected. You may need to stop wearing your dentures until your radiation therapy is over.
Your glands may produce less saliva than usual, making your mouth feel dry. It's helpful to sip cool drinks often throughout the day. Water probably is your best choice. In the morning, fill up a large cup or glass with ice, add water, and carry it with you so you have something to drink during the day. Keep a glass of cool water at your bedside at night, too. Many radiation therapy patients say that drinking carbonated beverages helps relieve dry mouth. Sugar-free candy or gum also may help. Avoid tobacco and alcoholic drinks because they will dry and irritate your mouth tissues even more. Moisten food with gravies and sauces to make eating easier. If these measures are not enough, ask your dentist about artificial saliva Dry mouth may continue to be a problem even after treatment is over.
Tips on Eating
If you are having radiation therapy to the chest, you may find
swallowing difficult or painful. Some patients say that it feels like
something is stuck in their throat.
Soreness or dryness in your mouth or throat can make it hard to eat. However, there are several ways to ease your discomfort:
Also, many helpful suggestions can be found in the NCI booklet, Eating Hints.
What Side Effects Occur With Radiation Therapy to the Breast
and Chest?
Radiation treatment to the chest may cause several changes. You will
notice some of these changes yourself, and your treatment team will
keep an eye on these and others. For example, you may find that it is
hard to swallow or that swallowing hurts. You may develop a cough. Or
you may develop a fever, notice a change in the color or amount of
mucus when you cough, or feel short of breath. It is important to let
your treatment team know right away if you have any of these
symptoms. Your doctor also may check your blood counts regularly,
especially if the radiation treatment area on your body is large.
Just keep in mind that your doctor and nurse will be alert for these
changes and will help you deal with them.
If you are receiving radiation therapy after a lumpectomy or mastectomy, it's a good idea to go without wearing a bra whenever possible. If this is not possible, wear a soft cotton bra without underwires. This will help reduce the irritation to your skin in the treatment area. You may have several other side effects if you are receiving radiation therapy for breast cancer. For example, you may notice a lump in your throat or develop a dry cough. Or, your shoulder may feel stiff; if so, ask your doctor or nurse about exercises to keep your arm moving freely. Other side effects that may appear are breast soreness and swelling from fluid buildup in the treated area. These side effects, as well as skin reddening or tanning, most likely will disappear in 4 to 6 weeks. If fluid buildup continues to be a problem, your doctor will tell you what steps to take.
Women who have radiation therapy after a lumpectomy may notice other changes in the breast after the therapy. These long-term side effects may continue for a year or longer after treatment. The redness of the skin will fade, and you may notice that your skin is slightly darker, just as when a sunburn fades to a suntan. The pores may be enlarged and more noticeable. Some women report increased sensitivity of the skin on the breast; others have decreased feeling. The skin and the fatty tissue of the breast may feel thicker, and you may notice that your breast is firmer than it was before your radiation treatment. Sometimes the size of your breast changes - it may become larger because of fluid buildup or smaller because of the development of fibrous tissue. Many women have little or no change in size.
Your radiation therapy plan may include implants of radioactive material a week or two after external treatment is completed. You may have some breast tenderness or a feeling of tightness while the implants are in your breast. After they are removed, you are likely to notice some of the same effects that occur with external treatment. If so, follow the advice given above and let your doctor know about any problems that persist.
After 10 to 12 months, no further changes are likely to be caused by the radiation therapy. If you see new changes in breast size, shape, appearance, or texture after this time, report them to your doctor at once.
What Side Effects Occur With Radiation Therapy to the Stomach
and Abdomen?
If you are having radiation treatment to the stomach or some portion
of the abdomen, you may have to deal with an upset stomach, nausea,
or diarrhea. Your doctor can prescribe medicines to relieve these
problems. Do not take any home remedies during your treatment unless
you first check with your doctor or nurse.
Managing Nausea
Some patients report feeling queasy for a few hours right after
radiation therapy to the stomach or abdomen. If you have this
problem, do not eat for several hours before your treatment time. You
may be able to handle the treatment better on an empty stomach. After
your treatment, you may find it helpful to wait 1 to 2 hours before
eating again. If the problem persists, ask your doctor to prescribe a
medicine (an antiemetic) to prevent nausea. If antiemetics are
prescribed, try to take them when your doctor suggests, even if you
sometimes feel that they are not needed.
If your stomach feels upset just before your treatment, try a bland snack such as toast or crackers and apple juice before your appointment. This type of side effect may be related to your emotions and concerns about treatment. Try to unwind a bit before you have your treatment. If you have to spend time in a waiting room, reading a book, writing letters, or working a crossword puzzle may help you relax.
Here are some tips to help an unsettled stomach:
How To Handle Diarrhea
Diarrhea most often begins in the third or fourth week of radiation
therapy. Your doctor may suggest you change your diet, prescribe
medicine for you, or give you special instructions to help with the
problem. Tell the doctor or nurse if these changes are not
controlling your diarrhea.
The following changes in your diet also may help:
Diet planning is a very important part of radiation treatment of the stomach and abdomen. Keep in mind that these problems will be reduced greatly when treatment is over. In the meantime, try to pack the highest possible food value into even small meals so that you will have enough calories and vital nutrients.
What Side Effects Occur With Radiation Therapy to the
Pelvis?
If you are having radiation therapy to any part of the pelvis (the
area between your hips), you might have one or more of the digestive
problems already described. You also may have some irritation to your
bladder. This can cause discomfort or frequent urination. Drinking
fluids can help relieve some of your discomfort. Your doctor can
prescribe some medicine to deal with these problems.
There are also certain side effects that occur only in the reproductive organs. The effects of radiation therapy on sexual and reproductive functions depend on which organs are treated. Some of the more common side effects for both men and women do not last long after treatment. Others may be long-term or permanent. Before your treatment begins, ask your doctor about possible side effects and how long they might last.
Effects on Fertility
Scientists are still studying how radiation treatment affects
fertility. If you are a women in your childbearing years, you should
discuss birth control measures with your doctor. It is not a good
idea to become pregnant during radiation therapy. Radiation may
injure the fetus. In addition, pregnancy, childbirth, and caring for
a very young child can add to the physical and emotional stress of
having cancer. If you are pregnant before beginning radiation
therapy, special steps should be taken to protect the fetus from
radiation.
Depending on the radiation dose, women having radiation therapy in the pelvic area may stop menstruating and may have other symptoms of menopause. Treatment also can result in vaginal itching, burning, and dryness. You should report these symptoms to your doctor or nurse, who can suggest treatment.
For men, radiation therapy to an area that includes the testes can reduce both the number of sperm and their effectiveness. This does not mean that conception cannot occur, however. If you're having this type of treatment, discuss your concerns and your birth control measures with your doctor. If you want to father a child and are concerned about reduced fertility, you can look into the option of banking your sperm before treatment.
Sexual Relations
During treatment to the pelvis, some women are advised not to have
intercourse. Others may find that intercourse is painful. You most
likely will be able to resume having sex within a few weeks after
your treatment ends.
Some shrinking of vaginal tissues occurs during radiation therapy. After your radiation therapy is finished your doctor will advise you about sexual intercourse and how to use a dilator, a device that gently stretches the tissues of the vagina.
With most types of radiation therapy, neither men nor women are likely to suffer any change in their ability to enjoy sex. Both sexes, however, may notice a decrease in their level of desire. This is more likely to be due to the stress of having cancer than to the effects of radiation therapy. This effect most likely will go away when the treatment ends, so it should not become a major concern. A booklet on sexuality and cancer is available without charge from your local American Cancer Society office. There are different versions for male and female patients.
Followup Care
What Does "Followup" Mean?
Once your course of radiation therapy is finished, it is important to
have regular exams to check the results of your treatment. No matter
what type of cancer you've had, you will need regular checkups and
perhaps lab tests and x-rays. The radiation oncologist will want to
see you at least once after your treatment ends. The doctor who
referred you for radiation therapy will schedule followup visits as
needed. Followup care, in addition to checking the results of your
treatment, might also include more cancer treatment, rehabilitation,
and counseling. Taking good care of yourself is also a part of
following through after radiation treatments.
Who Provides Care After Therapy?
Most patients return to the radiation oncologist for regular followup
visits. Others are referred back to their original doctor, to a
surgeon, or to a medical oncologist, a doctor who is trained
to give chemotherapy (treatment with anticancer drugs). Your followup
care will depend on the kind of cancer you have and on other
treatments that you had or may need.
What Other Care Might Be Needed?
Just as every patient is different, followup care varies. Your doctor
will prescribe and schedule the followup care that you need. Don't
hesitate to ask about the tests or treatments that your doctor
orders. Try to learn all the things you should do to take good care
of yourself.
Following are some of the questions that you may want to ask your doctor after you have finished your radiation therapy:
What if Pain Is a Problem?
A few patients need help to manage pain if it continues after
radiation therapy. You should not use a heating pad or warm compress
to relieve pain in any area treated with radiation. Mild pain
medicine may be enough for some people. If you have severe pain, ask
the doctor about prescription drugs or other methods of relief. Be as
specific as possible when telling the doctor about your pain so you
can get the best treatment for it. If you are unable to get relief
from pain, you may want to talk with a doctor who is a pain
specialist.
Because pain can be worse when you are afraid or worried, it may help to try relaxation exercises. Other methods such as hypnosis, biofeedback, and acupuncture may be useful for some cancer patients. Questions and Answers About Pain Control is a free booklet that may help you understand more about cancer pain.
How Can I Help Myself After Radiation Therapy?
Patients who have had radiation therapy need to continue some of the
special care used during treatment at least for a short while. For
instance, you may have skin problems for several weeks after your
treatments end. You should continue to be gentle with skin in the
treatment area until all signs of irritation are gone. Don't try to
scrub off the marks in your treatment area. They will fade and wear
away.
You may find that you still need extra rest while your healthy tissues are rebuilding. Keep taking naps as needed and try to get more sleep at night. You may need some time to test your strength, little by little, so you may not want to resume a full schedule of activities right away.
When Should I Call the Doctor?
After treatment for cancer, you're likely to be more aware of your
body and to notice even slight changes in how you feel from day to
day. The doctor will want you to report any unusual symptoms. If you
have any of the problems listed below, tell your doctor at once:
What About Returning to Work?
Many people continue to work during radiation therapy, but if you
have stopped working, you can return to your job as soon as you feel
up to it, even while your radiation therapy is continuing. If your
job requires lifting or heavy physical activity, you may need to
change your activities until you have regained your strength.
When you are ready to return to work, it is important to learn about your rights regarding your job and health insurance. If you have any questions about employment issues, contact the Cancer Information Service or the American Cancer Society. They can help you find local agencies that respond to problems cancer survivors sometimes face regarding employment and insurance rights. These organizations are listed in the "Resources" section at the end of this file.
Conclusion
We hope the information in this booklet will help you understand how
radiation therapy is used to treat cancer. Knowing what to expect
when you go for your treatments should lessen the anxiety you may be
feeling. Don't forget to call on your health care team whenever you
need more information.
Glossary
These are words that appear in this booklet or that you may hear your health team use. Adjuvant therapy: A treatment method used in addition to the primary therapy. Radiation therapy often is used as an adjuvant to surgery.
Alopecia (al-oh-PEE-she-ah): Hair loss.
Anesthesia: Loss of feeling or sensation resulting from the use of certain drugs or gases.
Antiemetic (an-tee-eh-MET-ik): A medicine to prevent or relieve nausea or vomiting.
Benign tumor: A growth that is not a cancer and does not spread to other parts of the body.
Biological therapy: Treatment by stimulation of the body's immune defense system.
Biopsy: The removal of a sample of tissue to see whether cancer cells are present.
Brachytherapy (BRAK-ee-THER-ah-pee): Internal radiation treatment achieved by implanting radioactive material directly into the tumor or very close to it. Sometimes called "internal radiation therapy."
Cancer: A general term for more than 100 diseases that have uncontrolled, abnormal growth of cells that can invade and destroy healthy tissues.
Catheter: A thin, flexible tube through which fluids enter or leave the body.
Chemotherapy: Treatment with anticancer drugs.
Cobalt 60: A radioactive substance used as a radiation source to treat cancer.
Dietitian (also registered dietitian): A professional who plans diet programs for proper nutrition.
Dosimetrist (do-SIM-uh-trist): A person who plans and calculates the proper radiation dose for treatment.
Electron beam: A stream of particles that produces highenergy radiation to treat cancer.
External radiation: Radiation therapy that uses a machine located outside of the body to aim high-energy rays at cancer cells.
Fluoride: A chemical applied to the teeth to prevent tooth decay.
Gamma rays: High-energy rays that come from a radioactive source such as cobalt-60.
Gray: A measurement of absorbed radiation dose; 1 Gray = 100 rads.
High dose rate remote brachytherapy: A type of internal radiation in which each treatment is given in a few minutes while the radioactive source is in place. The source of radioactivity is removed between treatments. Also known as high dose rate remote radiation therapy.
Hyperfractionated radiation: Division of the total dose of radiation into smaller doses that are given more than once a day.
Implant: A small container of radioactive material placed in or near a cancer.
Internal radiation: A type of therapy in which a radioactive substance is implanted into or close to the area needing treatment.
Interstitial radiation: A radioactive source (implant) placed directly into the tissue (not in a body cavity).
Intracavitary radiation: A radioactive source (implant) placed in a body cavity such as the chest cavity or the vagina.
Intraoperative radiation: A type of external radiation used to deliver a large dose of radiation therapy to the tumor bed and surrounding tissue at the time of surgery.
Linear accelerator: A machine that creates high-energy radiation to treat cancers, using electricity to form a stream of fast-moving subatomic particles. Also called megavoltage (MeV) linear accelerator or a linac.
Malignant: Cancerous (see cancer).
Medical oncologist: A doctor who specializes in using chemotherapy to treat cancer.
Metastasis: The spread of a cancer from one part of the body to another. Cells in the second tumor are like those in the original tumor.
Oncologist: A doctor who specializes in treating cancer.
Palliative care: Treatment to relieve, rather than cure, symptoms caused by cancer. Palliative care can help people live more comfortably.
Physical therapist: A health professional trained in the use of treatments such as exercise and massage.
Platelets: Special blood cells that help stop bleeding.
Prosthesis: An artificial replacement of a part of the body.
Rad: Short form for "radiation absorbed dose;" a measurement of the amount of radiation absorbed by tissues (100 rad = 1 Gray).
Radiation: Energy carried by waves or a stream of particles.
Radiation oncologist: A doctor who specializes in using radiation to treat cancer.
Radiation physicist: A person trained to ensure that the radiation machine delivers the right amount of radiation to the treatment site.
Radiation therapist: A person with special training who runs the equipment that delivers the radiation.
Radiation therapy: The use of high-energy penetrating rays or subatomic particles to treat disease. Types of radiation include x-ray, electron beam, alpha and beta particles, and gamma rays. Radioactive substances include cobalt, radium, iridium, and cesium. (See also gamma rays, brachytherapy, teletherapy, and x-ray. )
Radiologist: A physician with special training in reading diagnostic x-rays and performing specialized x-ray procedures.
Radiotherapy: See radiation therapy.
Remote brachytherapy: See high dose rate remote brachytherapy.
Simulation: A process involving special x-ray pictures that are used to plan radiation treatment so that the area to be treated is precisely located and marked for treatment.
Teletherapy: Treatment in which the radiation source is at a distance from the body. Linear accelerators and cobalt machines are used in teletherapy.
Treatment port or field: The place on the body at which the radiation beam is aimed.
Tumor: An abnormal mass of tissue. Tumors are either benign or malignant.
Unsealed internal radiation therapy: Internal radiation therapy given by injecting a radioactive substance into the bloodstream or a body cavity. This substance is not sealed in a container.
White blood cells: The blood cells that fight infection.
X-ray: High-energy radiation that can be used at low levels to diagnose disease or at high levels to treat cancer.
Resources
Information about cancer is available from the sources listed below. You may wish to check for additional information at your local library or bookstore and from support groups in your community.
Cancer Information Service (CIS)
The Cancer Information Service, a program of the National Cancer
Institute, is a nationwide telephone service for cancer patients and
their families and friends, the public, and health care
professionals. The staff can answer questions and can send booklets
about cancer. They also may know about local resources and services.
One toll-free number, 1-800-4-CANCER (1-800-422-6237), connects
callers with the office that serves their area. Spanish-speaking
staff members are available.
PDQ
People who have cancer, those who care about them, and doctors need
up-to-date and accurate information about cancer treatment. To meet
these needs, PDQ was developed by NCI. PDQ contains an up-to-date
list of trials all over the country. The Cancer Information Service,
at 1-800-4-CANCER, can provide PDQ information to doctors, patients,
and the public.
Publications
Cancer patients, their families and friends, and others may find the
following books useful. They are available free of charge by calling
1-800-4-CANCER.
American Cancer Society (ACS)
The American Cancer Society is a voluntary organization with a
national office and local units all over the country. It supports
research, conducts educational programs, and offers many services to
patients and their families. To obtain information about services and
activities in local areas, call the Society's toll-free
number,1-800-ACS-2345 (1-800-227-2345), or the number listed under
"American Cancer Society" in the white pages of the telephone book.
American Cancer Society
1599 Clifton Road, N.E.
Atlanta, GA 30329
1-800-ACS-2345
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