Radiation is a special kind of energy carried by waves or a stream of particles. It can come from special machines or from radioactive substances. When radiation is used at high doses (many times those used for x-ray exams), it can be used to treat cancer and other illnesses. Special equipment is used to aim the radiation at tumors or areas of the body where there is disease. The use of high energy rays or particles to treat disease is called radiation therapy. Sometimes it's called radiotherapy, x-ray therapy, cobalt therapy, electron beam therapy, or irradiation.
High doses of radiation can kill cells or keep them from growing and dividing. Radiation therapy is a useful tool for treating cancer because cancer cells grow and divide more rapidly than many of the normal cells around them. Although some normal cells are affected by radiation, most normal cells appear to recover more fully from the effects of radiation than do cancer cells. Doctors carefully limit the intensity of treatments and the area being treated so that the cancer will be affected more than normal tissue.
Radiation therapy is an effective way to treat many kinds of cancer in almost any part of the body. Half of all people with cancer are treated with radiation, and the number of cancer patients who have been cured is rising every day. For many patients, radiation is the only kind of treatment needed. Thousands of people are free of cancer after having radiation treatments alone or in combination with surgery, chemotherapy, or biological therapy.
Doctors can use radiation before surgery to shrink a tumor. After surgery, radiation therapy may be used to stop the growth of any cancer cells that remain. Your doctor may choose to use radiation therapy and surgery at the same time. This procedure is known as intraoperative radiation. In some cases, doctors use radiation along with anticancer drugs to destroy the cancer, instead of surgery.
Even when curing the cancer is not possible, radiation therapy still can bring relief. Many patients find the quality of their lives improved when radiation therapy is used to shrink tumors and reduce pressure, bleeding, pain, or other symptoms of cancer. This is called palliative care.
Like many other treatments for disease, there are risks for patients who are receiving radiation therapy. The brief high doses of radiation that damage or destroy cancer cells also can hurt normal cells. When this happens, the patient has side effects. The risk of side effects is usually less than the benefits of killing cancer cells.
Your doctor will not advise you to have any treatment unless the benefits -control of disease and relief from symptoms -are greater than the known risks. Although it will be many years before scientists know all of the possible risks of radiation therapy, they now know that it can control cancer.
A doctor who has had special training in using radiation to treat disease -a radiation oncologist- will prescribe the type and amount of treatment that best suits your needs. The radiation oncologist is the person referred to as "your doctor" throughout this booklet.
The radiation oncologist works closely with other doctors involved in your care and also heads a highly trained health care team. Your radiation therapy team may include:
- The radiation physicist, who makes sure that the equipment is working properly and ensures that the machines deliver the right dose of radiation.
- The dosimetrist, who helps carry out your treatment plan by calculating the number of treatments and how long each treatment should last.
- The radiation therapy nurse, who provides nursing care and helps you learn about treatment and how to manage side effects.
- The radiation therapist, who sets you up for your treatments and runs the equipment that delivers the radiation.
You also may use the services of a dietitian, a physical therapist, a social worker, and other health care professionals.
Treatment of cancer with radiation can be costly. It requires very complex equipment and the services of many health care professionals. The exact cost of your radiation therapy will depend on the type and number of treatments you need.
Most health insurance policies, including Part B of Medicare, cover charges for radiation therapy.
In some states, the Medicaid program may help you pay for treatments. You can find out from the office that handles social services in your city or county whether you are eligible for Medicaid and whether your radiation therapy is a covered expense.
If you need financial aid, contact the hospital social service office, the Cancer Information Service, or the local office of the American Cancer Society. They may be able to direct you to sources of help.
The radiation used in radiation therapy can come from a variety of sources. Your doctor may choose to use x-rays, an electron beam, or cobalt-60 gamma rays. Choosing which type of radiation to use depends on what type of cancer you have and on how deep into your body the doctor wants the radiation to penetrate. High-energy radiation is used to treat many types of cancer. Low-energy x-rays are used to treat some kinds of skin diseases.
After a physical exam and a review of your medical history, the radiation oncologist may need to do some special planning to pinpoint the treatment area. In a process called simulation, you will be asked to lie very still on a table while the radiation therapist uses a special x-ray machine to define your treatment port or field. This is the exact place on your body where the treatment will be aimed. You may have more than one treatment port. Simulation may take from a half hour to about 2 hours.
The radiation therapist often will mark the treatment port on your skin with tiny dots of colored, semipermanent ink to outline the treatment area. Be careful when you bathe because the marks must not be washed off until all of your treatment is over. If they start to fade, tell the therapist who will darken them so that they can be seen easily. Do not try to draw over faded lines at home unless they will be completely gone before your next visit. If you do replace the marks, be sure to tell the therapist at your next visit.
Using the information from the simulation, other tests, and your medical background, your doctor will meet with the radiation physicist and the dosimetrist.
Your doctor then decides how much radiation is needed, how it will be delivered, and how many treatments you should have. This process often takes several days.
After you have started the treatments, your doctor will follow your progress, checking your response to treatment and your overall well-being at least once a week. The treatment plan may be revised by your doctor, if needed. It's very important that you have all of your scheduled treatments to get the most benefit from your therapy. Unnecessary delays can lessen the effectiveness of your radiation treatment.
Radiation therapy usually is given 5 days a week for 6 or 7 weeks. When radiation is used for palliative care, the course of treatment lasts for 2 to 3 weeks. These types of schedules, which use small amounts of daily radiation, rather than a few large doses, help protect normal body tissues in the treatment area. Weekend rest breaks allow normal cells to recover. The total dose of radiation and the number of treatments you need will depend on the size and location of your cancer, type of tumor, your general health, and any other treatments you're receiving.
Before your treatment is given, you may need to change into a hospital gown or robe. It's best to wear clothing that is easy to take off and put on again.
In the treatment room, the radiation therapist will use the marks on your skin to locate the treatment area. You will sit in a special chair or lie down on a treatment table. For each external radiation therapy session, you will be in the treatment room about 15 to 30 minutes, but you will be getting your dose of radiation for only about I to 5 minutes of that time. Receiving external radiation treatments is painless, just like having an x-ray taken.
The radiation therapist may put special shields (or blocks) between the machine and certain parts of your body to help protect normal tissues and organs. There might also be plastic or plaster forms to help you stay in exactly the right place. You will need to remain very still during the treatment so that the radiation reaches only the area where it's needed and the same area is treated each time. You don't have to hold your breath just breathe normally.
The radiation therapist will leave the treatment room before the machine is turned on. The machine is controlled from a small area that is nearby. You will be watched on a television screen or through a window in the control room. Although you may feel alone, keep in mind that you can be seen and heard at all times by the therapist who can talk with you through a speaker.
The machines used for radiation treatments are very large, and they make noises as they move around to aim at the treatment area from different angles. Their size and motion may be frightening at first. Remember that the machines are being moved and controlled by your radiation therapist. They are checked constantly to be sure they're working right. If you are concerned about anything that happens in the treatment room, ask your therapist to explain.
You will not see or hear the radiation, and, most likely, you won't feel anything. If you do feel ill or very uncomfortable during the treatment, tell your therapist at once. The machine can be stopped at any time.
External radiation therapy does not cause your body to become radioactive. There is no need to avoid being with other people because of your treatment. Even hugging, kissing, or having sexual relations with others poses no risk to them of radiation exposure.
Side effects of radiation therapy most often are related to the area that is being treated. Your doctor and nurse will tell you about the possible side effects and how you should deal with them. You should contact your doctor or nurse if you have any unusual symptoms during your treatment, such as coughing, sweating, fever, or unusual pain. Most side effects that occur during radiation therapy, although unpleasant, are not serious and can be controlled with medication or diet. They usually go away within a few weeks after treatment ends. However, some side effects can last longer. Many patients have no side effects at all.
Throughout your treatment, your radiation oncologist will regularly check on the effects of the treatment. You may not be aware of changes in the cancer, but you probably will notice decreases in pain, bleeding, or other discomforts you may have had, especially after your treatment is completed. You may continue to notice more improvements with time. Your doctor probably will recommend some tests to be sure that the radiation is causing as little damage to normal cells as possible. You may have routine blood tests to check the levels of white blood cells and platelets, which may be lower than normal during treatment.
Each patient's body responds to radiation therapy in its own way. That's why the doctor must plan, and sometimes adjust, your treatment just for you. In addition, your doctor or nurse will give you advice for caring for yourself at home that is specific for your treatment and the side effects that might result.
Nearly all cancer patients receiving radiation therapy need to take special care of themselves to protect their health and help the treatment succeed. Some guidelines to remember are given below:
- Be sure to get plenty of rest. Sleep as often as you feel the need. Your body will use a lot of extra energy over the course of your treatment, and you may feel very tired. In fact, fatigue may last for 4 to 6 weeks after your treatment is finished.
- Good nutrition is a must. Try to eat a balanced diet that will prevent weight loss. For patients who have problems with eating or diet planning, the section titled "Managing Side Effects" offers practical tips.
- Avoid wearing tight clothes such as girdles or close fitting collars over the treatment area. It's best to wear older garments that feel comfortable and that you can wash or throw away if the ink marks rub off on them.
- Be extra kind to the skin in the treatment area:
- Do not use any soaps, lotions, deodorants, medicines, perfumes, cosmetics, talcum powder, or other substances in the treated area without talking with your doctor.
- Wear loose, soft cotton clothing over the treated area.
- Do not starch your clothes.
- Do not rub or scrub treated skin.
- Do not use adhesive tape on treated skin. If bandaging is necessary, use paper tape. Try to apply the tape outside of the treatment area.
- Do not apply heat or cold (heating pad, ice pack, etc.) to the treatment area. Even hot water can hurt your skin, so use only lukewarm water for bathing the treated area.
- Use an electric shaver if you must shave the area -but only after checking with your doctor or nurse.
- Do not use a preshave lotion or hair remover products.
- Protect the area from the sun. If possible, cover treated skin (with light clothing) before going outside. Ask your doctor if you should use a lotion that contains a sunblock. If so, use a PABA sunscreen or a sunblocking product with a protection factor of at least 15. Reapply the sunscreen often, even after your skin has healed following your treatment. Continue to protect your skin from sunlight for at least 1 year after radiation therapy.
- Be sure your doctor knows about any medicines you are taking before starting treatment. If you need to start taking any medicines, even aspirin, let your doctor know before you start.
- Ask your doctor, nurse, or radiation therapist any questions you have. They are the only ones who can properly advise you about your treatment, side effects, at-home care, and any other medical concerns you may have.
Your doctor may decide that very intense radiation given to a small area of your body is the best way to treat your cancer. Internal radiation therapy places the source of the high-energy rays as close as possible to the cancer cells so that fewer normal cells are exposed to radiation. By using internal radiation therapy, the doctor can give a higher total dose of radiation in a shorter time than is possible with external treatment. Instead of using a large radiation machine, the radioactive material is placed directly into (or as close as possible to) the affected area. Some of the radioactive substances used for internal radiation treatment include radium, cesium, iridium, iodine, phosphorus, and palladium.
Internal radiation therapy often is used for cancers of the head and neck, breast, uterus, thyroid, cervix, and prostate. Your doctor may recommend a combination of internal and external radiation therapy.
Implant radiation as described in this material means internal radiation treatment. You also may hear the terms interstitial radiation, intracavitary radiation, or brachytherapy; each is a form of internal radiation therapy. Some people use the term "brachytherapy" whenever they are talking about any form of internal radiation therapy.
When interstitial radiation is given, the radiation source is placed right in the affected tissue, usually in small tubes or containers. These implants may be temporary or permanent. When intracavitary radiation is used, a container of radioactive material is placed in a cavity of the body such as the uterus. In brachytherapy, the radioactive source, which is sealed in a small container, is placed on the surface of the body near the tumor or a short distance from the affected area. The radioactive source also may be delivered to the tumor through tubes; this is called remote brachytherapy. Internal radiation also may be given by injecting a solution of radioactive substance into the bloodstream or a body cavity. When the substance is injected, it is not sealed in a container and may be called unsealed internal radiation therapy.
For most types of implants, you will need to be in the hospital and have general or local anesthesia while the doctor places the container for the radioactive material in your body. In many hospitals, the radioactive material is placed in the container after you return to your room so that others are not exposed to radiation.
To get the radiation as close as possible to the cancer, doctors may use implants of radioactive material sealed in wires, seeds, capsules, or needles. The type of implant and the method of placing it depend on the size and location of the cancer. Implants may be put right into the tumor, in special applicators inside a body cavity, on the surface of a tumor, or in the area from which the tumor has been taken.
The radioactive substance in your implant may transmit rays outside your body. While you're receiving implant therapy, the hospital may require you to stay in a private room. Although the nurses and other people caring for you will not be able to spend a long time in your room, they will give you all of the care you need. You should call for a nurse when you need one, but keep in mind that the nurse will work quickly and speak to you from the doorway more often than from your bedside. In most cases, your urine and stool will contain no radioactivity. However, either one may contain some radioactive material if you have unsealed internal radiation therapy.
There also will be limits on visitors while your implant is in place. Most hospitals do not let children younger than 18 or pregnant women visit patients who have an implant. Visitors should sit at least 6 feet from your bed and stay for only a short time each day (10 to 30 minutes). Have visitors ask your nurse for specific instructions before they enter your room.
You are not likely to have severe pain or feel ill during implant therapy. However, if an applicator is holding your implant in place, it may be somewhat uncomfortable. If you need it, the doctor will order medicine to help you relax or to relieve pain. Some patients feel drowsy, weak, or nauseated after having the anesthesia to place the implant, but these effects do not last long.
Be sure to tell the nurse if you have any side effects such as burning, sweating, or other unusual symptoms.
The total amount of time that an implant is left in place depends on the dose (amount) of radioactivity with which the patient is treated. The implant may be low dose rate and left in place for several days, or it may be high dose rate and removed after a few minutes. Generally, low dose rate implants are left in place from 1 to 7 days. Your treatment schedule will depend on the type of cancer, where it is, your general health, and other cancer treatments you have had. Depending on where the implant is placed, you may have to stay in bed and lie fairly still to keep the implant from shifting.
For some cancer sites, the implant may be left in place permanently. If your implant is permanent, you may need to stay in your room away from other people in the hospital for a few days while the radiation is most active. The implant will lose energy each day, so by the time you are ready to go home, the radiation in your body will be much weaker. Your doctor will advise you if there are any special precautions you need to use at home.
High dose rate remote brachytherapy allows a person to be treated within a few minutes in inpatient or outpatient clinics. With remote brachytherapy, a very powerful radioactive source travels by remote control through tubes, or catheters, to the tumor. The radioactivity remains at the tumor for only a few minutes. This procedure is done by the brachytherapy team, who will watch you on a closed-circuit television. They will talk to you through an intercom. In some cases, several remote treatments may be required. Sometimes, the catheter stays in place between treatments and sometimes it is removed, depending on your condition.
High dose rate treatments are short (usually a few minutes) and result in less discomfort than other types of radiation therapy. Because radioactive materials are not left in your body, you can return home soon after you recover. Remote brachytherapy has been used to treat cancers of the cervix, breast, lung, pancreas, prostate, and esophagus.
Usually there is no need to have an anesthetic to take out the implant. Most can be taken out right in the patient's hospital room. If you had to stay in bed during implant therapy, you might have to remain in the hospital an extra day or so after the implant is removed. Once the implant is removed, there is no radioactivity in your body. The nurses and your visitors no longer will have to observe any special rules.
Your doctor will tell you if you should limit your activities after leaving the hospital. Most patients are allowed to do as much as they feel like doing. You may need some extra sleep or rest breaks during your first days at home, but you will feel stronger quickly.
The area that has been treated with an implant may be sore or sensitive for some time after therapy. Your doctor may advise you to limit sports and sexual activity for a while if they cause irritation in the treatment area.
The side effects of radiation treatment vary from patient to patient. You may have no side effects or only a few mild ones through your course of treatment. Or you may have more serious side effects. The side effects that you have depend mostly on the treatment dose and the part of your body that is treated. Your general health also can affect how your body reacts to radiation therapy and whether you have side effects. Before beginning your treatment, ask your doctor and nurse about the side effects you might experience, how long they might last, and how serious they might be.
There are two main types of side effects: acute and chronic. Acute, or short-term, side effects occur close to the time of the treatment and usually are gone completely within a few weeks of finishing therapy. Chronic, or long-term, side effects may take months or years to develop and usually are permanent.
The most common side effects are fatigue, skin changes, and loss of appetite. They can result from radiation to any treatment site. Other side effects are related to treatment of specific areas. For example, temporary or permanent hair loss may be a side effect of radiation treatment to the head. Fortunately, most side effects will go away in time. In the meantime, there are ways to reduce the discomfort they cause. If you have a side effect that is particularly severe, the doctor may prescribe a break in your treatments or change the kind of treatment you're receiving. Be sure to tell your doctor, nurse, or radiation therapist about any side effects that you notice. They can help you treat the problems and tell you how to lessen the chances that the side effects will come back.
Not necessarily. It will depend on what side effects you have and how severe they are. Many patients are able to go to work, keep house, and enjoy leisure activities while they are receiving radiation therapy. Others find that they need more rest than usual and therefore cannot do as much. You should try to do the things you enjoy as long as you don't become too tired.
Your doctor may suggest that you limit activities that might irritate the area being treated. In most cases, you can have sexual relations if you wish. Your desire for physical intimacy may be lower because radiation therapy may cause you to feel more tired than usual.
During radiation therapy, the body uses a lot of energy healing itself. Stress related to your illness, daily trips for treatment, and the effects of radiation on normal cells all may contribute to fatigue. Most people begin to feel tired after a few weeks of radiation therapy. Feelings of weakness or weariness will go away gradually after your treatment is finished.
You can help yourself during radiation therapy by not trying to do too much. If you feel tired, limit your activities and use your leisure time in a restful way. Do not feel that you have to do all the things you normally do. Try to get more sleep at night, and rest during the day if you can.
If you have been working a full-time job, you may want to continue. Although treatment visits are time consuming, you can ask your doctor's office or the radiation therapy department to help by trying to schedule treatments with your workday in mind.
Some patients prefer to take a few weeks off from work while they're receiving radiation therapy; others work a reduced number of hours. You may want to speak frankly with your employer about your needs and wishes during this time. You may be able to agree on a part-time schedule, or perhaps you can do some work at home.
Whether you're going to work or not, it's a good idea to ask family members or friends to help with daily chores, shopping, child care, housework, or driving. Neighbors may be able to help by picking up groceries for you when they do their own shopping. You also could ask someone to drive you to and from your treatment visits to help conserve your energy.
You may notice that your skin in the treatment area may begin to look reddened, irritated, sunburned, or tanned. After a few weeks you may have very dry skin from the therapy. Ask your doctor or nurse for advice on relieving itching or discomfort. With some kinds of radiation therapy, treated skin may develop a "moist reaction," especially in areas where there are skin folds. When this happens, the skin is wet and it may become very sore. It's important to notify your doctor or nurse if your skin develops a moist reaction. They can give you some suggestions on how you can keep these areas dry.
During radiation therapy you will need to be very gentle with the skin in the treatment area. Avoid irritating treated skin. When you wash, use only lukewarm water and mild soap. Don't wear tight clothing over the area. It's important not to rub, scrub, or scratch any sensitive spots. Also avoid putting anything that is very hot or very cold, such as heating pads or ice packs, on your treated skin. Don't use any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you're being treated or for several weeks afterward (unless approved by your doctor or nurse). Many skin products can leave a coating on the skin that can interfere with radiation therapy or healing.
Avoid exposing the area to the sun during treatment and for at least I year after your treatment is completed. If you expect to be in the sun for more than a few minutes you will need to be very careful. Wear protective clothing (such as a hat with a broad brim and a shirt with long sleeves) and use a sunscreen. Ask your doctor or nurse about using sunblocking lotions.
The majority of skin reactions to radiation therapy should go away a few weeks after treatment is finished. In some cases, though, the treated skin will remain darker than it was before.
Radiation therapy can cause hair loss, also known as alopecia, but only in the area being treated. For example, if you are receiving treatment to your hip, you will not lose the hair from your head. However, radiation to your head may cause you to lose some or all of the hair on your scalp. Many patients find that their hair grows back again after the treatments are finished, but accepting the loss of hair -whether from scalp, face, or body - can be a hard adjustment. The amount of hair that grows back will depend on how much radiation you receive and the type of radiation treatment your doctor recommends. Other types of treatment, such as chemotherapy, also can affect how your hair grows back. For example, if your radiation therapy is for palliative care, your hair probably will grow back slowly. However, if the goal of your radiation therapy is to cure rather than to relieve the symptoms of your cancer, then your hair may not grow back, and if it does, it probably will be very fine.
Although your scalp may be tender after the hair is lost, you may want to cover your head with a hat, turban, or scarf while you're in treatment. Also, you should wear a protective cap or scarf when you're in the sun. If you prefer a wig or toupee, be sure the lining does not irritate your scalp. A hairpiece that you need because of cancer treatment is a tax-deductible expense and may be covered in part by your health insurance. If you plan to buy a wig, it's a good idea to select it early in your treatment so that you can match the color and style to your own hair.
Sometimes radiation therapy can cause low white blood cell counts or low levels of platelets. These blood cells help your body fight infection and prevent bleeding. If your blood tests show this side effect, your treatment might be delayed for about a week to allow your blood counts to increase.
Many side effects can cause problems with eating and digesting food, but you always should try to eat enough to help damaged tissues rebuild themselves. It's very important not to lose weight during radiation therapy. Try to eat small meals often and eat a variety of different foods. Your doctor or nurse can tell you whether your treatment calls for a special diet and a dietitian will have a lot of ideas to help you maintain your weight.
If you have pain when you chew and swallow, your doctor may advise you to use a powdered or liquid diet supplement. Many of these products, available at the drugstore without prescription, are made in a variety of flavors. They are tasty when used alone, or they can be combined with other foods, such as pureed fruit, or added to milkshakes. Some of the companies that make diet supplements have produced recipe booklets to help you increase your nutrient intake. Ask your dietitian or pharmacist for further information.
You may lose interest in food during your treatment. Loss of appetite can happen when changes occur in normal cells. Some people just don't feel like eating because of stress from their illness and treatment or because the treatment changes the way foods taste. Even if you're not very hungry, it's important that you make every effort to keep your protein and calorie intake high. Doctors have found that patients who eat well can better handle both their cancer and the side effects of treatment.
The list below suggests ways to perk up your appetite when it's poor and to make the most of it when you do feel like eating.
- Eat when you are hungry, even if it is not mealtime.
- Eat several small meals during the day rather than three large ones.
- Use soft lighting, quiet music, brightly colored table settings, or whatever helps you feel good while eating.
- Vary your diet and try new recipes.
- If you enjoy company while eating, try to have meals with family or friends, or turn on the radio or television.
- Ask your doctor or nurse whether you can have a glass of wine or beer with your meal to increase your appetite. Keep in mind that in some cases, alcohol may not be allowed because of the chance that it will worsen the side effects of treatment. This may be especially true if you are receiving radiation therapy for cancer of the head or neck.
- When you feel up to it, make some simple meals in batches and freeze them to use later.
- Keep healthy snacks close by for nibbling when you get the urge.
- If other people offer to cook for you, let them. Don't be shy about telling them what you'd like to eat.
- If you live alone, you might want to arrange for "Meals on Wheels" to bring food to you. Ask your doctor, nurse, local American Cancer Society office, or Cancer Information Service about "Meals on Wheels." This service is active in most large communities.
- If you are able to eat only small amounts of food, you can increase the calories per serving by trying the following ideas:
- Add butter or margarine if you like the flavor.
- Mix canned cream soups with milk or half-and- half rather than water.
- Drink eggnogs, milkshakes, or prepared liquid supplements between meals.
- Add cream sauce or melted cheese to your favorite vegetables.
- Some people find they can handle large amounts of liquids even when they don't feel like eating solid foods. If this is the case for you, try to get the most from each glassful by having drinks enriched with powdered milk, yogurt, honey, or prepared liquid supplements.
Nearly all patients who receive treatment for cancer feel some degree of emotional upset. It's not unusual to feel depressed, afraid, angry, frustrated, alone, or helpless. Radiation therapy may affect the emotions indirectly through fatigue or changes in hormone balance, but the treatment itself is not a direct cause of mental distress.
Many patients help themselves by talking about their feelings with a close friend, family member, chaplain, nurse, social worker, or psychologist with whom they feel at ease. You may want to ask your doctor or nurse about meditation or relaxation exercises that could help you unwind and feel better. American Cancer Society nationwide programs can provide support. Groups such as the United Ostomy Association and the Lost Chord Club offer opportunities to meet with others who share the same problems and concerns. Some medical centers have formed peer support groups so that patients can meet to discuss their feelings and inspire each other.
Some people who are having radiation to the head and neck have redness and irritation in the mouth, a dry mouth, difficulty in swallowing, changes in taste, or nausea. Try not to let these symptoms keep you from eating.
Other problems that may occur during treatment to the head and neck are a loss of your sense of taste, earaches (caused by hardening of ear wax), and swelling or drooping of skin under the chin. There may be changes in your skin texture. You also may notice that your jaw feels stiff and that you cannot open your mouth as wide as before your treatment. Jaw exercises may help this problem. Report any side effects to your doctor or nurse and ask what you should do about them.
If you are receiving radiation therapy to the head or neck, you need to take especially good care of your teeth, gums, mouth, and throat. Side effects from treatment to these areas most often involve the mouth, which may be sore and dry. Here are a few tips that may help you manage mouth problems:
- Avoid spices and coarse foods such as raw vegetables, dry crackers, and nuts.
- Don't smoke, chew tobacco, or drink alcohol.
- Stay away from sugary snacks that promote tooth decay.
- Clean your mouth and teeth often, using the method your dentist or doctor recommends.
- Do not use a commercial mouthwash; the alcohol content has a drying effect on mouth tissues.
Radiation treatment to the chest may cause several changes. You will notice some of these changes yourself, and your treatment team will keep an eye on these and others. For example, you may find that it is hard to swallow or that swallowing hurts. You may develop a cough. Or you may develop a fever, notice a change in the color or amount of mucus when you cough, or feel short of breath. It is important to let your treatment team know right away if you have any of these symptoms. Your doctor also may check your blood counts regularly, especially if the radiation treatment area on your body is large. Just keep in mind that your doctor and nurse will be alert for these changes and will help you deal with them.
If you are receiving radiation therapy after a lumpectomy or mastectomy, it's a good idea to go without wearing a bra whenever possible. If this is not possible, wear a soft cotton bra without underwires. This will help reduce the irritation to your skin in the treatment area. You may have several other side effects if you are receiving radiation therapy for breast cancer. For example, you may notice a lump in your throat or develop a dry cough. Or, your shoulder may feel stiff; if so, ask your doctor or nurse about exercises to keep your arm moving freely. Other side effects that may appear are breast soreness and swelling from fluid buildup in the treated area. These side effects, as well as skin reddening or tanning, most likely will disappear in 4 to 6 weeks. If fluid buildup continues to be a problem, your doctor will tell you what steps to take.
Women who have radiation therapy after a lumpectomy may notice other changes in the breast after the therapy. These long-term side effects may continue for a year or longer after treatment. The redness of the skin will fade, and you may notice that your skin is slightly darker, just as when a sunburn fades to a suntan. The pores may be enlarged and more noticeable. Some women report increased sensitivity of the skin on the breast; others have decreased feeling. The skin and the fatty tissue of the breast may feel thicker, and you may notice that your breast is firmer than it was before your radiation treatment. Sometimes the size of your breast changes -it may become larger because of fluid buildup or smaller because of the development of fibrous tissue. Many women have little or no change in size.
Your radiation therapy plan may include implants of radioactive material a week or two after external treatment is completed. You may have some breast tenderness or a feeling of tightness while the implants are in your breast. After they are removed, you are likely to notice some of the same effects that occur with external treatment. If so, follow the advice given above and let your doctor know about any problems that persist.
After 10 to 12 months, no further changes are likely to be caused by the radiation therapy. If you see new changes in breast size, shape, appearance, or texture after this time, report them to your doctor at once.
If you are having radiation treatment to the stomach or some portion of the abdomen, you may have to deal with an upset stomach, nausea, or diarrhea. Your doctor can prescribe medicines to relieve these problems. Do not take any home remedies during your treatment unless you first check with your doctor or nurse.
If you are having radiation therapy to any part of the pelvis (the area between your hips), you might have one or more of the digestive problems already described. You also may have some irritation to your bladder. This can cause discomfort or frequent urination. Drinking fluids can help relieve some of your discomfort. Your doctor can prescribe some medicine to deal with these problems.
There are also certain side effects that occur only in the reproductive organs. The effects of radiation therapy on sexual and reproductive functions depend on which organs are treated. Some of the more common side effects for both men and women do not last long after treatment. Others may be long-term or permanent. Before your treatment begins, ask your doctor about possible side effects and how long they might last.
Once your course of radiation therapy is finished, it is important to have regular exams to check the results of your treatment. No matter what type of cancer you've had, you will need regular checkups and perhaps lab tests and x-rays. The radiation oncologist will want to see you at least once after your treatment ends. The doctor who referred you for radiation therapy will schedule followup visits as needed. Followup care, in addition to checking the results of your treatment, might also include more cancer treatment, rehabilitation, and counseling. Taking good care of yourself is also a part of following through after radiation treatments.
Most patients return to the radiation oncologist for regular followup visits. Others are referred back to their original doctor, to a surgeon, or to a medical oncologist, a doctor who is trained to give chemotherapy (treatment with anticancer drugs). Your followup care will depend on the kind of cancer you have and on other treatments that you had or may need.
Just as every patient is different, followup care varies. Your doctor will prescribe and schedule the followup care that you need. Don't hesitate to ask about the tests or treatments that your doctor orders. Try to learn all the things you should do to take good care of yourself.
Following are some of the questions that you may want to ask your doctor after you have finished your radiation therapy:
- How often do I need to return for checkups?
- Why do I need more x-rays, scans, blood tests, and so on? What will these tests tell us?
- Will I need chemotherapy, surgery, or other treatments?
- How will you know if I'm cured of cancer? What are the chances that it will come back?
- How soon can I go back to my regular activities?
- Do I need to take any special precautions?
- Do I need a special diet?
- Should I exercise?
- Can I wear a prosthesis?
- How soon can I have reconstructive surgery?
A few patients need help to manage pain if it continues after radiation therapy. You should not use a heating pad or warm compress to relieve pain in any area treated with radiation. Mild pain medicine may be enough for some people. If you have severe pain, ask the doctor about prescription drugs or other methods of relief. Be as specific as possible when telling the doctor about your pain so you can get the best treatment for it. If you are unable to get relief from pain, you may want to talk with a doctor who is a pain specialist.
Because pain can be worse when you are afraid or worried, it may help to try relaxation exercises. Other methods such as hypnosis, biofeedback, and acupuncture may be useful for some cancer patients.
Patients who have had radiation therapy need to continue some of the special care used during treatment at least for a short while. For instance, you may have skin problems for several weeks after your treatments end. You should continue to be gentle with skin in the treatment area until all signs of irritation are gone. Don't try to scrub off the marks in your treatment area. They will fade and wear away.
You may find that you still need extra rest while your healthy tissues are rebuilding. Keep taking naps as needed and try to get more sleep at night. You may need some time to test your strength, little by little, so you may not want to resume a full schedule of activities right away.
After treatment for cancer, you're likely to be more aware of your body and to notice even slight changes in how you feel from day to day. The doctor will want you to report any unusual symptoms. If you have any of the problems listed below, tell your doctor at once:
- A pain that doesn't go away, especially if it's always in the same place.
- Lumps, bumps, or swelling.
- Nausea, vomiting, diarrhea, or loss of appetite.
- Unexplained weight loss.
- A fever or cough that doesn't go away.
- Unusual rashes, bruises, or bleeding.
- Any other signs mentioned by your doctor or nurse.
Many people continue to work during radiation 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.
When you are ready to return to work, it is important to learn about your rights regarding your job and health insurance. If you have any questions about employment issues, contact the Cancer Information Service or the American Cancer Society. They can help you find local agencies that respond to problems cancer survivors sometimes face regarding employment and insurance rights.