IRRADIATION (Radio Therapy)

According to the National Cancer Association about 45% of cancer sufferers undergo irradiation - a therapy that many people are more scared of than an operation. But most of their fears are unfounded. Patients expect that they will immediately feel terribly ill, that they will be tired and sick and that their hair will fall out. They are always surprised - pleasantly - when they hear that their hair will only fall out if their head and neck are irradiated. Irradiation on any other part of your body leaves your hair unharmed. In the same way you are only sick if your abdomen is irradiated. The side effects depend on exactly where you are irradiated.

 

Simply put, "radio"-therapy means high energy x-ray treatment or electron bundles. Radiotherapy cannot be given through an ordinary x-ray apparatus used for taking x-rays. In order to understand how radiation works, you must first have an understanding of how cancer cells affect your body.

 

Cancer starts with one cell that loses its growth control. Normal cells divide in a highly controlled manner in order to form new cells. Cancer cells also divide and form new cells. The difference with cancer cells, however, is they don't know when they should stop dividing. They continue dividing until they have overcrowded or damaged the affected body tissue or organ. These cells continue growing excessively and because cancer cells do not grow in a capsule, some cells break away and are transported by the nodes or blood stream to other organs where they multiply; this is called a dissemination or metastasis. The effect of irradiation on the body is that the cells are damaged and eventually destroyed. However, the rays cannot distinguish between normal and malignant cells. Cancer cells are more sensitive to irradiation than normal cells. The aim of irradiation is therefore to irradiate until the malignant cells are dead or sterilised. The normal surrounding tissue, however, is still able to recover. Cells are more sensitive in certain phases of division than in other resting phases.

In order to irradiate as many cells as possible during the sensitive phases, the treatments are fractioned (i.e. administered) over a certain period. Another reason for fractionation is to give the normal cells, which recover more quickly than malignant cells, a chance to recover. Therefore you do not receive only one treatment. 

As the sensitivity of different tissues and organs differ, the number of treatments for various diagnoses will differ. The number of treatments is not related to the advancement of the cancer. The assumption that if you have to receive 30 treatments and another person only 10 treatments, that your prognosis is poorer, is incorrect. There is a very close relationship between the dosage applied, the number of treatments and the specific diagnosis.

During the course of treatment you will meet other patients and you will probably compare your symptoms and treatment. It is important for you to realise that irradiation for different conditions is handled differently. Your irradiation and side-effects may differ completely from those of another patient.

IRRADIATION PLANNING
IRRADIATION PLANNING

The first step in your irradiation is accurate determination of the area of treatment and planning of the fields and dose of irradiation that must be applied.

Irradiation works almost like x-rays, with the difference being that high energy rays literally kills the cells. Just as with x-rays you are positioned on a bed so that the rays focus exactly on the growth. Unfortunately the healthy tissue surrounding the cancerous growth is also irradiated and affected. The great art to successful radiotherapy, is therefore to target the cancer very accurately. Today we can determine the exact spot of growths beforehand with computer technology; we therefore know exactly where we should "aim". We also use techniques such as making the masks in order to position the patient so that only the growth is irradiated. Through partitioning with lead blocks, healthy tissue is protected as much as possible. The area to be irradiated is determined and marked with a CATscan. It is therefore important that the marks we have made remain intact. You may bath or shower if you ensure that the marks are not washed off.

The first step in irradiation is the accurate determination of the area of treatment and planning of the fields and dose of irradiation that must be applied.

Irradiation works almost like x-rays, with the difference being that high energy rays literally kill the cells. Just as with x-rays, you are positioned on a bed so that the rays focus exactly on the growth. Unfortunately the healthy tissue surrounding the cancerous growth is also irradiated and affected. The great art to successful radiotherapy, is therefore to target the cancer very accurately. Today we can determine the exact spot of growths beforehand with computer technology; we therefore know exactly where we should "aim". We also use techniques such as making the masks in order to position the patient so that only the growth is irradiated. Through partitioning with lead blocks, healthy tissue is protected as much as possible. The area to be irradiated is determined and marked with a CAT scan. It is therefore important that the marks we have made remain intact. You may bath or shower if you ensure that the marks are not washed off.

WHAT TO EXPECT

Irradiation is not painful and patients are not radioactive after irradiation. You are therefore no danger to other people.

One is alone in the treatment room during irradiation, but one will be observed on a television monitor. There is also an intercom system. It is extremely important that you lie very still, and breathe normally.

We are here to help! The patient and their family's peace of mind during treatment are very important to us. If there are any side-effects, questions or problems which occur that have not been covered in the above and below mentioned, the radiographers, our oncology sisters or doctors are there to help..

After treatment, you will regularly be followed up by one's Oncologist. The date of follow-up visit will be confirmed at the completion of irradiation.

It is also important that you maintain contact with your GP. He/She can help with the handling of side-effects and problems, should they occur.

POSSIBLE SIDE-EFFECTS OF IRRADIATION

There are certain side-effects, usually surprisingly light for the first few sessions. Only later, when you have had a larger dosage of irradiation can it worsen. Patients are mostly aware of nausea, tiredness, diarrhoea, tenderness and even infection of the mouth, oesophagus, mucous membranes and sore skin reactions. It can also result in dehydration. It is only human to be worried about the side-effects of irradiation, especially as there are so many misconceptions surrounding irradiation among the public. If, however, you understand understand what can or cannot possibly happen, you can eliminate unnecessary and unfounded nervousness and fear. The following information is aimed at giving you peace of mind.

  • NAUSEA AND VOMITING

Only patients receiving irradiation over the abdominal organs may experience nausea and possible vomiting. If worried, you may ask to have medication prescribed for it. If the symptoms continue, despite the medication, bring it to the doctor's attention so that alternative medication can be prescribed. It is extremely important that you take medication as prescribed, so that a constant blood level can be built up, and not only when you experience nausea.

  • MOUTH AND THROAT AREA

Patients receiving irradiation to the throat area will experience a sore throat after approximately 10 treatments. It will help to gargle with baking soda in water. The mouth will become dry due to irradiation of the salivary glands. This condition can be permanent.

If your diet is insufficient due to sore mouth or throat, supplement with Ensure, Nutren or other dietary supplement. 

  • ABDOMINAL AREA

Patients receiving irradiation over their lower abdomen may be plagued by diarrhoea or burning on urinating. You may also experience the need to pass urine more often. The intake of plenty of liquids will prevent or ease these symptoms. Please ask for medication for any of the above-mentioned symptoms.

  • SKIN REACTION

A skin reaction occurs in almost all cases receiving more than 10 treatments. The degree of reaction depends on several factors such as the dosage of irradiation applied, the area of the body treated and the sensitivity of the skin and skin folds. Redness of the skin will occur after about 15 treatments. The next degree of reaction is a dry flaking of the skin and thereafter wet sloughing, where blisters form which can drain. This type of reaction is still completely within expected normal limits. In early reactions you can apply maizena powder and if it worsens one may ask for a prescription cream. The frequent application of a cortisone ointment is the correct treatment for an irradiation reaction.

Please do not apply any ointments, powder, or aerosol under pressure, to the irradiation area; it will make the skin irritation worse. Do not expose the treatment area to direct sunlight. Therefore you should wear a hat and suitable clothing in the sun. You may wash the area but do it lightly and carefully and use normal soap to which you are not sensitive. 

  • HAIR LOSS

As opposed to chemotherapy, your hair will only fall out if you receive radiation to the head. Hair loss on your head will not occur if you are irradiated on any other area of the body.

 

  • DIET AND ACTIVITIES

You may possibly feel slightly tired, but not to such an extent as to affect your normal tasks. You may maintain your normal diet, but drink as many liquids as possible. Any medication you are presently using may be taken. If your food intake is little, you may get a dietary supplement at the chemist, such as Ensure or Nutren, as well as a tonic. You should try to maintain your normal activities as far as possible. 

GAUTENG ONCOLOGY
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DR. FRANK MICHAELIS​

 

M.B.BCh (Wits) MMed Rad. (T) (Wits)

Oncologist / Onkoloeë