What to Expect During Treatment
Fighting cancer is challenging. To help you prepare for the fight, here is a brief outline of what you can expect during the external beam radiation therapy. The details of some of the steps may differ depending on your particular case.
A Team Approach
Radiation treatment is administered to you by a team of highly qualified health care professionals. This team comprises of specialists that among them have years of experience in treating cancer. Some of the typical members of the team are listed below; depending on your particular case, other specialists may be asked to join the team.
The radiation oncologist is your doctor through this process—A medical doctor who specializes in the use of radiation for treating cancer. The radiation oncologist will prescribe, plan and direct your treatment and is responsible for deciding what method of radiation is indicated for your case.
The medical physicist works with the dosimetrist and the radiation oncologist to measure the precision of your treatment plan, and works with the equipment to calculate the best angles to treat your tumor, or tumor site. They also run frequent safety checks and make sure that the equipment is working properly.
The dosimetrist works closely with the radiation oncologist and the medical physicist in designing your treatment. The dosimetrist determines the best angles from which to deliver the radiation, prescribes the length of time for each pulse of radiation, and develops strategies on how best to avoid giving radiation to healthy tissue in your body.
The radiation therapist will conduct your treatment each time. He or she will position you on the treatment table so that radiation can be delivered, run the equipment, and works very closely with the medical physicist during your treatment.
The radiation nurse coordinates your care, helps you learn about treatment and about managing any potential side effects that you might experience.
First, you'll meet with your doctor, the radiation oncologist, to discuss your treatment. Your doctor may examine you with a fiberscope—a flexible device that uses fiber optics to look at internal organs. Your doctor will tell you what type of radiation therapy he or she recommends, whether it will be given alone or in conjunction with other treatment methods, what the specific goals of treatment are, and any side effects that you may experience. If you have more than one treatment option from which to choose, your doctor will give you the information you need to make a decision.
In addition, you may meet with an ENT (ear, nose, and throat) specialist—also called an otolaryngologist—to get information on how to manage side effects and to discuss other issues. You may also have a consultation with a medical oncologist to discuss chemotherapy to be given along with the radiation therapy—a treatment approach called concomitant chemotherapy.
The consultation is an excellent opportunity for you to ask the doctor whatever questions you may have. Click here for a list of some questions you might want to ask.
The first step of the planning process is called a simulation. Detailed imaging scans are made of the treatment area to show the location of your tumor and the normal areas around it. These scans usually include a CT scan (computed tomography), but they can also include an MRI (magnetic resonance imaging), PET scan (positron emission tomography), and ultrasound scans. These scans are combined by a computer to create a detailed 3-D image of your tumor. Your doctor can rotate the image on his computer screen to view the tumor from every angle.
During simulation and the treatments that follow, it is important for you to always be in the same position relative to the machine delivering the radiation. Temporary skin marks and even tiny tattoos (about the size of a freckle) are used to help your team position you for treatment. Depending on the location of your cancer, the radiation therapist may construct a face mask, shoulder mold, or "bite block" for your tongue, to make it easier for you to keep those parts of your body still during treatment.
After the simulation, your doctor will meet with the radiation physicist and dosimetrist to design the details of your treatment plan. After taking into account the location and type of cancer you have, your medical history, lab tests, and other factors, your treatment team will use sophisticated computer software to help them determine the exact area to be treated, the total amount of radiation that will be delivered to the tumor, the desired angles for the radiation beams, how many treatments you should have, and what kind of machine to use.
The radiation therapist (RT) will help you lie down on the treatment "couch"—a platform designed to work with the radiation machine. If a face mask or shoulder mold has been made for you, the RT will place it on you. Then the couch will be adjusted so a laser light shines on the mark(s) put on your skin.
Next, the two arms of the machine's On-Board Imager (OBI) will extend on either side of you in order to create another image of the tumor. The purpose of this new scan is to show if the tumor has changed in size or position since the first one was created during the simulation. If it reveals any changes at all—even ones as small as a fraction of a millimeter—the RT will make the necessary adjustments to the position of the couch.
No matter what type of machine you're treated on, it will have a gantry, which is the head of the machine. The gantry houses a device called a multi-leaf collimator, which "shapes" the radiation beam so it conforms to the shape of the tumor from any given angle. During your treatment, the gantry will move around you to deliver the radiation with sub-millimeter accuracy. The treatment, or radiation beam, is not visible to the eye when it leaves the gantry so you will not see it.
Your first two treatments may take 15 minutes or more, as your team helps you get into position and takes images to verify that your setup on the machine is the same as the treatment plan. Subsequent treatments, however, are often shorter. In fact, you could be in and out—from entering the waiting room to leaving the clinic—in as little as 12 to 30 minutes.
You may experience some side effects from radiotherapy. If you do, depending on your treatment, they might not begin until after a few weeks because the effects of radiation treatment are cumulative. Two of the most common side effects are irritation or damage to the skin near the treatment site, and fatigue. Talk to your doctor before or during treatment if you have any questions or experience discomfort. Click here to see more about possible side effects you may experience.
After your treatment has ended, your oncologist and other team members will recommend a schedule for periodic checkups to monitor the results. Typically, the first checkup is given in one to three months, and subsequent checkups are scheduled at six-month intervals, but yours may be more or less frequent, depending upon your situation. If symptoms or clinical circumstances suggest a recurrence, diagnostic tests such as blood tests, ultrasound, CT scans, or MRIs may be needed.
