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Summary

FOR ADDITIONAL INFORMATION ABOUT THE FOLLOWING SUBJECTS, SEE THE OTHER SECTIONS OF THIS DOCUMENT

While waiting for External Beam Radiation Treatment (EBRT) to begin, there are steps to take. For instance, see your dentist. Talk with your doctor about the drugs, vitamins etc you take in case he or she wants you to stop taking them temporarily. (We provide a check list).

Before your first session, there will be a planning session during which the precise details of your treatment are set. It is advisable to take a family member or friend with you to the meeting. It is also helpful to record the session.

It helps to learn who the members of the EBRT team are, and what each member does.

During the first and subsequent sessions, wear clothing that goes on and off easily and has no metal. Ask your radiologist whether you can eat and drink before a treatment.

Side effects such as skin irritation and fatigue during treatment are either controllable or there are techniques to lessen the effect. There may also be long term side effects. 

Keep in mind that treatment decisions may change as treatment goes along. A change does not mean that the original treatment was wrong. Medicine is a combination of science and art.

There are do's, don'ts and tips to be aware of during treatment. For example,

  • Don't apply powder or lotion to the radiated area before treatment. 
  • Do speak with your radiologist about what to do if you have to miss a day or two. The efficiency of the  treatment depends on having as few delays as possible.
  • If needed, transportation is available to and from treatment.
  • Call the treatment center before leaving for a treatment to find out if appointments are on time. Radiation therapy machines must be taken offline periodically to recalibrate the machine or for repair.

Women: Avoid getting pregnant during radiation treatment.

NOTE: Do not be surprised if the start of radiation brings up strong emotions. To help cope with them, see the documents in "To Learn More."

A Checklist To Consider If You Are Going To Have Radiation Therapy

  • If you want to have children in the future, ask the doctor whether radiation could affect your ability to have children. If so, consider banking your sperm or eggs before the treatment starts. (For more information, click here)
  • Set a treatment schedule that works for you as well as the facility. As a general matter, radiation treatments are scheduled at the same time 5 days a week for a period of weeks. Set a time slot that fits for your life. If the time isn't immediately available, perhaps one will become available in time. Check to find out how long you can wait to start treatment without affecting the effectiveness of your treatment. If the timing doesn’t work, consider using another radiation facility in your area.
  • Take care of the medical prep on a timely basis.
    • Expect to meet with your radiation oncologist before treatment starts. Also expect that he or she will consult with other members of your treatment team. Before treatment, the doctor will also examine you thoroughly and will review your medical reports.
    • Stay on top of doctors receiving reports from other doctors. Find out what date the doctor expects to receive a report. Check that day to be sure the report is received. If not, call the doctor’s office that was to forward the report to follow-up. If necessary, physically go and pick up the report and take it to the appropriate doctor.
  • Schedule a dental check up. Oral infections can worsen the effects of radiation.
    • Speak with your oncologist about possible oral complications from your treatment and what, if anything, your dentist should focus on prior to treatment.
    • Get an examination of your mouth, teeth and jawbone to check for potential problems that may arise during treatment.
      • Tell the dentist you are about to have treatment for colorectal cancer and the specific treatment(s) you have agreed to.
      • Mention to your dentist the risks for oral complications your doctor told you about.
      • If you have issues that could become a problem during treatment, take care of them now. Find out from your dentist how much time is needed for your mouth to heal properly. It is preferable for healing to be complete before treatment begins.
    • If your doctor recommends that you speak with a dental oncologist (a dentist who is trained in dental and oral care for people with cancer): Use the same technique to find the right dental oncologist as is recommended for choosing any medical specialist. (For information, click here). . You can locate a dental oncologist through any of the following:
      • A referral from your oncologist.
      • National Cancer Institute, www.cancer.gov offsite link or Tel.: 800.422.6237.
      • National Comprehensive Cancer Network, www.nccn.org offsite link, or Tel.: 215.690.0300.
  • Practice good oral hygiene. Good oral hygiene will reduce your chances of getting tooth decay, mouth sores and, most important, infections. Experts recommend that you brush your teeth after every meal and at bedtime. Use a soft toothbrush and toothpaste with fluoride in it.  Floss once a day.
  • Ask your doctor if there are any medications, supplements, herbs or vitamins you take that should be discontinued during treatment. If there are, check with the doctor who prescribed them to let him or her know what is happening and find out if you should be doing something else during treatment.
  • Learn about and prepare for possible side effects. For instance:
    • Speak with the radiologist about creams to purchase to reduce possible skin soreness. Test a small amount to be sure you don't have any adverse effects.
    • Fatigue generally accompanies radiation treatment. Start making room in your schedule for rest. For information on coping with fatigue, click here
    • Get a prescription for nausea “just in case.”  If you have a prescription, you can fill it without delay if the need arises. Prescriptions don't cost anything until you have them filled.
  • Ask your doctor for a prescription for a drug to control nausea or vomiting and one to control diarrhea “just in case.” 
    • You don’t have to fill the prescription. Prescriptions don't cost anything until you have them filled. If you have the prescriptions, you can fill them without delay if the need arises.  
    • if you do fill a prescription, you do not have to take the drugs. However, being prepared can save waiting time if you need a medication to help. 
    • To learn how to buy, store, and pay for drugs. Even the most experienced drug consumer is likely to learn something new. See Drugs 101
  • If you smoke, use the treatment as a trigger to stop. 
    • Stopping can help improve the body’s response to treatment, and lessen complications and side effects.
    • If you quit permanently, stopping can decrease the risk of recurrence and enhance the likelihood of survival.
    • For information about stopping smoking, click here
  • If you are around second hand smoke try to eliminate your exposure. Second hand smoke is as dangerous to your health as smoking.
  • If you use recreational drugs, let your doctor know. They may interfere with treatment.
  • Consider taking a tour of the area where radiation will be administered and any other location where you will be spending time. This way you will know what to expect. You'll also get a better idea of what to bring with you to make yourself comfortable. (For information about what to expect during treatment, click here.
  • It may make it easier for you if you line up a family member or friend to go with you to the first treatment. After that it may be easier if you go to treatments alone. Going alone makes going for treatment more like going to a standard doctor's appointment. You will likely find other people going through the same treatment with whom to have an informal support group.
  • Think about how you are going to get to and from appointments. If needed, American Cancer Society can help arrange transportation with its group of volunteer drivers. Call 800.ACS.2345. The more notice you give the Society, the more likely it can find a volunteer to fill your needs. The Society can also point you to available public transportation in your area.
  • Ask your doctor about changes to start making in your diet to build your system with nutrients that the treatment may effect.
    • The doctor may recommend you speak with a nutritionist/dietitian
    • Perhaps you should also be taking a multi-vitamin and/or supplements. If a vitamin or supplement is suggested, since they are not regulated by the FDA and quality varies, ask the doctor or nutritionist/dietitian for a brand which he or she recommends. If the doctor won't give a recommendation, ask which vitamin company he or she suggests for the doctor's family.
  • Ask about what exercise you can and cannot do during treatment. Also ask about the recovery period as well. (For information about exercise for survivors, click here.)
  • Stock up on single portions of your favorite comfort foods, including some in your freezer that you can defrost as needed. When you freeze foods for this period, make the portions smaller than usual for those occasions when you don't feel like eating a lot.
  • If you have children, and haven't told them yet about your condition and/or treatment, now is the time to do it in an age sensitive manner. See the document in "To Learn More."
  • Schedule doctor appointments for your convenience.
    • An appointment early in the day or at the beginning of that part of the day when the doctor sees patients generally gets you in and out quickly. Doctors' schedules tend to back up as the day progresses.
    • If you have appointments with different doctors and/or tests coming up, consider scheduling them for the same day or only setting doctor appointments for the same day every week.
  • Think about how you are going to get to and from appointments. If needed, American Cancer Society can help arrange transportation with its group of volunteer drivers. Call 800.ACS.2345. The more notice you give the Society, the more likely it can find a volunteer to fill your needs. The Society can also point you to available public transportation in your area.
  • If you are uncomfortable in institutional hospital gowns, consider creating your own or purchasing one that will be more comfortable than the one supplied by the facility. You can find gowns online(for example, through www.healingthreads.com offsite link) or create your own. For a pattern, see the article in To Learn More.
  • Last, but not least, check your health insurance policy to find out if prior approval is necessary and to determine how much money, if at all, you will be out of pocket. Start thinking about how to pay those costs. If you don't have health insurance, start thinking about how to pay for the treatment. For information about these subjects, see the documents in "To Learn More."

During And After Treatment

For information about:

The External Beam Radiation Team

External Beam Radiation Therapy is performed by a team which includes the following people:

Radiation oncologist: 

  •  An oncologist who specializes in radiation
  • The radiation oncologist does the planning for the radiation treatment and manages you medically throughout the therapy. 
  • The radiation oncologist also oversees the quality of the therapy.

Radiation physicist:

  • Maintains the radiation equipment and related computers. 
  • Is involved with setting the treatment plan.

Radiation therapy technician (technologist): The person who administers the treatment plan.  The radiation therapist also brings you into the treatment room, sets you into correct position for the treatment, and turns the machine on and off. 

Dosimetrist: The person who calculates the correct dose

Radiation physicist: The person who calibrates the treatment machine.

Radiation nurse: The person who schedules your appointments and answers your questions.

You: Your job is to:

  • Arrive on time
  • Ask questions if you have them
  • Let your team know of any side effects you are having.

To Learn More

Related Articles

How To Choose An Oncologist

The Setting In Which EBRT Is Given

The room in which treatment is given generally has thick concrete walls which are clad with lead, and the door is lead-lined, to prevent the very small amount of radiation that bounces off of  your shield from affecting medical staff and nearby people. While individual doses are safe, constant exposure to radiation rays by medical personnel can be dangerous.

Radiation treatment is given by means of a machine that either contains a radioactive substance or generates its own radiation as needed. The machine moves around you and your bed as you hold still.

You will be alone in the room during treatment. Staff will be able to see and hear you at all times. If you feel bad during treatment, it is advisable to let staff know.

The facility will likely be able to play music during treatment. You can ask for music that is compatible with your tastes.

What Happens During A Planning Session Before Your First Radiation Treatment

There will be a planning session at the radiation facility (generally the department of radiation oncology) which may take several hours.

During the planning session:

  • You will meet the technicians and other personnel who will be involved in giving the treatment. For the identities of the professionals, see the above section. (You may not meet all the medical professionals. Some may just work behind the scenes.)
  • You will be asked about metal in or near your body, such as pacemakers, surgical staples and clothing with metal zippers.
  • You will lie on a table. 
  • The treatment site (treatment ports) will be marked to ensure that the treatment beam is aimed accurately and in exactly the same place every treatment session. The mark will either be permanent or temporary.  
    • Permanent marks are tiny dots tattooed around the field to be radiated. These dots are hardly noticeable because of their small size. They are made permanent in case you need additional radiation at a later date. Other radiologists will know where the previous radiation was given so the two don't overlap.
    • Non permanent marks are made with colored ink. If a non-permanent mark is used:
      • Do not wash off the mark unless it is made permanent. 
      • If the mark begins to fade, rather than make it darker yourself, tell the technician.
      • Ask if the mark can rub off on clothing and other material. If so, wear older undergarments that will cover the mark.
  • The radiation therapist will determine the settings of the machine.
  • Staff may make a special shield or block to shape the radiation beam to match your tumor's shape exactly, or the shape of nearby surgical scars.  The purpose of the shield or block is to narrow the radiation beam to the silhouette of your tumor. This avoids radiating nearby healthy tissue. 
  • There will generally be a mock session (known as a simulation) when you and the technician will run through a radiation treatment. A beam of laser light substitutes for radiation. The purpose of the mock session is to make sure everything is correct (some people refer to this as a "dress rehearsal.")  A simulation can take an hour or more.
  • There will likely be another simulation after all shields and blocks are made and your skin is marked.

None of the preparations are paintul. However, they may be embarrassing or unpleasant depending on your particular situation. For example, it may be embarrassing if the doctor decides that the best access to a rectal tumor is by taping the buttocks into an open position. Or you may be asked to drink a solution containing barium to clarify the position of the small intestine.

NOTE:  As treatment progresses and your tumor shrinks, new blocks and shields will be made to fit the new size. A simulation may then be repeated.

Ask your radiologist about whether you can eat and drink prior to treatment. Generally you can, except for patients who take radiation to the abdomen.
 



 




What Happens During An EBRT Treatment

External radiation treatment is usually given at a set time on set days of the week. 

Before treatment begins

Generally, you change into a hospital gown. You can bring one of your own design. If you are interested in making your own, for a pattern, see the document in "To Learn More."  Alternatively, gowns designed for purchase are also available. For instance, see www.healingthreads.com offsite link

Then you will be taken into a treatment room which generally has thick concrete walls and lead-lined doors to protect people outside the treatment area from radiation.

You will be assisted onto the table or into the chair in which you will receive treatment. 

Blood may be drawn from time to time before the procedure starts to check your levels of white cells and platelets. They may become abnormally low during treatment. 

Radiation treatment is not invasive or painful so there is no need for anesthesia.

It will take the technician time to position you beneath the radiation unit. The tech may take a picture before treatment starts to be sure the field is aligned correctly. 

The technician will leave the room during treatment. You will be able to communicate via an intercom. The technician will also be able to visually observe you. 

Expect to be weighed at least once a week to see whether you are maintaining your normal weight. You may either lose or gain weight during treatment. 

In some instances, your bladder may be filled with saline water prior to treatment. The idea is to protect the small intestine by moving it away from the treatment area.

The treatment

The actual treatment will generally only be a few minutes long. 

You don't have to hold your breath. You will be able to breathe the whole time. (The whole appointment usually lasts fifteen minutes to a half hour).

During treatment you should feel no pain, heat or other sensation.  Some people report a feeling of being energized in the treated area during treatment.

Treatment for rectal cancer is generally four to six weeks.

Immediately after treatment

If you find you get queasy after treatment, let your radiation oncologist know immediately. He or she can prescribe anti-nausea medication.

If you experience nausea, consider not eating for several hours before and after each treatment. (There are other practical tips for dealing with nausea: see: To Learn More)

Activities during treatment:

  • You can generally can continue your regular schedule during radiation treatment, including exercise. Describe your general routine to your doctor to be safe.
  • When it comes to exercise, check with your radiation oncologist. Even swimming is likely to be okay once skin markers are made permanent if you don’t let your skin become too dry.
  • Listen to your body and take good care of yourself.

Side Effects From External Radiation: During Treatment

While radiation therapy is safe, there are few possible short and long term side effects of EBRT. Side effects vary from patient to patient and according to the exact location of the radiation. Most side effects are due to the fact that the radiation beam affects normal tissues around the tumor area.

Normal daily activities can usually be continued during treatment. 

With colon and rectal cancer, the most common side effects include the following:

  • Diarrhea 
    • If diarrhea appears, it may continue for a few weeks after the end of treatment. 
    • Drink plenty of clear liquids to make up for the fluids being lost due to diarrhea.
    • Avoid spicy foods.
    • Concentrate on easily digestible foods that are not excessively high in roughage or fiber.
    • For additional tips on how to deal with diarrhea, click here.
  • Nausea and vomiting
    • Consider fasting for a few hours before and after treatment.
    • Speak with your doctor about medications that may help. 
    • Review the information in the document in "To Learn More" for additional tips.
  • Bladder irritation - which generally appears as a need to urinate more frequently than normally.  If this symptom appears, it can continue for a while after the end of treatment. There is generally no need for a catheter (a tube through to the bladder to ease urination). People with severe urinary problems before starting EBRT are at risk for needing a catheter during EBRT.
  • Fatigue
    • Generally there is no fatigue during the first weeks of treatment.
    • Whether fatigue appears after that, and to what degree, depends on the individual.
    • If fatigue does appear, it generally plateaus around week 5.
    • Techniques are available for decreasing the effects of fatigue. 
    • Fatigue generally goes away within a week to a week and a half after end of treatment.
    • Fatigue does not generally keep people from working during treatment.
    • For tips about how to deal with fatigue, click here.
  • Skin changes
    • The energy waves used in radiation therapy can have the same effect on the skin as being in sunlight at noon. 
    • Irritation and redness may appear by the third or fourth week of treatment.
    • When washing, use mild soap (while being sure not to remove the marks used for the radiation treatment). 
    • Wear soft clothing - preferably cotton.
    • Protect the area from sunlight.
    • If your skin cracks or blisters, speak with your nurse or oncologist about a suitable moisturizer.
    • For additional information about radiation caused skin changes, click here
  • Erectile dysfunction in men
    • Radiation treatment to the pelvis can damage the blood vessels necessary to achieve an erection which can result in erectile dysfunction.
    • Whether you experience erectile dysfunction after EBRT depends on your potency level prior to the start of treatment, your age and other medical conditions which could effect erectile function such as diabetes, hypertension or cardio vascular disease.
    • If erectile dysfunction occurs, there is assistance available.See the Survivorship A to Z document about erectile dysfunction.
    • Keep in mind that there are ways to be intimate other than by having intercourse. Plus there is plenty of stimulation you can get and receive that doesn't involve an erection. Speak with your doctor for more information or for a referral to an expert in the area. 
    • If your medical condition is interfering with your sexual relations with your significant other, tell your significant other about your feelings and what you would like to change. Ask for your significant other's point of view. Listen to it rather than prepare your response. If the two of you can't work it out, speak with your doctor or seek counseling.
    • For more information about sex and intimacy, click here.
  • Women may experience:
    • Vaginal dryness as a result of radiation .  If this occurs talk with your doctor about lubricants that may be helpful.
    • Vaginal stenosis or narrowing of the vagina, there are vaginal dilators that your doctor can recommend for stretching the walls of the vagina thereby decreasing the discomfort associated with penetration.
  • Incontinence (in the sense that urine leaks unintentionally). For some people, incontinence happens when doing activities such as sitting. For some people it only happens when there is increased abdominal pressure – such as from laughing, coughing, sneezing or exercise.
    • EBRT rarely causes incontinence.
    • If a person is already incontinent before EBRT, incontinence tends to remain.
    • Sometimes urinary frequency can feel like incontinence.  As noted above, this goes away over time when caused by EBRT.
    • There are tips for dealing with incontinence. Click here.
  • White blood cell counts may drop during radiation treatment. White blood cells fight infection and prevent bleeding. If blood tests show this problem, you may have to put treatments on hold for a week or two to allow your blood counts to come back up. 
  • Radiation colitis 
    • Radiation colitis is inflammation of the colon. If it occurs, radiation colitis may become permanent.
    • Radiation colitis may include complications such as:
      • Deep ulcers in the lining of the colon which can cause bleeding which shows up as blood in the stool. If bleeding continues, it can lead to fatigue.
      • Ulcers may create fistulas - a tunnel through the affected area into surrounding areas.Fistulas may become infected.
      • Scar tissue may prevent absorption of nutrients from foods which can lead to protein and vitamin deficiency or cause bowel obstruction which can only be corrected by surgery.