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Radiation therapy is a modality of treatment used to kill cancer cells that is given by a radiation oncologist. It can be given alone or in combination with chemotherapy or surgery. It can go on for weeks or it can be given as a single dose.
Radiation therapy is used to fight many types of cancer.
It may also be used to:
Shrink a tumor as much as possible before surgery
Help prevent the cancer from coming back after surgery or chemotherapy
Relieve symptoms caused by a tumor
Treat cancers that cannot be removed with surgery
Radiation therapy uses high-powered x-rays, particles, or radioactive seeds. Radiation is most harmful to quickly growing cells. So it damages cancer cells more than normal cells (cancer cells multiply faster than normal cells). This prevents the cancer cells from growing and dividing, leading to cell death.
Radiation therapy can be given in different ways:
External beam radiation - given from outside the body through a machine, after locating the tumour and marking the site for radiation. This type of treatment is given as an out patient basis and does not make you radioactive. So you do not pose any harm to others.
Internal beam radiation - given from inside the body. This involves
a.Brachytherapy - radioactive seeds are placed directly into or near the tumour eg. Prostate cancer
b. Receiving radiation by drinking it, swallowing a pill, or through an intravenous route. Liquid radiation travels throughout your body, seeking out and killing your cancer cells. eg. Thyroid cancer and some types of lymphoma.
This type of radiation is generally given as an in-patient treatment. Your body becomes radioactive temporarily. So you will be discharged only when the radioactivity has become so low that it poses no harm to others. If you have taken radiation orally or intravenously then the radioactivity gradually reduces on its own depending on the radioactive material used. So during this time you will have certain restrictions in the hospital and also when you go home. The main constraint will be on the visitors, especially children and pregnant women are not allowed to visit you.
Fig 1 : Illustration of linear accelerator used for external beam radiation therapy
Radiotherapy is usually given as a number of individual treatments delivering a small dose of radiation daily over several weeks. Each dose is called a fraction which is usually given 5days a week (Monday to Friday) and 2 days of rest at the week end. The treatment will go on for weeks approximately 1-7weeks depending on the type of disease, type and purpose of radiation therapy. For example if radiation therapy is being given for pain control, then the duration of treatment will be less.
The area where radiotherapy is being given needs special care and attention.
You should wash the area very gently with lukewarm water and keep it dry.
Do not scrub or scratch over it.
Do not use soap, lotions, ointments, makeup, perfumed powders or products on this area.
Avoid direct sunlight to this area.
Avoid heating pads or ice bags on the treatment area.
If you are wearing a wig make sure it does not irritate your skin
Ask your doctor or nurse to recommend a good mouthwash. The alcohol in some
mouthwashes can dry and irritate mouth tissue
Sip cool drinks (not cold drinks) often throughout the day
Ask your doctor or nurse about medicines to help treat mouth sores and control pain while eating.
Care of hair constitutes an important part you are receiving treatment to brain.
Here are few tips:
For the first 2 weeks of treatment, wash your hair once a week with a gentle shampoo. After 2 weeks, use only warm water on your hair and scalp. Dry gently with a towel.
Never use a hair dryer.
Dental care: Use a toothbrush with soft bristles after meals and at bedtime.
Common things to expect at home:
You may have burning sensation of the skin after the radiation treatment.
After few days you may notice opening up of your skin
You may notice localised fall of hair that is from the area where you have received the treatment.
You may feel very tired. Do not try to over do things.
Nausea is the most expected side effect during radiation therapy. So take the prescribed anti-nausea medications prescribed by your doctor regularly. Also you can try eating a bland snack such as toast, dry biscuits or apple juice
Usually the side effects start after 2 weeks of starting the treatment. But they will resolve once the treatment has been stopped.
Vaginal itching, burning, dryness, atrophy and symptoms of menopause like hot flushes, vaginal dryness, and not having your period might be seen if you are a female and have received radiation to the pelvic region.
Diarrhoea, cramping in your belly, and upset stomach, difficulty in swallowing, dry or scratchy throat, cough, and swelling of arm, fever and cough with sputum.
External beam radiation causes skin changes like hair loss, red or burning skin, itchy skin, thinning of skin tissue, or even shedding of the outer layer of skin.
After few weeks to months, you may notice shortness of breath, dry mouth, mouth pain, nausea, loss of taste and menopause symptoms
The occurrence of side effects depends on the dose duration and frequency of radiation and also the part of the body receiving radiation.
Effects on sexuality and fertility-
Radiotherapy do have some effect on your sexual life, especially if radiation is being given to pelvis region.
If you are a male, then you may have problems like loss of interest in sex, problem getting an erection and also sharp pain when you ejaculate.
If you are a female, then you experience pain, discomfort, vaginal dryness, itching and symptoms of menopause.
Apart from these fatigue, pain, anxiety, or depression, can affect your interest in having sex.
Radiotherapy can have effects on fertility status also. But since radiation is known to effect the development of sperm and ovum, the development of the baby may be affected. Hence it is always better to use some form of contraception during and also for 6 months to 2 years after the completion of radiation therapy. You can discuss with your doctor before starting the treatment.
Follow up depends on the type of radiation you are taking. Your doctor will give you a written schedule mentioning when you need to visit the hospital. Once a week you will also be evaluated to check whether radiation given till date was appropriate.
Once the radiation therapy is over you will have to visit your doctor approximately after 4 weeks for further management.
Also you will need to get blood tests done at frequent intervals just to make sure your counts are within normal limits. If there are any variations in the blood counts then radiation therapy needs to be postponed. Discuss with your doctor in detail about this.
Tell your doctor about all medicines you are taking
Avoid eating 4 hours before and 2 hours after the treatment.
Do not eat very spicy foods, acidic foods, or foods that are very hot or cold.
Do not eat foods that are fried or are high in fat content
Drink plenty of liquids. You can have 8-10 glasses of water, but avoid orange juice, grape juice and other citrus fruits.
If you are having diarrhoea, try a clear liquid diet -- water, weak tea, apple juice etc. Also try low-fibre foods, such as white rice, bananas, applesauce, mashed potatoes, low-fat cottage cheese, and dry toast.
Never eat raw fruits and vegetables as it increases the chances of you getting infection and an upset stomach. Also avoid high-fibre foods, coffee, beans, cabbage, whole grain breads, cereals and sweets
Avoid eating outside food. If at all you have to then avoid salad bars raw or under cooked meat, fish (including shellfish), poultry, and eggs - these foods are more likely to contain harmful bacteria
Eat sugar-free candy or chew gum to help keep your mouth moist.
Moisten food with gravies and sauces to make it easier to eat and this also helps to deal with nausea.