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Radiation Therapy

What Does Radiation Therapy Involve?

Radiation therapy is usually given 5 days a week for several weeks. This schedule helps to protect healthy body tissue by extending the total dosage of radiation over a longer period of time and giving weekend rest breaks in which normal cells can rebuild.

The total dose of radiation and the number of treatments you need will depend on a set of highly individual factors. Your doctor must consider the size and location of your cancer, your general health, and any other treatment you're having.
( After talking to you about your medical history, the radiation oncologist may need some X-rays or other tests to pinpoint the location and size of the cancer. In the process called "simulation," a technologist may use a special machine (a simulator) to X-ray the cancer and locate your "treatment port" (The exact place on your body where the high,energy rays will be aimed), or simulation may be done on the treatment machine itself. Simulation is a process during which you must lie still on a hard table. Your cooperation will help the radiation oncologist plan your treatment so that the tumor is treated accurately and properly to avoid damaging the surrounding tissue.

For some treatment ports, you may need two or more simulations. Simulation may take from 30 minutes to 45 minutes.
After locating the treatment port, the technologist will mark your skin with indelible ink to define your treatment area. The ink marks should not be washed off until your full course of treatment is over. Since they may some times rub off on clothing, you may want to wear old clothes over the marks. If the marks begin to fade, ask one of the technicians to remark them for you.
After simulation, it may be necessary to make special aids to help with your treatment. For example, to protect normal tissues from radiation, special alloy blocks may be made. Special casts or molds may be used to keep your body from moving during treatments. You will be scheduled for your therapy after these devices are made.

There are few other facts about the treatment itself that are also important. First, radiation treatments do not hurt. It's like having X-rays taken only it takes a few minutes rather than a few seconds. Second, you may feel a little more tired than usual. If you do, taking a nap usually alleviates the problem. Third, eat a balanced nutritious diet to help you feel better during treatment.

Are There Any Side Effects?

Fatigue is the most common side effect. During radiation therapy, the body uses a lot of energy. Stress related to your illness, daily trips for treatment, the effects of radiation on normal cells -all may contribute to fatigue. Most people feel unusually tired after a few weeks of radiation therapy. Feelings of weakness or weariness will
gradually go away after your treatment is finished.

You can help yourself during radiation therapy by asking less of your body. 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 did before. Try to get more sleep at night and take naps during the day if you can.

If you are troubled by diarrhea, be sure to drink plenty of liquids to replenish your body fluids. Talk to your doctor if the symptoms persist.

Many patients continue to work throughout their treatments. However, some patients prefer to take a few weeks off from work while they are having radiation therapy. Others work a reduced number of hours. You should 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 of your work at home.

Whether you're working or not, it may be a good idea to ask family members or friends to help with shopping, child care, housework, or driving.

Is Hair Loss Normal?

If you're receiving radiation to your head or along the hair line, you may lose some or all of your hair in the area being targeted. You may find your hair growing back again after treatments are finished. But
the regrowth depends on many factors, so please discuss this with your Radiation Oncologist.
You may want to cover your head with a hat, turban, or scarf while you're under treatment. Some people prefer a wig or toupee. If you plan to buy a wig, it's a good idea to select it early in your therapy so that it can be matched to your present hair color and style.

What Can Be Done About Nausea and Indigestion?

Most patients complete their course of radiation therapy without any stomach or intestinal effects. However, some people experience discomfort that may range from a feeling of indigestion to one of nausea. The probability and severity of nausea is directly related to the type of cancer and area of the body being treated. Please don't assume all nausea is related to your
treatments, but discuss it with the Radiation Oncologist or nurse. The following are some hints to alleviate these symptoms should they occur.

Some patients find it helpful to avoid eating one hour after receiving radiation therapy and to avoid being around food during this time period. It may be helpful to eat several small meals during the day with a bedtime snack at the end of the day (five to six meals per day) rather than three large meals. Another plan that works for some people is to eat a large meal three to four hours before receiving radiation therapy and then eat very light meals for the rest of the day. It may be necessary to try several of these hints to see which will be most helpful for you.

If you are experiencing nausea, cold foods or foods served at room temperature, such as sandwiches, yogurt, cottage cheese, crackers, gelatin and light desserts are usually better tolerated than warm or hot foods. The aroma of hot foods may be unpleasant if you are feeling nauseated.

Sports beverages and carbonated beverages such as ginger ale and colas may relieve that feeling of indigestion or nausea. These liquids should be sipped slowly between meals rather than with meals.

Eating certain foods may relieve the feeling of indigestion or nausea. Some of these foods are dry toast, crackers, possible (eaten slowly) and sour food like lemons, sour pickles, or sour hard candy.

Avoid eating fatty foods like fried foods, sauces, gravies, nuts, cream, butter, rich pastries, bacon pork, or any meat with a large amount of fat. Also avoid gas,producing foods such as cauliflower, broccoli, beans, etc.

Avoid salted foods like potato chips and pretzels. Resting in a comfortable position in a quiet room may decrease the feeling of indigestion or nausea, or being involved in something you enjoy doing may be helpful.

If these measures are not effective in relieving your indigestion or nausea, report this to the Radiation Oncologist/Nurse. Medication can be prescribed to decrease the feeling of nausea.

Try to stay well,nourished during therapy. You need lots of good food to help your body repair itself. You will also feel better with a balanced nutritious diet.

How Should I Care For My Skin?

During each treatment, the radiation will pass treatment area in order to reach the in the tissues below the skin surface. Because of this, some skin cells in the treatment area are damaged, causing a temporary skin reaction. You may notice a gradual reddening of the skin in your treatment area and perspiration in this area may be diminished
or absent.

Gentle cleansing of the skin in the treatment area is necessary. Use the following guidelines for washing this area:

•If possible, avoid the use of soap and just wash with lukewarm water.
•If soap is necessary for cleaning the treatment area, use a mild soap. For example: Ivory, Dove, Camay, Alpha Keri Soap,   Baby Soap, and Neutrogena (plain or dry)
•Rinse the area well with lukewarm water.
•Gently pat the area dry with a soft towel.

The skin may become dry and flaking and peeling may occur. The use of skin moisturizers may be helpful to decrease this dryness. We recommend:

• Baby oil, cream or lotion
• Aquaphor lotion
• Hollister skin conditioning cream
• Vitamin E cream
• Cream or ointments containing Vitamins A & D
• Aloe vera gels and lotions
• Sweet Cream
• Sweet Peri-Care cream

Tell the radiation therapy nurse which moisturizers you are using. Apply these lotions or creams several times daily, but not immediately prior to your radiation treatment.

Do not rub, scratch, or massage the skin in the treatment area. If itchiness is unrelieved by skin moisturizers, the radiation therapy doctor or nurse may be able to prescribe a cream or spray to control itchiness.

While radiation is being administered and for several weeks following treatments, the skin in the treatment area must be protected from injury due to pressure, friction, heat, cold, and irritation

•Expose the treatment area to the air as often as possible, but avoid direct sunlight.
• Avoid wearing tight-fitting clothing, such as a bra or tight-fitting collar, over the treatment area.
• If you are experiencing itchiness of the skin in the treatment area, you may want to try laundry products used to wash infant's    clothing, such as Dreft and Ivory Snow. It may also be helpful to put any clothing that comes in direct contact with the skin of    the treatment
   area through a double rinse cycle to assure that all of the detergent used in laundering your clothing has been removed.
• Avoid wearing harsh fabrics, such as wool, directly on the skin.
• In areas where two layers of skin are in contact with each other, the skin is usually more sensitive and can be the first area to    react to the radiation therapy. Examples of these areas include skin under the breasts, under the arms and any other skin fold.    Usually these areas are slightly more moist; therefore do not apply skin moisturizers. Instead, plain cornstarch should be    sprinkled on the area three or four times daily. This decreases friction and also itchiness.
• Heat should be avoided in the treatment area. This includes
   hot water bottles, heating pads, sun lamps, and direct sunlight. If the treatment area is an exposed area of your skin, wear    protective clothing or use sun block when in direct sunlight.

• Cold temperatures can also irritate sensitive skin. Protect the skin in the treatment area from cold temperatures and wind by    wearing warm protective clothing to avoid exposure to winter weather. Ice bags
   should not be applied to the treatment area.
• Avoid the use of any medication, deodorant, perfume, or powder on the skin in the treatment area. Some brands or types of    cosmetics and
   toiletries are permitted, but you must check with the Radiation Oncologist before using these substances.
• Do not shave under your arms if this area is receiving radiation therapy.
• Do not use any type of adhesive tape or Band-Aids on the skin in the treatment area. If a bandage is necessary, ask the    Radiation Oncologist how to safely apply the dressing.
• Avoid exposing the skin in the treatment area to the direct sunlight. When in the sun, use one of the many products on the    market containing the maximum level of sunscreen PABA (minimum number 30). Use these products according to package    directions. You must avoid exposure throughout the treatment and for at least 4-6 weeks after the completion if radiation    therapy. The skin in the treatment area will always be more sensitive to the sun's rays. Some patients may need to
   continue to limit direct exposure of the treatment area to the sun for the rest of their life.

Most patients receiving radiation therapy only experience redness, dryness, and itchiness of the skin. However, if the skin in the treatment area becomes painful, begins to peel, or has a wet drainage notify the Radiation Oncologist as soon as possible. You will be given special skin care instructions. Do not apply anything to areas of skin which have blistered or peeled or are open and wet unless you have been instructed to do so by the Radiation Oncologist.

What If It Hurts To Swallow?

Esophagitis is inflammation of the lining of the esophagus (connecting passage or tube between the stomach). This is an expected reaction of the esophagus to the radiation therapy. If you experience pressure in the center of your chest, difficulty in swallowing, the feeling of having a "lump in your throat", or a burning,like pain when swallowing, report these symptoms to the Radiation Oncologist. There are liquid medications available which, when swallowed, can provide temporary
relief of this discomfort. If the radiation Oncologist prescribes
this type of medication, taking it 5-10 minutes prior to eating
will make mealtime a little more comfortable. If you are experiencing a "lump in your throat" or difficulty in swallowing your food, you may also find the following hints helpful:
• Chew your food thoroughly and drink sips of liquid between bites.
• Soft foods, such as gelatin, yogurt, pudding, ice cream, sherbet, or possible are foods that are easy to swallow. Others    include mashed
   potatoes, cream soups, soft-cooked eggs, custard, applesauce, and cooked cereal.
• Sauces, gravy, broth, milk, and/or water added to foods will moisten them for easier swallowing. Grinding, chopping, or    blenderizing foods also make them easier to swallow.
• Avoid rough or coarse foods such as raw fruits and vegetables, nuts, crackers, and whole grains.
• Avoid acidic food such as juices and citrus fruits like oranges, lemons, limes, grapefruits, and tomatoes.
• Avoid hot foods and highly spiced foods.
• Avoid tobacco and all forms of alcohol.
   Your Radiation Oncologist may schedule a rest period from your treatments. This usually allows a rapid improvement in your symptoms and could last from a few days to a week.

Is Eating Right Important?

As in all times of your life, good nutrition is important during cancer treatment. Not only will you feel better and have more energy, but you will be able to handle the treatment better if you are eating well.

Ask for a copy of Eating Hints: Recipes and Tips for Better Nutrition During Cancer Treatment. They are generally available in the display racks in the treatment area. This book will be valuable to you should you experience any side effects related to nutrition.

Nutrition counseling may be available through local sponsoring hospitals. If you feel you need to see a dietician, please ask your Radiation Oncologist/Nurse to arrange an appointment for you. If you start having nutrition problems first, we ask that you be on the lookout for any of the following:

•Unexplained weight loss
• Sudden loss of appetite, or lack of interest in food
• Nausea, vomiting, or change in bowel habits

These, and other changes in your eating habits, tell you that you need to be evaluated by a dietician.