Carolina Radiation Medicine
21st Century Oncology
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?
What Are The Side Effects Of Radiation Therapy?
What Can I Do About Skin Problems?
How Long Does Radiation Therapy Treatment Last?
For Which Types Of Cancer Is Radiation Therapy Used?
Will Radiation Therapy Make Me Radioactive?
How Does The Doctor Measure The Dose Of Radiation?
What Is Treatment Planning And Why Is It Important?
What Does Radiation Therapy Feel Like?
Will Radiation Therapy Make Me Nauseated?
Is Cancer Treatment Worse Than Cancer?
What Are The Typical Side Effects Of Radiation Therapy?
Can I Continue My Regular Routine Or Activities While Undergoing Radiation Treatments?
What Is Involved In The Implantation Of A Radioactive Seed (Brachytherapy) Into The Prostate?
Safety Precautions After Receiving Prostate Implant
Who Administers Radiation Treatments?
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.
What are the Side Effects Of Radiation Therapy?
The most common side effects are fatigue, skin changes, and some loss of appetite. Other side effects usually are related to the treatment of specific areas, such as hair loss following radiation treatment to the head. Fortunately, most side effects will go away in time and you can reduce the discomfort they cause. If you have a reaction that is particularly severe, the doctor may prescribe a break in your treatments or change the kind of treatment you're receiving. It is usually not desirable to interrupt a course of radiation therapy because the delay may decrease the treatment's effectiveness.
Although unpleasant, most side effects are not serious and can be controlled with medication or diet. Tell your doctor, nurse, or radiation therapist about any side effects you notice so that they can help you treat the problems.
What Can I Do About Skin Problems?
After radiation therapy, your skin in the treatment area may look red, irritated, sunburned or tanned. After a few weeks, it may become dry or reddened from the therapy. It is important to call your doctor or nurse of any skin changes. They may have solutions to relive your discomfort and possibly minimize further irritation. Most skin reactions should go away a few weeks after treatment is finished. In some cases, though, the treated skin will remain darker than it was before. You need to be gentle with your skin. Suggestions include:
- Use only lukewarm water and mild soap. Let water run over the treated area. Do not rub.
- Do not wear tight clothing over the treatment area.
- Try not to rub, scrub, or scratch any sensitive spots.
- Avoid putting anything that is hot or cold, such as heating pads or ice packs, on your treated skin, unless advised by your doctor.
- Do not use powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you are being treated and for several weeks afterward, unless approved by your doctor or nurse. Many skin products can leave a coating on the skin that may cause irritation, and some can interfere with penetration of radiation into the body.
- 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, wear protective clothing (such as a hat with a broad brim and shirt with long sleeves) and use a sunscreen. Ask your doctor or nurse about using sunscreen lotion.
How Long Does Radiation Therapy Treatment Last?
Radiation therapy treatments are usually given daily (5 days a week) over the course of 1-10 weeks, depending on your type of cancer and the treatment given.
For Which Types Of Cancer Is Radiation Therapy Used?
Treatment: Radiation therapy may be used to treat almost every type of solid tumor, including cancers of the brain, breast, cervix, larynx, lung, pancreas, prostate, skin, spine, stomach, uterus, or soft tissue sarcomas. Radiation can also be used to treat leukemia and lymphoma (cancers of the blood-forming cells and lymphatic system, respectively). Radiation dose to each site depends on a number of factors, including the type of cancer and whether there are tissues and organs nearby that may be damaged by radiation.
Prevention: For some types of cancer, radiation may be given to areas that do not have evidence of cancer. This is done to prevent.
Pain Management: Radiation therapy also can be given to help reduce symptoms such as pain from cancer that has spread to the bones or other parts of the body. This is called palliative radiation therapy.
Will Radiation Therapy Make Me Radioactive?
Cancer patients receiving radiation therapy are often concerned that the treatment will make them radioactive. The answer to this question depends on the type of radiation therapy being given.
External radiation therapy will not make the patient radioactive. Patients do not need to avoid being around other people because of the treatment.
Internal radiation therapy (interstitial, intracavitary, or intraluminal) that involves sealed implants emits radioactivity, so a stay in the hospital may be needed. Certain precautions are taken to protect hospital staff and visitors. The sealed sources deliver most of their radiation mainly around the area of the implant, so while the area around the implant is radioactive, the patient's whole body is not radioactive.
Systemic radiation therapy uses unsealed radioactive materials that travel throughout the body. Some of this radioactive material will leave the body through saliva, sweat, and urine before the radioactivity decays, making these fluids radioactive. Therefore, certain precautions are sometimes used for people who come in close contact with the patient. The patient's doctor or nurse will provide information if these special precautions are needed.
How Does The Doctor Measure The Dose Of Radiation?
The amount of radiation absorbed by the tissues is called the radiation dose (or dosage). Before 1985, dose was measured in a unit called a "rad" (radiation absorbed dose). Now the unit is called a gray (abbreviated as Gy). One Gy is equal to 100 rads; one centigray (abbreviated as cGy) is the same as 1 rad.
Different tissues can tolerate various amounts of radiation (measured in centigrays). For example, the liver can receive a total dose of 3,000 cGy, while the kidneys can tolerate only 1,800 cGy. The total dose of radiation is usually divided into smaller doses (called fractions) that are given daily over a specific time period. This maximizes the destruction of cancer cells while minimizing the damage to healthy tissue.
The doctor works with a figure called the therapeutic ratio. This ratio compares the damage to the cancer cells with the damage to healthy cells. Techniques are available to increase the damage to cancer cells without doing greater harm to healthy tissues.
What Is Treatment Planning And Why Is It Important?
Because there are so many types of radiation and many ways to deliver it, treatment planning is a very important first step for every patient who will have radiation therapy. Before radiation therapy is given, the patient's radiation therapy team determines the amount and type of radiation the patient will receive.
If the patient will have external radiation, the radiation oncologist uses a process called simulation to define where to aim the radiation. During simulation, the patient lies very still on an examining table while the radiation therapist uses a special x-ray machine to define the treatment port or field-the exact place on the body where the radiation will be aimed. Most patients have more than one treatment port. Simulation may also involve CT scans or other imaging studies to help the radiation therapist plan how to direct the radiation. The simulation may result in some changes to the treatment plan so that the greatest possible amount of healthy tissue can be spared from receiving radiation.
The areas to receive radiation are marked with a temporary or permanent marker, tiny dots or a "tattoo" showing where the radiation should be aimed. These marks are also used to determine the exact site of the initial treatments if the patient should need radiation treatment later.
Depending on the type of radiation treatment, the radiation therapist may make body molds or other devices that keep the patient from moving during treatment. These are usually made from foam, plastic, or plaster. In some cases, the therapist will also make shields that cannot be penetrated by radiation to protect organs and tissues near the treatment field.
When the simulation is complete, the radiation therapy team meets to decide how much radiation is needed (the dose of radiation), how it should be delivered, and how many treatments the patient should have.
What Does Radiation Therapy Feel Like?
Patients can not see, smell, taste, hear or feel radiation treatment. The actual radiation treatments are very similar to getting an X-ray.
When the machine is on there is no pain; however, an additive affect of many treatments over several weeks can lead to discomfort in the treatment area.
Radiation therapy can cause hair loss (alopecia), but only in the area being treated with radiation. For example, if the patient receives treatment to the spine, the patient will not lose hair on their head. However, radiation to the patient's brain may cause the patient to lose some or all of the hair on their scalp. Most patients find that their hair grows back after the treatments are finished.
Will Radiation Therapy Make Me Nauseated?
Radiation therapy effects only those areas being treated. If the patient is receiving radiation therapy to their abdomen then the patient may experience some nausea from their treatment. There are excellent medications available now that almost always allow good control of this nausea. Often times the doctor finds the nauseated radiation patient is nauseated from chemotherapy, other medications (most commonly pain medicines) or the flu and not the radiation treatment.
Is Cancer Treatment Worse Than Cancer?
Almost always cancer is worse than the treatment. Often people diagnosed with cancer have never experienced any symptoms or pain. It is only after the treatment starts that they begin to feel sick. Therefore, they associate feeling sick with getting treatment - not with the cancer itself. There are times when every cancer patient questions their commitment to the difficult journey of treatment and its side effects. Sometimes they can become discouraged by the uncertainty of treatment, and wonder if it's worth it. However, cancer treatments are becoming more and more effective, and doctors are learning more and more ways to control their side effects. Almost always uncontrolled cancer growth makes people much sicker than treatment. You are encouraged to discuss this with your doctor.
What Are The Typical Side Effects Of Radiation Therapy?
The most common side effects of radiation therapy reported by patients are fatigue and skin irritation at the site of treatment. Other side effects depend on the area of the body being treated and the dosage being given. Here are some typical side effects:
- Dry or sore mouth or throat may occur when treatment is being given in the mouth, throat, or neck area.
- Some coughing and excess mucus production may occur if treatment is given to the lung area.
- Mild nausea and/or diarrhea may occur if treatment involves the abdominal area. Most of these side effects will go away on their own within 4 to 6 weeks after treatment is completed. Some long-term effects may include changes in the color and elasticity of skin in the treatment area. Discuss any concerns you may have about side effects with the radiation oncologist before the start of your treatment, and ask about medications to counteract them.
Can I Continue My Regular Routine Or Activities While Undergoing Radiation Treatments?
You should continue with your normal routines. Most patients continue full-time occupations or leisure activities through the course of treatments. When you feel tired, do not overexert yourself; take time to rest when needed. Try to get plenty of sleep and maintain a healthy diet.
What Is Involved In The Implantation Of A Radioactive Seed (Brachytherapy) Into The Prostate?
For most of these patients, radioactive seed implantation into the prostate is a one-time, nonsurgical, low-impact procedure. Radioactive seed implantation into the prostate is typically performed in an outpatient hospital setting by a team of physicians consisting of a urologist, a radiation oncologist, and a radiation physicist. Spinal anesthesia is typically used, but general anesthesia may be used occasionally. Some centers perform this procedure in their hospital operating rooms. Both outpatient and inpatient settings are acceptable. Most patients can return to normal activity, including work, within 1 to 3 days, with little or no pain.
Safety Precautions After Receiving Prostate Implant
Patients receiving a radioactive prostate implant (seeds) will be given any special instructions before the implant is placed. The radiation given off by the seeds is low energy and is easily absorbed by the patient's body. It is recommended to stay six or more feet from small children and pregnant women. Small children should not sit in the patient's lap. These safety precautions will need to be followed for approximately six months after receiving the implant.
Who Administers Radiation Treatments?
A doctor who has had special training in using radiation to treat disease, known as a Radiation Oncologist, will prescribe the type and amount of treatment that is required in your individual case
Radiation Oncology, however, is a team approach and many professionals are involved in the planning and delivery of your treatment. Your radiation team includes:
- A Medical Physicist, who makes sure that the equipment is working properly and that the right dose of radiation is delivered;
- A Dosimetrist, who works closely with your Radiation Oncologist and Medical Physicist to develop your treatment plan;
- A Radiation Oncology Nurse, who provides nursing care and helps you learn about treatment and how to manage side effects;
- A Radiation Therapist, who sets you up everyday on the treatment table and operates the radiation equipment under the supervision of your Radiation Oncologist and Medical Physicist;
- A Social Worker, who addresses any social or psychological needs that may arise prior to, during or after your treatment.
A very common question after completing Radiation Therapy is regarding returning to work. Many people continue to work during 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.
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