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External Beam Radiation Therapy For Bone Metastasis

What is external beam radiation therapy?

External (eks-TER-nal) beam radiation (ra-de-A-shun) therapy is used to kill cancer (tumor) cells. Radiation is a very strong x-ray that has a beam of energy. External beam radiation can be used to treat one or more cancer tumors, or it can be used to help stop cancer cells from spreading. This therapy is used with other treatments such as medicines, chemotherapy and surgery.

What is bone metastasis?

When cancer spreads (metastasis) from one area of your body to your bones, it is called bone metastasis. Cancer that starts in the breast, lungs, bladder or prostate or thyroid gland is more likely to spread to your bones than cancer that begins in other body areas. The cancer cells travel through your blood or lymph vessels and go to one or more of your bones. When this happens, the cells can grow into a new tumor and destroy the bone. Cancer that spreads to your bones can be more painful than cancer that does not spread to your bones.

What problems may be caused by bone metastasis?

  • Fractures: With bone metastasis, bones are weak and can crack or break (fracture) easily. Bones in your arms, legs, and spine are most often fractured when you have bone metastasis.

  • Hypercalcemia: This is a condition where you have too much calcium in your blood. Calcium is a mineral that your body needs in a certain amount. When bones are damaged by tumor cells, the level of calcium in your blood can go too high. When this happens, your heart may not beat as it should, you may get confused, and have other changes.

  • Nerve problems: The tumor can grow in bones in your spine (back bones) and damage nerves in that area. This can make your arms and legs weak and hard to move. You may also lose some or all of the feeling in parts of your body.

  • Pain: At first, your pain may come and go, and the pain may be mild, or severe (very bad). Over time you may have mild pain that does not go away, with times of severe pain. The pain can be in one area, or you may feel it in many areas. It may hurt to move your arms and legs, or even to cough. The pain may be dull or aching, and is usually felt at night. It may decrease during exercise or other physical activity. When bone pain increases with activity, it may be a sign that your bone is very weak and may soon break.

  • Problems sleeping, anxiety, and trouble doing the things you enjoy doing: Having bone metastasis may make you anxious, or very tired. Even though you are tired, you may have trouble sleeping. You may have trouble doing your usual activities because you feel tired, or are coping with pain.

How can external beam radiation therapy help when I have bone metastasis?

External beam radiation therapy can help stop cancer from spreading further, and may decrease pain caused by bone metastasis. This treatment may be done after surgery to decrease pressure on nerves caused by cancer that has spread to your spine. It may also be done after surgery to repair bones or make them more stable. Radiation therapy after surgery can help prevent more surgery, and may help you be more active. If you have many tumors that cannot be removed, radiation therapy may be used to destroy the tumors. Your pain may decrease or go away within two days of a radiation treatment. For some people, it may take two weeks or longer for the pain to decrease or go away.

How is external radiation therapy given?

  • Your caregiver will place your body in a way that gives him a clear view of the area that needs to be treated. Pillows or supports are used to hold you in place. Shields to block radiation from going to other parts of your body may be put over you. A machine is moved near where you are lying. The size and power of the beam of radiation is set by your caregiver. The machine makes a buzzing sound as it is turned on.

  • The machine sends a beam of radiation to the area where the cancer is. The beam of radiation may be pointed at the tumor to kill only the cancer cells. A wider beam may be used to treat an area with many tumors. The beam may also be pointed at areas near the tumor to prevent cancer cells from spreading. You will need to lie still and breathe normally. You should not feel any pain, heat, or tingling during the treatment. Your caregiver will stay nearby in a room where you are able to talk to each other.

What are the risks of having external beam radiation?

  • Your bones may break between or after having radiation treatments. Bone marrow cells can be damaged. When this happens, the number of blood cells that the bone marrow makes can decrease. This can place you at an increased risk of getting infections, and cause you to get tired very easily. High doses of radiation can weaken your pelvis bone, making it easier to break for up to one year after your treatment. Your skin over the area getting radiation may get red and very dry or flaky. Your skin can also get moist, bleed, and peel off. If your lower body (below your waist) is treated with hemibody radiation, you may get an upset stomach, throw up and have loose, watery bowel movements. If your upper body (above your waist) is treated , you may lose your hair or get pneumonia. It may take a few days or weeks before your pain decreases or goes away. After treatment your pain may come back, and you may need to have more treatments.

  • You may be at a greater risk of getting a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.

  • If you do not have external beam radiation therapy, the tumor may damage or pinch your nerves and cause pain. You may have weakness or lose feeling in parts of your body. If the tumor is in your spine (back bones), you may have trouble moving or feeling parts of your body. Tumors in your bones may also grow. The tumors can damage and weaken your bones, causing them to break easily. Your pain may not get better with other treatments such as medicine or surgery. When you cannot do things you usually are able to do, you may get anxious or very sad. Talk to your caregiver if you have questions or concerns about your condition, treatment, or care.

How should I care for my skin while getting external radiation therapy?

External beam radiation therapy may make your skin red and very dry. Your skin may also get moist. It may begin to bleed, and start to peel off. Ask your caregiver if you should do the following to care for your skin:

  • Wash your hair and scalp gently with a mild shampoo.

  • Wash your skin gently with mild soap. Do not scrub your skin. Pat yourself dry with a towel instead of rubbing your skin.

  • While bathing, do not soak for a long time as this can make your skin drier.

  • Ask your caregiver what type of lotion or cream would be best for you to use on your skin.

When should I call my caregiver?

Call your caregiver if:

  • You cannot make it to your radiation treatment on time.

  • The skin over the area that was treated is bleeding or peeling off.

  • Your pain is worse after having radiation therapy.

  • You feel sick, are throwing up, or have loose watery bowel movements after your radiation treatment.

  • You have chest pain or trouble breathing that is getting worse over time.

When should I seek immediate help?

Call 911 or get to the nearest emergency room if:

  • You have a fever, chills, and body aches after your radiation treatment.

  • You have fallen, and your arm, leg, or another part of your body is swollen, painful, or does not look the same as it did before.

  • You suddenly feel lightheaded and have trouble breathing.

  • You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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