When you have been diagnosed with cancer -

We understand that it can be a very overwhelming time filled with questions and concerns for both you and your loved ones. There can be many new things that you are forced to learn and make decisions on in a seemingly short period of time. We know that this can be difficult and want you to know that we are here to help. We are a team of dedicated professionals, committed to helping you and your family through this season of your life. Our knowledgeable staff is available to you at any time throughout your treatment to answer any and all questions you have pertaining to your diagnosis, treatment, and general health. We look forward to the opportunity to assist you and your family in any way possible during this journey.

We hope that the information and resources contained in this site help answer your questions and make you feel confident and prepared to start this phase of your treatment. Feel free to contact us with any questions that you may have.

Before Treatment

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. A nurse practitioner, a physician’s assistant or a nurse may also see you. 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 as well as answer your questions.

 

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 your daily treatments. 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. Multi-leaf collimators (MLC) 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. Sophisticated treatment-planning computer software is then 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 Treatment

External Beam Radiation Therapy Treatments

When you undergo external beam radiation therapy treatment, each session is painless, just like getting an X-ray. The radiation is directed at your tumor from a machine located away from your body, using a linear accelerator. External beam radiation is noninvasive.

One of the benefits of radiation therapy is that it is usually given as a series of outpatient treatments (meaning you don’t have to stay in the hospital). You may not need to miss work or experience the type of recuperation period that may follow other types of treatments. Treatments are usually scheduled five days a week, Monday through Friday, and continue for one to six weeks. The number of radiation treatments you will need depends on the size, location and type of cancer you have, the intent of the treatment, your general health and other medical treatments you may be receiving.

The radiation therapist will give you your external beam treatment following your radiation oncologist’s instructions. It will take five to 15 minutes for you to be positioned for treatment and for the equipment to be set up. If an immobilization device was made during simulation, it will be used during every treatment to make sure that you are in the exact same position every day.

Once you are positioned correctly, the therapist will leave the room and go into the control room next door to closely monitor you on a television screen while giving the radiation. 

There is a microphone in the treatment room so you can always talk with the therapist if you have any concerns. The machine can be stopped at any time if you are feeling sick or uncomfortable.

The radiation therapist may move the treatment machine and treatment table to target the radiation beam to the exact area of the tumor. The machine might make noises during treatment that sound like clicking, knocking or whirring, but the radiation therapist is in complete control of the machine at all times.

The radiation therapy team carefully aims the radiation in order to reduce the dose to the normal tissue surrounding the tumor. Still, radiation will affect some healthy cells. The time between daily treatments allows your healthy cells to repair much of the radiation effect, while cancer cells are not as likely to survive the changes.

Sometimes a course of treatment is interrupted for a day or more. This may happen if you develop side effects that require a break in treatment. Missed treatments can be rescheduled at a later time. Try to arrive on time and not miss any of your appointments. Time spent in the treatment room may vary depending on the type of radiation, but it generally ranges from 10 to 15 minutes. Most patients are treated on an outpatient basis, and many can continue with normal daily activities. Your radiation oncologist monitors your daily treatment and may alter your radiation dose based on these observations.

Also, your doctor may order blood tests, X-rays, and other tests to see how your body is responding to treatment. If the tumor shrinks significantly, another simulation may be required. This allows your radiation oncologist to change the treatment to destroy the rest of the tumor and spare even more normal tissue.

Additional

 
 

Weekly Status Checks

During radiation therapy, your radiation oncologist and nurse will see you regularly to follow your progress, evaluate whether you are having any side effects, recommend treatments for those side effects (such as medication), and address any concerns you may have. As your treatment progresses, your doctor may make changes in the schedule or treatment plan depending on your response or reaction to the therapy. Your radiation therapy team may meet on a regular basis with other healthcare professionals to review your case to ensure your treatment is proceeding as planned. During these sessions, all the members of the team discuss your progress as well as any concerns.

Weekly Beam Films

During your course of treatment, correct positions of the treatment beams will be regularly verified with images made using the treatment beam itself. These images (called port films, beam films or portal verification) represent an important quality assurance check, but do not evaluate the tumor itself.

Follow Up

After treatment is completed, follow-up appointments may be scheduled if necessary so that your radiation oncologist can make sure your recovery is proceeding normally and can continue to monitor your health status. Your radiation oncologist may also order additional diagnostic tests. Reports on your treatment may also be sent to the other doctors helping treat your cancer. As time goes by, the number of times you need to visit your radiation oncologist will decrease. However, you should know that your radiation oncology team will always be available should you need to speak to someone about your treatment.

 
 

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Common Questions

 
  • Most people receive radiation therapy in an effort to eliminate all cancer cells as part of a curative treatment approach. In addition to destroying cancer cells and slowing tumor growth, radiation therapy can also be used to shrink tumors and reduce pressure, pain, and other symptoms of cancer in cases when it is not possible to completely eliminate the disease. This is called palliative radiation therapy, in which the goal is to improve a person’s quality of life.

  • The goal of radiation therapy is to get enough radiation into the body to kill the cancer cells while preventing damage to healthy tissue. During external beam radiation therapy, the radiation oncology team uses a machine to direct high-energy X-rays at your cancer. Internal radiation therapy, or brachytherapy, involves placing radioactive sources (for example, radioactive seeds) inside your body.

  • During external beam radiation therapy, a beam of radiation is directed through the skin to your cancer and the immediate surrounding area using a machine called a linear accelerator. The linear accelerator, or linac, is capable of producing high-energy X-rays and electrons for the treatment of your cancer. Using high-tech treatment planning software, your treatment team controls the size and shape of the beam and how it is directed at your body, to effectively treat your tumor while sparing the surrounding normal tissue. Several special types of external beam therapy are discussed in the next sections. These are used for specific types of cancer, and your radiation oncologist will recommend one of these treatments if he or she believes it will be best for you.

    Three-Dimensional Conformal Radiation Therapy (3D-CRT) Tumors are not regular – they come in different shapes and sizes. Three-dimensional conformal radiation therapy, or 3D-CRT, uses computers and special imaging techniques to show the size, shape, and location of the tumor. Computer assisted tomography (CT or CAT scans), magnetic resonance imaging (MR or MRI scans) and/or positron emission tomography (PET scans) are used to create detailed, three-dimensional representations of the tumor and surrounding organs. Your radiation oncologist can then precisely tailor the radiation beams to the size and shape of your tumor with a component of the linac called multi-leaf collimators (MLC), or custom fabricated field shaping blocks. Because the radiation beams are very precisely directed, nearby normal tissue receives less radiation and is able to heal quickly.

    Intensity Modulated Radiation Therapy (IMRT)
    Intensity modulated radiation therapy or IMRT, is a specialized form of 3D-CRT that allows radiation to be more exactly shaped to fit the tumor. With IMRT, the radiation beam can be broken up into many “beamlets,” and the intensity of each beamlet can be adjusted individually. Using IMRT, it may be possible to further limit the amount of radiation that is received by healthy tissue near the tumor. In some situations, this may also allow a higher dose of radiation to be delivered to the tumor, potentially increasing the chance of a cure.

    Stereotactic Radiotherapy Stereotactic radiotherapy is a technique that allows your radiation oncologist to precisely focus beams of radiation destroy certain types of tumors. Since the beam is so precise, your radiation oncologist may be able to spare more healthy tissue. This additional precision is achieved by using a very secure immobilization, such as a head frame used in the treatment of brain tumors. Stereotactic radiotherapy is frequently given in a single dose (sometimes called radiosurgery) although certain situations may require more than one dose. In addition to treating some cancers, radiosurgery can also be used to treat malformations in the brain’s blood vessels and certain noncancerous (benign) neurologic conditions. Sometimes a high dose of stereotactic radiotherapy can be focused upon a tumor outside the brain and given in a few treatments (typically three to eight). This form of treatment is called stereotactic body radiation therapy (SBRT).

    Image-Guided Radiation Therapy (IGRT)
    Radiation oncologists use image-guided radiation therapy, or IGRT, to better deliver the radiation to your cancer since tumors can move between treatments due to differences in organ filling or movements while breathing. IGRT involves conformal radiation treatment guided by imaging, such as CT, ultrasound or X-rays, taken in the treatment room just before the patient is given the radiation treatment. All patients first undergo a CT scan as part of the planning process. The imaging information from the CT scan is then transmitted to a computer in the treatment room to allow doctors to compare the earlier image with the images taken just before treatment. During IGRT, doctors compare these images to see if the treatment needs to be adjusted. This allows doctors to better target your cancer while avoiding nearby healthy tissue. In some cases, doctors will implant a tiny marker in or near the tumor to pinpoint it for IGRT.

  • Most people cannot feel radiation from the machine, even during daily treatments, so there is no need to worry that a treatment session will be painful. A few people have reported a slight warming or tingling sensation in the area being treated.

  • 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 cancer down the road. If you smoke, the most important thing you can do to reduce your risk of a second cancer is to quit smoking.

  • Although some types of cancer respond best to combination treatment approaches, which may include radiation plus surgery, chemotherapy, or immunotherapy, radiation therapy alone is often an effective treatment for some types of cancer.

  • 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 your cancer while avoiding healthy organs in the area.

    Throughout your treatment, members of your team will 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 need to take.

    Some patients worry that radiation therapy will cause cancer years after treatment. While this is a very small risk, it is most important to cure cancer now. Talk with your radiation oncologist or radiation oncology nurse about any fears you may have.

    Like all therapies, radiation can cause side effects.

  • Radiation therapy to the pelvic area can affect the reproductive system. For some women, permanent infertility (the inability to conceive a child or maintain a pregnancy) can occur, but usually only if both ovaries receive radiation. Men receiving radiation therapy to the testes or to nearby organs, such as the prostate, will have lowered sperm counts and reduced sperm activity, which affects fertility (the ability to father a child).

    If you are worried your treatment plan may reduce your fertility, talk to your health care team before treatment begins. There are a number of ways to preserve your fertility.

  • Radiation therapy is a local treatment, meaning it only affects the area of the body where the tumor is located. People do not lose their hair from having radiation therapy unless it is aimed at a part of the body that grows hair, such as the scalp.

  • 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.

    Follow doctor’s orders

    In many cases, your doctor will ask you to call if you develop a fever of 101° or higher. Be sure to read your instructions when caring for yourself during treatment.

    Eat a balanced, nutritious diet

    A nutritionist, 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 beneficial calories due to your cancer and treatment.

    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 sunburn. Your radiation oncology nurse will review specific instructions for caring for your skin with you. Some guidelines include:

    Clean the skin daily with warm water and a mild soap recommended by your nurse.

    Avoid using any lotions, perfumes, deodorants or powders in the treatment area unless approved by your doctor or nurse. Try not to use products containing alcohol and perfumes.

    Avoid putting anything hot or cold on the treated skin. This includes heating pads and ice packs.

    Stay out of the sun. If you must spend time outdoors, wear a hat or clothing to protect your skin. After treatment, use sunscreen with an SPF of at least 30.

    Seek out support

    There are many emotional demands that you must cope with during your cancer diagnosis and treatment. It is common to feel anxious, depressed, afraid or hopeless. It may help to talk about your feelings with a close friend, family member, nurse, social worker or psychologist. To find a support group in your area, ask your radiation oncology nurse. There are many support groups that meet in person, over the phone or on the internet.

  • A team of highly trained medical professionals will be involved in your care during radiation therapy. A radiation oncologist, a doctor who specializes in using radiation to treat cancer, leads this team.

    Radiation Oncologists

    Radiation oncologists are the doctors who will oversee your radiation therapy treatments. These physicians work with the other members of the radiation therapy team to develop and prescribe your treatment plan and make sure that each treatment is given accurately. Your radiation oncologist will also track your progress and adjust the treatment as necessary to make sure you receive the best care.

    Radiation oncologists help identify and treat any side effects that may occur due to radiation therapy. They work closely with other cancer doctors, including medical oncologists and surgeons, and all members of the radiation oncology team.

    Radiation oncologists have completed at least four years of college, four years of medical school, one year of general medical training and four years of residency (specialty) training in radiation oncology. They have extensive training in cancer medicine and the safe use of radiation to treat disease. If they pass a special examination the American Board of Radiology certifies them. You should ask if your doctor is board certified.

    Medical Physicists

    Medical physicists work directly with the radiation oncologist during treatment planning and delivery. They oversee the work of the dosimetrist and help ensure that complex treatments are properly tailored for each patient. Medical physicists develop and direct quality control programs for equipment and procedures. They also make sure the equipment works properly by taking precise measurements of the radiation beam and performing other safety tests on a regular basis.

    Dosimetrists

    Dosimetrists work with the radiation oncologist and medical physicist to carefully calculate the dose of radiation to make sure the tumor gets enough radiation. Using computers, they develop a treatment plan that can best destroy the tumor while sparing the healthy tissue.

    Radiation Therapists

    Radiation therapists work with radiation oncologists to give the daily radiation treatment under the doctor’s prescription and supervision. They maintain daily records and regularly check the treatment machines to make sure they are working properly.

    Radiation Oncology Nurses

    Radiation oncology nurses work with every member of the treatment team to care for you and your family before, during and after treatment. They will explain the possible side effects you may experience and will describe how you can manage them. They will assess how you are doing throughout treatment and will help you cope with the changes you are experiencing. If they pass a special exam, then the Oncology Nursing Exam will certify them as an Oncology Certified Nurse.

    Other Healthcare professionals

    You may work with a number of other healthcare professionals while undergoing radiation therapy. These specialists ensure that all of your physical and psychological needs are met during your treatment.

  • External-beam radiation therapy does not make a person radioactive at any time. The radiation is delivered to the body from a machine located in the treatment room so there is no radiation left behind once the treatment machine is turned off. However, with internal radiation therapy (also called brachytherapy), the implants placed in the patient’s body deliver most of the radiation to your cancer, but some radiation can be emitted (released). Therefore, people who receive internal radiation therapy need to take specific precautions for a period of time to reduce others’ exposure to the radiation.