Carolina Radiation Medicine
Cancer Treatment Center
Frequently Asked Questions (F.A.Q.)
How Does Radiation Therapy Work?
How Is Radiation Therapy Given?
What Happens During Each Treatment Visit?
Cancer develops when cells that make up the tissues of the body grow
at an uncontrolled rate. Virtually any cell from any part of the body
can grow out of control and become a cancer. Sometimes one refers to
a cancer as a “tumor”, but not all tumors are cancers. Those
tumors that are considered to be cancers are referred to as “malignant
tumors” as opposed to a “benign tumor” (or non cancer).
Malignant tumors usually are considered to have the ability to spread
(or metastasize) to other parts of the body. Not all cancers are the
same, and depending upon the part of the body in which they grow, and
the specific type of cell that makes up that particular cancer, the
risk to one’s life and health, and the treatment may vary greatly.
There are many causes of cancer, and for some cancers there may be no
known cause. Activities such as tobacco smoking and excessive alcohol
consumption can increase the risk of developing cancers. Tobacco use
is linked with increased risk of cancers of the mouth, throat, lungs,
bladder, kidneys as well as other sites. Not everyone who smokes will
develop a cancer, and not everyone who does not smoke or drink alcohol
will be spared from developing a cancer.
Exposure to radiation (x-rays) can cause cancer. The x-rays used by your physician or dentist are relatively low in energy, and are well regulated when used, so that these procedures are very safe. Too much exposure to sunlight without any protection can cause skin cancer.
There are many dietary issues that have been show to have an effect on increasing the risk of developing some forms of cancer, such as excessive eating of animal fat with an increased risk of colon cancer.
There are many different ways to treat patients who have cancer. The
most common treatments consist of surgery, chemotherapy, radiation therapy,
and biological response modifiers including hormonal therapy. Tamoxifen
used to decrease the risk of developing breast cancer would be an example
of hormonal therapy.
The use of any or all of these types of treatment depends upon each individual’s type of cancer, the extent of the cancer, and the individual’s general health. The utilization and coordination of such treatment requires special training. Cancer treatment is conducted, therefore, by doctors who have special training such as Surgical Oncologists, Medical Oncologists (Chemotherapists), and Radiation Oncologists. Once a cancer is diagnosed, one or more of these cancer specialists will likely assess the extent of disease and recommend one or more treatment options. Cancer diagnosis and treatment is very complex, and requires thorough “hands-on” involvement by the doctors who will be involved in your care.
At the Carolina Radiation Medicine Cancer Treatment Center in Greenville, NC, radiation therapy is the type of specific cancer treatment that is conducted. The radiation oncologist works with a highly trained special staff, including radiation therapists, an oncology certified nurse, medical physicist, dosimetrist, and many other office support personnel who assist with coordinating the radiation treatments. Many patients are also receiving chemotherapy, hormonal therapy, and have already undergone surgery as part of their treatment. The staff has a long history of working with many other specialists in the Greenville area who may also take part in some part of an individual’s cancer treatment.
Radiation therapy uses an invisible beam of high-energy particles, such
as electrons, or waves, such as x-rays, or gamma rays to destroy or
damage cancer cells. Other names for radiation therapy include radiotherapy,
x-ray therapy, electron beam irradiation, and some older forms of radiation
therapy using radioactive Cobalt. The first patient with cancer to receive
radiation treatment for her tumor was treated in 1896, just one year
after the “discovery” of X-rays. There has been a phenomenal
improvement in the science of radiation cancer therapy, and in the development
in the technology involving the production of, and delivery of cancer
killing therapeutic radiation since that time. The technological progress
in just the past ten years has been amazing.
Radiation therapy is one of the most common treatments for cancer available today, and is used in more than half of all cancer cases. It is the primary treatment for some types of cancer, such as certain non-melanoma skin cancers, head and neck cancers, early-stage Hodgkin's disease and non-Hodgkin's lymphomas. Cancers of the lung, breast, cervix, prostate, testes, bladder, thyroid, and brain are also treated with radiation therapy. For some patients, radiation therapy may be the only treatment required.
If you have had radiation therapy in the past, it may limit the amount of radiation you can now receive: however, this limitation depends upon the body site treated and the total dose of radiation delivered. Only a specially trained radiation oncologist (the physician or doctor who is specially trained to plan, prescribe, direct, and manage radiation cancer treatments) is qualified to make this determination. You should always expect to be treated by a board certified radiation oncologist (certified by the American Board of Radiology in Therapeutic Radiology or Radiation Oncology). If you are not certain if your doctor is board certified……….ask.
The unit of radiation delivered is called a “centigray (cGy)”, the “Gray”, or “rad” (the rad is an old term that was replaced by the centigray over a decade ago, although, some centers still use this old terminology). The current international standard is the centigray.
Thousands of people become free of cancer after receiving radiation treatments alone, or in combination with surgery, chemotherapy, or immune therapy (biologic therapy). For example, doctors can use radiation before surgery to shrink a tumor so that it can be removed more easily or after surgery to stop the growth of any cancer cells that remain. The coordination of all of these forms or cancer therapy require that all of the specialists involved in your care communicate with each other, prior to, during, and after your cancer treatment.
How Does Radiation Therapy Work?
All cells, cancerous and healthy, grow and divide, and thus more tissue
develops. This is a part of normal growth and renewal of cells and tissues
that make up our bodies. Cancer cells grow and divide more rapidly than
many of the normal cells around them, and do so out of the control that
is typical of our normal cells growth regulating systems. Radiation
therapy uses special equipment to deliver high doses of radiation to
cancerous tumors, killing or damaging them so they cannot grow, multiply,
or spread. Although some normal cells may be affected by radiation,
most appear to recover fully from the effects of the treatment. Unlike
chemotherapy, which exposes the entire body to cancer-fighting chemicals,
radiation therapy affects only the tumor and the surrounding area. Radiation
therapy, therefore, is thought of as a “local or regional”
type of cancer therapy, in contrast to chemotherapy, which is a type
of systemic therapy (since if passes through, and has effects on the
entire body system).
How Is Radiation Therapy Given?
Radiation therapy is given in two ways: external and internal. Some
patients receive both types of radiation therapy.
External Beam Radiation Therapy (EBRT), (or external beam
radiation) requires a machine (linear accelerator) that directs high-energy
X-rays, or particles (usually electrons) at the cancer and some normal
surrounding tissue. Most people receive external radiation therapy during
outpatient visits to a radiation therapy facility.
Internal radiation therapy uses a radioactive source in the form of
a wire, pellet or seed that is sealed and “implanted” into
a body cavity near the tumor, or into the tumor itself. This is known
as a radioactive implant. In general, this is called brachytherapy.
In some instances, a radioactive liquid is used to treat a cancer. This
may be injected into a vein, or into a sealed device, such as a balloon-containing
catheter, which is positioned in a tumor cavity after the main tumor
is removed surgically. Sometimes, after a tumor has been removed by
surgery, radioactive implants are put into the area around the incision
to kill any tumor cells that remain. Implants may be permanent or temporary.
Some brachytherapy procedures require a short hospital stay, while others
may be conducted as an outpatient.
What Happens During Each Treatment Visit?
External radiation treatments are painless. The experience is just like having a regular X-ray taken. The treatment takes only a few minutes; but each session can last 15 to 30 minutes, because of the time it takes to set up the equipment and place you in the correct position. Very specific techniques are used to position you for each treatment. Typically, laser lights are used to carefully and accurately align your body so that the radiation “beam” is accurately directed at the correct target (the tumor itself, and sometimes an area at risk for tumor spread around the main tumor).
Depending on the treatment area, you may need to undress, so it is wise to wear clothes that are easy to take on and off. You will lie on a treatment table that is positioned in a special room or vault where the radiation machine (linear accelerator) is located. The radiation therapist (the certified technologist who sets up your daily treatment under the direction of the doctor (radiation oncologist), may put special shields (or blocks) between the machine and other parts of your body to help protect normal tissues and organs. Although radiation does not distinguish between tumor cells and healthy cells, healthy tissue usually recovers with little or no permanent damage. Nevertheless, you should remain as still as possible during the treatment. You do not have to hold your breath - just breathe normally. Normal breathing motion is expected and is taken into account when the doctor plans your treatment. Sometimes a special “custom immobilization device” is prepared to help position you correctly for each treatment. The use of such devices is common, but not required for all treatments.
Once you are in the correct position, the radiation therapists will go into an nearby room to turn on the machine and watch you on a TV monitor. You will be able to talk with the therapists over an intercom. X-rays may be taken during treatments to confirm accuracy.
The radiation therapy machine may make clicking and whirring noises as it moves to aim at the radiation beam at the tumor to treat from different angles. A sophisticated computer system operated by the radiation therapist controls the movement of the treatment machine, and constantly checks to be sure that it is working properly. If you are concerned about anything that happens in the treatment room, ask your therapist to explain. He or she may refer you to the oncology nurse or the radiation oncologist (specialist doctor) if necessary. If you feel ill or uncomfortable during the treatment, you can signal the therapist who is operating the machine so that the radiation treatment can be stopped immediately if necessary. While you are being treated, you are constantly being monitored visually by two camera systems, and by audio monitoring (microphones in the treatment room). Although you are alone in the treatment room, you are never really alone, since you are being constantly monitored by duplicated sight and sound systems. These are duplicated just in case one system fails.
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