Post # 35 – Radiation Therapy

Dear Family and Friends

I thought I would share with you a little bit about my radiation therapy, which began shortly after my mastectomy had healed. That surgery was done in December of 2015 and my radiation therapy began in February. I went every day for a radiation treatment Monday through Friday until my little grandson was born on March 21, 2016.

I remember being at the hospital awaiting his arrival and having to walk over to the cancer center for my final radiation treatment. I went across the road to the cancer center, received my last radiation treatment, then went back to the hospital in plenty of time to watch my new grandson being born --- what more could I ask for? He was good to wait until his grandma returned to enter this world😊

Radiation Therapy Basics Radiation is one of the most common treatments for cancer. Other names for radiation treatment are radiation therapy, radiotherapy, irradiation, or x-ray therapy.

A couple of my friends have said that “they give you just enough chemo to kill the cancerous cells and still keep you alive.” I am just so very grateful that they have the chemo therapy available for me to take so that I have more time to spend with my family and friends.

What is radiation therapy? Radiation therapy uses high-energy particles or waves, such as x-rays, gamma rays, electron beams, or protons, to destroy or damage cancer cells.

Your cells normally grow and divide to form new cells. But cancer cells grow and divide faster than most normal cells. Radiation works by making small breaks in the DNA inside cells. These breaks keep cancer cells from growing and dividing and cause them to die. Nearby normal cells can also be affected by radiation, but most recover and go back to working the way they should.

Unlike chemotherapy, which usually exposes the whole body to cancer-fighting drugs, radiation therapy is usually a local treatment. In most cases, it’s aimed at and affects only the part of the body being treated. Radiation treatment is planned to damage cancer cells, with as little harm as possible to nearby healthy cells.

Some radiation treatments (systemic radiation therapy) use radioactive substances that are given in a vein or by mouth. Even though this type of radiation does travel throughout the body, the radioactive substance mostly collects in the area of the tumor, so there’s little effect on the rest of the body.

Who gets radiation therapy? More than half of people with cancer get radiation therapy. Sometimes, radiation therapy is the only cancer treatment needed.

What are the goals of radiation therapy? Most types of radiation therapy don’t reach all parts of the body, which means they’re not helpful in treating cancer that has spread to many places within the body. Still, radiation therapy can be used to treat many types of cancer either alone or in combination with other treatments. Here are some of the reasons radiation therapy may be used:

To cure or shrink early-stage cancer Some cancers are very sensitive to radiation. Radiation may be used by itself in these cases to make the cancer shrink or completely go away. In some cases, a few cycles of chemotherapy may be given first. For other cancers, radiation may be used before surgery to shrink the tumor (this is called pre-operative therapy or neoadjuvant therapy), or after surgery to help keep the cancer from coming back (called adjuvant therapy).

For certain cancers that can be cured either by radiation or by surgery, radiation may be the preferred treatment. This is because radiation can cause less damage and the organ may be more likely to work the way it should after treatment.

For some types of cancer, radiation and chemotherapy might be used together. Certain chemo drugs (called radiosensitizers) help radiation work better by making cancer cells more sensitive to radiation. The drawback of getting chemo and radiation together is that side effects are often worse.

If you’ll need more than one kind of cancer treatment, your cancer care team will work with you to plan your treatment.

To stop cancer from coming back (recurring) somewhere else  Cancer can spread from where it started to other body parts. Doctors often assume that a few cancer cells might already have spread even when they can’t be seen on imaging scans like CT scans or MRIs. In some cases, the area where the cancer most often spreads to may be treated with radiation to kill any cancer cells before they grow into tumors. For instance, people with certain kinds of lung cancer may get preventive (prophylactic) radiation to the head because their type of lung cancer often spreads to the brain. Sometimes, radiation to prevent future cancer can be given at the same time radiation is given to treat existing cancer, especially if the area the cancer might spread is close to the tumor itself.

To treat symptoms caused by advanced cancer  Sometimes cancer has spread too much to be cured. But some of these tumors can still be treated to make them smaller so that the person can feel better. Radiation might help relieve problems like pain, trouble swallowing or breathing, or bowel blockages that can be caused by advanced cancer. This is often called palliative radiation.

To treat cancer that has returned (recurred)  If a person's cancer has returned (recurred), radiation might be used to treat the cancer or to treat symptoms caused by advanced cancer.  Whether radiation will be used after recurrence depends on many factors.  For instance, if the cancer has come back in a part of the body that has already been treated with radiation, it might not be possible to give more radiation in the same place. It depends on the amount of radiation that was used before.  In other instances, radiation might be used in the same area of the body or a different area.  Some tumors do not respond as well to radiation and for these cancers radiation might not be used to treat recurrence.

The radiation oncologist and the radiation technicians told me that the radiation treatments I was going to receive would be to kill any remaining cancerous cells in my chest wall after I had my mastectomy and had healed.

How is radiation therapy given? Radiation therapy can be given in 3 ways:

• External radiation (or external beam radiation): uses a machine that directs high-energy rays from outside the body into the tumor. Most people get external radiation therapy over many weeks. It’s done during outpatient visits to a hospital or treatment center.
• Internal radiation: Internal radiation is also called brachytherapy. A radioactive source is put inside the body into or near the tumor.
• Systemic radiation: Radioactive drugs given by mouth or put into a vein are used to treat certain types of cancer. These drugs then travel throughout the body.

The type of radiation you might get depends on the kind of cancer you have and where it is. In some cases, more than one type is used.

Who gives radiation therapy treatments? During your radiation therapy, a team of highly trained medical professionals will care for you. Your team may include these people:

• Radiation oncologist: This doctor is specially trained to treat cancer with radiation. This person oversees your radiation treatment plan.
• Radiation physicist: This is the person who makes sure the radiation equipment is working as it should and that it gives you the exact dose prescribed by your radiation oncologist.
• Dosimetrist: This person is supervised by the radiation physicist and helps the radiation oncologist plan the treatment.
• Radiation therapist or radiation therapy technologist: This person operates the radiation equipment and positions you for each treatment.
• Radiation therapy nurse: This nurse has special training in cancer treatment and can give you information about radiation treatment and managing side effects.

You may also need the services of a dietitian, physical therapist, medical or clinical social worker, dentist or dental oncologist, or other health care providers.

Does radiation therapy cause cancer? It has long been known that radiation therapy can slightly raise the risk of getting another cancer. It’s one of the possible side effects of treatment that doctors have to think about when they weigh the benefits and risks of each treatment. For the most part, the risk of a second cancer from these treatments is small and is outweighed by the benefit of treating the cancer, but the risk is not zero. This is one of the many reasons each case is different and each person must be part of deciding which kind of treatment is right for them.

If your cancer care team recommends radiation treatment, it’s because they believe that the benefits you’ll get from it will outweigh the possible side effects. Still, this is your decision to make. Knowing as much as you can about the possible benefits and risks can help you be sure that radiation therapy is best for you.

Does radiation therapy affect pregnancy or fertility? Women: It’s important not to become pregnant while getting radiation – it can harm the growing baby. If there’s a chance you might become pregnant, be sure to talk to your doctor about birth control options.

If you are or might be pregnant, let your doctor know right away.

Men: Not much is known about radiation’s effect on the children conceived by men while getting radiation therapy. Because of this, doctors often advise men to not get a woman pregnant during and for some weeks after treatment. Talk to your doctor to find out more about this.

Questions to ask about radiation therapy Before treatment, you’ll be asked to sign a consent form saying that your doctor has explained how radiation therapy may help, the possible risks, the type of radiation to be used, and your other treatment options. Before signing the consent form, be sure that you have had a chance to get all your questions answered. Here are some of the things you may want to ask about:

• What’s the purpose of radiation treatment for my type of cancer? To destroy or shrink the tumor? To prevent or stop cancer spread? To lower the chance the cancer may come back?
• If radiation is to be done after surgery, what are the chances it will kill any cancer cells left behind? Could radiation be used instead of surgery?
• What’s the chance that the cancer will spread or come back if I do – or don’t – get radiation therapy?
• What type of radiation therapy will I get?
• Are there other treatment options?
• What can I do to be ready for treatment?
• Can I eat before treatment or do I need to avoid certain foods before getting treatment?
• What will radiation treatment be like? How often is it given? How long will it take?
• How will the radiation affect the area near the cancer?
• How will I feel while I’m getting treatment? Will I be able to work? Go to school? Take care of my family?
• What side effects am I likely to have, when will they start, and how long will they last?
• Will any of these side effects affect how I do things, such as eat or drink, exercise, work, etc.?
• Will treatment and/or side effects change how I look?
• What long-term side effects might I have?
• Will I be at higher risk for any other health problems in the future?

Will I be radioactive during or after external radiation treatment? External radiation therapy affects cells in your body only for a moment. Because there’s no radiation source in your body, you are not radioactive at any time during or after treatment.

Radiation for Breast Cancer Some women with breast cancer will need radiation, often in addition to other treatments. The need for radiation depends on what type of surgery you had, whether your cancer has spread to the lymph nodes or somewhere else in your body, and in some cases, your age. Tumors that are large or involve the skin might also need radiation. You could have just one type of radiation, or a combination of different types.

Radiation therapy is treatment with high-energy rays (such as x-rays) or particles that destroy cancer cells. Two main types of radiation therapy can be used to treat breast cancer:

• External beam radiation: This type of radiation comes from a machine outside the body. This is the type of radiation treatment that I received
• Internal radiation (brachytherapy): For this treatment, a radioactive source is put inside the body for a short time. I did not have to experience the Brachytherapy type of radiation. It is also known as internal radiation. You can find more information here at the Cancer Society website:

When might radiation therapy be used? Not all women with breast cancer need radiation therapy, but it may be used in several situations:

• After breast-conserving surgery (BCS), to help lower the chance that the cancer will come back in the breast or nearby lymph nodes.
• After a mastectomy, especially if the cancer was larger than 5 cm (about 2 inches), or if cancer is found in the lymph nodes.

This was the case with me, my tumor grew very rapidly so they did the strong chemo therapy first to try to shrink the tumor before the surgery and all of my lymph nodes were cancerous, so they had to be taken as well.

• If cancer has spread to other parts of the body, such as the bones or brain.

When I went to see the radiation, oncologist is when I found out that my breast cancer was stage IV and not stage III as I had originally been told by my oncologist, but at that time they saw a spot in my back – at that time they didn’t know that the spot was also cancerous.  

External Beam Radiation Therapy --- External radiation (or external beam radiation) is the most common type of radiation therapy used for cancer treatment. A machine is used to aim high-energy rays (or beams) from outside the body into the tumor. (The machine most commonly used is called a linear accelerator or “linac.”)

Radiation technology allows the precise delivery of external beam radiation therapy. Modern machines better focus the radiation and do less damage to normal tissues, so doctors can use higher doses of radiation.

External radiation is usually done during outpatient visits to a hospital or treatment center. Most people get external radiation therapy in multiple sessions over many weeks.

I found out when my daughter and I went in the first time to the radiation section of the cancer center, that her father-in-law helped design the very machine they were going to use to administer my radiation therapy.

Types of external radiation therapy

Three-dimensional conformal radiation therapy (3D-CRT) delivers radiation beams from different directions designed to match the shape of the tumor. This helps to reduce radiation damage to normal tissues and better kill the cancer by focusing the radiation dose on the tumor.

Image guided radiation therapy (IGRT) is a form of 3D-CRT where imaging scans (like a CT scan) are done before each treatment. This allows the radiation oncologist to adjust the position of the patient or re-focus the radiation as needed to hit the tumor and limit other damage.

Intensity modulated radiation therapy (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 tumor and helps lessen damage to nearby normal body tissues.

Helical-tomotherapy a form of IMRT delivers radiation inside a large “donut.” For this treatment, you lie on a table that slowly slides through the donut as the machine spirals around you. It delivers many small beams of radiation at the tumor from different angles around the body. This may allow for even more precisely focused radiation.

Photon beam radiation therapy is another name for what is traditionally known as external beam radiation therapy. It uses photon beams to get to the tumor but also can damage healthy tissue around the tumor. Photons are used in treatments that are given by a machine called a linear accelerator.

Proton beam radiation therapy uses proton beams instead of photons or electrons. Protons are parts of atoms that cause little damage to tissues they pass through but are very good at killing cells at the end of their path. This means that proton beam radiation may be able to deliver more radiation to the tumor while reducing side effects on normal tissues. Protons can only be put out by a special machine called a cyclotron or synchrotron.

Stereotactic radiosurgery isn’t really surgery, but a type of radiation treatment that gives a large dose of radiation to a small tumor area, usually in one session. It’s used for brain tumors and other tumors inside the head. In some cases, a head frame or shell may be used to help keep the patient’s head still. Once the exact location of the tumor is known from brain scans, radiation is sent to the area from many different angles. The radiation is very precisely aimed to affect nearby tissues as little as possible.

Treatment outside the brain is called stereotactic body radiation therapy (SBRT). SBRT may be used for certain lung, spine, and liver tumors.

In many radiation therapy clinics this technology is called by the name of the vendor that makes the machine.

There are 3 main ways stereotactic radiosurgery can be given:

• The most common type uses a movable linac that’s controlled by a computer. The machine moves around to target the tumor from many different angles. X-Knife^™, CyberKnife^®, and Clinac^® all work this way.
• The Gamma Knife^® uses about 200 small beams aimed at the tumor from different angles for a short period to deliver a large dose of radiation. It’s usually given in one treatment session. Again, this is a type of radiation therapy – it doesn’t use a knife and there’s no cutting.
• Another type aims heavy charged particle beams (like proton or helium ion beams) at the tumor from different angles. These particles release most of the radiation’s energy at the end of their paths, at more precise depths. This limits damage to nearby healthy tissues or organs.

Although most patients will be given the full radiation dose in one session with stereotactic radiosurgery, it may be repeated if needed. Sometimes doctors give the radiation in several smaller treatments to deliver the same or slightly higher dose. This may be called fractionated radiosurgery or fractionated stereotactic radiotherapy.

Intraoperative radiation therapy (IORT) is external radiation given directly to the tumor or tumors during surgery. It may be used if the tumors can’t be removed completely or if there’s a high risk the cancer will come back in the same area. While you are asleep, the surgeon moves normal tissues away from the tumor and protects them with special shields. This lets the doctor give one large dose of radiation to the cancer and limit the effects on nearby tissues. IORT is given in a special operating room that has radiation-shielding walls.

How does your doctor plan your radiation treatment? Radiation is planned and given by a team of trained health care providers. The radiation oncologist is a doctor who treats cancer with radiation and oversees the care of each patient getting radiation. Working closely with the radiation oncologist, the radiation therapist gives the daily radiation treatment and positions patients for each treatment. Other professionals include the medical physicist and dosimetrist who plan and calculate the doses of radiation.

Before starting radiation therapy, your radiation oncologist will examine you, review your medical history and test results, and pinpoint the exact area to be treated in a process called simulation. You’ll be asked to lie still on a table while the radiation therapist uses imaging scans (like a CT scan or MRI) to define your treatment field (also called the treatment port). These are the exact places on your body where the radiation beams will be aimed.

Radiation beams are aimed very precisely. A special mold, mask, or cast of a body part might be made to make sure you are in the same position for each treatment and to help you stay still during treatment. The radiation therapist might mark the treatment field with freckle-sized dots of semi-permanent ink. The marks will likely fade away over time, but they’re needed until your treatment is finished. Don’t use soap on or scrub these marks. Sometimes the area may be marked with permanent dots like a tattoo. (These can later be removed with a laser.)

Based on the simulation, other tests, and your cancer type, the radiation oncologist will decide how much radiation is needed, how it will be given, and how many treatments you should have.

How long does external radiation treatment take? In most cases the total dose of radiation needed to kill a tumor can’t be given all at once. This is because a large dose given one time can cause more damage to nearby normal tissues. This can cause more side effects than giving the same dose over spread out into many treatments.

The total dose of external radiation therapy is usually divided into smaller doses called fractions. Most patients get radiation treatments daily, 5 days a week (Monday through Friday) for 5 to 8 weeks. Weekend rest breaks allow time for normal cells to recover. The total dose of radiation and the number of treatments is based on:

• The size and location of the cancer
• The type of cancer
• The reason for the treatment
• Your general health
• Any other treatments you’re getting

Other radiation schedules might be used in certain cases. For instance, radiation therapy might last only a few weeks (or less) when it’s used to relieve symptoms, because the overall dose of radiation is lower. In some cases, radiation might be given as 2 or more treatments each day. Or it might be given as split-course therapy, which allows for several weeks off in the middle of treatments, so the body can recover while the cancer shrinks. Your doctor will talk to you about the best plan in your case.

What happens during each treatment visit? External radiation is a lot like getting a regular x-ray. The treatment itself is painless and takes only a few minutes. But each session can last 15 to 30 minutes because of the time it takes to set up the equipment and put you in the right position.

External radiation therapy is usually given with a linear accelerator (or linac) which delivers a beam (or multiple beams) of radiation. The machine has a wide arm that extends over the treatment table. The radiation comes out of this arm. The machine can move around the table to change the angle of the radiation, if needed, but it won’t touch you.

Depending on the area being treated, you might need to undress, so wear clothes that are easy to take off and put on. You’ll be asked to lie on the treatment table next to the radiation machine.

The radiation therapist might put special heavy shields between the machine and parts of your body that aren’t being treated to help protect normal tissues and organs.

Once you’re in the right position, the radiation therapist will go into a nearby room to operate the machine and watch you on a TV screen. The room is shielded, or protected from the radiation so that the therapist isn’t exposed to it. You can talk with the therapist over an intercom. You’ll be asked to lie still during the treatment, but you won’t have to hold your breath.

The linac will make clicking and whirring noises and might sometimes sound like a vacuum cleaner as it moves to aim the radiation beam from different angles. The radiation therapist controls the movement and checks to be sure it’s working properly. If you’re concerned about anything that happens in the treatment room, ask the therapist to explain. If you feel ill or uncomfortable during the treatment, tell the therapist right away. The machine can be stopped at any time.

 Here are a few places you can go to find more information:

https://ww5.komen.org/BreastCancer/SideEffectsofRadiationTherapy.html

https://www.cancer.org/cancer/breast-cancer/treatment/radiation-for-breast-cancer.html
http://www.nationalbreastcancer.org/breast-cancer-radiation-therapy
https://www.cancercenter.com/treatments/radiation-therapy
https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you
https://www.mayoclinic.org/tests-procedures/radiation-therapy/about/pac-20385162?p=1

The Mayo Clinic has some really good information on radiation therapy, some of it is the same as what I have put here in this post. It explains how the “Radiation therapy damages cells by destroying the genetic material that controls how cells grow and divide. While both healthy and cancerous cells are damaged by radiation therapy, the goal of radiation therapy is to destroy as few normal, healthy cells as possible. Normal cells can often repair much of the damage caused by radiation.” I also like how they explain how you prepare for and what you can expect from your radiation therapy:

How you prepare Before you undergo external beam radiation therapy, your health care team guides you through a planning process to ensure that radiation reaches the precise spot in your body where it's needed. Planning typically includes:

·         Radiation simulation. During simulation, your radiation therapy team works with you to find a comfortable position for you during treatment. It's imperative that you lie still during treatment, so finding a comfortable position is vital. To do this, you'll lie on the same type of table that's used during radiation therapy. Cushions and restraints are used to position you in the right way and to help you hold still. Your radiation therapy team will mark the area of your body that will receive the radiation. Depending on your situation, you may receive temporary marking with a marker or you may receive small permanent tattoos.

After the tattoos were in place, they had me lay on the table on a foam-like substance to make a form that I would have to lay on each time I went in for radiation treatments. I would lay in the same exact position so that they would be able to get the radiation beam in the exact place they needed it to be.

·         Planning scans. Your radiation therapy team will have you undergo computerized tomography (CT) scans to determine the area of your body to be treated.

After the planning process, your radiation therapy team decides what type of radiation and what dose you'll receive based on your type and stage of cancer, your general health, and the goals for your treatment.

The precise dose and focus of radiation beams used in your treatment is carefully planned to maximize the radiation to your cancer cells and minimize the harm to surrounding healthy tissue.

What you can expect  External beam radiation therapy is usually conducted using a linear accelerator — a machine that directs high-energy beams of radiation into your body.

As you lie on a table, the linear accelerator moves around you to deliver radiation from several angles. The linear accelerator can be adjusted for your particular situation so that it delivers the precise dose of radiation your doctor has ordered.

You typically receive external beam radiation on an outpatient basis five days a week over a certain period of time. In most instances, treatments are usually spread out over several weeks to allow your healthy cells to recover in between radiation therapy sessions.

Expect each treatment session to last approximately 10 to 30 minutes. In some cases, a single treatment may be used to help relieve pain or other symptoms associated with more-advanced cancers. I went every day Monday through Friday and it seems like it was about twenty minutes each session.

During a treatment session, you'll lie down in the position determined during your radiation simulation session. You might be positioned with molds to hold you in place. This was during the first visit to the radiation section of the cancer center.

The linear accelerator machine may rotate around your body to reach the target from different directions. The machine makes a buzzing sound.

You'll lie still and breathe normally during the treatment, which takes only a few minutes. For some patients with lung or breast cancer, you might be asked to hold your breath while the machine delivers the treatment.

Your radiation therapy team stays nearby in a room with video and audio connections so that you can talk to each other. You should speak up if you feel uncomfortable, but you shouldn't feel any pain during your radiation therapy session.

Radiation Therapy and You: Support for People With Cancer

You can find a whole lot of information about cancer here in this publication at this website: https://www.cancer.gov/types/breast/patient/breast-treatment-pdq

How Radiation Works Radiation therapy uses a special kind of high-energy beam to damage cancer cells. (Other types of energy beams include light and X-rays.) These high-energy beams, which are invisible to the human eye, damage a cell’s DNA, the material that cells use to divide.

Over time, the radiation damages cells that are in the path of its beam — normal cells as well as cancer cells. But radiation affects cancer cells more than normal cells. Cancer cells are very busy growing and multiplying — 2 activities that can be slowed or stopped by radiation damage. And because cancer cells are less organized than healthy cells, it's harder for them to repair the damage done by radiation. So cancer cells are more easily destroyed by radiation, while healthy, normal cells are better able to repair themselves and survive the treatment.

There are two different ways to deliver radiation to the tissues to be treated:

·         a machine called a linear accelerator that delivers radiation from outside the body

·         pellets, or seeds, of material that give off radiation beams from inside the body

Tissues to be treated might include the breast area, lymph nodes, or another part of the body.

In some cases, your doctor may recommend hyperthermia be used in combination with radiation therapy. Hyperthermia (also called thermal therapy or thermotherapy) uses an energy source such as ultrasound or microwave to heat cancer cells to high temperatures, up to 113 degrees Fahrenheit. Early research has shown that hyperthermia may make some cancer cells more sensitive to radiation. Hyperthermia is still being studied in clinical trials and isn't available everywhere. Hyperthermia and radiation are usually given within an hour of each other.

Some people may fear radiation therapy. They may worry that therapeutic radiation may be dangerous like an atomic bomb or nuclear power plant. Stories about radiation side effects, some of them exaggerated, can circulate around hospital waiting rooms. It's important for you to know that there is NO connection between therapeutic radiation and the types of radiation in bombs and nuclear reactors. The radiation used in cancer treatment is highly focused, controllable, and generally safe.

Why radiation is necessary Radiation is an important and often necessary form of anti-cancer therapy because it is able to reduce the risk of recurrence after surgery. Although it's quite possible that your surgeon removed all the cancer, breast cancer surgery cannot guarantee that every last cancer cell has been removed from your body.

Individual cancer cells are too small to be felt or seen during surgery or detected by testing. Any cells that remain after surgery can grow and eventually form a new lump or show up as an abnormality on a test such as a mammogram.

Research has shown that people who are treated with radiation after lumpectomy are more likely to live longer, and remain cancer-free longer, than those who don't get radiation. Research has shown that even women with very small cancers (1 centimeter or smaller) benefit from radiation after lumpectomy.

I hope you have learned along with me about radiation therapy. I am sorry that it is a bit long, but I only put in what I though would give you a good idea of what to expect, what to prepare for, when you or someone you know has to undergo radiation. If you are a support person, please check out Radiation Therapy and You: Support for People With Cancer. the website is just above President Monson's quote. There is a lot of good information in there that may be of some help for you. Remember that with Heavenly Father’s help we can do all things. Keep smiling, laugh a lot, and count your blessing each and every day and don’t forget to thank Heavenly Father for them.  Remember too, that your Heavenly Father is always there for you and for those you love, and He will help you through all your ups and downs.