Radiation Therapy

WHAT YOU SHOULD KNOW

Side Effects

• Eating Problems: Cancer and/or radiation therapy can destroy your appetite or leave you too tired to eat. This can become a vicious circle: Without sufficient calories, you're likely to lose weight and become even more fatigued.
• Blood Problems: If radiation damages your bone marrow, where the red blood cells are normally produced, you may develop anemia or bleeding problems. Production of infection-fighting white blood cells can also be disrupted, leaving you open to disease. If your white blood cell count drops too far, your doctor may order blood transfusions.
• Brain Swelling: Radiation therapy in your head may lead to brain swelling (edema). This swelling can cause headaches, nausea, vomiting, seizures, and problems seeing, talking, thinking, or walking.
• Chest Problems: If the radiation is near your lungs, you may develop a cough, either with mucus (a "productive" cough) or without it (a "nonproductive" cough). Coughing can become severe enough to keep you awake and lead to fatigue. You may also experience shortness of breath (dyspnea). This problem is a frequent result of pneumonitis, an inflammation in the lung, or fibrosis, the development of scar tissue in the lung.
• Cystitis (sis-TI-tis): Bladder infections, known medically as cystitis, are also a danger. Symptoms include burning pain when you urinate, difficulty starting urination, a constant or sudden urge to urinate, frequent urination at night, a decline in the amount of urine, blood in the urine, and inability to hold urine.
• Diarrhea: If the radiation is near your intestines, diarrhea may develop 2 to 3 weeks after radiation begins and continue until the treatments are finished.
• Fatigue: You may feel tired during and after each treatment. (However, most people are still able to keep working despite the fatigue.) Pain, infection, anemia, poor appetite, and depression can make the problem worse. Fatigue can persist for weeks or months after therapy is finished, but should eventually disappear.
• Hair Loss: You may lose some or all of your body hair during the first 2 to 3 weeks of radiation therapy. It should start to grow back about 2 to 3 months after therapy is finished.
• Mouth Problems: The skin inside your mouth and throat may become swollen and sore and develop a white coating of fungus called "thrush." Don't attempt to pull this coating off; your doctor can prescribe medicine to kill it. In addition, your saliva may become very thick and sticky, making it hard to talk and eat, and easier to develop cavities in your teeth. Food may start to taste bad, and you may not be able to taste some foods at all.
• Stomach Problems: You may develop nausea or vomiting if your stomach or intestines are in the area of radiation. The attacks are usually brief, generally starting within 6 hours after radiation and continuing for 3 to 6 hours.
• Skin Problems: The skin over the radiation area may become swollen and sore and may change color from light pink to red to brown. It may also become itchy, dry, or flaky. If the top layers of the skin peel off, the area may become sore and wet. Skin problems are also possible on the side of the body where the radiation exits.
• Sexual Problems in Men: Radiation therapy can damage a man's testicles, lowering his sperm count or causing sterility. Men may also experience difficulty getting erections. These problems are sometimes temporary, but can also be permanent.
• Sexual Problems in Women: A woman may have the symptoms of menopause (hot flashes, no periods) if her ovaries receive radiation, and may lose interest in sex. To reduce these side effects, your doctor may suggest surgery to move your ovaries out of the way of the radiation.

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• Blood Tests: You'll need blood taken for tests before, during, and after radiation therapy. Samples can be drawn from a vein in your hand or from the bend in your elbow.
• Blood Transfusion: If you have anemia (a shortage of red blood cells) or a low white blood cell count, you may need a transfusion. Although you might be worried about catching AIDS or hepatitis from tainted blood, the risks posed by going without a transfusion are actually much greater. Your chance of receiving infected blood is about 1 in a million; severe blood loss, on the other hand, can easily trigger a heart attack.
• Anesthesia: If you're receiving a radioactive implant, you'll need a pain-killer during the operation. For this type of procedure, the following options are available:
• Spinal Anesthesia: This type of anesthesia requires an injection in the spine. You will be awake during surgery but will be numb below the waist. Feeling will return in about 2 hours.
• Epidural Anesthesia: For this type, a tiny tube is positioned near the spine, allowing administration of additional medication during the operation. You will be awake during surgery but will be numb below the waist. Feeling will return to your legs when the anesthesia wears off.
• General Anesthesia: This alternative puts you completely to sleep throughout the operation. The anesthetic is given either as a liquid in your IV or as a gas through a face mask or endotracheal (END-o-TRA-kee-ull) tube placed in your mouth and throat.
• Local Anesthesia: This is simply a pain-killing injection at the site of the operation. You'll remain awake, and may feel some painless pressure or pushing.
• Intravenous Regional Anesthesia: This approach can be used on an arm or leg. A pressure cuff is first put on the limb, then painkillers are given through an IV. The cuff keeps the medication in the affected limb.

During Implant Surgery

During External Beam Therapy

After Implant Surgery

• Isolation: To protect others from radiation, you may be assigned a private room. Visitors and nurses will not be allowed to stay more than 30 minutes a day and will have to stay 6 feet away from you. They may have to wear a lead apron when approaching you, and you'll have to bathe, eat, and go to the bathroom with a minimum of assistance. Call your doctor when you feel you need help.
• Activity: Depending on the location of the implant, you may have to stay in bed for a while. But even if you are confined to bed, it's important to exercise your legs in order to stop blood clots from forming. Lift one leg off the bed and draw big circles with your toes, then repeat with the other leg. You can also try lying on your side and pretending to pedal a bike. When you're told it's OK to get out of bed, make sure someone is with you the first time you try. If you feel weak or dizzy, sit or lie down right away.
• Handwashing and bathing: Because all your body fluids and secretions---including bowel movements, urine, vomit, sweat, and blood---will be radioactive, it is very important to wash your hands every time you go to the bathroom or touch any secretions. Frequent showers are recommended. They will relieve itching caused by sweat.
• Oxygen: At times during your stay, your body may need extra oxygen. It is given either through a plastic mask over your mouth and nose or through nasal prongs. If the oxygen dries out your nose or the nasal prongs bother you, tell your nurse, but don't take off the oxygen on your own.
• Implant: If the implant falls out, do not attempt to pick it up or touch it with your bare skin. Call a nurse, who will pick up the implant with tongs, put it in a metal container, and call your radiation doctor.
• Medicines:
• A variety of drugs may be needed to reduce side effects once the implant is in place. Among them are:
• Antibiotics: These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
• Anti-Diarrhea Medicine: This medicine may be given by mouth to decrease your diarrhea. Some of these medicines coat the intestine and make the stool less watery. Others slow the movement of the intestine.
• Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
• Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
• Diuretics: Often called "water pills," these medications rid the body and lungs of excess fluid to help you breathe more easily. They work by increasing urination. They can be given as a pill or in your IV.
• Expectorants: This medicine helps thin your sputum, making it easier to cough up. This will help ease your breathing.
• Steroids: This medicine reduces swelling and inflammation. While it can be helpful, it may have side effects. Nevertheless, don't stop taking it on your own. Sudden withdrawal can cause problems.

After You Leave

• Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up, even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
• If you are taking pain medicine as a shot or IV, arrange to have a friend or family member learn how to give it. Take enough medicine to keep you comfortable. You should not worry about becoming addicted to these drugs.
• Do NOT take any medicine that contains aspirin or ibuprofen-like ingredients. Ask your doctor before taking any over-the-counter medication.
• Try to maintain a healthy diet with items from all 5 food groups: fruits, vegetables, breads, dairy products, meat and fish. It's important to keep your strength up.
• Drink 6 to 8 large glasses of liquid, such as water, juices, and milk, each day. Limit caffeinated beverages, such as coffee, tea, and soda.
• Gently brush your teeth and gums with a soft-bristle brush, or rinse your mouth, 2 to 3 times every day, especially after meals. See your dentist for regular check-ups. Your dentist may need to speak to your doctor before the exam.
• You'll probably be weighed once a week to determine any change in your fluid balance. If you loose too much fluid, you can become dehydrated. If you have excess fluid, you may find it hard to breath.
• If breathing becomes difficult, try raising the head of your bed or putting 3 or 4 pillows under your head. Resting in a reclining chair may also help. If breathing problems continue, call your doctor right away.
• Match your activity to your energy level. Nap a couple of times during the day. Go to bed early and get up late.
• If your skin gets sore in the treatment area, do not rub it or attempt to put lotion on it. Cover the area to protect it from heat and cold.
• If you begin to lose your hair, consider buying a scarf, hat, or wig to help hide the loss.
• Using a humidifier will moisten the air in your home and make it easier to cough up your sputum. Wash the humidifier each day with soap and warm water to keep it germ-free.
• Radiation therapy often weakens the immune system. To guard against infections, stay away from people who have a cold or the flu and avoid large groups. You may need flu and pneumonia shots.
• You may have problems with sex after radiation therapy, but they are often temporary and many can be helped. Talk to your doctor if you are worried. He can help you find ways to handle these problems.
• Your pain may never be entirely eliminated. But a pain clinic can help you learn new ways to live with it. Ask your doctor to teach you how to control the pain without medicine. Two good techniques are relaxation therapy and special breathing exercises.
• To protect their ability to have children, radiation patients often make the following arrangements:
• • Men can put sperm in a sperm bank, where it will be kept frozen for later use.
  • Women can have their ovaries surgically moved out of the radiation area.

Call Your Doctor If...

• You are running a temperature.
• You have chills, a cough, red or swollen skin, weakness, or achiness. You may have an infection.
• You have itchy, swollen skin or a rash. You may be allergic to your medicine.