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.
If radiation therapy is recommended to you, the first thing you will do is meet with your doctor. Based on your specific case, 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 what side effects you may expect. You can talk to your doctor about your treatment options and make a decision together.
The consultation is an excellent opportunity for you to ask the doctor whatever questions you may have. Click here for a list of some common questions you could ask.
The second step of the radiotherapy process is called simulation, during which you and your team will take the first steps toward planning your treatment. During simulation, detailed imaging scans are made of the treatment area to show the location of your seroma and the normal areas around it. These scans usually include a CT scan, but they can also include an MRI, PET scan, and ultrasound scans. The scans are analyzed and combined by a sophisticated software program to create a detailed 3-D image of your tumor site and surrounding tissues. Your doctor can rotate the image on his computer screen in order to view the tumor from every angle. If you are interested in seeing the images, ask your doctor and he or she will be happy to show you.
During the simulation, your radiotherapy team will help you find a comfortable position relative to the machine delivering the radiation. They will also help you get into that same position for each treatment session. Temporary skin marks and even tiny tattoos (about the size of a freckle) are used to help guide you into position for each treatment. The radiation therapist will probably position you lying on your back with your shoulders propped slightly higher than your feet, as if you were reclining in a lounge chair. There will be a pad to hold your arm above your head out of the beam. You may be asked to hold still in that position for up to 20 minutes each day. Your therapist will work with you to get a pose that feels right for you and can meet the treatment goals.
For some breast cancers on the left side, radiation oncologists may use respiratory gating technology. To use this treatment technique, your team studies the motion of your chest as you breath. They will evaluate the targeted area's movement in and out of the beam's view. They then turn the beam on only when the targeted area is in a specific position. With visual/audio coaching, the therapist may direct you to hold your breath (if that is comfortable) while a small cube on your chest broadcasts the position of the ribcage back into the control room. Holding the breath while the lungs are expanded creates more space between your heart and breastplate, so that the radiation can target the surgical site while distancing and minimizing exposure to the heart and lung tissue. If you don't feel comfortable holding your breath, talk to your team, and ask if it is possible for you to continue to breathe normally. It is often possible, but it may take a little longer for the treatment since the beam will only "flash" on when your target is in position.
After simulation is completed, the radiation oncologist will meet with the medical physicist and dosimetrist to design the details of your treatment plan. No two patients and no two targets are exactly alike. That's why your doctor will develop a treatment plan that's been carefully customized for you. 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 assist them in prescribing the exact volume to be treated, the total amount of radiation that will be delivered to the tumor, the angles for the radiation beams, how many treatments you should have, and what kind of machine to use.
Before each day's treatment, you may be asked to change into a gown. Then the radiation therapist (RT) will help you lie down on the treatment "couch"—a platform designed to work with the radiation machine. Then your arm(s) will be placed in the immobilization board designed to keep you still during treatment. The couch will be adjusted so a laser light shines on the mark that was put on your skin, helping to position you correctly. Next, the two arms of the machine's On-Board Imager (OBI) will extend on either side of you in order to create an image of the tumor in that day's treatment position and match it to the position that was planned for you. The scan is compared to the planned position, and if there is any difference between the two, with the touch of a button, the couch adjusts slightly to align you perfectly for treatment.
Your RT may offer to play soft music while you are in treatment. You can also ask your team about other ways to help make you more comfortable.
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 are often shorter. In fact, some treatments—from entering the waiting room to leaving the clinic—can take 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 and 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 of periodic checkups to monitor the results for your treatment. Typically, checkups, which include mammograms, are scheduled at six-month intervals. If symptoms or clinical circumstances suggest a recurrence, diagnostic tests such as blood tests, ultrasound, CT scans, MRIs, chest x-ray (CXR), or a bone scan may be needed.
