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Who is in charge of the patient’s radiation therapy? Who works with radiation oncologists? What happens before radiation treatment begins? What happens during treatment? How will a patient know the treatment has worked? How safe are radiation treatments? Will the patient be radioactive? |
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The cause of cancer lies deep within the building blocks of a person's cells (genes and DNA). If these blocks become disorganized, cancer may develop. Some forms of cancer may be inherited; they are passed down from parents to their children. For example, if a woman has close family members who have had breast cancer, she is more likely to get breast cancer. Some cancers are caused by outside factors. For example, anyone who smokes is more likely to get lung throat or mouth cancer. A tumor is a mass of abnormal cells. Tumors are either benign or malignant. Benign tumors usually grow very slowly and generally do not spread. Doctors can remove most of them. In the beginning, cancerous (malignant) tumors, usually stay in the organ where the cancer started. This is called localized disease. As cancers continue to grow, they are more likely to spread, or metastasize into the lymph nodes. This is called regional disease. When the cancer spreads beyond the nearby lymph nodes it is called distant disease. The more advanced the cancer (the more the cancer has spread) the more difficult it is to control or cure. Doctors usually cannot tell if a tumor is cancer until a biopsy test is done. A tiny piece of tissue is removed with a needle or by surgery. A special doctor called a pathologist studies the tissue under a microscope to see if it is cancer. Often, more tests are done on the tissue if it is cancer. These tests let the doctor know more about the cancer. This information guides treatment. The pathologist might "grade" cancer from one to four. Grade one tumors have cells that look very similar to normal cells. Grade four tumors have cells that look very different from normal cells. Higher grade tumors are more likely to grow and spread. Tumors also are "staged" to indicate the extent of the tumor. For example, tumors may be "called" stage one to stage four. The oncologist stagers a tumor based on the pathology report and other tests. Patients with the same stage and type of cancer have similar treatment in general, the higher the stage of cancer the more difficult it is to treat. There are hundreds of different types of cancer. They are identified by the type of body tissue involved or by the body part involved. The major classifications of cancer are:
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Cancer is usually treated by surgery, radiation therapy, or chemotherapy. Sometimes cancer specialists combine these treatments to provide the best patient care. Surgery: the tumor and some surrounding areas of normal tissue are removed during an operation; Radiation therapy: x-rays, other sources of gamma rays and radiation destroy the cancer cells; Chemotherapy or Hormonal therapy: medicine is taken by mouth or injected into a patient's vein. It travels through the body and works to destroy or stop the growth of cancer cells wherever they are within the body. Some chemotherapy also makes tumors sensitive to radiation. All cancer patients should talk with their doctor about their treatment options. Patients should ask their doctor about the goal of the treatment. Is it for cure? Is it for palliation (relief of symptoms caused by the cancer)? Treatment also might be adjuvant (to prevent or reduce the risk of cancer returning). |
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About 50 to 60 percent of cancer patients are treated with radiation at some time during their disease. Radiation therapy is a safe and effective treatment for patients of all ages, including children and the elderly. Radiation therapy is the careful use of high energy radiation by doctors called radiation oncologists to treat cancer. The radiation oncologist may use radiation to cure cancer or to relieve a patient's pain or other symptoms that are caused by cancer. This is called palliation. Radiation therapy works because the radiation destroys the cancer cells' ability to reproduce. The cancer cells that receive radiation can't make more cancer cells. The body naturally gets rid of these cells. A cancer patient may be treated with radiation alone. Prostate cancer, Cervix cancer, Skin cancer and larynx cancer are, often treated in this manner. Sometimes radiation therapy is only part of a patient's treatment. For example, a patient may have radiation therapy after surgery. The radiation therapy destroys many cancer cells that were left behind following surgery. This is called adjuvant treatment. Patients can be treated with radiation therapy and/or chemotherapy before surgery. This may allow a patient to have less radical surgery than would otherwise be required. For example, some bladder cancer patients can keep their bladder if they are treated with all three treatments rather than only one treatment. A radiation oncologist may use radiation from a source outside a patient's body (external beam radiation therapy). Radiation also may be given with radioactive sources that are put inside the patient (brachytherapy). |
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Who is in charge of the patient’s radiation therapy? RADIATION ONCOLOGISTS Radiation oncologists oversee, the care of each cancer patient. They develop and prescribe each cancer patient's treatment plan. They make sure that every treatment is accurately given. They monitor the patient's progress and adjust treatment to make sure patients get quality care throughout treatment. Radiation oncologists also help identify and treat any side effects of radiation therapy They work closely with other physicians, and all members of the radiation oncology team to make sure each patient is getting the best treatment. Each patient's treatment is personalized. Radiation oncologists are doctors who have completed four years or more of college, four years or more of medical school, one year of general medical or surgical training, then three to four years of residency (specialty) training in radiation oncology and additional speciality training. They have extensive training in the safe use of radiation to treat disease. If they pass a special examination they are certified by the American Board of Radiology. |
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Who works with Radiation Oncologists? (OTHER MEMBERS OF THE TREATMENT TEAM) Medical Radiation Physicists Medical physicists work directly with the doctor in the treatment planning and delivery. They oversee the work of the dosimetrist. Medical physicists are responsible for developing and directing quality control programs for equipment and procedures. They are responsible for making sure the equipment works properly. Medical radiation physicists take precise measurements of radiation beam characteristics and do other safety measurements on a regular basis. Medical physicists have doctorates or master's degrees. Qualified physicists have completed four years of college. They also have had two to four years of graduate school and typically one to two years of clinical physics training. They may be certified by the American Board of Radiology or the American Board of Medical Physics. Radiation Therapists (sometimes called radiation therapy technologists) Radiation therapists work with the radiation oncologists in treatment planning and treatment. They treat each patient under the physician's prescription and supervision. They maintain daily records and regularly check the treatment machines to make sure they are working properly. Radiation therapists go through a two-to-four year educational program following high school. They take a special examination, and can be certified by the American Registry of Radiologic Technologists. In addition, many states require that radiation therapy technologists be licensed. Dosimetrists Dosimetrists carefully calculate the dose of radiation to make sure the tumor gets enough radiation. They develop a number of treatment plans that can best destroy the tumor while sparing the normal tissues. They work with the doctor and the medical physicist to choose the treatment plan that is just right for each patient. Many dosimetrists start as radiation therapists then, with on-the-job training, become dosimetrists. Others are graduates of a one to-two-year dosimetry program following high school. The Medical Dosimetrist Certification Board certifies dosimetrists. Radiation OncoIogy Nurses Radiation therapy nurses help doctors educate each patient and his/her family about cancer and radiation treatment. They provide resources for emotional support to patients and their families. They also help with the examination of the patient, for example, taking the patient's blood pressure and weighing the patient assess the nutrition needs etc. These examinations might take place several times during treatment. They also help the doctor care for any side effects of treatment. Radiation therapy nurses have completed a registered nursing program, have passed a written examination and are licensed to practice professional nursing. Social Workers Social workers may be available to provide practical or emotional help to patients or members of their families. They may offer counseling for patients who have a hard time coping with their cancer. They also may help arrange for home health care and other services. Social workers may be licensed. Licensed social workers must have a master's degree. They also must pass an examination. Dietitians Dietitians work with patients to make sure they eat properly during treatment. Dietitians monitor patients' weight, etc. Dietitians may provide patients with recipes, vitamins, and nutritional supplements, etc. to improve their nutritional status. Dieticians attend four years of college then usually take part in a one-year internship. The American Dietetic Association registers dietitians who have passed a professional examination. Dietitians, nurses, social workers, etc. make up the radiation oncology support team. |
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What happens before radiation treatment begins? Patients visit other specialists before they see a radiation oncologist. They undergo medical tests to determine whether they have cancer and if so whether it has spread. Patients might talk with a surgeon, medical oncologist or radiation oncologist about their treatment choices. These doctors can work together to determine the best treatment for each cancer patient. Sometimes a patient needs to be treated by more than one kind of cancer specialist. For example, a patient might have surgery to remove the tumor (by a surgeon), then have radiation therapy to destroy any remaining cancer cells (by a radiation oncologist). The patient also might receive chemotherapy (by a medical oncologist). Sometimes cancer cases are discussed by tumor boards. Tumor boards are made up of cancer specialists. These cancer specialists listen to all the information about a specific cancer case. The information is usually presented by a patient's primary care physician. The cancer specialists then recommend the treatment program that might be best for the patient. CONSULTATION The patient's first visit to the radiation oncologist is for consultation. The radiation oncologist will review the results of the patient's previous medical tests, such as x-ray examinations and blood tests. The radiation oncologist will examine the patient. The doctor will then sit down with the patient and some times the patient's family. They talk about the patient's cancer. They discuss radiation therapy as a treatment option. The radiation oncologist then describes how radiation therapy works and the goal of the treatment. The goal of the treatment might be to cure the cancer or to relieve symptoms of the cancer. Side effects and treatment for any side effects also are discussed. The radiation oncologist answers any questions the patient might have. The radiation oncologist might order additional medical tests. Sometimes the radiation oncologist recommends that the patient see other cancer specialists too. TREATMENT PLANNING After radiation therapy is chosen as the right treatment option, treatment planning begins. The first step in treatment planning is simulation. The treatment team begins to map out the actual treatment. The radiation oncologist and the therapist place the patient in the position in which they will be treated. This is important because the patient will be in this position for each treatment. Sometimes molds, casts, headrests and other types of devices are used to keep the patient in the exact position. These devices are specially made. In some cases the radiation therapist marks the area to be treated directly on the patient's skin. At other times the radiation therapist marks the treatment area on the molds, casts, headrests or other devices that the patient will use during treatment. These "treatment aids" allow the radiation therapist to aim the radiation at the same spot during each treatment. If a patient's cancer is difficult to treat, more than one session of simulation may be needed. After simulation, the radiation oncologist considers the patient's type and size of tumor, the location of the tumor and organs nearby. The doctor reviews the information provided during simulation. The radiation oncologist decides if the patient should undergo external beam therapy, brachytherapy, or a combination of the two methods of treatment. The radiation oncologist and other members of the treatment team use information on the location and size of the tumor surrounding tissues and organs, and the patient's medical condition to develop a treatment plan that will provide the safest and most effective treatment. Often a special computed tomography (CT) scan is done to help with the treatment planning. Frequently a computer helps design the best possible treatment plan. Special blocks or shields might be made for a patient. The blocks or shields are put in the external beam therapy machine before each of the patient's treatments. The blocks or shields are used to focus the radiation to the tumor, sparing normal tissue. The doctor writes a prescription that outlines the course of treatment and completes the plan of action. This plan is done with all the patient's cancer doctors and primary care physicians. |
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What happens during treatment? EXTERNAL BEAM THERAPY - (Radiation from a machine) Most patients undergo external beam radiation treatment. Each external beam treatment is painless. The radiation comes from an outside source. It is directed to the cancer inside the patient. A radiation oncologist uses linear accelerators, cobalt machines or orthovoltage x-ray machines for external beam therapy. These machines produce ionizing radiation, such as x-rays, gamma rays, and electron beams, which destroy cancer cells. The machines produce different, types of radiation that can destroy tumors at different sites within the body. The radiation oncologist will choose which machine is best suited to treat each patient. The patient usually receives external beam therapy four or five times a week. It takes several minutes for each patient to be positioned for treatment. The treatment itself only takes a few minutes. Sometimes a patient is treated twice a day. Rarely, the patient is treated only once or twice a week. An entire course of treatment usually lasts from one to seven weeks depending on the type of cancer and the goal of treatment (cure, adjuvant or palliation). The treatment team carefully aims the radiation to spare as much as possible the normal tissues surrounding the tumor. Still, radiation may affect some healthy cells. Patients are treated with multiple small doses of radiation with time in between treatments so their healthy cells can repair much of the radiation damage. Generally, radiation is directed to the tumor and the surrounding area. This destroys the main tumor and any nearby tumor spread. Higher total doses of radiation are needed to destroy the main tumor. Lower doses are given to destroy the, spread of the tumor. This helps to protect normal tissues. The radiation therapist gives external beam treatment following the radiation oncologist's instructions. The therapist is not in the treatment room with the patient but. closely monitors the, patient on a television screen. There is a microphone in the treatment room. The patient can always talk with the therapist and the therapist can communicate with the patient . During the treatment, the, patient lies very still on a treatment table. The patient can breathe normally during treatment. The radiation therapist is able to move the treatment machine and treatment table. This way the radiation beam can be targeted to the exact area of the tumor. The machine and treatment table may rotate up to 360 degrees if the radiation oncologist wants the radiation to hit the tumor from all angles. The machine also might make noises during treatment. Each treatment generally lasts only a few minutes. Even though the machine on time can vary from day to day, the radiation dose stays the same unless the radiation oncologist changes it. Most patients do not need to stay in the hospital while they are having external beam therapy. Patients do not see or feel the actual treatment. They can go home following each treatment. Most can continue with normal daily activities. Some patients may need other medical help or services. These patients may need to stay in the hospital, nursing home or a rehabilitation center. Periodically, the doctor may order blood tests, x-ray examinations and other tests to see how the patient is tolerating treatment. On a regular basis, the radiation oncologist examines and talks with the patient. Other members of the treatment team the radiation therapist, the radiation oncology nurse, the dietician and possibly others also regularly monitor the patient's progress. When the tumor shrinks, another simulation may be, done. This allows the radiation oncologist to change the treatment so it destroys the rest of the tumor and spares even more normal tissues. On occasion, x-rays are taken of patients while they are being treated. These x-rays or port films show the radiation oncologist and other members of the treatment team if the treatment is going as planned or needs to be adjusted. BRACHYTHERAPY - (Radiation from radioactive sources put inside patient) Brachytherapy is a technique that puts the radiation sources as close as possible to the tumor site. Sometimes they are put right into the tumor. The radioactive sources or isotopes are in the form of wires, seeds or rods. They are usually cesium, iridium or iodine . This technique is particularly useful in treating cancers of the cervix, uterus, vagina, rectum, eye and certain head and neck cancers. It also is used to treat breast, brain, skin, anal, esophageal, lung, bladder and prostate cancer. There are two types of brachytherapy: intracavitary treatment and interstitial treatment. In intracavitary treatment, containers that hold radioactive sources are put in or near the tumor. The sources are put into body cavities such as the vagina, uterus or windpipe. In interstitial treatment the radioactive sources alone are put into the tumor. These radioactive sources may stay in the patient permanently. These patients can continue with their normal activities. Some prostate cancer patients may undergo this type of treatment. More often, the radioactive sources are removed from the patient after several days. The radioactive sources are in containers. Patients may be put under general anesthesia during insertion of brachytherapy sources. Since the sources inside the patient are radioactive, special precautions are necessary. While the sources are in place, the patient stays in a special hospital room, away from other patients. Doctors, nurses and other medical staff will continue to take care of these patients while they are in the special hospital room. Devices called high dose rate afterloading machines allow the radiation oncologist to complete the brachytherapy quickly when this is appropriate. The radiation oncologist may put in and take out the radioactive sources on the same day or soon thereafter. The patient may go home shortly after the procedure. Sometimes brachytherapy is done in conjunction with external beam therapy. The external beam radiation destroys cancerous cells in a large, area surrounding the, tumor. Brachytherapy delivers a boost, or higher dose of radiation, and over a shorter period of time to help destroy the main mass of tumor cells. |
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How will a patient know the treatment has worked? After patients finish radiation treatments they talk with the doctor, are, examined by the, doctor and have several medical tests. These tests show the doctor if the tumor has gone away. If the tumor has gone away it means the cancer has "completely responded" to the treatment. However, cancer isn't considered "cured" for several years after treatment ends. Sometimes radiation therapy is given to relieve a cancer patient's symptoms. The symptoms may end while the radiation therapy is given. Even if the symptoms end, the radiation therapy continues to help make sure the symptoms don't return. Sometimes the symptoms don't go away until after all the radiation treatments are completed. |
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How safe are radiation treatments? The radiation oncologist tailors each patient's treatment to make sure it is safe and effective. The treatment plan is checked and re-checked before any actual treatment begins. Sophisticated treatment machines double-check to make sure that the proper treatment is given. This system is called "record and verify" system that helps to monitor accuracy and quality of care. The entire treatment team is responsible for making sure the daily treatment provides the patient with the best quality care. In addition, states and the federal government, have regulations and standards to ensure the safety of cancer patients treated with external beam therapy or brachytherapy. The American Society for Therapeutic Radiology and Oncology and other cancer specialty organizations also have guidelines designed to provide the best patient, care. |
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The radiation oncologist is the best person to advise the patient on whether or what side effects will occur. Side effects usually begin by the middle or end of the treatment program. The side effects might last for a short time after the final radiation treatment. Side effects usually depend on what part of, the body is being treated. They usually only happen in the area of treatment. For example, a woman's breast may darken if she is being treated for breast cancer. A man being treated for lung cancer may have soreness when he swallows. These side effects are usually temporary and easily treated by the doctor or other members of the treatment team. Fatigue is a common side effect of radiation therapy. This is not usually very severe, and patients can often continue their normal daily activities. Patients should talk with their doctor about any symptoms they are having. The doctor can give the patient information or prescribe medicines that can help relieve some side effects caused by the radiation therapy. In rare instances, serious delayed side effects might occur. These are uncommon and the radiation oncologist will explain them to the patient during consultation. The radiation oncologist should be contacted if a patient has any questions or concerns about their treatment. The radiation oncologist plays an important role in the follow-up care of all their cancer patients. |
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Will the patient be radioactive? Patients who undergo external beam radiation treatment are not radioactive. In brachytherapy the sources are radioactive. Family and friends of a brachytherapy patient must take special care if they visit while the radioactive sources are in place. If the radioactive sources are, to be left in permanently the radiation oncologist will advise the patient and family about the levels of and any special significance of the radiation exposure and as well as special precautions to be taken and for how long the precautions are to be followed. Patients should talk to their radiation oncologist about any questions they might, have about this. |
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Can radiation therapy cause another cancer? Patients who have one cancer have an increased risk of having a second cancer later. It does not matter how their first tumor was treated. The risk of developing a second tumor because of radiation therapy is very low. Radiation therapy can cure a patient's cancer in certain sites particularly when detected early. This benefit far outweighs any very small risk that the treatment will cause a later cancer. |
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Radiation oncologists, physicists and others continue to explore new ways to treat the cancer patient effectively with radiation and radioactive sources. The practice of radiation oncology continues to grow and change. Cancer specialists are conducting studies now to determine what treatment is best for each cancer patient. These studies are called "clinical trials" or "treatment protocols." Most large clinical trials compare standard treatment to a treatment that cancer experts think might be better. All patients who participate in clinical trials are carefully monitored to make sure they are getting quality care. Cancer patients should talk to their doctor about clinical trials before they choose treatment. Today's standard treatments are a result of studies that were done years ago. |
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What else is being done in radiation therapy? Radiosurgery is now being investigated. This new technique allows the radiation oncologist to focus precisely several beams of radiation to destroy tumors in the brain. Since the beam is so precise, the radiation oncologist can focus the treatment and spare more normal brain cells than is possible with conventional external beam radiation. Systemic radiation therapy is the use of unsealed radiation sources (liquid form usually) to treat certain cancers. The radioactive sources may be taken by mouth; the doctor might inject them into a patient's body cavity or they may be given to a patient intravenously. For example, radioactive iodine (I-131) capsules are given to patients to cure their thyroid cancer. Researchers are investigating the possibility of injecting the radioisotopes directly into a patient’s tumor. Injected radioactive sources can often treat or prevent pain due to cancer that has spread to the bone. For example, strontium-89 or samarium hare been shown to be effective in treating bone pain caused by advanced prostate, breast, and other cancers. Research also is underway using radiolabeled antibodies. Some antibodies can search out and identify tumors. These antibodies are made radioactive then the radiation oncologist injects them into a patient. The radioactive antibodies search out, the tumor cells and kill them. This technique is called radio - immunotherapy. Hyperthermia is the use of heat. Heat appears to make some tumors more susceptible to the effects of radiation and/or chemotherapy. Heat can be applied on the surface, directly into the tumor, to a body region, or to the whole body. Some drugs are being researched as a means to make the tumor more sensitive to radiation. It is hoped that these radiosensitizers will help the radiation better destroy the tumor. Some drugs are being researched as a way to better protect the normal tissues near the area being treated. These are called radiation protectors. Doctors also are investigating intra-operative radiotherapy (radiation treatment given, in the operating room). This technique is helpful when vital normal organs overlie the area of the tumor, thus limiting the total radiation dose that can be delivered to the tumor. During an operation, a surgeon temporarily moves the, normal organs out of the way so radiation can be applied directly to the tumor. Conformal Radiation Therapy is a new technique that allows the radiation oncologist to "conform" or shape the radiation treatments to the tumor. The technique allows the doctor to treat the tumor from different angles. It is designed to reduce the radiation dose to normal tissues as much as possible. Radiations produced by linear accelerators or cobalt units are the main treatment tools for radiation oncologists. There are other forms of radiation available in a few areas of the country. Neutrons and particles such as protons require extensive technology and equipment. Neutron beam treatment can be used to treat advanced prostate, and salivary glands with excellent results. Proton beam therapy can selectively be used for uncommon tumors, around the eye and spinal tumor. It also can be used to treat cancers like advanced prostate cancer. Radiation has been used to treat cancer for about 100 years. During that period, it has been shown to be one of the best ways to fight many kinds of cancer. Many advances have been made to make the treatment safe and more effective. Radiation therapy has saved countless lives and has improved the quality of life for many other cancer patients. If you are uncertain about anything you have read, please ask your doctor. We want you to understand as fully as possible what radiation therapy is, and how it may help you. |
| Address: Department of Radiation Medicine, Zalmen A. Arlin Cancer Institute, Westchester Medical Center, 95 Grasslands Road, Valhalla, NY 10595, Phone: 914-493-8561, Email: info@cancerdocs-radiation.com |