Radiation therapy FAQ
- Before Treatment
What is cancer?
Cancer is described in medical terms as a malignant neoplasm of the epithelial tissue. Epithelia are present in every body part – they line, among others, the oral cavity and the respiratory and urinary tracts. This is why we find such a high variety of epithelial neoplasms. It is worth noting, however, that cancer is only one of the forms of malignant neoplasm. This may be phrased as follows: each cancer is a malignant neoplasm but not each malignant neoplasm is cancer.
What is neoplasm?
Neoplasm – literally “new formation” or “new growth” – develops from the organism’s own cells which are damaged (as a result of genetic changes). Their uncontrolled divisions ultimately lead to the formation of a neoplastic tumour. If the neoplasm demonstrates an ability to destroy its neighbouring organs and create metastasis, it is called malignant neoplasm. In everyday language, it is often identified with cancer, which is only one of its forms. Other types of malignant neoplasm include sarcoma, melanoma, lymphoma and glioma. A neoplasm diagnosed early has a far greater chance of successful treatment. In many other cases, however, the presence of metastasis does not exclude the possibility of treatment.
What is the difference between tele-radiotherapy and brachytherapy?
Both tele-radiotherapy and brachytherapy are types of therapy relying on treatment with the use of ionizing radiation. The difference is in the type of irradiation: external or internal. In the case of tele-radiotherapy, the radiation is generated in a device called an accelerator, at a certain distance from the patient. During treatment, the apparatus rotates around the patient and sends radiation towards the neoplastic tumour. In brachytherapy, on the other hand, special applicators are used which contain the radiation source. Such applicators are placed directly in the tumour or in its immediate vicinity (in the patient’s natural body cavities or tissues). After treatment, applicators are removed. The choice of the technique depends, among other considerations, on the neoplasm type and its location.
What is combination therapy?
Contemporary medicine has at its disposal several methods of treating neoplasms, which include: surgery, radiotherapy, hormonotherapy, standard and molecular chemotherapy and immunotherapy. For best results, these methods are often applied together (this is precisely what combination therapy is). The choice of the optimum treatment depends on the neoplasm type, its state of advancement, and patient-related factors (general condition, co-existing diseases and preferences). Hence it is vital for doctors with various specialisations and other specialists to be involved in deciding on the treatment.
How long is a radiotherapy treatment?
Radiotherapy treatments can last from 1 to 8 weeks and are usually performed daily on workdays. Each daily session can last from 5 to 15 minutes, depending on the type of treatment.
What are the side effects of the treatment?
Complications may occur during or after it is finished. The radiotherapeutic doctor and nurse always provide information about complications the patient may expect and how to cope with them. Most of them are not serious and may be controlled using medication or diet. They usually disappear within several weeks of the end of treatment. Early complications occur during treatment and within 6 months of its end. The most frequent symptoms during radiotherapy are a feeling of tiredness, sleepiness, lowered mood, lack of appetite, nausea, diarrhoea, skin reddening and inflammation, hair loss on the irradiated area, a feeling of skin tightness and difficulties swallowing (irritation of the oesophagus and oral cavity). Late complications occur several to more than ten months and even several dozens of years after radiotherapy. Doses safe for the targeted organs are applied but the occurrence of symptoms of organ and tissue damage depends on their individual sensitivity to radiation, a factor which is unpredictable before commencement of treatment and as is the effect of co-existing diseases such as cirrhosis, diabetes, autoimmune diseases and pneumoconiosis. Clinical consequences may vary from an adverse cosmetic effect to symptoms worsening the quality of life, for instance fibrosis of the skin and subcutaneous layer, dilated capillaries, fistulas or more difficult healing of wounds at the place which was subjected to irradiation.
I have to do radiotherapy, will my hairs fall off?
Radiotherapy is a highly localised treatment. Therefore, this particular side-effect will only occur in those cases in which the treatment area is located inside the head. In any case, hair will start to naturally re-grow after the end of the treatment.
Will I be able to keep taking my usual medicines during radiotherapy?
Most medicines can be used alongside radiotherapy, but it is in any case mandatory to inform your Radiotherapist of any medical treatment you are undergoing, to avoid toxic build-ups.
How should I be dressed for radiotherapy?
We suggest to use comfortable clothing to facilitate positioning procedures.
Will a single doctor follow me, or will I be followed by the entire medical team?
Each one of our doctors is specialized in a particular kind of cancer and you will be assigned to the one most fitting for your condition, but every member of our medical staff will be available to take care of your needs.
- During Treatment
What should I do during a radiotherapy session?
The staff will instruct you of the procedures and positions you will have to keep to ensure the correct execution of the treatment.
I am undergoing a radiotherapy treatment, can I drink alcohol?
You can, as long as you exercise moderation. A glass of red wine at lunch is perfectly fine, but it is important to not exceed alcohol consumption.
What is a Radiation Therapy Simulation and how to prepare for it?
With each patient, computer tomography (CT) is used to plan radiotherapy (simulation), and this is different from diagnostic tomography: • Its aim is not to make the diagnosis because that was done before qualification for radiotherapy (the patient does not need to receive the result). • The patient is placed in a special, therapeutic position which will be reconstructed precisely during the treatment. • Additional devices stabilising the patient’s position are used (e.g. when treating neoplasms located within the area of the head and neck, such as thermoplastic masks to immobilise the head). After CT, location points are marked on the patient’s skin with a tattoo, which guarantees replication of the patient’s position during the whole radiotherapy cycle. Performance of a CT scan may require special preparation of the patient depending on the location of the neoplastic disease and the use (or not) of contrast medium (containing iodine). The images from such a scan are necessary to precisely identify the treated area and protect healthy neighbouring tissues and organs. The contrast medium enables exposure of autonomous structures, which are invisible or hard to discern from their surroundings in a scan without contrast medium.
What happens during irradiation treatment?
During irradiation treatment, the patient lies in the irradiation room on the therapeutic table in the position established during the CT scan. An electro-radiology technician locates the treatment area based on the tattoos on the patients’ skin, and then leaves the irradiation room and starts the apparatus. The patient is monitored with cameras in the control room next door. A microphone and a loudspeaker placed on the wall enable communication with the technicians. During irradiation, the patient must lie completely still, breathing gently and regularly. A single irradiation session lasts 10 – 20 minutes. During that time, the therapeutic apparatus may rotate and produce various sounds. Any anxiety, ailments or discomfort during the therapy should be reported to the electro-radiology technicians. Irradiation may be interrupted at any moment.
Will I become radioactive after radiotherapy?
No, radiotherapy does not induce radioactivity in the patient. Even the most intense radiation used traverses the patient’s body for a mere instant and is focused on the treated area. Therefore, there is no risk of becoming radioactive.
Will Radiotherapy make me sterile?
As a side effect, sterility has a chance of developing as a result of treatments to the testicular or ovary area. Other type of treatments do not cause sterility.
Does irradiation hurt?
Each patient responds differently to radiotherapy. Irradiation treatments are pain-free, but complications may occur during or after treatment completion. They most frequently concern the treated area and are different for different patients, depending on the irradiation dose and the part of the body treated. If the patient notices any atypical symptoms during the treatment, they should report them to the doctor in charge. Most complications involved in radiotherapy are not serious and may be contained using medicines or diet. They usually disappear after several weeks from the end of the treatment. Only some complications may last longer.
Do radiations cause skin damage?
Treatment may cause a reduction in skin thickness, sometimes exposing the derma. The skin within the irradiated area becomes reddened, irritated or discoloured. After several weeks of radiotherapy it may become very dry and if the irradiation reaction is strong, it may peel off. The degree of the reaction depends on treatment duration and dosage, but also on the patient’s individual response. Please note, however, that treatment side-effects are usually temporary and disappear after radiotherapy ends. It is very important to report more serious lesions of this type (e.g. moderate or severe rash, epidermis peel-off in skin folds and over joints) to your doctor, who will prescribe the appropriate treatment and give additional recommendations on what products to use for your skin care.
May I wash or shave during radiotherapy?
Washing or shaving restrictions apply to irradiated areas only – the skin after radiotherapy is very sensitive and because of that you should take particular care of it. Above all, avoid rubbing, scrubbing and scratching the skin within the irradiation area. Use a pH-neutral shower gel for daily intimate hygiene (a pharmacist will indicate the appropriate product) or water with medicated simple soap and rinse gently with tepid water. Do not rub the skin with a towel – instead, dry it gently using water-absorbent fabric. Patients irradiated on the face or neck cannot shave during radiotherapy. If you wish to shave the treated area, use an electric shaver but only after consultation with a doctor. Do not apply any substances before shaving or use hair removal creams.
How do I know my treatment is working?
The doctor that supervises your treatment will evaluate the effectiveness of the therapy with clinical and instrumental tests and will inform you of your progress during your weekly monitoring consultations.
What can I do to help myself during the treatment? How can I take care of myself during that time?
• Avoid alcohol – excessive alcohol intake irritates mucous membranes, intensifies the ailments associated with radiotherapy and distorts the organism’s metabolism. • Absolutely no smoking – failure to comply with this prohibition may intensify radiation reactions and worsen treatment results. • Lead a gentle lifestyle – avoid intensive physical exercise and make sure you rest during the day and take enough sleep at night. • Make sure you follow the appropriate diet, to be customised depending on your general condition, disease location and type of therapy. • Care for your skin – use soft, preferably cotton fabric, do not irritate the irradiated area, and discuss the use of cosmetics with your doctor. Wash the skin of the irradiated area with tepid water. Do not heat or cool the site or apply pain relief plasters. Protect your skin against sunrays for at least one year after the end of radiotherapy. Cover it during the duration of therapy and after the reaction to radiation has healed. Also apply creams with sun filters. Nutrition is a major element within an oncological treatment. A wholesome and correctly balanced diet is of great importance for the success of the treatment. In a neoplastic disease, the organism has a higher demand for the quantity of calories and protein consumed. You should try and eat a little more than before the diagnosis and gradually increase the volume and frequency of meals. In the event of weakness and noticeable body weight loss, taking orally administered food supplements should be considered. Sometimes it is necessary to modify the diet due to the specific nature of the disease and the need to protect a particular organ. The best methods of making meals for patients include boiling, stewing and roasting. You should take a lot of drinks at room temperature, avoid sweetened drinks and highly processed food with a high sugar content. Drink still mineral water and light tea infusions. Appetite may drop during therapy and nausea and other ailments may occur. You should discuss them with your doctor. Radiotherapy is not, however, a reason why you should withdraw from normal life. You can have a normal sex life during its course (as long as effective contraception is used) and the treatment is safe for your environment – there is no need to avoid contact with your loved ones, including children.
What happens if I skip one of the daily sessions?
It is advisable not to delay or stop treatment for radiobiological reasons. Were it to be unavoidable for you to skip one of your daily treatments, our radiotherapists will change your treatment plan to compensate for the delay.
How long does one irradiation take?
It all depends on the treatment plan and the irradiation dose applied. A single irradiation session lasts for 10 – 20 minutes, but account should be taken of the preceding time to properly position the patient on the therapeutic table or control the patient’s position using the Image-guided Radiation Therapy (IGRT) system. In total, the patient can stay in the irradiation room for between a dozen or so to 40 minutes.
Is there any specific diet which should be followed during the treatment?
Nutrition is an exceptionally important element of oncological treatment. A wholesome and correctly balanced diet is of great importance for the success of the treatment. Key dietary principles: • Diet in neoplastic diseases should be customised – each patient may tolerate treatment (and diet during its course) differently. • The patient should maintain correct body weight. Identification of slight malnutrition, accompanied by changes in the diet, has a very significant impact on treatment outcome. In a neoplastic disease, the organism has a higher demand for calories and protein. You should try and eat a little more than before the diagnosis and gradually increase the volume and frequency of meals. In the event of weakness and noticeable body weight loss, the oral intake of food supplements should be considered. • Sometimes it is necessary to modify the diet due to the specific nature of the disease and the need to protect a particular organ. The best methods of preparing meals for patients include boiling, stewing and roasting. • You should take a lot of drinks at room temperature. Avoid sweetened beverages and highly processed food with high sugar content. It is good to drink still mineral water and light tea infusions. • Do not take food supplements, but in certain situations (some diseases result in vitamin and mineral deficiencies) this should be done under the supervision of a doctor or a dietician. A properly balanced and varied diet covers the organism’s demand for all necessary nutritional components.
- After Treatment
I just finished my radiotherapy treatment, am I radioactive or otherwise dangerous?
No, external radiotherapy or afterloading brachytherapy sessions do not induce radioactivity. Therefore, you will be able to continue your day as normal and normally interact with other people, including pregnant women and children. However, in case your treatment requires the implantation of radioactive seeds in the prostate or the administration of radioactive substances (such as I131 for thyroid cancer), minor radioactivity risks may emerge. Your doctor will provide you with all information to minimise these issues.
I just finished my radiotherapy session, can I go to the beach and sunbathe?
For at least 1 year after the treatment it is unadvisable to expose the treated part to the sun.
Can I stay with children after a treatment or session?
Yes, without any problem