What Happens Before, During, and After Treatment?
Once the diagnosis has been made, you will probably talk with your primary care physician along with several cancer specialists—such as a surgeon, a medical oncologist, and a radiation oncologist—to discuss your treatment choices. These specialists will work together to recommend the best treatment for you.
In some cases, your cancer will need to be treated by using more than one type of treatment. For example, if you have breast cancer, you might have surgery to remove the tumor (by a surgeon), then have radiation therapy to destroy any remaining cancer cells in or near your breast (by a radiation oncologist). You also might receive chemotherapy (by a medical oncologist) to destroy cancer cells that have traveled to other parts of the body.
Meeting With a Radiation Oncologist
If you are considering radiation therapy, you must first meet with a radiation oncologist to see if radiation therapy is right for you. During your first visit, your doctor will evaluate your need for radiation therapy and its likely results. This includes reviewing your current medical problems, past medical history, past surgical history, family history, medications, allergies, and lifestyle. The doctor will also perform a physical exam to assess the extent of your disease and judge your general physical condition. A nurse practitioner, a physician’s assistant or a nurse may also see you. After reviewing your medical tests, including CT scans, MRI scans and PET scans, and completing a thorough examination, your radiation oncologist will discuss with you the potential benefits and risks of radiation therapy as well as answer your questions.
To be most effective, radiation therapy must be aimed precisely at the same target or targets each and every time treatment is given. The process of measuring your body and marking your skin to help your team direct the beams of radiation safely and exactly to their intended locations is called simulation.
During simulation, your radiation oncologist, and radiation therapist place you on the simulation machine in the exact position you will be in during your daily treatments. Your radiation therapist, under your doctor’s supervision, then marks the area to be treated directly on your skin or on immobilization devices. Immobilization devices are molds, casts, headrests or other devices that help you remain in the same position during the entire treatment. The radiation therapist marks your skin and/or the immobilization devices either with a bright, temporary paint or a set of small, permanent tattoos.
Your radiation oncologist may request that special blocks or shields be made for you. These blocks or shields are put in the external beam therapy machine before each of your treatments and are used to shape the radiation to your tumor and keep the rays from hitting normal tissue. Multi-leaf collimators (MLC) may also be used to shape the beam and achieve safe delivery of your radiation treatment.
Once you have finished with the simulation, your radiation oncologist and other members of the treatment team review the information they obtained during simulation along with your previous medical tests to develop a treatment plan. Often, a special treatment planning CT scan is done to help with the simulation and treatment planning. This CT scan is in addition to your diagnostic CT scan. Sophisticated treatment-planning computer software is then used to help design the best possible treatment plan. After reviewing all of this information, your doctor will write a prescription that outlines exactly how much radiation you will receive and to what parts of your body.
External Beam Radiation Therapy Treatments
When you undergo external beam radiation therapy treatment, each session is painless, just like getting an X-ray. The radiation is directed at your tumor from a machine located away from your body, using a linear accelerator. External beam radiation is noninvasive.
One of the benefits of radiation therapy is that it is usually given as a series of outpatient treatments (meaning you don’t have to stay in the hospital). You may not need to miss work or experience the type of recuperation period that may follow other types of treatments. Treatments are usually scheduled five days a week, Monday through Friday, and continue for one to six weeks. The number of radiation treatments you will need depends on the size, location and type of cancer you have, the intent of the treatment, your general health and other medical treatments you may be receiving.
The radiation therapist will give you your external beam treatment following your radiation oncologist’s instructions. It will take five to 15 minutes for you to be positioned for treatment and for the equipment to be set up. If an immobilization device was made during simulation, it will be used during every treatment to make sure that you are in the exact same position every day.
Once you are positioned correctly, the therapist will leave the room and go into the control room next door to closely monitor you on a television screen while giving the radiation.
There is a microphone in the treatment room so you can always talk with the therapist if you have any concerns. The machine can be stopped at any time if you are feeling sick or uncomfortable. The radiation therapist may move the treatment machine and treatment table to target the radiation beam to the exact area of the tumor. The machine might make noises during treatment that sound like clicking, knocking or whirring, but the radiation therapist is in complete control of the machine at all times.
The radiation therapy team carefully aims the radiation in order to reduce the dose to the normal tissue surrounding the tumor. Still, radiation will affect some healthy cells. The time between daily treatments allows your healthy cells to repair much of the radiation effect, while cancer cells are not as likely to survive the changes.
Sometimes a course of treatment is interrupted for a day or more. This may happen if you develop side effects that require a break in treatment. Missed treatments can be rescheduled at a later time. Try to arrive on time and not miss any of your appointments. Time spent in the treatment room may vary depending on the type of radiation, but it generally ranges from 10 to 15 minutes. Most patients are treated on an outpatient basis, and many can continue with normal daily activities. Your radiation oncologist monitors your daily treatment and may alter your radiation dose based on these observations.
Also, your doctor may order blood tests, X-rays, and other tests to see how your body is responding to treatment. If the tumor shrinks significantly, another simulation may be required. This allows your radiation oncologist to change the treatment to destroy the rest of the tumor and spare even more normal tissue.
Weekly Status Checks
During radiation therapy, your radiation oncologist and nurse will see you regularly to follow your progress, evaluate whether you are having any side effects, recommend treatments for those side effects (such as medication), and address any concerns you may have. As your treatment progresses, your doctor may make changes in the schedule or treatment plan depending on your response or reaction to the therapy. Your radiation therapy team may meet on a regular basis with other healthcare professionals to review your case to ensure your treatment is proceeding as planned. During these sessions, all the members of the team discuss your progress as well as any concerns.
Weekly Beam Films
During your course of treatment, correct positions of the treatment beams will be regularly verified with images made using the treatment beam itself. These images (called port films, beam films or portal verification) represent an important quality assurance check, but do not evaluate the tumor itself.
After treatment is completed, follow-up appointments will be scheduled so that your radiation oncologist can make sure your recovery is proceeding normally and can continue to monitor your health status. Your radiation oncologist may also order additional diagnostic tests. Reports on your treatment may also be sent to the other doctors helping treat your cancer. As time goes by, the number of times you need to visit your radiation oncologist will decrease. However, you should know that your radiation oncology team will always be available should you need to speak to someone about your treatment.