HEALTH - RADIATION THERAPY (CANCER TREATMENT & SIDE EFFECTS)
What is Radiation Therapy?
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.
Radiation has been described as moving packets
of energy that are made when subatomic particles (for example, protons,
electrons, and neutrons) break apart into pieces. Radiation of
different types is used in such things as microwaves, telephones, and
televisions, or unleashed to produce the extreme power in a nuclear
reactor or—at a much greater level—in the sun. The differences in these
forms of radiation have to do with their frequency. Only the highest
frequencies of radiation, those defined as ionizing radiation, have the
intensity to damage living tissue.
Almost everyone has experienced ionizing radiation in the form of a
sunburn from ultraviolet (UV) light. Short exposure to radiation from
medical x-rays allows us to view things in our bodies that are denser
than skin and tissue, such as bones and teeth, without causing any
injury. However, radiation of even higher intensity can penetrate
(reach) into cells themselves and disrupt the genetic material in cells
that is necessary for cell replication (copying). When the damaged
cells die, the body naturally gets rid of them. Radiation therapy (also
called radiotherapy) makes use of ionizing radiation as a "bladeless
knife" to destroy active cancer cells inside the body.
Radiation therapy is considered a local
treatment, as it only affects one part of the body. The goals of
radiation therapy can include shrinking the tumor before surgery,
keeping the tumor from returning after surgery, eliminating cancer
cells in other parts of the body, and relieving pain.
Before beginning external-beam radiation therapy, the doctor will plan
where to aim the radiation. The goal is to hit as much of the tumor as
possible while minimizing the exposure of healthy tissue. A person's
skin may be marked to show where the radiation will be directed. New
computerized techniques help pinpoint the best place to give the
radiation.
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Health: The Goal of Radiation Therapy (Cancer)
The goal of radiation therapy is to kill cancer
cells without harming the surrounding healthy tissue. Some forms of
cancer, such as prostate and larynx cancer, can be successfully treated
with radiation therapy as the sole or primary therapy. In other types
of cancer, such as breast cancer, radiation therapy is a complementary
treatment used along with surgery, chemotherapy, or immunotherapy
(biologic therapy).
In these cases, radiation therapy represents an extremely important additional, or adjuvant, therapy to the other treatment(s) because of its ability to target specific cells. Even when surgery may remove the cancer completely, or when chemotherapy eliminates detectable cancer cells, the health risk remains that a few cancer cells survived and can again cause disease. In cases where successfully treating the cancer is not possible, radiation therapy can be used to shrink tumors and reduce the pressure, pain, and other symptoms of cancer. This is called palliative radiation. More than half of all people with cancer undergo some form of radiation therapy.
Radiation is considered a local treatment because only cells in and around the cancer are affected. It is not as useful against cancer that has already spread to distant parts of the body, because most forms of radiation therapy do not reach all parts of the body. Radiation may be used in several ways:
To cure or shrink early stage cancer: Some cancers are very sensitive to radiation. Radiation may be used by itself in these cases to make the cancer shrink or disappear completely. For other cancers, it may be used before surgery to shrink the tumor (pre-operative therapy) or after surgery to prevent the cancer from coming back (adjuvant therapy). It may also be used along with chemotherapy in some cases. When radiation is to be used along with other forms of therapy, the treatment is planned by the surgeon, medical oncologist, and radiation oncologist, as well as the patient.
To stop cancer from recurring (coming back) in another area: If a type of cancer is known to spread to a certain area, doctors often assume that a few cancer cells may have already spread there, even though imaging scans (CT or MRI scans) show no tumors. That area may be treated to keep these cells from growing into tumors. For example, people with some types of lung cancer may receive preventive (prophylactic) radiation to the head because this type of cancer often spreads to the brain.
To treat
symptoms for advanced cancer: Some cancers may spread too
far to be cured. But this does not mean they can't be treated to make
the person feel better. Radiation may help to relieve symptoms such as
pain, trouble swallowing or breathing, or bowel problems that can be
caused by advanced cancer. This is often referred to as palliative radiation.
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Health: Types of Radiation Therapy (Cancer)
External-beam radiation therapy. The most widely used type of
radiation therapy delivers high-energy x-rays or electrons from a
machine external to, or outside of, your body. The machine most
commonly used is called a linear accelerator, or sometimes, a linac.
External-beam radiation therapy allows large areas of the body to be
treated, if required. Special software helps direct the beam to
effectively treat tumors while sparing the normal tissue surrounding
the cancer cells. The treatments occur at the hospital, but require
only short visits (approximately 30 minutes) and can be performed on an
outpatient basis. External-beam radiation therapy will not make you
radioactive health wise.
Three-dimensional conformal radiation therapy (3D-CRT). This new
treatment uses special computers to generate detailed three-dimensional
pictures of the cancer. More accurately aimed radiation allows higher
doses to be used, while reducing radiation damage to healthy tissue.
Studies have shown that 3D-CRT can result in decreased risk of
complications. The beneficial impact on survival has not been proven.
Proton beam therapy. This type of external-beam radiation
therapy makes use of protons rather than x-rays to treat certain
cancers. Protons are parts of atoms and possess enough energy to
destroy cancer cells when directed to a particular site of cancer in
the body. The proton's energy has only a very local effect, such that
normal cells in front of and behind the tumor are left mostly unharmed.
Although still new, treatment using protons promises to deliver more
radiation to the cancer, while reducing the damage to nearby, healthy
tissue. Because this therapy requires highly specialized equipment, it
is currently only available in a few medical centers.
Neutron beam therapy. Neutron beam therapy uses particles called
neutrons from the center of atoms. The effectiveness of neutron beam
therapy means that compared with conventional radiation therapy, less
than half the radiation sessions are required. This makes neutron beam
therapy especially useful with certain inoperable and fast-growing
brain tumors.
Stereotactic radiation therapy. Stereotactic radiation therapy
delivers a large, precise radiation dose to a small tumor area. Because
of the precision involved in this type of treatment, the patient must
remain extremely still. Head frames or individual body molds may be
made to keep the patient from moving. Although often performed as a
single treatment, fractionated radiation therapy, where patients
receive multiple treatments, may be necessary.
Internal radiation therapy. Also known as brachytherapy, which
means short-distance therapy, internal radiation therapy involves
placing radioactive material into the cancer itself or into tissue
surrounding it. These implants may be permanent or temporary (lasting
several minutes to a few days). Sealed devices containing the
radioactive sources can be in the form of thin wire or tubes, ribbons,
or capsules (seeds). Internal radiation therapy may require a hospital
stay. The sealed sources deliver most of the radiation around the area
of the implant, but some radiation can be emitted (sent) from your
body. Your whole body does not become radioactive, but certain
precautions should be taken to protect hospital staff and visitors from
radiation exposure.
Other treatment options
Intraoperative radiation therapy (IORT). Radiation therapy can
be delivered directly to the tumor during surgery, either as
external-beam radiation therapy or as internal radiation therapy. This
technique allows normal tissue to be moved out of the way by the
surgeon before radiation therapy occurs and is especially helpful when
vital, normal organs are dangerously close to the tumor.
Systemic radiation therapy. Systemic radiation therapy uses
radioactive materials, such as iodine 131 or strontium 89, that can be
taken by mouth or injected into your body and used to treat cancer of
the thyroid. These radioactive materials can leave the body through
saliva, sweat, and urine, making these fluids radioactive. Additional
safety measures must be used to protect people who come in close
contact with the patient (see Safety for the patient and family).
Radioimmunotherapy. Proteins called antibodies have been
discovered that can bind (stick) to some types of cancer cells while
not binding to normal body cells. Recent research makes use of such
antibodies by generating them in large quantities in the laboratory and
physically attaching radioactive molecules to them to produce
radiolabeled antibodies. When injected into the body, these
radiolabeled antibodies deliver doses of radiation directly to the
tumor. Because the original antibodies come from cells of the immune
system, this therapy is called radioimmunotherapy.
Radiosensitizers and radioprotectors. Researchers are studying
radio sensitizing and radioprotectant substances that help radiation
better destroy tumors or better protect normal tissues near the area
being treated.
Safety for the patient and family
Radiation comes from a source, but a person does not become radioactive
when receiving external-beam radiation therapy. The radiation remains
in the treatment room. However, if a source of radiation is implanted
inside you, as occurs with internal radiation therapy, a number of
safety measures are necessary.
While you are in the hospital and the implant is in place, women who
are pregnant and children younger than 18 should not visit. Other
visitors should sit at least 6 feet from your bed and limit their stay
to 30 minutes or less each day. Permanent implants remain radioactive
after a patient is discharged from the hospital, and he or she should
refrain from close (less than 6 feet) or lengthy (more than 5 minutes)
contact with women who are pregnant and children for two months.
If your treatment includes systemic (whole body) radiation therapy,
safety precautions must be followed for the first few days after
treatment. The health risk of radiation exposure to family and friends can be
minimized using the following precautions. Your health-care team will
provide specific instructions on:
- Personal hygiene following toilet use
- Use of separate utensils and towels
- The importance of drinking plenty of fluids to flush the remaining radioactive material from your body
- Avoiding sexual contact
- The necessity to minimize contact with infants, children, and women who are pregnant
Health: Cancer Treatment Side Effects
It is hard to limit the effects of treatment so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes unpleasant side effects.
The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment.
Also, each person reacts differently. Doctors try to plan the patient's therapy to keep side effects to a minimum
and they can help with any problems that occur.
Health: Radiation Therapy Side Effects (Cancer)
Diarrhea Effects:
Diarrhea is frequent bowel movements which may be soft, formed, loose, or watery. Diarrhea can occur at any time during radiation therapy. Radiation therapy to the pelvis, stomach, and abdomen can cause diarrhea. People get diarrhea because radiation harms the healthy cells in the large and small bowels. These areas are very sensitive to the amount of radiation needed to treat cancer.
Fatigue Effects:
Fatigue from radiation therapy can range from a mild to
an extreme feeling of being tired. Many people describe
fatigue as feeling weak, weary, worn out, heavy, or slow. Fatigue can happen for many reasons. These include:
- Anemia
- Anxiety
- Depression
- Infection
- Lack of activity
- Medicines
Fatigue can also come from the effort of going to radiation therapy each day or from stress. Most of the time, you will not know why you feel fatigue.
When you first feel fatigue depends on a few factors, which include your age, health, level of activity, and how you felt before radiation therapy started.
Fatigue can last from 6 weeks to 12 months after your last radiation therapy session. Some people may always feel fatigue and, even after radiation therapy is over, will not have as much energy as they did before.
Hair Loss Effects:
Hair loss (also called alopecia) is when some or all of your hair falls out.
Radiation therapy can cause hair loss because it damages cells that grow quickly, such as those in your hair roots.
Hair loss from radiation therapy only happens on the part of your body being treated. This is not the same as hair loss from chemotherapy, which happens all over your body. For instance, you may lose some or all of the hair on your head when you get radiation to your brain. But if you get radiation to your hip, you may lose pubic hair (between your legs) but not the hair on your head.
You may start losing hair in your treatment area 2 to 3 weeks after your first radiation therapy session. It takes about a week for all the hair in your treatment area to fall out. Your hair may grow back 3 to 6 months after treatment is over. Sometimes, though, the dose of radiation is so high that your hair never grows back.
Once your hair starts to grow back, it may not look or feel the way it did before. Your hair may be thinner, or curly instead of straight. Or it may be darker or lighter in color than it was before.
Mouth Changes Effects:
Radiation therapy to the head or neck can cause health problems such as:
- Mouth sores (little cuts or ulcers in your mouth)
- Dry mouth (also called xerostomia) and throat
- Loss of taste
- Tooth decay
- Changes in taste (such as a metallic taste when you eat meat)
- Infections of your gums, teeth, or tongue
- Jaw stiffness and bone changes
- Thick, rope-like saliva
Radiation therapy kills cancer cells and can also damage healthy cells such as those in the glands that make saliva and the soft, moist lining of your mouth. Some health problems, like mouth sores, may go away after treatment ends. Others, such as taste changes, may last for months or even years. Some health problems, like dry mouth, may never go away.
Nausea and Vomiting Effects:
Radiation therapy can cause nausea, vomiting, or both. Nausea is when you feel sick to your stomach and feel like you are going to throw up. Vomiting is when you throw up food and fluids. You may also have dry heaves, which happen when your body tries to vomit even though your stomach is empty.
Nausea and vomiting can occur after radiation therapy to the stomach, small intestine, colon, or parts of the brain. Your health risk for nausea and vomiting depends on how much radiation you are getting, how much of your body is in the treatment area, and whether you are also having chemotherapy.
Nausea and vomiting may occur 30 minutes to many hours after your radiation therapy session ends. You are likely to feel better on days that you do not have radiation therapy.
Sexual and Fertility Effects:
Health problems for women include:
- Pain or discomfort when having sex
- Vaginal itching, burning, dryness, or atrophy (when the muscles in the vagina become weak and the walls of the vagina become thin)
- Vaginal stenosis, when the vagina becomes less elastic, narrows, and gets shorter
- Symptoms of menopause for women not yet in menopause. These include hot flashes, vaginal dryness, and not having your period.
- Not being able to get pregnant after radiation therapy is over
- Impotence (also called erectile dysfunction or ED), which means not being able to have or keep an erection
- Not being able to get a woman pregnant after radiation therapy is over due to fewer or less effective sperm
After radiation therapy is over, most people want to have sex as much as they did before treatment. Many sexual side effects go away after treatment ends. But you may have health problems with hormone changes and fertility for the rest of your life. If you are able to get pregnant or father a child after you have finished radiation therapy, it should not affect the health of the baby.
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Skin Changes Effects:
Radiation therapy can cause skin changes in your treatment area. Here are some common skin changes:
- Redness. Your skin in the treatment area may look as if you have a mild to severe
sunburn or tan. This can occur on any part of your body where you are getting
radiation.
- Pruritus.The skin in your treatment area may itch so much that you always feel like
scratching. This causes problems because scratching too much can lead to skin breakdown and infection.
- Dry and peeling skin. This is when the skin in your treatment area gets very dry -
much drier than normal. In fact, your skin may be so dry that it peels like it does after
a sunburn.
- Moist reaction. Radiation kills skin cells in your treatment area, causing your skin to
peel off faster than it can grow back. When this happens, you can get sores or ulcers.
The skin in your treatment area can also become wet, sore, or infected. This is more
common where you have skin folds, such as your buttocks, behind your ears, under
your breasts. It may also occur where your skin is very thin, such as your neck.
- Swollen skin. The skin in your treatment area may be swollen and puffy.
Radiation therapy causes skin cells to break down and die. When people get radiation almost every day, their skin cells do not have enough time to grow back between treatments. Skin changes can happen on any part of the body that gets radiation.
Skin changes may start a few weeks after you begin radiation therapy. Many of these changes often go away a few weeks after treatment is over. But even after radiation therapy ends, you may still have skin changes. Your treated skin may always look darker and blotchy. It may feel very dry or thicker than before. And you may always burn quickly and be sensitive to the sun. You will always be at risk for skin cancer in the treatment area. Be sure to avoid tanning beds and protect yourself from the sun by wearing a hat, long sleeves, long pants, and sunscreen with an SPF of 30 or higher.
Throat Changes Effects:
Radiation therapy to the neck or chest can cause the lining of your throat to become inflamed and sore. This is called esophagitis You may feel as if you have a lump in your throat or burning in your chest or throat. You may also have trouble swallowing.
Radiation therapy to the neck or chest can cause throat changes because it not only kills cancer cells, but can also damage the healthy cells that line your throat. Your health risk for throat changes depends on how much radiation you are getting, whether you are also having chemotherapy, and whether you use tobacco and alcohol while you are getting radiation therapy.
You may notice throat changes 2 to 3 weeks after starting radiation. You will most likely feel better 4 to 6 weeks after radiation therapy has finished.
Urinary and Bladder Effects:
Radiation therapy can cause urinary and bladder problems, which can include:
- Burning or pain when you begin to urinate or after you empty your bladder
- Trouble starting to urinate
- Trouble emptying your bladder
- Frequent, urgent need to urinate
- Cystitis, a swelling (inflammation) in your urinary tract
- Incontinence, when you cannot control the flow of urine from your bladder, especially when coughing or sneezing
- Frequent need to get up during sleep to urinate
- Blood in your urine
- Bladder spasms, which are like painful muscle cramps
Urinary and bladder problems may occur when people get radiation therapy to the prostate or bladder. Radiation therapy can harm the healthy cells of the bladder wall and urinary tract, which can cause inflammation, ulcers, and infection.
Urinary and bladder problems often start 3 to 5 weeks after radiation therapy begins. Most problems go away 2 to 8 weeks after treatment is over.
Late Radiation Therapy Side Effects
Late side effects are those that first occur at least 6 months after radiation therapy is over. Late side effects are rare, but they do happen. It is important to have follow-up care with a radiation oncologist or health care provider for the rest of your life.
Whether you get late side effects will depend on:
- The part of your body that was treated
- The dose and length of your radiation therapy
- If you received chemotherapy before, during, or after radiation therapy
Your doctor or health care provider will talk with you about late side effects and discuss ways to help prevent them, symptoms to look for, and how to treat them if they occur.
Some late side effects are brain problems, infertility, joint problems, lymphedema, mouth problems, and secondary cancers.
Brain Effects:
Radiation therapy to the brain can cause problems months or years after treatment ends. Side effects can include memory loss, problems doing math, movement problems, incontinence, trouble thinking, or personality changes. Sometimes, dead tumor cells can form a mass in the brain, which is called radiation necrosis.
Infertility Effects:
For men, infertility means not being able to get a woman pregnant. For women, it means not being able to get pregnant.
Joint Effects:
Radiation therapy can cause scar tissue and weakness in the part of the body that was treated. This can lead to loss of motion in your joints, such as your jaw, shoulders, or hips. Joint problems can show up months or years after radiation therapy is over.
Lymphedema Effects:
Swelling in an arm or a leg caused by a build up of lymph fluid. Lymphedema can happen if your lymph nodes were removed during surgery or damaged by radiation therapy. Tell your doctor or health care provider, if you notice swelling in the arm or leg on the side where you had radiation.
Mouth Effects:
Radiation therapy to your head and neck can cause late side effects in your mouth. Problems may include dry mouth, cavities, or bone loss in the jaw.
Secondary Cancer:
Radiation therapy can cause a new cancer many years after you have finished treatment. This does not happen very often.
Surgery Side Effects
The side effects of surgery depend on the location of the tumor, the type of operation, the
patient's general health, and other factors. Although patients are often uncomfortable during the first few days
after surgery, this pain can be controlled with medicine. Patients should feel free to discuss pain relief with the
doctor or health care provider. It is also common for patients to feel tired or weak for a while. The length of time it takes to
recover from an operation varies for each patient.
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Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.
Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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