What Questions Should I Ask My Doctor
Coping with a diagnosis of cancer and researching the various treatment options can be a stressful experience. To assist you in this process, below is a list of questions you may want to ask your radiation oncologist if you are considering radiation therapy.
Questions to ask before treatment
- What type and stage of cancer do I have?
- What is the purpose of radiation treatment for my type of cancer?
- How will the radiation therapy be given? Will it be external beam or brachytherapy? What do the treatments feel like?
- For how many weeks will I receive radiation? How many treatments will I receive per week?
- What are the chances that radiation therapy will work?
- Can I participate in a clinical trial? If so, what is the trial testing? What are my benefits and risks?
- What is the chance that the cancer will spread or come back if I do not have radiation therapy?
- Will I need chemotherapy, surgery or other treatments? If so, in what order will I receive these treatments? How soon after radiation therapy can I start them?
- How should I prepare for this financially?
- What are some of the support groups I can turn to during treatment?
- If I have questions after I leave here, who can I call?
- Will radiation therapy affect my ability to have children?
- Do you take my insurance?
Questions to ask during Treatment
Questions to ask After Treatment Ends
Q: How Can Patients Cope With These Concerns
A: The first step is to recognize ones fears and worries. The next step is to find a way of dealing with these worries. Information and education are essential to regain some control. Sharing ones fears and worries with loved ones, a support group, or seeking professional help can and will bring relief. It is normal to have many concerns after completing treatment for cancer and important to feel supported and accompanied in this journey.
What Should I Expect Before Radiation Therapy For Breast Cancer
Most people who have breast cancer treatment receive external beam radiation therapy. The goal is to destroy any remaining cancerous cells while protecting healthy tissue.
Before your first treatment, you will have a planning session . This simulation helps your provider map out the treatment area while sparing normal tissues . This session may take one hour or longer.
During the simulation, your provider:
Radiation Therapy Timing And Breast Reconstruction
The timing of radiation treatment in your overall breast cancer treatment plan depends on your individual situation and the characteristics of the breast cancer.
In many cases, radiation therapy is given after surgery. If chemotherapy is planned after surgery, radiation usually follows chemotherapy.
If youre having mastectomy and have decided to have breast reconstruction, its important to know that radiation can cause a reconstructed breast to lose volume and change color, texture, and appearance.
In particular, radiation therapy is known to cause complications with implant reconstruction. Research also suggests that a reconstructed breast may interfere with radiation therapy reaching the area affected by cancer, though this can vary on a case-by-case basis.
For these reasons, some surgeons advise waiting until after radiation and other treatments, such as chemotherapy, are completed before breast reconstruction surgery is done.
Other surgeons may recommend a more staged approach, which places a tissue expander after mastectomy to preserve the shape of the breast during radiation treatments. Once radiation is completed and the tissues have recovered, the expander that was used to maintain the shape of the breast is removed and replaced with tissue from another part of the body or a breast implant.
External Radiation Planning And Treatment: What To Expect
Daily external radiation treatments require careful planning to make sure the treatment area is mapped out as accurately as possible and that each day of your treatment goes smoothly.
Heres what you can generally expect from the planning session through your daily treatment routine.
Planning and simulating external radiation treatment
Your first radiation therapy session is called a simulation. It is a planning and practice session, and you receive no radiation.
During the simulation session, your radiation oncology team maps out the area of the breast that needs treatment using imaging such as a CT scan, MRI, or X-ray.
Because it is so important to position the angles of radiation accurately, the simulation session can sometimes last up to an hour.
During the simulation session, your doctor will:
- explain the pros and cons of radiation, the planning and treatment process, and answer any questions or concerns you may have
- review the consent form and have you sign it
- introduce you to the treatment team
- precisely identify the area where you will receive radiation
A second planning session usually is needed to confirm the treatment and your positioning. Special X-rays are taken of each treatment field to make sure they are all set up correctly, and additional markings may be made to better define the confirmed treatment fields.
External radiation therapy routine
Here’s what to expect during your visit to the radiation treatment center:
Written by: Jamie DePolo, senior editor
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Finding Premiere Experts And Care
I visited many specialists and consulted numerous reputable cancer centers around the country. Through a referral, I contacted neuro-oncologist , of NCIs Center for Cancer Research Neuro-Oncology Branch and a specialist in rare neurological cancers, in November 2018 to schedule an appointment at NIH.
Before visiting NIH, I had a full body MRI with my local doctor who discovered multiple tumors in the lumbar, thoracic, and C1 vertebrae near the base of my brain. I had an emergency thoracic spine surgery locally.
A few months after my fourth surgery, I had an MRI at NIH and talked to Dr. Gilbert about treatment options. Asking Dr. Gilbert and his team specific questions about my case really helped calm my fears, provide guidance, and trust that I would receive the best care possible. His team acknowledges there is a person going through a difficult time. Together, we developed a plan that included craniospinal radiation full body radiation to the brain and spine in Houston for six weeks.
It took me six months to fully recover from surgery and radiation as physical therapy was rather challenging. Post-surgery, I experienced difficulty walking, had to use a cane for a week or so, and still have neuropathy in both of my feet.
My biggest goal was to be healthy enough to get married to my beautiful fiancé , Nicole. My wedding was planned for June 2019, so this helped motivate me to push forward and never give up.
Will Side Effects Limit My Activities
Not necessarily, says Yale Medicine radiation oncologist Lynn Wilson, MD, who is the chair of Therapeutic Radiology and a professor of therapeutic radiology at Yale School of Medicine. It will depend on what side effects you experienceand how severe they are. Many patients are able to go to work, keep house, and enjoy leisure activities while they are receiving radiation therapy. Others find that they need more rest than usual and therefore cannot do as much. You should try to do the things you enjoy, as long as you don’t become too tired. Your doctor may suggest that you limit activities that might irritate the area being treated. In most cases, you can have sexual relations if you wish. However, your desire for physical intimacy may be lower because radiation therapy may cause you to feel more tired than usual.
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Nerve Damage Around The Treatment Area
Scaring from radiotherapy may cause nerve damage in the arm on the treated side. This can develop many years after your treatment. Symptoms include tingling, numbness, pain, and weakness. In some people, it may cause some loss of movement in the arm and shoulder.
Speak to your doctor if you notice any of these symptoms.
Keeping Health Insurance And Copies Of Your Medical Records
Even after treatment, its very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
At some point after your treatment, you might find yourself seeing a new doctor who doesnt know about your medical history. Its important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.
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Working During Radiation Therapy
Some people are able to work full-time during radiation therapy. Others can work only part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect from the treatment you will have.
You are likely to feel well enough to work when you first start your radiation treatments. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished treatment, it may take just a few weeks for you to feel betteror it could take months.
You may get to a point during your radiation therapy when you feel too sick to work. Talk with your employer to find out if you can go on medical leave. Check that your health insurance will pay for treatment while you are on medical leave.
What Are Possible Side Effects Of Radiation Therapy
There are usually no immediate side effects from each radiation treatment given to the breast. Patients do not develop nausea or hair loss on the head from radiation therapy to the breast.
Most patients develop mild fatigue that builds up gradually over the course of therapy. This slowly goes away one to two months following the radiation therapy. Most patients develop dull aches or sharp shooting pains in the breast that may last for a few seconds or minutes. It is rare for patients to need any medication for this. The most common side effect needing attention is skin reaction. Most patients develop reddening, dryness anditching of the skin after a few weeks. Some patients develop substantial irritation.
Skin care recommendations include:
- Keeping the skin clean using gentle soap and warm but not hot water
- Avoiding extreme temperatures while bathing
- Avoiding trauma to the skin and sun exposure
- Avoiding shaving the treatment area with a razor blade
- Avoiding use of perfumes, cosmetics, after-shave or deodorants in the treatment area
- Using only recommended unscented creams or lotions after daily treatment
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Radiation Therapy Uses High Energy X
Its a localised treatment affecting only the area which is specifically targeted. Although some healthy tissue may be in the treatment area, it generally has the ability to repair itself, unlike cancer cells.
In early breast cancer, radiation therapy is used with the aim of getting rid of any malignant or pre-cancerous cells remaining in the breast following partial mastectomy or lumpectomy. This reduces the risk of developing a local recurrence of cancer in the breast in the future. Radiation therapy is also used to treat the chest wall after mastectomy if the cancer has high-risk features.
The regional lymph nodes in the axilla , supraclavicular fossa or internal mammary chain may also be treated in some cases.
In these settings, large international trials have demonstrated that radiation therapy reduces the incidence of local breast cancer recurrence.
Radiation therapy is usually given after surgery, once the wounds have healed. For people needing chemotherapy, radiation is given after that treatment has been completed.
What Is External Beam Radiation Therapy
During external beam radiation therapy, a beam of radiation is directed through the skin to the cancer and the immediate surrounding area in order to destroy the main tumor and any nearby cancer cells. To minimize side effects, the treatments are typically given five days a week, Monday through Friday, for a number of weeks. This allows doctors to get enough radiation into the body to kill the cancer while giving healthy cells time each day to recover.
The radiation beam is usually generated by a machine called a linear accelerator. The linear accelerator, or linac, is capable of producing high-energy X-rays and electrons for the treatment of your cancer. Using high-tech treatment planning software, your treatment team controls the size and shape of the beam, as well as how it is directed at your body, to effectively treat your tumor while sparing the surrounding normal tissue. Several special types of external beam therapy are discussed in the next sections. These are used for specific types of cancer, and your radiation oncologist will recommend one of these treatments if he or she believes it will help you.
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What Kind Of Skin Problems Can Radiation Therapy Cause
The way external radiation therapy affects your skin is similar to what happens when you spend time in the sun. It may look red, sunburned, or tanned. It may also get swollen or blistered. Your skin may also become dry, flaky, or itchy. Or it may start to peel.
Be gentle with your skin:
- Don’t wear tight clothing over the area that’s being treated.
- Don’t scrub or rub your skin. To clean it, use a mild soap and let lukewarm water run over it.
- Avoid putting anything hot or cold on the area unless the doctor tells you to.
- Ask your doctor before you use any type of ointment, oil, lotion, or powder on your skin.
- Ask about using corn starch to help relieve itching.
- Stay out of the sun as much as possible. Cover the area getting radiation with clothing or hats to protect it. Ask the doctor about using sunscreen if you must be outdoors.
- If youâre having radiation therapy for breast cancer, try not to wear a bra. If that isn’t possible, wear a soft, cotton one without underwire.
- Don’t use any tape, gauze, or bandages on your skin unless the doctor tells you to.
Your skin should start to feel better a few weeks after therapy ends. But when it heals, it may be a darker color. And youâll still need to protect yourself from the sun even after radiation therapy has ended.
Urinary And Bladder Changes
Radiation therapy to the pelvis can cause urinary and bladder problems by irritating the healthy cells of the bladder wall and urinary tract. These changes may start 35 weeks after radiation therapy begins. Most problems go away 28 weeks after treatment is over. You may experience:
- Burning or pain when you begin to urinate or after you urinate
- Trouble starting to urinate
- Bladder spasms, which are like painful muscle cramps
Ways to manage include:
- Drink lots of fluids. Aim for 68 cups of fluids each day, or enough that your urine is clear to light yellow in color.
- Avoid coffee, black tea, alcohol, spices and all tobacco products.
- Talk with your doctor or nurse if you think you have urinary or bladder problems. You may need to provide a urine sample to check for infection.
- Talk with your doctor or nurse if you have incontinence. He/she may refer you to a physical therapist to assess your problem. The therapist may recommend exercises to help you improve your bladder control.
- Your doctor may prescribe medications to help you urinate, reduce burning or pain, and ease bladder spasms.
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Why The Procedure Is Performed
After surgery, cancer cells may remain in the breast tissue or lymph nodes. Radiation can help kill the remaining cancer cells. When radiation is delivered after surgery is performed, it is called adjuvant treatment.
Adding radiation therapy can kill the remaining cancer cells and lower the risk of the cancer growing back.
Wholebreast radiation therapy may be given for several different cancer types:
- For ductal carcinoma in situ
- For stage I or II breast cancer, after lumpectomy or partial mastectomy
- For more advanced breast cancer, sometimes even after full mastectomy
- For cancer that has spread to local lymph nodes
- For widespread breast cancer, as a palliative treatment to relieve symptoms
How Do I Prepare For My Treatments
Before your first radiation treatment, you will have a simulation appointment. This appointment will last approximately one to two hours. During this appointment, the doctor will identify the exact fields on your body to treat with radiation. This involves lying on a table while the radiation therapist marks the field with small dots made with permanent ink. Each dot is similar to a very small tattoo. You will not receive any radiation treatment during this appointment.
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Easing Worries About Radiation Therapy
Its normal to worry about possible side effects of radiation therapy.
Talk with your health care provider about your concerns.
Your provider may be able to suggest a hospital social worker, patient navigator, psychologist or support group to help ease anxiety related to radiation therapy .
With any standard radiation therapy, you will not be radioactive when you leave the radiation treatment center. You will not pose any radiation risk to your family or your pets.
Learn more about support groups.
What To Expect During And After Radiation Treatments
Nick and his wife, Nicole
Nick had four surgeries and multiple radiation treatments to treat his ependymoma tumors. He shares what to expect during and after radiation and how cancer changed his outlook on life.
In 2004, when I was 12 years old, I had severe back pain and spasms. When I laid down at night, I experienced episodes where I couldnt move for 10 to 15 minutes. Since my father was in the medical field, he knew something wasnt normal.
An MRI showed a 12-centimeter grade I myxopapillary ependymoma inside my spinal column in my lower lumbar. After emergency surgery, the doctors reported they removed all the tumor except for a couple of very microscopic spots.
A couple years later, follow-up MRIs showed growth and I had a second surgery. During my recovery, I wore a back brace for six months and was not able to participate in any physical activities for almost a year. That was the hardest part as a kid. I was playing basketball the second after doctors cleared me for activity.
Two years later, around age 14, an MRI revealed spots had grown for a third time. I had surgery on my lower lumbar, followed by proton radiation. At the time, only eight centers in the United States performed this type of radiation. Luckily, one of the centers was within driving distance to my home. So, for two-and-a-half months that summer, my mom spent three hours every day driving me to radiation.
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