The First Radiation Treatment

When radiation therapy is the recommended course of cancer treatment, the most pressing question many patients and caregivers share is, “What will radiation be like?”  For most, the first treatment is the most intimidating:  we cannot imagine what it feels like, or how we will respond.

Radiation therapy is a highly effective, pain-free treatment option used to cure or control the spread of cancer, bring relief to symptoms including pain, and to improve the quality of life of a cancer patient.

Although no two treatment plans are exactly the same and no two individuals experience exactly the same side-effects, most patients find their introduction to radiation therapy manageable if they have a good understanding of what to expect – and if they prepare for it.

Radiation is delivered by one of three methods:

·         External radiation therapy involves the carefully precise use of a high-energy beam that passes through living tissue, aims directly at a cancerous tumor, and then exits the other side of the body. This type of radiation is always performed in hospitals or clinical settings where nuclear medicine is practiced.

·         Internal radiation therapy involves the careful and accurate placement of radioactive sources directly into cancerous and/or living tissue. Implantation of the radiation source is done in a hospital and may require several days hospitalization.  The therapy is determined by the type of cancer. Contact with pregnant woman and young children may be restricted for a few days or weeks.

·         Systemic radiation therapy involves the individual swallowing or receiving an injection of a radioactive substance, such as radioactive iodine.  Systemic radiation therapy is commonly used to help treat some types of thyroid cancer. Thyroid cells naturally take up radioactive iodine.  This type of radiation is always performed in a hospital and may require several days hospitalization. Some types of systemic radiation therapy may temporarily make a patient’s bodily fluids (such as saliva, urine, sweat, or stool) emit a low level of radiation. Patients receiving systemic radiation therapy may need to limit their contact with other people during this time, and especially avoid contact with children younger than 18 and pregnant women.

A patient’s doctor or nurse will provide more information to family members and caretakers if any of these special precautions are needed. Over time (usually days or weeks), the radioactive material retained within the body will break down so that no radiation can be measured outside the patient’s body.

Radiation kills cancer by damaging DNA, causing cells to die rather than replicate at cell division. Unfortunately radiation can also kill normal tissue, but normal tissue – unlike cancerous tissue -- is usually able to repair itself after treatment. 

In some cases radiation therapy may be used alone, but in other cases it may be combined with surgery and/or chemotherapy to achieve the best outcome.  Sometimes, radiation therapy is the last form of cancer treatment, following chemotherapy or other treatments.

Patients cannot see, smell, taste, hear or feel the radiation. Cancer radiation treatments are very similar to getting an X-ray. A small number of patients feel warmth or a tingling sensation in the treatment area, but they do not feel any pain.

Even though the effects of radiation are powerful, the patient will not become permanently radioactive. External radiation therapy affects targeted cells only for a moment, so by the time the patient leaves the treatment area which is usually less than thirty minutes the patient will not be emitting any radiation. With internal  and systemic radiation therapy, the patient's body may emit a small amount of radiation for a short time.  An individual’s doctor or nurse will provide more information to family members and caretakers if any of these special precautions are needed. It is very important to follow the instructions given by the health care staff.

Before external radiation therapy can be initiated, the treatment area needs to be precisely identified and marked so that the radiation technician can pinpoint the radiation. This process is time consuming because precision is essential, and many individuals complain of fatigue because of the time and positioning that may be required.  Usually, treatments are not started on that same day. Yet time invested at this stage allows all subsequent treatments to proceed more smoothly, because the technician can line up the treatment fields quickly.   

To mark radiation treatment areas, most cancer centers use tattoo markers, but some may use a felt-tip marker similar to the ones you may have in your desk. Tattoos are much more precise than felt-tip markings. The tattooing process feels like a pinprick and is much less painful than having blood drawn.  The tattoo lines are permanent. The benefit of the tattoo is that during the course of treatment, it will allow you to take showers or go swimming without worrying about having the marks disappear.  Whatever form of radiation marking is used, it is very important to follow the skin-care instructions the radiation therapist provides. 

With radiation, many patients have no side effects at all.  Those who experience side effects find that they vary depending on the treatment dose, the part of the body that is treated and the patient's general health before treatment.  As with chemotherapy, it is very important to begin and maintain good health while undergoing radiation therapy:   ample rest, adequate nutrition and avoidance of infections.