What Is Radiation Therapy?
Radiation therapy is a common type of cancer treatment that uses high-energy particles or waves to damage or destroy cancer cells. Cancer cells usually spread by growing and dividing. Radiation therapy slows or stops cancer growth by damaging the cells and preventing them from dividing.
A radiation oncologist (a medical doctor who is specially trained in treating cancer with radiation) usually plans the dosage and treatment schedule for you. During your radiation appointments, a radiation therapist or technologist will operate the equipment and a radiation nurse will be available to provide education and answer any questions.
Your healthcare team may recommend radiation therapy on its own or in combination with chemotherapy, surgery, immunotherapy, or targeted therapy. The type of radiation therapy you receive will depend on your type of cancer, the size and location of the tumor, and your overall health.
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Purpose
The purpose of radiation therapy is to stop or slow the growth of cancer. Radiation therapy can help remove cancer cells, slow cancer growth, improve symptoms, and prevent cancer from coming back (which is known as recurrence). Radiation therapy may also be given before surgery to shrink a tumor or after surgery to ensure that all cancer cells have been destroyed. Your healthcare team may recommend radiation therapy alone or in combination with other cancer treatments.
Radiation therapy works by damaging your cancer cells’ DNA, which is the material inside cells that contain their genetic information. When the DNA becomes damaged, the cancer cell cannot grow and divide normally. This causes the cell to die without multiplying and thus slows or stops cancer growth.
Types of Radiation Therapy
There are three main types of radiation therapy: external beam radiation, internal radiation (also known as brachytherapy), and systemic therapy. Each of these types treats cancer a bit differently.
External Beam Radiation
External beam radiation is the most common type of radiation therapy. During external beam radiation, the technologist uses a machine to aim high-energy rays or particles at the body to destroy cancer cells. Your radiation oncologist may recommend this type of radiation to treat cancers of the head and neck, eye, breast, cervix, and prostate.
Common types of external beam radiation include:
Photon beam radiation therapy: Uses the same type of radiation used in X-rays but in a much stronger dose
Particle beam radiation therapy: Uses radiation in the form of separate units of energy (protons or neurons)
Electron beam radiation therapy: Uses radiation in the form of separate units of energy that act like particle beams
Internal Radiation (Brachytherapy)
Internal radiation is known as brachytherapy and involves a healthcare provider placing a sealed source of radiation inside the body. The radioactive implant inside your body may be temporary or permanent. This allows for higher doses of radiation to reach the tumor.
There are several types of radiation implants including pellets, seeds, ribbons, wires, needles, capsules, and tubes. Your healthcare team decides which part of your body is the best fit to place a radiation implant. Some people may have an implant placed in a body cavity (such as their rectum or uterus) while others have these implants inserted directly into the body near the location of the tumor.
Systemic Radiation
Systemic radiation is a type of radiation that affects the entire body. You can take this treatment orally as a liquid or pill or have it injected into a vein. While this type of radiation affects the whole body, it only collects in areas of the body where cancer cells are present. Your healthcare team may recommend this type of radiation for cancers of the thyroid, bone, or prostate. It's worth noting that most people stay in the hospital for some time after receiving systemic radiation.
How Does It Work?
Radiation therapy is a common cancer treatment that usually takes place in a hospital or cancer treatment facility. External beam radiation is usually given in an outpatient facility (where you can go home after treatment), while internal and systemic radiation often require a hospital stay.
Before Radiation Therapy
When you arrive for your radiation therapy appointment, you will be asked to fill out screening questionnaires and consent for treatment. Before the appointment, your healthcare provider will perform a physical exam and ask about your medical history. They will also check your most recent lab values.
Before external beam radiation, your radiation therapist will determine the exact placement of the beams by using a process called simulation. During the simulation, you will be asked to lie on the radiation table while the therapist uses imaging scans such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) to locate the tumor. The therapist will define the treatment field, which is the exact area of the body where the radiation beams will be directed.
The process of simulation can take some time. Your therapist may create a mold or cast for the area of the body that is receiving radiation. This is done to make sure your body is positioned the same way at each radiation appointment. They may also mark the area with semi-permanent or permanent ink. External beam radiation is painless and does not require pain medications. The appointment usually takes about 15 to 30 minutes but the radiation time is only a few minutes long.
Prior to brachytherapy, you will be taken to the hospital operating room. You will receive either general anesthesia (where you are put into a deep sleep) or local anesthesia (where only a part of your body becomes numb). The surgeon will locate the tumor with an imaging test such as an X-ray, CT scan, or MRI. Similarly, you'll check into a hospital for an overnight stay if you're receiving systemic radiation. This treatment however doesn't require anesthesia.
During Radiation Therapy
The experience of receiving radiation varies depending on which type you're getting. For external beam radiation, the radiation therapist will help you to lie on the treatment table. You may need to change into a hospital gown. Once you are in the correct position, the therapist will move the arm of the machine over the specific area of the body that needs radiation. The machine will never touch your body, and the process is painless.
To administer radiation, the therapist will step out of the room to operate the machine. There will be an intercom for you to communicate. The machine tends to be very noisy and may sound like a vacuum cleaner. The therapist can stop it any time if you start to feel ill or need to move.
During brachytherapy, your anesthesiologist will administer anesthesia and monitor your health during the appointment. your surgeon will use an applicator to place the radiation implants into your body. You should not feel this procedure because of the anesthesia. Temporary implants usually stay in place for a few minutes to a few days. Permanent implants will stay in your body permanently but will eventually stop emitting radiation.
When receiving systemic radiation, your healthcare provider will administer radiation by giving you a pill or liquid to swallow or by injecting the liquid intravenously (IV).
After Radiation Therapy
After external beam radiation, you will be able to leave the hospital or treatment facility as long as you feel well. Most radiation oncologists recommend external beam radiation five days per week (Monday through Friday) for five to eight weeks. Taking a break over the weekend gives your healthy cells a chance to recover.
Once your brachytherapy session is complete, your healthcare team will take you to the hospital's post-anesthesia care unit (PACU) to recover from anesthesia. You may feel drowsy, weak, or nauseous when you wake up. These are common side effects of anesthesia. But, you may also feel soreness or tenderness near the treatment area.
After brachytherapy, your body may give off small amounts of radiation for a short time. Your healthcare team will talk to you about safety precautions that you should take. For both brachytherapy and systemic radiation, you may need to stay in the hospital while your body is still giving off radiation. This ensures that you do not expose others to small doses of radiation. Your healthcare team may recommend limiting time with visitors, especially with children and pregnant people.
After you go home from the hospital, you may need to take special precautions to protect your loved ones. After systemic radiation, your healthcare provider may recommend washing your laundry separately and using different towels and utensils. You may need to abstain from kissing and sexual contact for a week. Plan to stay home from work or school during this time as well.
Risks and Precautions
Radiation therapy has risks and may cause serious side effects. Everyone reacts to radiation differently. Your risks and side effects will depend on the type of radiation you receive, the dose, and the location of your tumor. Fortunately, most side effects go away on their own within a few months of ending radiation therapy.
General side effects of radiation therapy may include:
Emotional exhaustion
Itchy, irritated, swollen, or dry skin
Hair loss
But radiation can also affect different parts of your body. Here are some side effects based on body part or location:
Brain: Radiation to the brain may cause headaches, hair loss, nausea, vomiting, fatigue, hearing loss, scalp changes, memory and speech problems, and seizures. In the years after surgery, it is possible to develop memory loss, stroke-like symptoms, poor brain function, and an increased risk of another brain tumor.
Head or neck: Radiation to the head or neck area may lead to mouth sores, dry mouth, trouble swallowing, changes in taste, nausea, ear pain, tooth decay, swelling in the gums and throat, hair loss, skin changes, and jaw stiffness.
Breast: Radiation to the breast might cause side effects like skin irritation and dryness, soreness, and swelling. Over time, you may experience darker skin, larger pores, and changes in the size of the breast. Brachytherapy specifically may cause breast tenderness, tightness, redness, bruising, and inflammation of the lungs (known as pneumonitis).
Chest: Radiation to the chest often leads to a sore throat, swallowing problems, loss of appetite, cough, and shortness of breath.
Abdomen: Radiation to the abdomen can sometimes cause side effects such as nausea, vomiting, cramping, diarrhea, and constipation.
Pelvis: Radiation to the pelvis may cause pain or bleeding with urination, trouble passing urine, painful sex, and fertility problems.
How to Prepare for Radiation Therapy
It is normal to feel nervous when starting radiation therapy for cancer. Fortunately, the benefits of radiation therapy outweigh the risks. When preparing for your first appointment, consider the following factors:
Location: External beam radiation therapy appointments may take place in a hospital or outpatient facility. Brachytherapy and systemic radiation appointments take place in a hospital.
Attire: Plan to wear clothing that is loose, comfortable, and easy to remove. You may be asked to change into a hospital gown. It's also a good idea to leave any jewelry or valuables at home.
Food and drink: It is not safe to eat before brachytherapy because you will receive anesthesia. Ask your radiation oncologist if it is OK to eat and drink before external beam radiation. If the radiation is aimed at your abdomen, you may feel nauseous after the appointment. Consider meeting with a dietician to ensure that you take in enough calories and protein to maintain a healthy weight during the treatment period.
Medications: You may have a long list of medications for cancer treatment. If you take any herbal supplements, your provider may ask you to stop them during your treatment. Ask your oncologist which medications and supplements are safe to continue during radiation therapy.
Items to bring: It's important to bring your insurance card and a photo identification card to your radiation appointments. If you are staying overnight in the hospital, pack a bag with clothes and toiletries. Consider bringing a book, music, or another activity to do as you recover.
Emotional support: It is not safe for anyone to be in the room with you when you receive radiation. For external radiation therapy, a friend or family member could wait in the waiting room for you and drive you home. Because brachytherapy and systemic radiation therapy cause your body to give off small amounts of radiation, you may need to avoid contact with others for a few days to a week.
Cost and insurance: Radiation therapy is a common cancer treatment that is usually covered by insurance. Talk with your insurance company and hospital billing department before your first appointment to know what to expect and if there are any out-of-pocket costs.
Work and school: You may be able to continue working or attending school during radiation therapy but it will depend on the type of radiation you're receiving. Fatigue usually gets worse as your treatment progresses. Consider cutting back to part-time or taking a break from other responsibilities if you're able.
Fertility: Radiation therapy may affect your ability to conceive or have children. Radiation to the ovaries or testicles can cause infertility. Talk with your healthcare team about fertility options before you begin radiation treatment.
A Quick Review
Radiation therapy is a common type of cancer treatment that uses high-energy particles or waves to damage or destroy cancer cells. Radiation therapy works by disrupting the DNA inside cancer cells. This prevents the cells from growing and dividing, leading to cell death. There are three main types of radiation therapy: external beam radiation, brachytherapy, and systemic radiation therapy. Your healthcare team will determine which treatment option is best for you.
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