External Radiation Therapy

GENERAL INFORMATION:

What is it? External (eks-ter-null) radiation (ra-d-a-shun) therapy is using x-rays on the outside of your body to treat cancer. This may also be called teletherapy (teh-luh-th-air-uh-p). A special x-ray machine sends a beam of radiation over the area where there is cancer. Radiation can be used to treat many kinds of cancer. Even if radiation therapy does not cure your cancer, it may help you feel better or live longer.

How does it work? Most cells in your body divide and grow. Normally each cell knows when to stop dividing and growing. But cancer cells do not know when to stop dividing and growing. Instead of making just one cell like itself, the cancer cell makes many. After a while, the body becomes overworked because of all the cancer cells. Radiation therapy kills these cancer cells or keeps them from growing, dividing, and spreading. Radiation kills some cancers better than others. The following are the 4 basic goals of radiation treatments.

• To cure the cancer.
  
  
• To control the cancer or limit its growth.
  
  
• To improve symptoms or problems that the cancer is causing.
  
  
• To prevent some kinds of problems from happening.

How does radiation therapy effect my body? Even though radiation kills cancer cells, it can also hurt normal cells at the same time. Normal cells that divide and grow the fastest in your body are the ones first hurt by radiation. Some of these fast growing cells are in your blood, hair, or bone marrow (spongy tissue inside bones). What kind of side effects you have with radiation therapy depend upon the following.

• The body tissues and body areas that are being treated with radiation.
  
  
• How much daily radiation you get (dose), and the total dose (amount) your are being given. A dose of radiation is called a centigray (cent-uh-gray).
  
  
• Your age.
  
  
• What other cancer treatments you may be getting along with radiation therapy.

Kinds of side effects: You may have one or more of the side effects of radiation therapy listed below. Caregivers will work with you to help lessen these side effects

• Blood Problems: Bone marrow is the soft spongy tissue inside bones. This is where blood cells are made. When radiation damages bone marrow, you may get anemia (not enough red blood cells). Or, you may bleed easier and bleed more when you are cut (not enough platelets). Radiation may cause you to not have enough white blood cells (WBCs). These are the cells that fight infections. You may get infections more easily if you have too few WBCs. You may need blood transfusions to help raise your blood count.
  
  
• Brain Swelling: Radiation therapy to the head may cause you to have brain swelling (edema). This swelling can cause headaches, nausea, vomiting, or seizures. It may also cause you to have problems seeing, talking, thinking, or walking.
  
  
• Chest Problems:
  
  
  • You may get a cough if your lungs are near the area getting radiation. Caregivers will call your cough "productive" (pro-duk-tiv) if you are coughing up mucous (mew-kus). Or, your cough may be nonproductive (dry and hacking) if the mucous dries up. Coughing may keep you awake at night and may cause you to be tired all the time.
    
    
  • You may be short of breath or have breathing problems. You may have dyspnea (dih-sp-nee-uh) which means that it is hard to breathe. Dyspnea may be caused by changes in the lung called pneumonitis (new-muh-ni-tis). Or, dyspnea may be caused when hard tissue called fibroids grow in the lungs. These lung changes may not happen until 1 to 3 months after you finish radiation therapy.
  
  
• Cystitis (sis-ti-tis):
  
  
  • This is inflammation (tenderness, swelling and pain) to the bladder. The bladder is the organ where urine stays before you urinate. Cystitis may mean that there is an infection in the bladder. It may also happen if you are getting radiation to the bladder, or to an area near it.
    
    
  • You may have burning pain when you urinate or you may have trouble starting to pass urine. You may feel like you have to urinate often and in small amounts. Or, you may have to urinate all of a sudden. You may not be able to hold very much urine in your bladder. Or, you may have to urinate often at night. You may also have blood in your urine.
  
  
• Diarrhea (di-uh-ree-uh): You may have loose BMs if your intestines (bowel) are in the area of radiation. Diarrhea may start 2 to 3 weeks after radiation has begun. It may continue until a month after your radiation treatment is done.
  
  
• Eating Problems: Sometimes cancer and/or radiation therapy can cause anorexia (an-or-eks-e-uh). This is when you lose your appetite (taste or interest) for food. You may not have an appetite and not want to eat because you are tired. Being tired can make you not want to be active like before so your appetite seems to go away. Or you may have a feeling like a lump in your throat where it feels like food just doesn't go down. If you do not eat enough food you will lose weight and you will get even more tired. Cancer medicines can also cause you to lose your appetite for food. Some cancers make it hard to swallow food.
  
  
• Fatigue (fuh-t-guh): You may feel tired during and after radiation therapy. Fatigue (being tired) is different for every person who is having radiation therapy. But, most people are still able to keep working in spite of the fatigue. You may feel more fatigued in the afternoons. You may have less fatigue on Sundays when there is no treatment over the weekend. Pain, infection, anemia (low blood count), poor appetite, and depression can make your fatigue worse. You may feel fatigued for weeks to months after your radiation therapy is done but it should go away with time.
  
  
• Hair Loss: You may lose some or all of your body hair in the area where you have radiation therapy. Your hair may start to get thin and/or fall out over 2 to 3 weeks. Your hair may also change color or may become very dry and thin. About 2 to 3 months after your radiation therapy is done, your hair should start to grow back. It usually grows slower than normal. New hair continues to grow for up to a year. It may be thinner and a different color. These changes may be short-term or lasting. Radiation does not usually make hair grow over areas that were bald before treatment.
  
  
• Mouth Problems: You may have mouth problems if you are getting radiation to the head, neck or upper chest.
  
  
  • The skin inside your mouth and throat may become swollen and sore. This is called stomatitis (sto-mah-tih-tus). It usually begins 2 to 3 weeks after radiation starts. Stomatitis may cause it to hurt when you swallow. Sometimes stomatitis may also cause you trouble swallowing both solids and liquids.
    
    
  • A white coating may grow over the skin in your mouth. This is called "thrush" and it's usually caused by a fungus. Do not pull it off. Caregivers will give you medicine to make it go away. Your mouth may then have sore areas that can bleed.
    
    
  • Your mouth may get very dry 1 to 2 weeks after therapy is started. Your saliva (the liquid that makes your mouth wet) may get very thick and sticky. This can make it hard to talk and eat, and easier to get cavities in your teeth.
    
    
  • Food may start to taste bad or you may not be able to taste some foods at all. Your taste will usually return to normal in a few months.
  
  
• Sexual Problems in Men: Radiation therapy can damage a man's testicles. This may cause a man to have a low sperm count. Radiation can cause a man to have no sperm at all and become sterile (unable to make babies). Men can put sperm in a sperm bank. At the sperm bank, the sperm will be kept frozen so it can be used later. Men may also have trouble having an erection. These problems may go away or may last forever.
  
  
• Sexual Problems in Women: A woman may have the symptoms of menopause (men-o-paws) if her ovaries get radiation. You may have hot flashes or your monthly period may stop. A woman may also have less interest in sex. Caregivers may suggest surgery to move your ovaries out of the way of the radiation. This could lessen the side effects of radiation therapy. It will also help protect your egg if you want to have children later on.
  
  
• Stomach Problems: You may have nausea (upset stomach) or vomiting (throwing up) if your stomach or intestines (bowel) are in the area of radiation. It also may happen if you are getting radiation to your brain. This nausea and vomiting usually happens in the first 6 hours after radiation. It may last 3 to 6 hours.
  
  
• Skin Problems: The skin over the area getting radiation may become swollen and sore. It may change color from light pink to red to brown. The skin may be itchy, dry, or flaky. Your skin may become sore and wet if the top layers of the skin peel off. You may have skin problems on the opposite side of your body where the radiation leaves your body.

Care: You may need many blood tests before, during, and after having radiation therapy. These blood tests show how your body is doing with the radiation. The tests can tell caregivers if the radiation therapy dose needs to be adjusted (changed). Or sometimes, the treatment needs to be stopped for a short time to let your body heal. Before radiation, you may need surgery to remove as much of the cancer as possible. You may also have chemotherapy (anti-cancer medicine) or biological therapy with radiation.

Support:

• Accepting that you have cancer is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings and let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with cancer.
  
  
• You may also want to join a support group. This is a group of people who also have cancer. Ask your caregiver for the names and numbers of support groups in your town. Or, you can contact one of the following national organizations for more information.

• American Cancer Society
  Phone: 1-800-227-2345
  Web Address: http://www.cancer.org
  

• National Cancer Institute
  Phone: 1-800-422-6237
  Web Address: http://www.cancer.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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