Know Your Cancer
Radiation for Breast Cancer
Radiation therapy is a procedure that kills cancer cells with high-energy rays (or particles). In addition to other therapies, certain people with Breast Cancer may require radiation. For some cases, the radiation treatment is used:
- After breast-conserving Surgery (BCS), help to reduce the risk of cancer returning to the same or surrounding lymph nodes.
- After mastectomy, particularly if the cancer is larger than 5 cm (about 2 inches), if there is cancer in several lymph nodes, or if other surgical margins have cancer such as the skin or muscle.
- If cancer has spread to other areas of the body, for example the bones or brain.
External beam Radiation therapy (EBRT) and brachytherapy are the primary forms of Radiation therapy that can be used to treat Breast Cancer.
Types and schedules of external beam radiation for breast cancer
Whole breast radiation
- The standard schedule for getting whole breast radiation is 5 days a week (Monday through Friday) for about 6 to 7 weeks.
- Another option is hypofractionated radiation therapy where the radiation is also given to the whole breast, but in larger daily doses (Monday through Friday) using fewer treatments (typically for only 3 to 4 weeks). In women treated with breast-conserving Surgery (BCS) and without cancer spread to underarm lymph nodes, this schedule has been shown to be just as good at keeping the cancer from coming back in the same breast as giving the radiation over longer periods of time. It might also lead to fewer short-term side effects.
Accelerated partial breast irradiation
In select women, some doctors are using accelerated partial breast irradiation (APBI) to give larger doses over a shorter time to only one part of the breast compared to the entire breast. Since more research is needed to know if these newer methods will have the same long-term results as standard radiation, not all doctors use them. There are several different types of accelerated partial breast irradiation:
- Intraoperative Radiation therapy (IORT): In this approach, a single large dose of radiation is given to the area where the tumour was removed (tumour bed) in the operating room right after BCS (before the breast incision is closed). IORT requires special equipment and is not widely available.
- 3D-conformal Radiation therapy (3D-CRT): In this technique, the radiation is given with special machines so that it is better aimed at the tumour bed. This spares more of the healthy breast. Treatments are given twice a day for 5 days.
- Intensity-modulated Radiation therapy (IMRT): IMRT is like 3D-CRT, but it also changes the strength of some of the beams in certain areas. This gets stronger doses to certain parts of the tumour bed and helps lessen damage to nearby normal body tissues.
- Brachytherapy: See brachytherapy below.
Women who are interested in these approaches may want to ask their doctor about taking part in clinical trials of accelerated partial breast irradiation.
Chest wall radiation
If you had a mastectomy and none of the lymph nodes had cancer, radiation will be given to the entire chest wall, the mastectomy scar, and the areas of any surgical drains. It is typically given daily 5 days a week for 6 weeks.
Lymph node radiation
Whether or not you have had BCS or a mastectomy, if cancer was found in the lymph nodes under the arm (axillary lymph nodes), this area may be given radiation. In certain cases, the lymph nodes above the collarbone (supraclavicular lymph nodes) and behind the breast bone in the centre of the chest (internal mammary lymph nodes) will also receive radiation along with the underarm nodes. It is typically given daily 5 days a week for 6 weeks at the same time as the radiation to the breast or chest wall is given.
Possible side effects of external radiation
The main short-term side effects of external beam Radiation therapy to the breast are:
- Swelling in the breast
- Skin changes in the treated area similar to a sunburn (redness, skin peeling, darkening of the skin)
- Fatigue
Your health care team may advise you to avoid exposing the treated skin to the sun because it could make the skin changes worse. Most skin changes get better within a few months. Changes to the breast tissue usually go away in 6 to 12 months, but it can take longer.
External beam Radiation therapy can also cause side effects later on:
- Some women may find that Radiation therapy causes the breast to become smaller and firmer.
- Radiation may affect your options for breast reconstruction later on. It can also raise the risk of problems with appearance and healing if it’s given after reconstruction, especially
- Women who have had breast radiation may have problems breastfeeding.
- Radiation to the breast can sometimes damage some of the nerves to the arm. This is called brachial plexopathy and can lead to numbness, pain, and weakness in the shoulder, arm, and hand.
- Radiation to the underarm lymph nodes might cause lymphedema, a type of Pain and swelling in the arm or chest.
- In rare cases, Radiation therapy may weaken the ribs, which could lead to a fracture.
- In the past, parts of the lungs and heart were more likely to get some radiation, which could lead to long-term damage of these organs in some women. Modern Radiation therapy equipment better focuses the radiation beams, so these problems are rare today.
- A very rare complication of radiation to the breast is the development of another cancer called an angiosarcoma.
Brachytherapy
Brachytherapy, also known as internal radiation, is another way to deliver Radiation therapy. Instead of aiming radiation beams from outside the body, a device containing radioactive Seeds or pellets is placed into the breast tissue for a short time in the area where the cancer had been removed (tumour bed).
For certain women who had breast-conserving Surgery (BCS), brachytherapy can be used by itself (instead of radiation to the whole breast) as a form of accelerated partial breast irradiation. Tumour size, location, and other factors may limit who can get brachytherapy.
Types of brachytherapy
- Intracavitary brachytherapy: This is the most common type of brachytherapy for women with Breast Cancer. A device is put into the space left from BCS and is left there until treatment is complete. There are several different devices available, most of which require surgical training for proper placement. They all go into the breast as a small catheter (tube). The end of the device inside the breast is then expanded like a balloon so that it stays securely in place for the entire treatment. The other end of the catheter sticks out of the breast. For each treatment, one or more sources of radiation (often pellets) are placed down through the tube and into the device for a short time and then removed. Treatments are typically given twice a day for 5 days as an outpatient. After the last treatment, the device is deflated and removed.
- Interstitial brachytherapy: In this approach, several small, hollow tubes called catheters are inserted into the breast around the area where the cancer was removed and are left in place for several days. Radioactive pellets are inserted into the catheters for short periods of time each day and then removed. This method of brachytherapy has been around longer (and has more evidence to support it), but it is not used as much.
Early studies of intracavitary brachytherapy as the only radiation after BCS have had promising results as far as having at least equal cancer control compared with standard whole breast radiation, but may have more complications including poor cosmetic results. Studies of this treatment are being done and more follow-up is needed.
Possible side effects of intracavitary brachytherapy
As with external beam radiation, intracavitary brachytherapy can have side effects, including:
- Redness and/or bruising at the treatment site
- Breast pain
- Infection
- Damage to fatty tissue in the breast
- Weakness and fracture of the ribs in rare cases
- Fluid collecting in the breast (seroma)
External beam radiation therapy
The most common way to give radiation for these cancers is to carefully focus a beam of radiation from a machine outside the body. This is called external beam radiation therapy or EBRT. To reduce the risk of side effects, doctors carefully figure out the exact dose needed and aim the beam as accurately as they can to hit the tumour.
Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. Radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time — getting you into place for treatment — takes longer.
Treatments are usually given 5 days a week for 6 to 7 weeks. But sometimes other schedules are used, for instance:
Hyperfractionation refers to giving the total radiation dose in a larger number of doses, for example giving two smaller doses per day instead of one large dose a day.
Accelerated fractionation means giving two or more doses each day so that the radiation treatment is completed faster (3 weeks instead of 6 weeks, for instance).
Hyperfractionation and accelerated fractionation schedules may reduce the risk of cancer coming back in or near the place; it started (called local recurrence) and might help some people live longer. The drawback is that treatments given on these schedules also tend to have more severe side effects.
Radiation is commonly given using techniques that help doctors focus the radiation more precisely, such as such as three-dimensional conformal Radiation therapy (3D-CRT) and intensity modulated Radiation therapy (IMRT). These use the results of imaging tests, like MRI, and special computer programs to precisely map the cancer’s location. Radiation beams are then shaped and aimed at the tumour from several directions, which makes the treatments less likely to damage normal nearby tissues than older ways of giving external beam radiation.
Brachytherapy
Another way to deliver radiation is by placing radioactive materials right into or near the cancer. This is called internal radiation, interstitial radiation, or brachytherapy. The radiation travels only a very short distance, which limits its effects on nearby normal tissues.
Brachytherapy is not used often to treat oral cavity or oropharyngeal cancers because newer external radiation approaches, such as IMRT, are now very precise. When brachytherapy is used, it's most often combined with external radiation to treat early lip or mouth cancers.
Different types of brachytherapy may be used. In one form, hollow catheters (thin tubes) are placed into or around the tumour during Surgery. They are left in place for several days while the patient stays in the hospital. Radioactive materials are put into the tubes for a short time each day.
In another form, small radioactive pellets (about the size and shape of a grain of rice) are put right into the tumour. The pellets give off low levels of radioactivity for several weeks and, over time, lose their strength. The pellets themselves are just left in place and rarely cause any problems.
Possible side effects of radiation therapy
Radiation of the mouth and throat area can cause several short-term side effects, including:
- Skin changes like a sunburn or suntan in the treated area that slowly fades away
- Hoarseness
- Loss of sense of taste
- Redness and soreness or even Pain in the mouth and throat
Sometimes open sores develop in the mouth and throat, making it hard to eat and drink during treatment. Liquid feeding through a tube placed into the stomach may be needed.
Radiation therapy may also cause long-lasting or permanent side effects:
Damage to the salivary glands: Permanent damage to the salivary (spit) glands can cause a Dry mouth. This can lead to problems eating and swallowing.
The lack of saliva can also lead to tooth decay (cavities). People treated with radiation to the mouth or neck need to practice careful oral hygiene to help prevent this problem. Fluoride treatments may also help.
Newer Radiation therapy techniques such as IMRT may help reduce this side effect. A drug called amifostine (Ethyol®) can also help reduce this side effect by limiting radiation damage to normal tissues. It is given into a vein over 15 minutes just before each radiation treatment. Amifostine has side effects, such as low blood pressure, nausea, and vomiting, that can make it hard to tolerate.
Damage to the jaw bone: This problem, known as osteoradionecrosis of the jaw, can be a serious side effect of radiation treatment. This is more common after tooth infection, extraction, or trauma, and it can be hard to treat. The main symptom is Pain in the jaw. In some cases, the bone actually breaks. Sometimes the fractured bone heals by itself, but often the damaged bone will have to be repaired with Surgery.
To help prevent this problem, people getting radiation to the mouth or throat area need to see a dentist to have any problems with their teeth treated before radiation is started. In some cases, teeth may need to be removed.
Damage to the pituitary or thyroid gland: If the pituitary or thyroid gland is exposed to radiation, their production of hormones may decrease over time. This can lead to problems with metabolism that may need to be corrected with medicine.
Side effects tend to be worse if Chemotherapy is given at the same time as radiation (chemoradiation). Both the radiation and the Chemotherapy side effects are worse, which can make this treatment hard to tolerate. For this reason, it’s important that anyone getting chemoradiation be in relatively good health before starting treatment, that they understand the possibility of serious side effects, and that they're treated at a medical canter with a lot of experience with this approach.
Cervix uteri
The types of Radiation therapy most often used to treat Cervical Cancer are:
- External beam radiation
- Brachytherapy
It is important to know that smoking increases the side effects from radiation and can make treatment less effective. If you smoke, you should stop.
External beam radiation
External beam Radiation therapy (EBRT) aims x-rays at the cancer from a machine outside the body. Treatment is much like getting a regular x-ray, but the radiation dose is stronger.
Each radiation treatment lasts only a few minutes, but getting you into place for treatment usually takes longer. The procedure itself is painless.
When EBRT is used as the main treatment for cervical cancer, it is usually combined with Chemotherapy (called concurrent chemoradiation). Often, a low dose of the chemo drug called cisplatin is used. Other chemo drugs can be used as well. The radiation treatments are given 5 days a week for about 5 weeks. The Chemotherapy is given at scheduled times during the radiation. The schedule is determined by which drug is used. If the cancer has not spread to distant areas, brachytherapy, which is discussed below, may also be given after the concurrent chemoradiation is complete.
EBRT can also be used as the main treatment of Cervical Cancer in patients who can’t tolerate chemoradiation, can’t safely have surgery, or choose not to have Surgery. It can also be used by itself to treat areas of cancer spread.
Possible side effects of EBRT
Short-term side effects of external beam Radiation therapy for Cervical Cancer can include:
- Fatigue (tiredness)
- Upset stomach
- Diarrhea or loose stools (if radiation is given to the pelvis or abdomen)
- Nausea and vomiting
- Skin changes (mild redness to peeling or flaking)
- Radiation cystitis: Radiation to the pelvis can irritate the bladder (radiation cystitis), causing discomfort, an urge to urinate often, and sometimes blood in the urine.
- Vaginal pain: Radiation can make the vulva and vagina more sensitive and sore, and sometimes causes a discharge.
- Menstrual changes: Pelvic radiation can affect the ovaries, leading to menstrual changes and even early menopause
- Low blood counts: Anaemia (low levels of red blood cells) can make you feel tired. Neutropenia (low levels of white blood cells) increases the risks of serious infection. Thrombocytopenia (low levels of Platelet counts) increases the risk of bleeding.
When Chemotherapy is given with radiation, the blood counts tend to be lower and Fatigue and Nausea tend to be worse. These side effects typically improve in the weeks after treatment is stopped.
Other, long-term side effects are also possible with EBRT. These are described below.
Brachytherapy (internal radiation therapy)
Brachytherapy, or internal radiation therapy, puts a source of radiation in or near the cancer. This type of radiation only travels a short distance. The type of brachytherapy used most often to treat Cervical Cancer is known as intracavitary brachytherapy. The radiation source is placed in a device in the vagina (and sometimes in the cervix). Brachytherapy is mainly used in addition to EBRT as a part of the main Treatment for Cervical Cancer. Rarely, it might be used alone in very specific cases of early-stage cervical cancers.
There are two types of brachytherapy:
- Low-dose rate (LDR) brachytherapy is completed over a few days. During this time, the patient stays in bed in a private room in the hospital with instruments holding the radioactive material in place. While the Radiation therapy is being given, the hospital staff will care for you, but will also take precautions to avoid being exposed to radiation themselves.
- High-dose rate (HDR) brachytherapy is done as an outpatient over several treatments (often at least a week apart). For each high-dose treatment, the radioactive material is inserted for a few minutes and then removed. The advantage of HDR treatment is that you do not have to stay in the hospital or stay still for long periods of time.
To treat Cervical Cancer in women who have had a hysterectomy, the radioactive material is placed in a tube in the vagina.
To treat a woman who still has a uterus, the radioactive material can be placed in a small metal tube (called a tandem) that goes in the uterus, along with small round metal holders (ovoids) placed near the cervix. This is sometimes called tandem and ovoid treatment.
Another option is called tandem and ring. For this, a round holder (like a disc) is placed close to the uterus. The choice of which one to use depends on what type of brachytherapy is planned.
Possible short-term side effects of brachytherapy
Since the radiation only travels a short distance with brachytherapy, the main effects of the radiation are on the cervix and the walls of the vagina. The most common side effect is irritation of the vagina. It may become red and sore, and there may be a discharge. The vulva may become irritated as well.
Brachytherapy can also cause many of the same side effects as EBRT, such as fatigue, diarrhea, nausea, irritation of the bladder, and low blood counts. Often brachytherapy is given right after external beam radiation (before the side effects can go away), so it can be hard to know which type of treatment is causing the side effect.
Long-term side effects of radiation therapy
Women can experience side effects related to radiation months to years after treatment.
Vaginal stenosis: Both EBRT and brachytherapy can cause scar tissue to form in the vagina. The scar tissue can make the vagina narrower (called vaginal stenosis), less able to stretch, or even shorter, which can make vaginal sex painful.
A woman can help prevent this problem by stretching the walls of her vagina several times a week, either by having sex or by using a vaginal dilator (a plastic or rubber tube used to stretch out the vagina).
Vaginal dryness: Vaginal dryness and painful sex can be long-term side effects from radiation (both brachytherapy and EBRT). Estrogens used locally may help with vaginal dryness and changes to the vaginal lining, especially if radiation to the pelvis damaged the ovaries, and caused early menopause. These hormones are typically applied in the vagina and absorbed into the genital area, rather than taken by mouth. They come in gel, cream, ring, and tablet forms.
Rectal bleeding/rectal stenosis: Radiation to the rectal wall can cause chronic inflammation of the area which can lead to bleeding and sometimes stenosis (narrowing) of the rectum which can be painful. An abnormal opening (called a fistula) also may form between the rectum and vagina, causing stool to come out of the vagina. These problems typically happen during the first 3 years after radiation treatment. Additional treatments, such as surgery, may be needed to fix these complications.
Urinary problems: Radiation to the pelvis can cause chronic radiation cystitis (as mentioned above), blood in the urine, or an abnormal opening between the bladder and vagina (called a fistula). These side effects can be seen many years after Radiation therapy.
Weakened bones: Radiation to the pelvis can weaken the bones, leading to fractures. Hip fractures are the most common, and might occur 2 to 4 years after radiation. Bone density tests are recommended to monitor the risk of fracture.
Swelling of the leg(s): If pelvic lymph nodes are treated with radiation, it can lead to fluid drainage problems in the leg. This can cause the leg to swell severely , a condition called lymphedema.
Lung
Radiation Therapy for Non-Small Cell Lung Cancer
Radiation therapy uses high-energy rays or particles to kill cancer cells.
Depending on the stage of the non-small cell Lung Cancer (NSCLC) and other factors, Radiation therapy might be used:
- As the main treatment (sometimes along with chemotherapy), especially if the lung tumour can’t be removed because of its size or location, if a person isn’t healthy enough for surgery, or if a person doesn’t want Surgery.
- After Surgery (alone or along with chemotherapy) to try to kill any small areas of cancer that Surgery might have missed.
- Before Surgery (usually along with chemotherapy) to try to shrink a lung tumour to make it easier to operate on.
- To treat cancer spread to other areas such as the brain or bone.
- To relieve (palliate) symptoms of advanced NSCLC such as pain, bleeding, trouble swallowing, cough, or problems caused by spread to other organs such as the brain.
Types of Radiation therapy used for NSCLC
Different types of Radiation therapy can be used to treat NSCLC. There are 2 main types:
- External beam radiation therapy
- Brachytherapy (internal radiation therapy)
External beam radiation therapy
External beam Radiation therapy (EBRT) focuses radiation from outside the body onto the cancer. This is the type of Radiation therapy most often used to treat NSCLC or its spread to other organs.
Treatment is much like getting an x-ray, but the radiation dose is stronger. The procedure itself is painless and each treatment lasts only a few minutes. Most often, radiation treatments to the lungs are given 5 days a week for 5 to 7 weeks, but this can vary based on the type of EBRT and the reason it’s being given.
Newer EBRT techniques have been shown to help doctors treat lung cancers more accurately while lowering the radiation exposure to nearby healthy tissues. These include:
- Stereotactic body Radiation therapy (SBRT) also known as stereotactic ablative Radiation therapy (SABR), is most often used to treat early-stage lung cancers when Surgery isn’t an option due to a person’s health or in people who don’t want Surgery. It might also be considered for tumours that have limited spread to other parts of the body, such as the brain or adrenal gland.
Instead of giving a small dose of radiation each day for several weeks, SBRT uses very focused beams of high-dose radiation given in fewer (usually 1 to 5) treatments. Several beams are aimed at the tumour from different angles. To target the radiation precisely, you are put in a specially designed body frame for each treatment. This reduces the movement of the lung tumour during breathing.
- Three-dimensional conformal Radiation therapy (3D-CRT) uses special computers to precisely map the tumour’s location. Radiation beams are then shaped and aimed at the tumour(s) from several directions, which makes it less likely to damage normal tissues.
- Intensity modulated Radiation therapy (IMRT) is a form of 3D therapy. Along with shaping the beams and aiming them at the tumour from several angles, the strength of the beams can be adjusted to limit the dose reaching nearby normal tissues. This technique is used most often if tumours are near important structures such as the spinal cord.
A variation of IMRT is called volumetric modulated arc therapy (VMAT). It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes.
- Stereotactic radiosurgery (SRS) isn't really surgery, but a type of stereotactic Radiation therapy that is given in only one session. It can sometimes be used instead of or along with Surgery for single tumours that have spread to the brain. In one version of this treatment, a machine focuses about 200 beams of radiation on the tumour from different angles over a few minutes to hours. Your head is kept in the same position with a rigid frame. In another version, a linear accelerator (a machine that creates radiation) that is controlled by a computer moves around your head to deliver radiation to the tumour from many different angles. These treatments can be repeated if needed.
Brachytherapy (internal radiation therapy)
In people with NSCLC, brachytherapy is sometimes used to shrink tumours in the airway to relieve symptoms.
The doctor places a small source of radioactive material (often in the form of small pellets) directly into the cancer or into the airway next to the cancer. This is usually done through a bronchoscope, but it may also be done during Surgery. The radiation travels only a short distance from the source, limiting the effects on surrounding healthy tissues. The radiation source is usually removed after a short time. Less often, small radioactive “seeds” are left in place permanently, and the radiation gets weaker over several weeks.
Possible side effects of Radiation therapy for NSCLC
If you are going to get radiation therapy, it’s important to ask your doctor about the possible side effects so you know what to expect. Common side effects depend on where the radiation is aimed and can include:
- Fatigue
- Nausea and vomiting
- Loss of appetite and weight loss
- Skin changes in the area being treated, which can range from mild redness to blistering and peeling
- Hair loss where the radiation enters the body
Often these go away after treatment. When radiation is given with chemotherapy, the side effects may be worse.
Radiation therapy to the chest may damage your lungs and cause a cough, problems breathing, and shortness of breath. These usually improve after treatment is over, although sometimes they may not go away completely.
Your oesophagus, which is in the middle of your chest, may be exposed to radiation, which could cause a sore throat and trouble swallowing during treatment. This might make it hard to eat anything other than soft foods or liquids for a while. This also often improves after treatment is finished.
Radiation therapy to large areas of the brain can sometimes cause memory loss, headaches, or trouble thinking. Usually these symptoms are minor compared with those caused by cancer that has spread to the brain, but they can affect your quality of life.
Stomach
Radiation Therapy for Stomach Cancer
Radiation therapy uses high-energy rays or particles to kill cancer cells in a specific body area. Radiation can be used in different ways to help treat stomach cancer:
- Before Surgery for some cancers, radiation can be used along with Chemotherapy (chemo) to try to shrink the tumour to make Surgery easier.
- After surgery, Radiation therapy can be used to kill very small remnants of the cancer that cannot be seen and removed during Surgery. Radiation therapy — especially when combined with chemo drugs such as 5-FU — may delay or prevent cancer recurrence after Surgery and may help patients live longer.
- Radiation therapy can be used to slow the growth and ease the symptoms of advanced stomach cancer, such as pain, bleeding, and eating problems.
External beam Radiation therapy is often used to treat Stomach Cancer. This treatment focuses radiation on the cancer from a machine outside the body. Often, special types of external beam radiation, such three-dimensional conformal Radiation therapy (3D-CRT) and intensity modulated Radiation therapy (IMRT) are used. These use computers and special techniques to focus the radiation on the cancer and limit the damage to nearby normal tissues.
Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. This planning session, called simulation, usually includes getting imaging tests such as CT or MRI scans. Radiation therapy is much like getting an x-ray, but the radiation is much stronger. The treatment itself is painless. Each treatment lasts only a few minutes, although the setup time — getting you into place for treatment — usually takes longer. Treatments are usually given 5 days a week over several weeks or months. Side effects from Radiation therapy for Stomach Cancer can include:
- Skin problems, ranging from redness to blistering and peeling, in the area the radiation passed through
- Nausea and vomiting
- Diarrhea
- Fatigue
- Low blood cell counts
These usually go away within several weeks after the treatment is finished.
When radiation is given with chemotherapy, side effects are often worse. Patients may have problems eating and getting enough fluids. Some need to have fluids given into a vein (IV) or have a feeding tube placed to get nutrition during treatment.
Please be sure to tell your doctor about any side effects you have, because there are often ways to relieve them.
Radiation might also damage nearby organs. This could lead to problems such as heart or lung damage, or even an increased risk of another cancer later on. Doctors do everything they can to prevent this by using only the needed dose of radiation, carefully controlling where the beams are aimed, and shielding certain parts of the body from the radiation during treatment.
It is very important that you get treated at a centre that has extensive experience in treating Stomach Cancer.
Oesophagus
Radiation Therapy for Oesophageal Cancer
Radiation therapy uses high-energy rays (such as x-rays) or particles to destroy cancer cells. It is often combined with other types of treatment, such as chemotherapy (chemo) and/or surgery, to treat oesophageal cancer. Chemotherapy can make Radiation therapy more effective against some oesophagus cancers. Using these 2 treatments together is called chemoradiation.
When is Radiation therapy used for oesophagus cancer?
Radiation therapy may be used:
- As part of the main treatment of oesophageal cancer in some patients, typically along with chemo (chemoradiation). This is often used for people who can’t have Surgery due to poor health or for people who don’t want Surgery.
- Before Surgery (and along with chemo when possible), to try to shrink the cancer and make it easier to remove. This is called neoadjuvant treatment.
- After Surgery (and along with chemo when possible), to try to kill any cancer cells that may have been left behind but are too small to see. This is known as adjuvant therapy.
- To ease the symptoms of advanced oesophageal cancer such as pain, bleeding, or trouble swallowing. This is called palliative therapy.
Types of radiation therapy
There are two main types of Radiation therapy used to treat oesophageal cancer.
External-beam Radiation therapy (EBRT) is the type of Radiation therapy used most often for people with oesophageal cancer. The radiation is focused on the cancer from a machine outside the body. It is much like getting an x-ray, but the radiation is more intense. How often and how long the radiation treatments are delivered depends on the reason the radiation is being given and other factors. It can last anywhere from a few days to weeks.
Internal Radiation therapy (brachytherapy) is a type of radiation where the doctor passes an endoscope (a long, flexible tube) down the throat to place radioactive material very close to the cancer. The radiation travels only a short distance, so it reaches the tumour but has little effect on nearby normal tissues. This usually means fewer side effects than with external beam radiation. The radioactive source is removed a short time later.
Brachytherapy is not used often to treat oesophageal cancer, but might be helpful with more advanced oesophageal cancers to shrink tumours so a patient can swallow more easily. This technique cannot be used to treat a very large area, so it is better used as a way to relieve symptoms (and not to try to cure the cancer).
Brachytherapy can be given 2 ways:
- For high-dose rate (HDR) brachytherapy, the doctor leaves the radioactive material near the tumour for a few minutes at a time, which may require several treatments.
- In low-dose rate (LDR) brachytherapy, a lower dose of radiation is put near the tumour for longer periods (1 or 2 days) at a time. The patient needs to stay in the hospital during this treatment, but it can usually be completed in only 1 or 2 sessions.
Other types of radiation, such as IMRT (a type of EBRT) as well as proton therapy, are being studied to treat oesophageal cancer.
Side effects of radiation therapy
If you are going to get radiation therapy, it’s important to ask your doctor beforehand about the possible side effects so you know what to expect. Possible Side effects of external Radiation therapy can include:
- Skin changes in areas getting radiation, such as redness, blistering and peeling
- Nausea and vomiting
- Diarrhea
- Fatigue
- Painful sores in the mouth and throat
- Dry mouth or thick saliva (spit)
- Pain with swallowing
These side effects are often worse if Chemotherapy is given at the same time as radiation.
Most side effects of radiation are temporary, but some less common side effects can be permanent. For example, in some cases radiation can cause a stricture (narrowing) in the oesophagus, which might require more treatment. Radiation to the chest can cause lung damage, which may lead to problems breathing and shortness of breath.
If you notice any side effects, talk to your doctor right away so steps can be taken to lessen them.
Leukaemia
Radiation Therapy for Acute Lymphocytic Leukaemia (ALL)
(Note: This information is about treating acute lymphocytic leukaemia (ALL) in adults. To learn about ALL in children, see Leukaemia in Children.)
Radiation therapy uses high-energy radiation to kill cancer cells. It is not usually part of the main treatment for people with acute lymphocytic leukaemia (ALL), but it is used in certain situations:
- Radiation is sometimes used to treat leukaemia that has spread to the brain and spinal fluid, or to the testicles.
- Radiation to the whole body is often an important part of treatment before a bone marrow or peripheral blood stem cell transplant (see High-dose Chemotherapy and Stem Cell Transplant for Acute Lymphocytic Leukaemia).
- Radiation is used (rarely) to help shrink a tumour if it is pressing on the trachea (windpipe) and causing breathing problems. But Chemotherapy is often used instead, as it may work more quickly.
- Radiation can also be used to reduce Pain in an area of bone invaded by leukaemia, if Chemotherapy has not helped.
External beam radiation therapy, in which a machine delivers a beam of radiation to a specific part of the body, is the type of radiation used most often for ALL. Before your treatment starts, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. This planning session, called simulation, usually includes getting imaging tests such as CT or MRI scans.
Radiation treatment is much like getting an x-ray, but the radiation is much stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer. The number of treatments you get depends on the reason Radiation therapy is being used.
Side effects
The possible side effects of Radiation therapy depend on where the radiation is aimed. They include:
- Fatigue (tiredness)
- Skin changes in the treated area, which can range from mild redness to burning and peeling
- Hair loss in the area being treated
- Nausea and Vomiting (if the head or belly is being treated)
- Diarrhea (if the belly or pelvis is being treated)
- Mouth sores and trouble swallowing (if the head and neck area are being treated)
- Headaches (if the head is being treated)
- Lowered blood cell counts, which can lead to Fatigue and shortness of breath (from low red blood cell counts), bleeding or bruising (from low Platelet counts), and an increased risk of infection (from low white blood cell counts)
Radiation Therapy for Acute Myeloid Leukaemia (AML)
Radiation therapy uses high-energy radiation to kill cancer cells. It is usually not part of the main treatment for people with acute myeloid leukaemia (AML), but there are a few instances in which it may be used:
- Radiation is sometimes used to treat leukaemia that has spread outside of the bone marrow and blood, such as to the brain and spinal fluid, or to the testicles.
- Radiation to the whole body is often an important part of treatment before a stem cell transplant.
- It is used (rarely) to help shrink a tumour (myeloid sarcoma) if it is pressing on the trachea (windpipe) and causing breathing problems. But Chemotherapy is often used instead, as it often works more quickly.
- Radiation can be used to reduce Pain in an area of bone that is invaded by leukaemia, if Chemotherapy has not helped.
Before your treatment starts, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. This planning session, called simulation, usually includes getting imaging tests such as CT or MRI scans.
The type of Radiation therapy used to treat AML is called external beam radiation. The treatment is much like getting an x-ray, but the radiation is much stronger. The procedure itself is painless. The number of treatments you get depends on the reason Radiation therapy is being used. Each treatment lasts only a few minutes, although the setup time − getting you into place for treatment – usually takes longer.
The possible side effects of Radiation therapy depend on where the radiation is aimed. Sunburn-like skin changes and Hair loss in the treated area are possible. Radiation to the head and neck area can lead to mouth sores and trouble swallowing. Radiation to the abdomen can cause nausea, vomiting, or Diarrhea. Radiation can lower blood counts, leading to Fatigue (from low red blood cell counts), bleeding or bruising (from low Platelet counts), and an increased risk of infection (from low white blood cell counts).
Ovary
Radiation Therapy for Ovarian Cancer
Radiation therapy uses high energy x-rays or particles to kill cancer cells. These x-rays may be given in a procedure that is much like having a regular X-Ray. Aggressive Chemotherapy is usually more effective, so Radiation therapy is rarely used in this country as the main Treatment for Ovarian Cancer. However, it can be useful in treating areas where the cancer has spread, either near the main tumour or in a distant organ, like the brain or spinal cord.
External beam radiation therapy
This is the most common type of Radiation therapy for women with Ovarian Cancer. External Radiation therapy is much like getting an x-ray, but the radiation is stronger. A machine focuses the radiation on the area affected by the cancer. The procedure itself is painless. Each treatment lasts only a few minutes, but the setup time—getting you into place for treatment—usually takes longer. Treatments are given 5 days a week for several weeks.
Some common side effects include:
- Skin changes – the skin in the treated area may look and feel sunburned or even blister and peel
- Fatigue (tiredness)
- Nausea and vomiting
- Diarrhea
- Vaginal irritation, sometimes with a discharge (if the pelvis is being treated)
These side effects improve after treatment is stopped. Skin changes gradually fade, and the skin returns to normal in 6 to 12 months.
If you are having side effects from radiation, tell your cancer care team. There may be ways to manage them.
Brachytherapy
Brachytherapy, also known as internal radiation, is another way to deliver Radiation therapy. Instead of aiming radiation beams from outside the body, a device containing radioactive Seeds or pellets is placed inside the body, near the cancer. This is rarely done for Ovarian Cancer.
Larynx
Radiation Therapy for Laryngeal and Hypopharyngeal Cancers
Radiation therapy uses high-energy x-rays, gamma rays, or particles to kill cancer cells. When treating laryngeal and hypopharyngeal cancers, Radiation therapy might be used in several ways:
- As the main (primary) treatment for some early stage laryngeal and hypopharyngeal cancers. If the cancer is small, it can often be destroyed by radiation and Surgery isn't needed. This can help to preserve better voice quality.
- To treat patients who are too sick to have Surgery.
- After surgery, to try to kill any small areas of cancer that may remain and help lower the chance the cancer will come back. (This is called adjuvant treatment.)
- To treat cancer that comes back after treatment (cancer recurrence).
- To ease symptoms of advanced laryngeal and hypopharyngeal cancer such as pain, bleeding, trouble swallowing, and problems caused when cancer spreads to the bones. (This is called palliative or supportive care.)
Many times Chemotherapy is given along with the radiation. This combination, called chemoradiation, can work better than radiation alone, but it also has more side effects.
Radiation to this part of your body can affect your teeth and gums, so it's important to see a dentist before starting treatment. A dentist can make sure your mouth is healthy before treatment. During and after treatment a dentist can help check for and treat any problems that may come up, such as infection or tooth/bone damage.
Smoking during radiation treatment is linked to worse outcomes, so you should stop smoking completely before starting treatment. Smoking also increases the risk of the cancer coming back after treatment as well as the risk of getting another cancer, so quitting smoking for good is the best way to improve your survival.
Types of radiation therapy
There are 2 main types of radiation therapy:
External beam radiation therapy
This is the most common type of Radiation therapy used to treat laryngeal and hypopharyngeal cancer. Radiation from a source outside the body is focused on the cancer.
Before your treatments start, the radiation team will use a CT scan to take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. A mesh head and body cast may be made to hold your head, neck, and shoulders in the exact same position for each treatment.
Radiation therapy is much like getting an x-ray, but the radiation is much stronger. The procedure itself is painless. Each treatment lasts only a few minutes, but the setup time – getting you into place for treatment – usually takes longer.
Radiation therapy for laryngeal and hypopharyngeal cancer is usually given in daily fractions (doses), 5 days per week, for about 7 weeks.
Other schedules for radiation may be used to treat laryngeal cancer. For instance, in hyperfractionation radiation therapy, a slightly higher daily radiation dose is split into 2 smaller doses and the patient gets 2 doses per day instead of 1.
There are also newer techniques that help doctors focus the radiation more precisely:
- Three-dimensional conformal Radiation therapy (3D-CRT): 3D-CRT uses the results of imaging tests such as MRI and special computers to precisely map the location of the tumour. Several radiation beams are then shaped and aimed at the tumour from different directions. Each beam alone is fairly weak, which makes it less likely to damage normal tissues it passes through, but the beams meet at the tumour to give a higher dose of radiation there.
- Intensity modulated Radiation therapy (IMRT): IMRT is an advanced form of 3D therapy. It uses a computer-driven machine that actually moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the tumour from several angles, the intensity (strength) of the beams can be adjusted to limit the dose reaching the most sensitive nearby normal tissues. This may let the doctor deliver a higher dose to the tumour. This is the most common way radiation is given for laryngeal and hypopharyngeal cancer.
Brachytherapy
Internal radiation therapy, also known as brachytherapy, uses radioactive material put right into or near the cancer. Brachytherapy may be used alone or along with external beam Radiation therapy. It's rarely used to treat laryngeal and hypopharyngeal cancer.
Side effects of radiation therapy
Many people treated with radiation to the neck and throat area have painful sores in the mouth and throat that can make it very hard to eat and drink. This can lead to weight loss and malnutrition. The sores heal with time after the radiation ends, but some people continue to have problems swallowing long after treatment ends. Ask about swallowing exercises you can do to help keep those muscles working and increase your chance of eating normally after treatment.
Other side effects of Radiation therapy may include:
- Skin problems in the area being treated, ranging from redness to blistering and peeling
- Dry mouth
- Worsening of hoarseness
- Trouble swallowing
- Loss of taste
- Possible breathing trouble from swelling
- Tiredness
- Hearing problems
Most of these side effects slowly go away when treatment is over. Side effects of radiation tend to be worse if Chemotherapy is given at the same time. Tell your doctor about any side effects you have because there are often ways to help.
Radiation aimed at the head and neck might damage the salivary glands, leading to Dry mouth that doesn't get better with time. This can cause discomfort and problems swallowing, and can also lead to tooth decay. People treated with radiation to the neck and throat must pay close attention to their oral health.
Radiation may also damage your thyroid gland. Your doctor will do Blood Tests to see how well your thyroid is working. You may need treatment if it's been damaged.
When radiation is used as the main treatment for cancer of the larynx, it could very rarely lead to breakdown of the cartilage in the throat. If this happens, you may need a tracheostomy or laryngectomy.
Brain, nervous system
Radiation Therapy for Adult Brain and Spinal Cord Tumours
Radiation therapy uses high-energy rays or small particles to kill cancer cells. This type of treatment is given by a doctor called a radiation oncologist. Radiation therapy may be used in different situations:
- After Surgery to try to kill any remaining tumour cells
- As the main treatment if Surgery is not a good option and medicines are not effective
- To help prevent or relieve symptoms from the tumour
Types of radiation therapy
Most often, the radiation is focused on the tumour from a source outside the body. This is called external beam Radiation therapy (EBRT). This type of Radiation therapy is much like getting an x-ray, but the dose of radiation is much higher.
Before your treatments start, the radiation team will determine the correct angles for aiming the radiation beams and the proper dose of radiation. This planning session, called simulation, usually includes getting imaging tests such as CT or MRI scans.
In most cases, the total dose of radiation is divided into daily amounts (usually given Monday through Friday) over several weeks. At each treatment session, you lie on a special table while a machine delivers the radiation from precise angles. The treatment is not painful. Each session lasts about 15 to 30 minutes, and much of that time is spent making sure the radiation is aimed correctly. The actual treatment time each day is much shorter.
High doses of Radiation therapy can damage normal brain tissue, so doctors try to deliver the radiation to the tumour while giving the lowest possible dose to normal surrounding brain areas. Several techniques can help doctors focus the radiation more precisely:
Three-dimensional conformal Radiation therapy (3D-CRT): 3D-CRT uses the results of imaging tests such as MRI and special computers to map the location of the tumour precisely. Several radiation beams are then shaped and aimed at the tumour from different directions. Each beam alone is fairly weak, which makes it less likely to damage normal tissues, but the beams converge at the tumour to give a higher dose of radiation there.
Intensity modulated Radiation therapy (IMRT): IMRT is an advanced form of 3D therapy. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the tumour from several angles, the intensity (strength) of the beams can be adjusted to limit the dose reaching the most sensitive normal tissues. This may let the doctor deliver a higher dose to the tumour. Many major hospitals and cancer centres now use IMRT.
Volumetric modulated arc therapy (VMAT): This newer technique is similar to IMRT. For this treatment, the patient lies on a table, which passes through the machine delivering the radiation. The source of the radiation (the linear accelerator) rotates around the table in an arc, delivering the beams from different angles. A computer controls the intensity of the beams to help keep the radiation focused on the tumour. It’s not yet clear if this approach results in better outcomes than IMRT, although it does allow the radiation to be given over less time in each treatment session.
Conformal proton beam radiation therapy: Proton beam therapy uses an approach similar to 3D-CRT. But instead of using x-rays, it focuses proton beams on the tumour. Protons are positive parts of atoms. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and then release their energy after traveling a certain distance. This lets doctors deliver more radiation to the tumour and do less damage to nearby normal tissues.
This approach may be more helpful for brain tumours that have distinct edges (such as chordomas), but it is not clear if it will be useful for tumours that typically grow into or mix with normal brain tissue (such as astrocytomas or glioblastomas). There are a limited number of proton beam centres in the United States at this time.
Stereotactic radiosurgery (SRS)/stereotactic Radiation therapy (SRT): This type of treatment delivers a large, precise radiation dose to the tumour area in a single session (SRS) or in a few sessions (SRT). (There is no actual Surgery in this treatment.) It may be used for some tumours in parts of the brain or spinal cord that cannot be treated with Surgery or when a patient is not healthy enough for Surgery.
A head frame might be attached to the skull to help aim the radiation beams. (Sometimes a facemask is used to hold the head in place instead.) Once the exact location of the tumour is known from CT or MRI scans, radiation is focused at the tumour from many different angles. This can be done in 2 ways:
- In one approach, thin radiation beams are focused at the tumour from hundreds of different angles for a short period of time. Each beam alone is weak, but they all converge at the tumour to give a higher dose of radiation. An example of a machine that uses this technique is the Gamma Knife.
- Another approach uses a movable linear accelerator (a machine that creates radiation) that is controlled by a computer. Instead of delivering many beams at once, this machine moves around the head to deliver radiation to the tumour from many different angles. Several machines with names such as X-Knife, CyberKnife, and Clinac deliver Stereotactic Radiosurgery in this way.
SRS typically delivers the whole radiation dose in a single session, though it may be repeated if needed. For SRT (sometimes called fractionated radiosurgery), doctors give the radiation in several treatments to deliver the same or a slightly higher dose. Frameless techniques are now available to make this more comfortable.
Image-guided Radiation therapy (IGRT): For IGRT, an imaging test such as a CT scan is done just before each treatment to help better guide the radiation to its target. IGRT is typically used along with some of the more precise techniques for delivering radiation described above. It is most useful when the radiation needs to be delivered very precisely, such as when a tumour is very close to vital structures.
Brachytherapy (internal radiation therapy): Unlike the external radiation approaches above, brachytherapy involves inserting radioactive material directly into or near the tumour. The radiation it gives off travels a very short distance, so it affects only the tumour. This technique is most often used along with external radiation. It provides a high dose of radiation at the tumour site, while the external radiation treats nearby areas with a lower dose.
Whole brain and spinal cord Radiation therapy (craniospinal radiation): If tests like an MRI scan or lumbar puncture find the tumour has spread along the covering of the spinal cord (meninges) or into the surrounding cerebrospinal fluid, radiation may be given to the whole brain and spinal cord. Some tumours such as ependymomas and medulloblastomas are more likely to spread this way and often require craniospinal radiation.
Possible side effects of radiation therapy
Radiation is more harmful to tumour cells than it is to normal cells. Still, radiation can also damage normal brain tissue, which can lead to side effects.
Side effects during or soon after treatment: Some people become irritable and tired during the course of Radiation therapy. Nausea, vomiting, and headaches are also possible side effects but are uncommon. Sometimes dexamethasone (a corticosteroid) or other drugs can help relieve these symptoms. Some people might have Hair loss in areas of the scalp that get radiation. Other side effects are also possible, depending on where the radiation is aimed.
Problems with thinking and memory: A person may lose some brain function if large areas of the brain get radiation. Problems can include memory loss, personality changes, and trouble concentrating. There may also be other symptoms depending on the area of brain treated and how much radiation was given. These risks must be balanced against the risks of not using radiation and having less control of the tumour.
Radiation necrosis: Rarely after radiation therapy, a mass of dead (necrotic) tissue forms at the site of the tumour in the months or years after radiation treatment. This can often be controlled with corticosteroid drugs, but Surgery may be needed to remove the necrotic tissue in some instances.
Increased risk of another tumour: Radiation can damage genes in normal cells. As a result, there is a small risk of developing a second cancer in an area that got radiation — for example, a meningioma of the coverings of the brain, another brain tumour, or less likely a bone cancer in the skull. If this develops, it is usually many years after the radiation is given. This small risk should not prevent those who need radiation from getting treatment.
Non-Hodgkin lymphoma
Radiation Therapy for Non-Hodgkin Lymphoma
Radiation therapy uses high-energy rays to kill cancer cells.
When might Radiation therapy be used for non-Hodgkin lymphoma?
Radiation might be used to treat non-Hodgkin Lymphoma (NHL) in some different situations:
- It can be used as the main treatment for some types of NHL if they are found early (stage I or II), because these tumours respond very well to radiation.
- For more advanced lymphomas and for some lymphomas that are more aggressive, radiation is sometimes used along with Chemotherapy.
- People who are getting a stem cell transplant may get radiation to the whole body along with high-dose chemotherapy, to try to kill Lymphoma cells throughout the body.
- Radiation therapy can be used to ease (palliate) symptoms caused by Lymphoma that has spread to internal organs, such as the brain or spinal cord, or when a tumour is causing Pain because it’s pressing on nerves.
How is Radiation therapy given?
When radiation is used to treat NHL, it is most often done with a carefully focused beam of radiation, delivered from a machine outside the body. This is known as external beam radiation. External beam radiation treatment for NHL might include beams made of photons (most common), protons or electrons depending on the situation.
Before your treatment starts, your radiation team will take careful measurements to find the correct angles for aiming the radiation beams and the proper dose of radiation. This planning session, called simulation, usually includes getting imaging tests such as CT or MRI scans.
Most often, radiation treatments are given 5 days a week for several weeks. The treatment is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer.
Radiation can also be given as a drug in some cases.
Possible side effects
The side effects of Radiation therapy depend on where the radiation is aimed. Common side effects include:
- Skin changes in areas getting radiation, ranging from redness to blistering and peeling
- Feeling tired
- Nausea
- Diarrhea
Nausea and Diarrhea are more common if the abdomen (belly) is treated with radiation.
Radiation given to several areas, especially after chemotherapy, can lower blood cell counts and increase the risk of infections.
Radiation to the head and neck area can lead to mouth sores and trouble swallowing. Some people later have problems with Dry mouth.
Often these effects go away shortly after treatment is finished.
Side effects tend to be worse if radiation and Chemotherapy are given together.
Radiation techniques are much more advanced and can limit the radiation exposure to nearby organs, but long-term serious side effects are possible:
- Radiation to the chest might damage the lungs and lead to trouble breathing. It can also affect the heart, and may increase the chance of a heart attack later on.
- Radiation to the neck can lead to thyroid problems later in life. This can lead to Fatigue and weight gain.
- Side effects of brain Radiation therapy may become serious 1 or 2 years after treatment and may include headaches and problems such as memory loss, personality changes, and trouble concentrating.
- Other types of cancer can form in the area that received radiation. For example, radiation to the chest may increase the risk of Lung Cancer (especially in smokers) and of breast cancer, but this is rare.
Liver
Radiation Therapy for Liver Cancer
Radiation therapy uses high-energy rays (or particles) to kill cancer cells. It may not be a good option for some patients whose liver has been greatly damaged by diseases such as hepatitis or cirrhosis.
Radiation can be helpful in treating:
- Liver cancer that cannot be removed by surgery
- Liver cancer that cannot be treated with ablation or embolization or did not respond well to those treatments
- Liver cancer that has spread to other areas such as the brain or bones
- People with Pain because of large liver cancers
- People with a tumour thrombus (a collection of Liver Cancer cells) blocking the portal vein.
How is Radiation therapy given?
External beam Radiation therapy (EBRT) focuses radiation from a source outside of the body on the cancer. Getting Radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer. Most often, EBRT treatments are small doses of radiation given 5 days a week for several weeks.
Although Liver Cancer cells are sensitive to radiation, much care is taken when planning the treatment to avoid damaging normal liver tissue as much as possible. Newer radiation techniques, such as stereotactic body Radiation therapy (SBRT), help doctors target liver tumours while reducing the radiation to nearby healthy tissues. This makes it more effective and reduces side effects. SBRT allows treatment to be completed in a short-time compared to EBRT. It uses very focused beams of high-dose radiation given on one or a few days. Beams are aimed at the tumour from many different angles. To focus the radiation precisely, the person is put in a specially designed body frame for each treatment. This type of radiation may be used in people with small cancers who are waiting for a liver transplant.
Radioembolization
As mentioned in Embolization Therapy for Liver Cancer, tumours in the liver can be treated by injecting small radioactive beads into the hepatic artery. The beads then lodge in the liver near the tumour and give off small amounts of radiation that travel only a short distance.
Possible side effects of Radiation therapy for liver cancer
Some of the more common side effects of Radiation therapy include:
- Skin changes in areas getting radiation, ranging from redness to blistering and peeling
- Nausea and vomiting
- Fatigue
- Diarrhea
- Loss of appetite
These effects typically go away within a few weeks after treatment ends.
A more serious side effect of Radiation therapy to the liver is radiation-induced liver disease (RILD). It commonly happens 3 to 4 months after treatment and usually only lasts a set time, but can be fatal in some instances. Signs and symptoms seen with RILD can include abnormal blood liver tests, an enlarged liver and spleen, ascites (fluid build up in the abdomen), and jaundice. Ask your doctor what side effects to expect and how to prevent or relieve them.
Colorectal
Radiation Therapy for Colorectal Cancer
Radiation therapy uses high-energy rays (such as x-rays) or particles to destroy cancer cells. It's more often used to treat people with Rectal Cancer than for people with Colon Cancer. For some colon and rectal cancers, treating with Chemotherapy at the same time can make Radiation therapy work even better. Using these 2 treatments together is called chemoradiation or chemoradiation therapy.
When is Radiation therapy used for colorectal cancer?
Radiation for colon cancer
It's not common to use Radiation therapy to treat colon cancer, but it may be used in select cases:
- Before Surgery (along with chemo) to help shrink a tumour and make it easier to remove.
- After surgery, if the cancer has attached to an internal organ or the lining of the belly (abdomen). If this happens, the surgeon cannot be sure that all the cancer has been removed. Radiation therapy may be used to try to kill any cancer cells that may have been left behind.
- During surgery, right to the area where the tumour was, to kill any cancer cells that may be left behind. This is called intraoperative Radiation therapy or IORT.
- Along with chemo to help control cancers if a person is not healthy enough for Surgery.
- To ease symptoms if advanced cancer is causing intestinal blockage, bleeding, or Pain.
- To help treat cancer that has spread to other areas, such as the bones or brain.
Radiation for rectal cancer
For rectal cancer, Radiation therapy is a more common treatment and may be used:
- Either before and/or after Surgery to help keep the cancer from coming back. In this case, it is often given along with Chemotherapy. Many doctors now favor giving Radiation therapy before surgery, as it may make it easier to remove the cancer, especially if the cancer's size and/or location might make Surgery difficult. In either case, nearby lymph nodes are usually treated too.
- During surgery, right to the area where the tumour was, to kill any cancer cells that may be left behind. This is called intraoperative Radiation therapy or IORT.
- With or without chemo to help control rectal cancers if a person is not healthy enough for Surgery or to ease symptoms if advanced cancer is causing intestinal blockage, bleeding, or Pain.
- To retreat tumours that come back in the pelvis after radiation was given.
- To help treat cancer that has spread to other areas, such as the bones or brain.
Types of radiation therapy
Different types of Radiation therapy can be used to treat colon and rectal cancers.
External-beam Radiation therapy (EBRT)
This is the type of Radiation therapy used most often for people with colon or Rectal Cancer. The radiation is focused on the cancer from a machine outside the body. It is a lot like getting an x-ray, but the radiation is more intense. How often and how long a person gets radiation treatments depends on the reason the radiation is being given and other factors. Treatments might be given over the course of a few days or several weeks.
Internal Radiation therapy (brachytherapy)
This type of Radiation therapy might be used to treat some rectal cancers, but more research is needed to understand how to best use and when to use brachytherapy.
For this treatment, a radioactive source is put inside your rectum next to or into the tumour. This allows the radiation to reach the rectum without passing through the skin and other tissues of the belly (abdomen), so it is less likely to damage nearby tissues.
Endocavitary radiation therapy: For this treatment, a small balloon-like device is placed through the anus and into the rectum to deliver high-intensity radiation for a few minutes. This is typically done in 4 treatments (or less), with about 2 weeks between each treatment. This can let some patients, particularly elderly patients, avoid major Surgery and a colostomy. This type of treatment is used for some small rectal cancers. Sometimes external-beam Radiation therapy is also given.
Interstitial brachytherapy: For this treatment, a tube is placed into the rectum and right into the tumour. Small pellets of radioactive material are then put into the tube for several minutes. The radiation travels only a short distance, limiting the harmful effects on nearby healthy tissues. It's sometimes used to treat people with Rectal Cancer who are not healthy enough for Surgery. This can be done a few times a week for a couple of weeks, but it can also be just a one-time procedure.
Radioembolization
Radiation can also be given during an embolization procedure.
Side effects of radiation therapy
If you are going to get radiation therapy, it is important to ask your doctor beforehand about the possible short- and long-term side effects so that you know what to expect. Possible side effects of Radiation therapy for colon and Rectal Cancer can include:
- Skin irritation at the site where radiation beams were aimed, which can range from redness to blistering and peeling
- Problems with wound healing if radiation was given before surgery
- Nausea
- Rectal irritation, which can cause diarrhea, painful bowel movements, or blood in the stool
- Bowel incontinence (stool leakage)
- Bladder irritation, which can cause problems like feeling like you have to go often (called frequency), burning or Pain while urinating, or blood in the urine
- Fatigue/tiredness
- Sexual problems (erection issues in men and vaginal irritation in women)
- Scarring, fibrosis (stiffening), and adhesions that cause the tissues in the treated area to stick to each other
Most side effects should get better over time after treatment ends, but some problems may not go away completely. If you notice any side effects, talk to your doctor right away so steps can be taken to reduce or relieve them.
Gallbladder
Radiation Therapy for Gallbladder Cancer
Radiation therapy uses high-energy rays (such as x-rays) or particles to destroy cancer cells. Doctors are not sure of the best way to use Radiation therapy to treat gallbladder cancer, but it might be used in one of these ways:
- After Surgery has removed the cancer: Radiation may be used to try to kill any cancer that might have been left after Surgery but was too small to see. This is called adjuvant therapy.
- As part of the main therapy for some advanced cancers: Radiation therapy might be used as a main therapy for some patients whose cancer has not spread widely throughout the body, but cannot be removed with Surgery. While treatment in this case does not cure the cancer, it may help patients live longer.
- As palliative therapy: Radiation therapy is used often to help relieve symptoms if the cancer is too advanced to be cured. It may be used to help relieve Pain or other symptoms by shrinking tumours that block blood vessels or bile ducts, or press on nerves.
External beam Radiation therapy (EBRT)
For gallbladder cancer, a large machine is used to create a beam of x-rays or particles that are aimed at the cancer. This is called external beam Radiation therapy (EBRT).
Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. The treatment is much like getting an x-ray, but the radiation is much stronger. The procedure itself is painless. Each treatment lasts only a few minutes, but the set-up time − getting you into place for treatment − usually takes longer. Most often, radiation treatments are given 5 days a week for many weeks. These are some of the ways EBRT might be given:
Three-dimensional conformal Radiation therapy (3D-CRT) Uses special computers to precisely map the location of the tumour(s). Radiation beams are then shaped and aimed at the tumour(s) from several directions, which makes it less likely to damage normal tissues.
Intensity modulated Radiation therapy (IMRT) This is an advanced form of 3D-CRT. It uses a computer-driven machine that moves around you as it delivers radiation. Along with shaping the beams and aiming them at the cancer from many angles, the intensity (strength) of the beams can be adjusted to limit the dose reaching the most sensitive normal tissues. This lets doctors deliver an even higher dose to the cancer.
Chemoradiation: Chemotherapy (chemo) is given along with EBRT to help it work better. This is the way radiation is most often used for gallbladder cancer. The main drawback of this approach is that the side effects tend to be worse than giving radiation alone. Still, some studies have shown that giving chemoradiation after Surgery may help patients live longer, especially those whose cancer had spread to lymph nodes.
Possible side effects of radiation therapy
Some common side effects of Radiation therapy to treat gallbladder cancer include:
- Sunburn-like skin problems, like redness, blisters, and peeling in the area being treated
- Nausea and vomiting
- Diarrhea
- Tiredness (fatigue)
- Liver damage
Side effects from radiation often start a week or 2 into treatment, and usually get better over time once treatment is over. Ask your doctor or nurse what side effects to expect and how you might prevent or relieve them.
Prostate
Radiation Therapy for Prostate Cancer
Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the Prostate Cancer and other factors, Radiation therapy might be used:
- As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
- As part of the first treatment (along with hormone therapy) for cancers that have grown outside the prostate gland and into nearby tissues.
- If the cancer is not removed completely or comes back (recurs) in the area of the prostate after Surgery.
- If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.
Types of radiation therapy
The main types of Radiation therapy used for Prostate Cancer are:
- External beam radiation
- Brachytherapy (internal radiation)
(Another type of radiation therapy, in which a medicine containing radiation is injected into the body, is described in Treating Prostate Cancer Spread to the Bone.)
External beam Radiation therapy (EBRT)
In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone Pain if the cancer has spread to a specific area of bone.
You will usually go for treatment 5 days a week in an outpatient centre for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an X-Ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time — getting you into place for treatment — takes longer.
Newer EBRT techniques focus the radiation more precisely on the tumour. This lets doctors give higher doses of radiation to the tumour while reducing the radiation exposure to nearby healthy tissues.
Three-dimensional conformal Radiation therapy (3D-CRT)
3D-CRT uses special computers to precisely map the location of your prostate. Radiation beams are then shaped and aimed at the prostate from several directions, which makes it less likely to damage surrounding normal tissues and organs.
Intensity modulated Radiation therapy (IMRT)
IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam Radiation therapy for Prostate Cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity (strength) of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.
Some newer radiation machines have imaging scanners built into them. This advance, known as image guided Radiation therapy (IGRT), lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.
A variation of IMRT is called volumetric modulated arc therapy (VMAT). It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasn’t yet been shown to be more effective than regular IMRT.
Stereotactic body Radiation therapy (SBRT)
This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.
SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife®, X-Knife®, CyberKnife®, and Clinac®.
The main advantage of SBRT over IMRT is that the treatment takes less time (days instead of weeks). The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.
Proton beam radiation therapy
Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.
Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they aren’t available in many centres in the United States. Proton beam radiation might not be covered by all insurance companies at this time.
Possible risks and side effects of EBRT
Some of the side effects from EBRT are the same as those from surgery, while others are different.
Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during Radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.
Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.
Some men develop urinary incontinence after treatment, which means they can’t control their urine or have leakage or dribbling. As described in the Surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with Radiation therapy than after Surgery. The risk is low at first, but it goes up each year for several years after treatment.
Rarely, the tube that carries urine from the bladder out of the body (the urethra) may become very narrow or even close off, which is known as a urethral stricture. This might require further treatment to open it up again.
Erection problems, including impotence: After a few years, the impotence rate after radiation is about the same as that after Surgery. Problems with erections usually do not occur right after Radiation therapy but slowly develop over time. This is different from surgery, where impotence occurs immediately and may get better over time.
As with surgery, the older you are, the more likely it is you will have problems with erections. Erection problems can often be helped by treatments such as those listed in the Surgery section, including medicines.
For more about coping with erection problems and other sexuality issues, see Sexuality for the Man with Cancer.
Feeling tired: Radiation therapy can cause Fatigue that might not go away until a few weeks or months after treatment stops.
Lymphedema: Lymph nodes normally provide a way for fluid to return to the heart from all areas of the body. If the lymph nodes around the prostate are damaged by radiation, fluid can collect in the legs or genital region over time, causing swelling and Pain. Lymphedema can usually be treated with physical therapy, although it may not go away completely.
Brachytherapy (internal radiation therapy)
Brachytherapy (also called seed implantation or interstitial radiation therapy) uses small radioactive pellets, or “seeds,” each about the size of a grain of rice. These pellets are placed directly into your prostate.
- Brachytherapy alone is generally used only in men with early-stage Prostate Cancer that is relatively slow growing (low-grade).
- Brachytherapy combined with external radiation is sometimes an option for men who have a higher risk of the cancer growing outside the prostate.
The use of brachytherapy is also limited by some other factors. For men who have had a transurethral resection of the prostate (TURP) or for those who already have urinary problems, the risk of urinary side effects may be higher. Brachytherapy might not work as well in men with large prostate glands because it might not be possible to place the Seeds into all of the correct locations. One way to get around this may be to get a few months of Hormone therapy beforehand to shrink the prostate.
Imaging tests such as transrectal ultrasound, CT scans, or MRI are used to help guide the placement of the radioactive pellets. Special computer programs calculate the exact dose of radiation needed.
There are 2 types of prostate brachytherapy. Both are done in an operating room. You will get either spinal anaesthesia (where the lower half of your body is numbed) or general anaesthesia (where you are asleep), and you might need to stay in the hospital overnight. Either brachytherapy treatment can be used alone or combined with external beam radiation (given at a lower dose than if used by itself).
Permanent (low dose rate, or LDR) brachytherapy
In this type, pellets (seeds) of radioactive material (such as iodine-125 or palladium-103) are placed inside thin needles, which are inserted through the skin in the area between the scrotum and anus and into the prostate. The pellets are left in place as the needles are removed and give off low doses of radiation for weeks or months. Radiation from the Seeds travels a very short distance, so the Seeds can give off a large amount of radiation in a very small area. This limits the amount of damage to nearby healthy tissues.
Usually, around 100 Seeds are placed, but this depends on the size of the prostate. Because the Seeds are so small, they seldom cause discomfort, and are simply left in place after their radioactive material is used up.
You may also get external beam radiation along with brachytherapy, especially if there is a higher risk that your cancer has spread outside the prostate (for example, if you have a higher Gleason score).
Temporary (high dose rate, or HDR) brachytherapy
This technique is done less often. It leaves higher doses of radiation in place for a short time. Hollow needles are placed through the skin between the scrotum and anus and into the prostate. Soft nylon tubes (catheters) are placed in these needles. The needles are then removed but the catheters stay in place. Radioactive iridium-192 or cesium-137 is then placed in the catheters, usually for 5 to 15 minutes. Generally, about 1 to 4 brief treatments are given over 2 days, and the radioactive substance is removed each time. After the last treatment the catheters are removed. For about a week after treatment, you may have some Pain or swelling in the area between your scrotum and rectum, and your urine may be reddish-brown.
Possible risks and side effects of brachytherapy
Radiation precautions: If you get permanent (LDR) brachytherapy, the Seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesn’t travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctor’s note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.
There's also a small risk that some of the Seeds might move (migrate). You may be asked to strain your urine for the first week or so to catch any Seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the Seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesn’t seem to cause any ill effects.
These precautions aren’t needed after HDR brachytherapy, because the radiation doesn’t stay in the body after treatment.
Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or Diarrhea (sometimes with bleeding) can occur, but serious long-term problems are uncommon.
Urinary problems: Severe urinary incontinence (trouble controlling urine) is not a common side effect. But some men have problems with frequent urination or other symptoms due to irritation of the urethra, the tube that drains urine from the bladder. This tends to be worse in the weeks after treatment and gets better over time. Rarely, the urethra may actually close off (known as a urethral stricture) and need to be opened with a catheter or Surgery.
Erection problems: Some studies have found rates of erection problems to be lower after brachytherapy, but other studies have found that the rates were no different than with external beam radiation or Surgery. The younger you are and the better your sexual function before treatment, the more likely you will be to regain function after treatment.
Bladder
Radiation Therapy for Bladder Cancer
Radiation therapy uses high-energy radiation to kill cancer cells.
When is Radiation therapy used?
Radiation therapy can be used:
- As part of the treatment for some early-stage bladder cancers , after Surgery that doesn’t remove the whole bladder (such as TURBT)
- As the main treatment for people with earlier-stage cancers who can’t have Surgery or chemotherapy
- To try to avoid cystectomy (surgery to take out the bladder)
- As part of treatment for advanced bladder cancer (cancer that has spread beyond the bladder)
- To help prevent or treat symptoms caused by advanced bladder cancer
Radiation therapy is often given along with Chemotherapy to help the radiation work better. This is called chemoradiation.
How is Radiation therapy given?
The type of radiation most often used to treat bladder cancer is called external beam radiation therapy. It focuses radiation from a source outside of the body on the cancer.
Before your treatments start, your radiation team will take careful measurements to find the exact angles for aiming the radiation beams and the proper dose of radiation. This planning session, called simulation, usually includes getting imaging tests such as CT or MRI scans. This helps the doctor map where the tumour is in your body. You'll be asked to empty your bladder before simulation and before each treatment.
The treatment is a lot like getting an x-ray, but the radiation is stronger. Radiation doesn't hurt. Each treatment lasts only a few minutes, but the setup time – getting you into place for treatment – usually takes longer. Most often, radiation treatments are given 5 days a week for many weeks.
Possible side effects of radiation therapy
Side effects of radiation depend on the dose given and the area being treated. They tend to be worse when chemo is given along with radiation. They can include:
- Skin changes in areas getting radiation, ranging from redness to blistering and peeling
- Nausea and vomiting
- Bladder symptoms, like burning or Pain when you urinate, feeling the need to go often, or blood in your urine
- Diarrhea
- Blood in stool and/or urine
- Tiredness (fatigue)
- Low blood counts, which can lead to fatigue, easy bruising or bleeding, or increased risk of infection
These effects usually go away over time after treatment, but some people can have longer-term problems. For instance:
- In some people radiation treatments can lead to incontinence (problems holding urine) later on.
- Radiation can damage the lining of the bladder. This is called radiation cystitis and can cause long-term problems such as blood in the urine or painful urination.
- Nearby nerves and blood vessels might be damaged, leading to erection problems in men.
If you have side effects from radiation therapy, talk to with your health care team. They can suggest ways to ease many of them.
Thyroid
External Beam Radiation therapy for Thyroid Cancer
External beam Radiation therapy uses high-energy rays (or particles) to destroy cancer cells or slow their growth. A carefully focused beam of radiation is delivered from a machine outside the body.
This type of Radiation therapy is most often used to treat medullary thyroid cancer and anaplastic thyroid cancer. For cancers that take up iodine (most differentiated thyroid cancers) radioiodine therapy is usually a better treatment.
External beam Radiation therapy is often used for cancers that do not take up iodine and have spread beyond the thyroid. This might be done to help treat the cancer or to lower the chance of cancer coming back in the neck after Surgery.
If a cancer does not respond to radioiodine therapy, external Radiation therapy may be used to treat cancer that has come back in the neck or distant metastases that are causing Pain or other symptoms.
External beam Radiation therapy is usually given 5 days a week for several weeks. Before your treatments start, the medical team will take careful measurements to find the correct angles for aiming the radiation beams and the proper dose of radiation. The treatment itself is painless and much like getting a regular X-Ray. Each treatment lasts only a few minutes, although the setup time — getting you into place for treatment — usually takes longer.
Possible side effects
The main drawback of this treatment is that the radiation can destroy nearby healthy tissue along with the cancer cells. Some patients get skin changes similar to a sunburn, but this slowly fades away. Trouble swallowing, dry mouth, hoarseness, and Fatigue are also potential side effects of external beam Radiation therapy aimed at or near the thyroid.
To reduce the risk of side effects, doctors carefully figure out the exact dose needed and aim the beam as accurately as they can to hit the target.
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