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Know Your Cancer

What is Radiotherapy in cancer?

Radiation therapy or Radiotherapy is often abbreviated as RT, RTx, or XRT. Radiotherapy uses ionising radiation, generally as part of Cancer Treatment to control or kill malignant cells. Radiotherapy is usually delivered by a device called linear accelerator (linac).

Every day, everywhere, we are surrounded by radiation. The light waves we use to see, heat, radio waves, or microwaves we use to cook, are all forms of radiation. The sun, TV remote controls, even some minerals are all sources of radiation. Radiation is also a standard Cancer Treatment. In fact, more than half the people diagnosed with cancer get some type of Radiation therapy. They all use high-energy waves to kill cancer cells.

Doctors use radiation as a Cancer Treatment because it is good at shrinking and destroying tumours without causing much damage to healthy tissues. The high energy waves pass through the body to reach the cancer. Cancer cell divides faster than normal cell and does not obey the rules of the body. When the cancer cells are hit with high-energy radiation, they are damaged. If they do not die right away, they die the next time they try to divide. As the cancer cells continue to die, the tumour shrinks. Most normal cells do not die with radiation because they are not diving fast, and they are better able to repair themselves.

The decision of whether radiation can be used as a treatment for a patient depends on the:

  • type of cancer
  • location of the cancer
  • whether or not cancer has spread
  • the current health of the patient
  • other treatments the patient is on or will be on

A radiation oncologist uses radiation to cure cancer or to relieve a cancer patient's Pain or alleviate other symptoms due to the cancer.

Radiation treatment works because radiation stops the capacity of the cancer cells to replicate and eventually kills them, and the body eliminates these dead cells naturally. Radiation affects cancer cells by causing damage to their DNA to prevent the division and development of cancer cells. Radiation is the fastest way to destroy rapidly dividing cells. Cancer cells are more vulnerable to radiation as:

  • they divide more rapidly than healthy cells
  • they do not repair this damage as effectively as healthy cells

There are various ways in which a cancer patient can receive Radiation therapy. The most common form of Radiation therapy is external beam radiation. This form includes a machine that guides high-energy beams of radiation to hit cancer cells. The device allows radiation to be aimed at certain tumour sites. Doctors use external beam radiation for nearly all types of cancer.

As per the National Cancer Institute, approximately half of all cancer patients undergoes Radiation therapy. A growing number of patients have their cancers treated successfully using Radiation therapy.

New technology has incorporated the use of three-dimens

Professionals involved in Radiation therapy treatment include:

  1. Radiation oncologists: Radiation Oncologists supervises the treatment of each cancer patient undergoing radiation treatment. They establish and administer each cancer patient's treatment plan, make sure that every medication is correctly administered, and they track the patient's progress and change treatment to ensure sure patients receive quality care during treatment. Radiation oncologists can help detect and manage the side effects of Radiation therapy and work closely with other members of the radiation oncology team.
  2. Radiation therapists: Radiation therapists work with radiation oncologists. They administer the daily radiation to patients, under the radiation oncologist's orders and supervision. They also keep daily records and periodically check the radiation machines to make sure they are functioning properly.
  3. Radiation oncology nurses: Nurses work collaboratively with the radiation team to care for patients during treatment. They help assess the patient before treatment begins and talk to the patient about their therapy, the possible side effects and their management. Throughout radiation treatments, patients may be evaluated weekly, or more often, by the nurse, to determine symptoms and concerns. Radiation oncology nurses are registered nurses. Some nurses in Radiation therapy have additional accreditation in the field of oncology nursing. Registered professional nurses in oncology, which include registered nurse professionals and nurse practitioners, have completed a master's degree program.
  4. Medical radiation physicists: Qualified medical physicists work closely with the oncologist in the careful preparation and delivery of radiation. They oversee the work of the dosimetrist and help ensure that specific procedures are appropriately adapted for each patient. Qualified medical physicists are responsible for developing and directing quality control programs for equipment and procedures. We are responsible for making sure the equipment works properly. Health radiation physicists take accurate measurements of radiation beam characteristics and perform certain health checks daily.
  5. Dosimetrists: Dosimetrists carefully measure the dose of radiation to make sure the tumour receives an appropriate amount of radiation. They create several treatment plans that can destroy the tumour while sparing the normal tissues. Many of these treatment strategies are very complex. Dosimetrists collaborate with the doctor and the medical physicist to select the right treatment plan for each patient.
  6. Social workers: Social workers will be available to provide practical support and emotional therapy to patients or members of their families and may support them to cope. We also can help arrange for home health care and other services. Social workers may be certified. Certified social workers must hold a master's degree and must pass an examination.
  7. Dietitians: Dietitians consult with patients to help improve wellness. They track patients' weight and nutritional issues. Dietitians advise patients and may provide them with recipes and nutritional supplements to enhance their nutritional status before, during and after radiation treatment.

How is Radiation therapy used in cancer treatment?

A radiation oncologist may use either external beam radiation therapy, or brachytherapy to treat cancer. External beam Radiation therapy can be provided by a linear accelerator. Proton therapy is another type of external beam Radiation therapy that uses cyclotrons or synchrotrons to create charged atoms that kill tumours.

Radiation therapy provided by radioactive sources that are inserted inside the patient is called brachytherapy. The radioactive sources are enclosed in needles, seeds, cables, or catheters, and inserted directly into or near a tumour either temporarily or permanently. Brachytherapy is a common procedure for cancers of the prostate, abdomen, cervix or breast.

Many cancer patients can be treated with radiation as their primary treatment. In certain cases, Radiation therapy is given at the same time as Chemotherapy. Chemotherapy combined with Radiation therapy can enhance outcomes and reduce recurrence.

Radiation therapy may also be given before surgery(neoadjuvant radiation treatment) or after Surgery (adjuvant radiation treatment).

Radiation Therapy Process

Once Radiotherapy has been ordered, a planning stage initiates. The patient will first undergo a simulation scan on a special CT scanner. IV or oral contrast can be used. In case a device is needed to keep the patient still (such as a mask), this is made at the simulation scan appointment.

The radiation oncologist then describes the area to be treated, the tumour, and the areas to be avoided. The radiation plan is created and verified by dosimetrists, radiation physicists and radiation oncologists. The plan then undergoes quality and safety checks.

The radiation oncologist, along with other team members, like nurses and dietitians, will take care of the patient during Radiation therapy and look for side effects.

Radiation Therapy Techniques

Radiation can damage healthy cells. The radiation must be targeted to the cancer.

An advanced type of three-dimensional (3-D) conformal radiation, called strength modulated radiation therapy, or IMRT, more specifically conforms the dose to the tumours, allowing safer delivery of higher doses of radiation.

Certain techniques that allow ultra-precise doses of radiation to tumours include stereotactic radiosurgery, which uses 3-D imaging to define the exact location of a tumour. The intensely concentrated gamma rays or x-rays then concentrate on the tumour to treat it. The Gamma Knife is a treatment method that uses radioactive cobalt sources to concentrate several beams of radiation on a small region. Linear accelerators can also be used to administer stereotactic Radiation therapy to the brain. Many areas of the body may be treated with stereotactic body Radiation therapy (SBRT). Emerging areas for using SBRT include lung, liver and bone cancer.

Image-guided Radiation therapy (IGRT) is also used in combination with IMRT to ensure the radiation is transmitted to the targeted location. IGRT involves performing a CT scan at the time of radiation treatment to ensure the target is aligned in the correct location. IGRT may allow for changes during treatment in areas of the body that are sensitive to movement, such as the lungs, and tumours located close to vital organs and tissues.

Radiation can be used to cut off blood flow to a tumour in vascular organs such as the liver. For instance, radio embolisation uses microspheres filled with radioactive isotopes to block a tumour's blood supply and starve it.

Why is Radiotherapy needed?

Radiotherapy is beneficial in the treatment of cancer. About 50 per cent of patients undergo Radiotherapy at some stage during the treatment of their cancer. Radiation is a localised procedure to the cancer site destroying the cancer cells, which helps healthy cells restore themselves usually. Radiotherapy may be offered alone or in combination with other therapies to destroy the cancer cells. Such treatments include surgery, Chemotherapy and Hormone therapy. The medical staff agree on the best course of action tailored to the patient.

Radiotherapy may be given to either cure the disease (Radical treatment) or to relieve symptoms (Palliative treatment) of the disease. The course of treatment will be different for a patient undergoing radical Radiotherapy treatment or palliative care.

Radical Radiotherapy is used with the purpose to destroy the cancer cells and cure the disease. A course of radical radiation treatment can be anywhere from 2 to 8 weeks Monday to Friday. Both therapies deliver a small dose of radiation a day to kill the cancer cells also to give healthy cells time to heal.

Palliative Radiotherapy is used to relieve symptoms of the cancer, e.g. Pain. If a tumour is no longer curable, palliative Radiotherapy may be used. Higher doses of radiation are administered than for curative care, usually over a shorter period of time (sometimes only a single care).

Radiation therapy is a standard treatment of cancer and is often used in conjunction with other therapies, such as Chemotherapy or Surgery.

The key aims of Radiation therapy are to reduce tumours and destroy cancer cells. Although the treatment itself most possibly harm healthy cells, the damage is not permanent. Healthy, noncancerous cells can recover from Radiation therapy. To minimise the effect radiation has on the body, the radiation is aimed only at required points in the body.

Radiation therapy can be used at various periods of Cancer Treatment and with different outcomes. Radiation therapy can be used:

  • To reduce symptoms in advanced or late-stage cancer
  • As the main treatment for cancer
  • In conjunction with other cancer treatments
  • To shrink a tumour before surgery
  • To kill any remaining cancer cells after surgery

When is Radiotherapy required?

Radiation therapy, or radiotherapy, is the use of different types of radiation to safely and efficiently cure cancer and other diseases. Radiation oncologists can use radiation to cure cancer, to control the growth of the cancer or to alleviate symptoms, such as Pain. Radiation therapy works by destroying cells. Healthy cells can rebuild themselves, while cancer cells can not. New techniques also allow doctors to better aim the radiation to protect healthy cells.

Often Radiation therapy is the only medication a patient requires. In many times, it is just one aspect of a patient's diagnosis. For example, Prostate Cancer and larynx cancer are often treated with Radiotherapy alone, while a woman with Breast Cancer may be treated with surgery, radiation and Chemotherapy.

Radiation can also be used to make the primary treatment more successful. For example, you may be treated with Radiotherapy before Surgery to help shrink the tumour and allow less aggressive operation; or you may be treated with radiation after Surgery to destroy small amounts of cancer that may have been left behind. A radiation oncologist can choose to use Radiation therapy in a variety of different ways. Often the aim is to cure cancer. In this case, Radiation therapy can be used to:

  • Destroy tumours that have not spread to other areas of the body.
  • Reduce the likelihood that cancer will return after you undergo Surgery or Chemotherapy by killing tiny quantities of cancer that may remain.

Sometimes, the ultimate aim is to slow down the cancer as much as possible. For other situations, the objective is to reduce the symptoms caused by increasing tumours and to improve the quality of life. When Radiation therapy is administered for this purpose, it is called palliative care. In this instance, radiation may be used to:

  • Shrink tumours that are messing with the quality of life, such as a lung tumour that is causing shortness of breath.
  • Relieve Pain by reducing the size of the tumour.

Who needs radiotherapy?

You may have radiation after Surgery to kill cancer cells that might have been left behind.

It is also prescribed as the only treatment for disabled people or others who have health problems that make it unsafe for them to undergo Surgery. Radiation also can be used instead of Surgery if the tumour is massive or in a hard-to-treat region (like the eyelids or the tip of your nose) and the procedure may influence how you appear.

Yet non-melanoma skin cancers treated only with radiation are more likely to come back than those treated with Surgery. And if you have specific other health problems, such as lupus or scleroderma, Radiotherapy can sometimes make those outcomes worse.

How Radiotherapy works against cancer?

Radiation therapy (also called radiotherapy) is an extremely effective Cancer Treatment with wide-ranging applications. Radiation therapy contributes to cancer cure in many patients (either alone or with other treatments) and/or alleviates symptoms induced by more advanced cancers. There are validated roles for almost all cancer types.

Radiotherapy is a highly targeted treatment, aimed accurately and directly at the cancer wherever it could be in the body. This enables the cancer cells to be killed or reduced in number while protecting the large proportion of other organs and tissues in the body.

Radiation treatment leads to 40 per cent of all cancer therapies world-wide as well as relieving symptoms, such as pain, and improving the quality of life for many others. In certain common cancers, such as breast cancer, bowel cancer and prostate cancer, Radiation therapy is highly effective in minimising the risk of cancer recurrence following Surgery or making the procedure more successful. This can even heal the cancer if it has recurred locally following Prostate Cancer Surgery. For certain cancers (prostate, head and neck, liver, lung, cervix and skin cancers), radiation therapy, with or without drug therapy, may be used as the primary curative treatment and in this way eliminates the complications of Surgery and the loss of organs.

For certain cancers that are too advanced to be healed, Radiation therapy is beneficial for Pain and other complications caused by cancer, such as bleeding from the lung or bladder. For example, Pain in the bones from the spread of cancer can be improved dramatically or be eliminated entirely in about 75 per cent of patients.

Cells and radiation:

The cell cycle process is critical because usually, radiation first destroys the cells that are actively dividing. This does not function very fast on cells that are in the resting stage (G0) or are dividing less frequently. The amount and type of radiation that enters the cell and the speed of cell growth determine whether and how easily the cell can die or be injured. The word radio sensitivity explains how likely the cell is to be affected by radiation. Cancer cells tend to divide quickly and grow out of control. Radiation therapy destroys cancer cells that are dividing, but it also affects dividing cells in healthy tissues. The disruption to normal cells produces undesirable side effects. Radiation treatment is also a balance between killing the cancer cells and minimising damage to the healthy cells. Radiation doesn't always kill cancer cells or healthy cells right away. It may take days or even weeks of treatment for cells to start dying, and they may keep dying off for months after treatment ends. Tissues that develop rapidly, such as skin, bone marrow, and the lining of the intestines are often affected right away. In comparison, nerve, breast, brain, and bone tissue demonstrate subsequent effects. Therefore, radiation treatment can cause side effects that might not be seen until long after treatment is over.

How is Radiotherapy done?

Radiation therapy usually takes treatment sessions five days a week for 1 to 10 weeks. The overall number of procedures depends on the size and type of cancer. Each Radiotherapy session usually takes about 10 to 30 minutes. Often, the patient is given each weekend off from therapy, which helps with the restoration of healthy cells.

During each session, you will lie on the treatment table, and your team will position you and apply the same types of cushions and restraints used during your initial radiation simulation. Protective shielding or covers can also be placed on or around you to protect other body parts from harmful radiation.

Radiation therapy requires the use of a linear accelerator system, which focuses radiation at the correct location. The machine could shift around the table to aim the radiation at the correct angles. The computer can even create a clicking sound, which is perfectly natural.

You should experience no Pain during this test. You'll also be able to connect with your team through the room's intercom, if necessary. Your doctors will be nearby in an adjacent room, watching the examination.

Side Effects of Radiotherapy

Side effects are complications that may arise as a result of treatment. These can occur with Radiation therapy because the high doses of radiation that are used to destroy cancer cells may also damage healthy cells in the treatment area. Side effects are different for each individual. Many may have multiple side effects. Others have barely any. Side effects may be more severe if you also undergo Chemotherapy before, during, or after your Radiation therapy.

Consult with the doctor or nurse about the chances of getting side effects. The team will observe you and ask if you have any issues. If you do have side effects, the doctor or nurse can speak with you about ways to treat them.

Common Side Effects

Many people who get Radiation therapy have skin changes and some Fatigue. Certain side effects depend on the portion of the body being treated.

Surface changes can include dryness, scratching, peeling, or blistering in the treatment area. These changes occur because radiation passes through the skin on its way to the cancer. You will need to take extra care of your skin during Radiation therapy.

Fatigue is also described as feeling tired or exhausted. Depending on the part of the body being treated, you might also have:

Part of the Body Being Treated

Possible Side Effects



Hair loss

Nausea and vomiting

Skin changes


Blurry vision



Hair loss

Skin changes





Hair loss

Skin changes

Throat changes, such as trouble swallowing


Shortness of breath

Head and Neck


Hair loss

Mouth changes

Skin changes

Throat changes, such as trouble swallowing

Taste changes

Less active thyroid gland




Hair loss

Nausea and vomiting

Sexual and fertility changes

Skin changes

Urinary and bladder changes




Hair loss

Sexual and fertility changes

Skin changes

Urinary and bladder changes

Stomach and Abdomen



Hair loss

Nausea and vomiting

Skin changes

Urinary and bladder changes

Before, during and after radiotherapy

Before Radiation Treatment

  • Meeting with a Radiation Oncologist for a Consult: Before determining whether you would like to undergo Radiation therapy treatments, you will first consult with a radiation oncologist to help determine whether Radiation therapy is right for you.

During your appointment, you must first speak with a nurse. The nurse will escort you into an exam room to report your weight, vital signs, drugs, and allergies. First, you should meet with the physicians- usually, a radiation oncology nurse and radiation oncologist should meet with you. We will test you and ask you questions. You will be asked about your current medical conditions, past medical history, past surgical history, drugs, and lifestyle.

Treatment methods, as well as the advantages and disadvantages of these treatments, will be discussed with you. If Radiation therapy treatments are suggested, the doctors will speak to you about treatment plans. In case you decide that Radiation therapy is right for you, you will be scheduled for a planning CT scans and simulation.

  • Treatment Planning CT Scans and Simulations: For the radiation beams to be impactful, they must be directed at the very same target for each treatment. The procedure of measuring your body and marking your skin to help your team direct the radiation beams is called a simulation or treatment planning.

During a simulation or care preparation CT scan, you will be put on the table the same way you will be for care. Since positioning is so critical for your care, you may have a special mask or mould made. The radiation therapists will mark the region on the body that the doctor needs to be treated with Radiotherapy and take X-rays of the region. Depending on the area treated, your physician may request that you take IV contrast or barium to drink. Contrast is used to highlight organs so that they can be seen on X-Ray or CT images. Once the X-rays or CT scans are done, the radiation specialist will mark the skin with a series of small tattoos. The tattoos will be used to place you for your radiation treatments.

  • Treatment Planning: If you are done with your treatment planning CT or simulation, your radiation oncologist and other members of the treatment team will review the details. Tumours are not ordinary-they come in various shapes and sizes. To configure the Radiation therapy to the scale, shape and position of your tumour, the treatment team (radiation oncologists, nurses, medical physicists and dosimetrists) uses computers and the treatment preparation photos to prepare your care.

Based on the complexity of your treatment, this step can take anywhere from two days to two weeks. After reviewing all of your information and your treatment plan, your doctor will write a prescription that outlines exactly how much radiation you will receive and what parts of your body will receive the radiation.

During Treatment

The radiation therapist will give your treatment following your radiation oncologist 's instructions. The first day of therapy would take about 45 minutes. On the first day, the treatments will take about 15-30 minutes. The radiation therapists will help you lie down on the table in the same position you were in for the treatment planning CT or simulation. They will be using the tattoos that were put on your skin during your treatment planning session to help align you, and that make changes according to your treatment plan.

Once you are positioned, X-rays (also called port films)are taken on the first day of treatment and once a week. The port films are used to test the positioning and will not reveal whether any disease is present. Once your doctor checks the port videos, you will receive the first medication. During the port films and the appointments, the therapists must move out of the room. We are closely observing you on a television screen while providing your radiation. There is a microphone in the recovery room so you can still speak with the therapist if you have any questions. The computer can be stopped at any moment if you are feeling sick or irritated. During your care, the therapist can transfer the care machine or treatment table. The machine can make noises during therapy that sound like clicking, knocking or whirring, but the radiation therapist is in full control of the machine at all times.

Weekly Status Checks

During radiation therapy, the radiation oncologist and nurse will visit you periodically to monitor your progress, assess any side effects, and answer any questions you may have. You may want to bring a family member or friend with you to these appointments.

After Treatment: Follow-Up

After therapy is finished, follow-up appointments will be arranged so that your radiation oncologist can make sure your recovery is progressing properly and can continue to track your health. Your doctor can order laboratories, X-rays and other Diagnostic Tests.

As time goes on, the number of times you need to see your radiation oncologist should decrease. Nonetheless, please note that the radiation oncology team will still be available if you need to talk to anyone about the diagnosis.