Treatment Information

During the consultation visit, your Radiation Oncologist (and a Resident Physician, Nurse Practitioner, or Physician’s Assistant) will examine you and reconfirm your diagnosis with the use of your x-rays, medical images and pathology to determine and discuss your treatment options. Once it is determined that you will undergo a course of radiation therapy, your simulation/ treatment planning visit will be scheduled.

Simulation/Treatment Planning

Simulation is the first step of your treatment planning process, and it often includes a CT scan. A simulation is an imitation of your radiation treatment in the position that you will be treated. No treatment will take place during simulation. Your simulation may take 30-90 minutes depending upon the area being treated. You may receive a call from the clinic before your visit if there are special instructions, such as not eating before your appointment, not taking certain medications, arriving early to have blood drawn, or whether you will need an appointment to have an IV placed, or your power port accessed (if you have one) prior to your simulation.

Immobilization Devices

In some cases, the radiation therapist my decide an immobilization device is necessary for treatment. If an immobilization device is needed it will be made for you at this appointment and it will be used during your simulation and your treatment, and will be labeled with your name and stored in our department.

Temporary Marks

The therapists will draw marks on your skin or on the immobilization device during simulation so that your exact position can be used for each treatment session. During simulation, laser beams are used to help confirm your precise alignment. These lasers are not harmful to you and are just for positioning purposes. Permanent tattoos may be given at the end of your simulation appointment, or on your first day of radiation treatment. If temporary marks are placed on your skin, be careful not to remove them before your first treatment. If the marks are gone at your first treatment visit they will have to be re-drawn which will add time to your visit. Pictures will be taken of the marks on your skin and of the position that you will be treated in. The pictures are for documentation purposes only and will be placed in your treatment chart.

During treatment: side effects

Radiation therapy is a powerful treatment. Some people experience side effects from their therapy. Below are some of these conditions, along with information written by our Radiation Oncology nurses to help patients alleviate the side effects.

• Bladder Irritation
• Diarrhea
• Fatigue
• Low Blood Count
• Mouth Irritation
• Taste Alterations
• Loss of Appetite
• Hair Loss
• Skin Care

Bladder Irritation

When your bladder is in the area being treated with radiation, you may feel frequency of urination, burning and urgency. You may also experience spasm-like sensations when urinating.

What causes bladder irritation?

Cells that line the bladder grow rapidly and are very susceptible to radiation. The irritation is temporary.

Self-care measures

• Avoid substances that may irritate the bladder. These include coffee, tea, alcoholic beverages, spicy foods and tobacco products.
• Increase daily fluid intake so that you are drinking 2 1/2 to 3 quarts a day.
• Acidic juices such as cranberry juice can be helpful in decreasing symptoms of irritation.
• Notify a Radiation Oncology nurse or physician as soon as you notice any symptoms.

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Diarrhea

Diarrhea varies from person to person and depends on the dose of radiation and how large an area is being treated. Diarrhea does not usually occur until after you have had several treatments. Your stools may become very soft or liquid.

What causes diarrhea?

Radiation is especially effective on cells that grow rapidly. The cells that line the gastrointestinal tract (mouth, stomach, intestines and colon) are rapidly dividing and growing and are therefore very susceptible to the effects of radiation.

Self-care measures

• The Radiation Oncology nurses will talk to you about a personal diet plan.
• Avoid foods that contain a lot of roughage and bulk. These include salads, fibrous or stringy vegetables, whole grains, seeds, skins, nuts, berries, dates, raisins, raw fruits and vegetables. Bananas, applesauce, peeled apples and fruit nectars are permitted. Cooked vegetables may be included in your diet.
• Avoid alcohol.
• Avoid foods with strong spices like chili pepper, curry, peppers and garlic.
• Drink at least 3 quarts of liquid a day. You may need even more to replace the liquid you are losing due to the diarrhea.
• Eat foods that are high in potassium, especially if you are experiencing frequent loose stools. These include bananas, baked potato without the skin, meat, mushrooms and oranges.
• Keep track of the number of stools you have.
• If you are not sure of what is in a certain food, it is best to avoid eating it until you can talk to your primary nurse.

Notify your primary nurse and physician if:

• Your diarrhea is not controllable by diet or medications
• The skin around the rectal area becomes sore or irritated. A nurse will give you suggestions for proper treatment.
• Your diarrhea becomes severe (over 6-8 stools a day).

After treatment is completed :

• Diarrhea may continue for a few weeks after treatment is completed.
• Continue to follow your diet.

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Fatigue

Fatigue is a common side effect of radiation therapy. The extent to which this is a problem varies from person to person. You may have very little fatigue or have varying degrees of tiredness. Most people will not notice any change the first couple of weeks during treatment. You may notice it more if you are maintaining all of your usual activities.

Why might I feel tired?

There are several reasons for feeling fatigue. They are:

• Increased energy used as a result of the cancer
• Increased tissue building to repair the effects of radiation treatment
• Stress of cancer and its effect on lifestyle, including daily trips for radiation treatments

Self-care measures:

• Rest when you are feeling tired. Resting after radiation treatment is helpful.
• Pace yourself. Don't try to do too many things when you are feeling fatigued.
• Maintain your normal activities as much as possible, but adjust the time you perform them to fit your energy level.
• Maintain your weight and overall nutritional status.
• If possible, seek help with your household duties.
• Let your friends and family know when you are feeling tired after treatment is completed
• Your fatigue will gradually disappear within 6-8 weeks after your treatment ends.

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Low Blood Count

Low blood counts (bone marrow depression) are sometimes encountered by people receiving radiation therapy. If your blood counts become low, you may not feel any different, but you could potentially develop other effects such as bleeding, infection or fatigue.

What causes low blood counts?

The bone marrow is your blood cell producing factory. It quickly produces the white blood cells that fight infection, platelets that prevent bleeding, and red blood cells that carry oxygen. Radiation affects these quickly dividing cells and can temporarily or permanently decrease their production. A decrease will not occur unless the treatment area includes a significant portion of the bones that produce blood cells (pelvic bones, sternum, ribs and spinal column). It is important to watch for infection or bleeding. Your blood count will be checked weekly to monitor radiation effects. Your nurse will tell you if your blood counts become low.

Self-care measures

If you are told by your physician or nurse that your white blood cell count is low:

• Avoid persons with easily transmitted infections.
• Take your temperature twice a day, once in the morning and once in the afternoon and call your physician if your temperature is greater than 100 degrees.

If you are told by your physician or nurse that your platelet count is low:

• Radiation therapy will usually be stopped until your platelet levels return to a high enough level.
• Use a soft bristle toothbrush.
• Avoid using a straight edge or safety razor.
• Avoid contact sports.
• Avoid using rectal suppositories, thermometers or enemas.
• Do not take alcohol, aspirin or drugs containing aspirin unless approved by your doctor.

Notify your primary nurse and physician if:

• Your temperature is greater than 100° F or 38.5° C. Do not take any medication like Tylenol or aspirin unless it is ordered by your doctor.
• You have chills or sweating.
• You have a persistent cough or sore throat.
• You have a painful rectum.
• You have excessive vaginal bleeding.
• You notice blood in your urine or stools (either bright red or black bowel movements).
• You have a nosebleed that does not stop after 10 or 20 minutes.
• You experience painful urination.

After treatment is completed

Usually your blood counts will return to normal within 3-4 weeks after ending your treatment. Occasionally it can take longer for counts to normalize.

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Mouth Irritation

Saliva aids in eating, talking and swallowing. Radiation to the throat and mouth areas causes dryness and irritation. The amount of dryness depends on the radiation dosage and extent of treatment. It may begin within 1-2 weeks of your treatments and continue after treatment is complete. It may take up to 6 months for saliva to return.

What causes mouth irritation and dryness?

Cells that line the mouth and throat are rapidly growing and are therefore very sensitive to radiation effects. When the salivary glands are within the treatment area, there is a decreased production of saliva.

Self-care measures

• Drink water or other liquids frequently. Keep a water bottle or Thermos with you when you are in areas where it is difficult to obtain water (in the car, for example).
• Follow your dental/mouth care plan as outlined by the dental clinic (if you have been seen there).
• 1 teaspoon of soda and 1 teaspoon salt dissolved in 1 glass of warm water is a good mouthwash. Avoid any commercial mouthwashes, as they may contain alcohol, which is an irritant.
• Artificial saliva may be a helpful means to keeping the inside of your mouth moist. It is commercially available under different names.
• Avoid spicy foods. This includes foods seasoned with chili powder, horseradish, hot chili sauces and curry powder.
• Avoid foods that are coarse or hard such as toast, hard rolls, potato chips, pretzels or raw vegetables.
• Avoid fruits that are high in acid content, such as grapefruit, lemons, oranges, pineapple and tomatoes.
• Avoid alcoholic and carbonated beverages, as they are irritating to the skin on the inside of your mouth.
• Avoid extremes in temperatures of food which might also irritate your mouth.
• Eat moist foods such as soups, casseroles, quiches and puddings.

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Taste Alterations

Radiation directed to the mouth will affect taste buds located on the tongue. Foods may taste differently to you or you may have a temporary aversion to some foods. It may take 2 or 3 months or more before your taste sensations return.

Why is taste affected?

The tongue's lining and taste buds are susceptible to radiation. A decrease in saliva also causes changes in taste.

Self-care measures

• Many people find that the taste of meat, fish, poultry and eggs changes a lot. Instead of eating these foods, use other high-protein foods such as cottage cheese, milk, ice cream and peanut butter.
• You may have to increase the amount of sugar to achieve a sweet taste.
• Usually the taste of fresh fruit does not substantially change.
• Meats may be more palatable if marinated in sweet fruit.
• Other seasonings such as lemon juice or mint may help with taste changes. Experiment with seasonings.
• Continue to eat, even though you may not be able to taste the food. In order to repair the effects of radiation, you need the calories and protein.
• Sometimes there is little you can do to affect changes.
• If you are having any difficulty, talk with your primary nurse. There are many different dietary supplements available for you to try.

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Loss of Appetite

Loss of appetite is a common symptom associated with cancer.

Why might my appetite be affected?

There are several reasons why you may experience a decreased appetite during radiation therapy. Loss of appetite can be due to the fatigue and stress related to your illness and treatment. It can also occur because of the change in your normal cells, which changes taste and causes difficulty in swallowing, nausea, dry mouth and diarrhea. Prior abdominal surgery can affect your ability to eat. Changes in normal routines can also affect your appetite.

Self-care measures

Maintaining good nutrition is particularly important during radiation therapy. Keeping protein and calorie intake high will help with healing and building new tissues. You will be weighed weekly to monitor your progress.

• Eat a high-calorie diet (unless you are overweight). Include foods in your diet like ice cream, whole milk and peanut butter.
• Eat several times a day. Eating small amounts frequently will be easier than trying to eat three meals a day.
• Keep nutritious snacks in your house for nibbling when you are watching television or reading.
• Increase the amount of protein in your diet by adding dry milk in your cooking and ice cream to milk. Ask your nurse for other suggestions like these.
• Serve foods attractively and eat in a quiet and relaxed atmosphere.
• Consume the highest number of calories during the time of day you feel best.
• After your radiation treatments, rest before trying to eat.
• Use nutritional supplements if you are unable to maintain your weight. There are many brands available. Ask your Radiation Therapy nurse for samples and suggestions.
• If you are having any eating problems, speak with a Radiation Oncology nurse. She can arrange for you to see a dietitian.

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Hair Loss

We spend a great deal of time and money on physical appearance, and self-image is greatly affected by hair. Losing it is very stressful and a constant reminder of cancer and its treatment. It is normal to feel anger, sadness, embarrassment or fear with the loss of hair.

Why is there hair loss?

There will be a loss of hair within the radiation treatment area usually within 2 weeks of treatment. The amount of loss depends on the dose of radiation and the size of the treatment area. Hair grows quickly and therefore is very sensitive to the effects of radiation. Regrowth of hair usually starts once radiation treatments are over, unless chemotherapy is being administered. Often it may take 6 months or more for hair to return. There may be changes in the hair when it does return.

Self-care measures

• When radiation therapy first begins, find out from your physician or nurse how much hair loss you can expect. This way, you can decide whether to make arrangement for a wig.
• Keep your hair long to cover any patchy areas.
• Wear a turban or scarf to conceal hair loss. Ask a Radiation Oncology nurse for information on buying attractive headwear.
• University Hospital has a Wig Bank. Ask one of the Radiation Oncology nurses about making arrangements for a wig.
• You may wish to wear a wig prior to losing much of your hair. Others have found it easier to adjust to wearing a wig by doing this.

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Skin Care

Your skin in the irradiated area will gradually dry and redden. The amount of redness varies from person to person and depends on the length of treatment, radiation dosage, area being treated and skin type. In some patients, it is a desired effect for the skin to get very red.

Why is my skin affected?

Radiation is especially effective on cells that are rapidly growing, such as skin cells. The skin in certain areas will be more sensitive to the effects of radiation. These areas include where two skin surfaces touch or are thinner (breast, buttocks, armpit, groin, face and genitals) or where there was an incision or previous injury.

Self-care measures

• It will usually take 2 or 3 weeks before you notice much redness, dryness or itching.
• Gently clean the treatment area. You may use a mild soap, lukewarm water, a soft cloth and a gentle patting motion. Rinse the area thoroughly and then gently pat it dry with a soft towel. Be careful not to wash off your marks.
• Avoid wearing tight-fitting clothes over the skin in the treatment area. Collars, bras, girdles and belts are major causes of discomfort. If possible, expose the skin in the area to air.
• Avoid wearing scratchy fabrics next to the skin; lightweight cotton is most comfortable.
• Avoid excessive exposure of the skin in the treatment area to sunlight. If it is an area usually exposed to the sun, wear protective clothing such as a wide-brimmed hat or scarf when out in the sun.
• Avoid all sources of heat on your skin. Hot water bottles, heating pads and sun lamps should not be used.
• Avoid exposing your skin to cold temperatures, including ice bags and winter weather. Warm, protective clothing is necessary when your skin is exposed to cold temperatures and wind.
• Avoid the use of all medications, deodorant, perfumes, powders or cosmetics on your treated skin. Tape, dressings and band-aids should also be avoided unless permitted by the therapist.
• Avoid shaving. Use an electric razor if shaving is necessary in the treatment area.
• If you develop more than dry peeling of the skin, notify your nurse so that she can give you additional care instructions.

After treatment is completed

You will continue to see the effects of radiation therapy on your skin after you have finished treatment. Generally, you will have redness, dryness and peeling of the skin in the treatment area for about 2 weeks following the end of treatment. You may have more than peeling on the skin surface, depending on the extent of the redness when treatment ended.

You may use baby oil or a lubricating cream of your choice on the dry skin area. Your skin will gradually return to its normal color, although there may always be a slightly deeper tone.

Disclaimer Notice: The information contained in this online brochure is intended for general information purposes only. You should always seek the advice and assistance of your radiation oncologist or nurse if you experience symptoms or side effects such as the ones described here. The self-care measures described above are not meant to replace the advice of your personal physician, nor do we advocate following these measures without consulting a professional.

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