After the patient has been referred to the radiation oncologist, a consultation is set up. In a consultation, the radiation oncologist examines the patient and the medical records sent by the referring doctor to decide whether radiation therapy could be of benefit. The radiation oncologist may also recommend surgery or chemotherapy during consultation. If so, he/she will direct the patient to another specialist or back to the referring physician.

If radiation therapy is recommended, the possible benefits and risks of the treatment will be explained to the patient. If the patient agrees to go ahead with the treatment, appointments will be made at that time for treatment times, simulations, and other tests as necessary.

A simulation is performed to pinpoint the body area to be treated by imitating treatment conditions. No treatments are given during the simulation. The simulation room is set up in a similar way to the treatment room, but instead of having a linear accelerator, the simulation room contains a movable table and a CT Scanner.

After the area to be treated is defined by CT Scan, the skin over this specific area is marked with colored ink. These marks are very important in delivering the radiation treatments; they should not be washed away or redrawn at home without talking to a therapist. Some patients have several simulations during treatment; others never require one. Simulation may take between 30 minutes and two hours.

To further assist the radiation oncologist in determining the best way to deliver the radiation, MercyOne Genesis Cancer Care uses a treatment-planning computer. Size of the tumor, location, and simulation information (if necessary) are all included in the computer’s calculations to maximize tumor exposure to radiation to minimize the healthy tissue exposure. 

The number of radiation treatments given to a patient depends on the individual, but often treatment courses last between two and nine weeks. The treatments are given five days a week (Monday through Friday) with the weekends off for rest. Each daily treatment takes just 1-10 minutes, but set-up in the treatment room may take longer. It is very important to come in for each treatment every day. If problems arise with weather or scheduling, please call the receptionist at 563-421-1900 or at 1-800-446-6088.

When the patient enters the treatment room to be treated, he or she will be asked to remove the clothing covering  the treatment site and then to lie on the table. The ink marks on the treatment site will then allow the linear accelerator to be lined up correctly. On the first day in the treatment room, x-ray films are taken to verify the correct position. Next, small permanent tattoos (the size of a freckle) are given to a patient to further mark the area to be treated. These tattoos will not wash off. The first treatment may be given on that day or the following day.

The linear accelerator can be rotated 360 degrees, starting from directly above the table to around it on both sides and then back up to above the patient again. The angle of rotation depends on the cancer’s location. Once lined up on the treatment table, the patient needs to remain very still; normal breathing is of course allowed!  Positioning devices may be used to make the patient comfortable and to assure the exact location of the treatment.

Because the radiation is much like x-rays, the technologists are required to leave the treatment room when the machine is turned on to minimize their radiation exposure. The patient is watched closely on a television screen at the therapists’ station. An intercom between the patient and the therapists allows communication into and out of the treatment room.

Throughout the treatment course, the radiation oncologist will review the patient’s chart and records frequently. In addition, the radiation oncologist will meet with the patient weekly. During this time, patients will be asked how they are tolerating treatments. Any problems that the patients are having should be discussed at this time. Patients should also mention any medications, including aspirin that they have taken over the last week. A blood count will also be taken regularly. Meetings with the dietitian or social worker may also be scheduled during treatment if appropriate.

Finishing Radiation Therapy

After the last treatment has been given, follow-up appointments with the radiation oncologist will be made. The first appointment is usually one month after treatments are completed. These appointments will allow the radiation oncologist to follow a patient’s health over a longer period. The patients should also continue to see their referring doctors for check-ups.

The cost of radiation therapy is often high because of the many personnel required and the cost of the technology and equipment. The hospital and radiation oncologist bill separately.  Most insurance policies cover both bills, but the best source of information about coverage is the insurance company itself.  If there is any question about cost, please talk to the receptionist, doctor, or social worker.

The side effects of radiation therapy may differ between any two individuals and are related to the tumor size and location. Some patients experience very few to no radiation side effects, but in general, if an extensive area of the body is given radiation, side effects commonly include fatigue and loss of appetite. Radiation therapy treatments also affect the site being treated. The radiation therapy staff will talk with the patient more specifically about managing side effects.

The common side effects of radiation to specific sites may include:

If you are smoking, please stop. Smoking will make radiation less effective. It also increases the severity of your side effects and decreases your body’s ability to heal. If you need help quitting, just ask your doctor, nurse or therapist.

Radiation to the Chest: Many patients receiving radiation to the chest experience a sore throat or “lump” in their throats when swallowing food. These side effects are often caused by the radiation’s temporary irritation of the esophagus. The soreness and difficulty with swallowing feeling should disappear after radiation therapy is finished.

Often dietary modifications (i.e., soft and liquid foods – see Dietary Concerns section) help lessen the effects; medications may also be available.

Patients may also experience a dry throat or cough during treatment. These effects are usually temporary and may be relieved with medication.

Radiation to Abdomen and Pelvis: Side effects of radiation to this region depend on the specific location. Radiation to the upper abdomen and stomach may cause nausea, while radiation to the lower abdomen or pelvis may cause frequent diarrhea. If the bladder is treated, urination may be frequent and may give a burning sensation. Medication may be available to control these symptoms.

Radiation to the Head and Neck: To lessen or prevent problems and soreness in the mouth area during radiation therapy, the patient should have a dental checkup prior to onset of treatment. Dentures and false teeth should fit well and not irritate the gums.  During treatment, good oral hygiene is essential since radiation may make teeth and oral tissues more prone to infection and disease. The following suggestions can be done at home:

• Brush your teeth after each meal with a soft-bristled toothbrush. Most toothpaste is satisfactory as long as they contain fluoride and are not very abrasive. If the patient’s teeth are especially sensitive, the dentist may have specific recommendations.
• Frequent gargling with table salt and baking soda (1/2 teaspoon of each in a quart of lukewarm water) is helpful to relieve dry, sore mouth and throat.
• No mouthwashes or sprays should be used unless specifically allowed by the doctor. (Most mouthwashes contain alcohol, which will dry out mouth tissues.)
• Oral cleaning with a fine water spray is often a comfortable way to dislodge food particles.
• Also, avoid chewing or biting hard objects like ice or hard candies.
• It is very important to keep dentures and false teeth clean! It may feel better to wear the dentures only when eating. After radiation therapy is finished, the dentures may be worn as normal.
• STOP SMOKING
• STOP DRINKING ALCOHOL (This includes beer and wine!)  Smoking and drinking alcohol will actually worsen your symptoms.

Side Effects to Head and Neck: Many patients experience sore throat, dry mouth, loss of taste, and nonexistent or sticky saliva. These symptoms may be relieved with frequent mouth rinses (once every 2 hours) with the salt and baking soda solution described above. One tablespoon of Karo syrup in the mouth may also help if the patient is not diabetic.

Medications may be available if the symptoms persist. Sore and cracked lips may be relieved with Vaseline.

Some patients develop hoarseness during treatment if the larynx (voice box) is treated. The voice likely will improve after treatment is ended.

After Radiation Therapy to the Head and Neck: Sore throats and loss of taste usually return to normal after radiation therapy is finished; recovery may take several months. Dry mouth may improve slightly but salivary production will likely be permanently lessened.

Several suggestions to relieve persisting symptoms are:

• For dry mouth and stickiness, try citrus fruits or citrus-flavored sugar-free candies.
• See a dentist regularly and have fluoride treatments. Have dental work done including fillings. Because teeth are more prone to infection, be sure to ask the dentist for antibiotics if surgical procedures are necessary.
• Hold off on getting dentures refitted for at least 6 months. This allows the gums time to readjust and stabilize.

To treat the internal organs, radiation must pass through the skin. Sometimes the treated skin becomes red, crusty, scaly, dark, and occasionally, moist. Special suggestions apply to care of the skin being treated to lessen discomfort during radiation therapy.

• Any skin changes should be told to the doctor or technologist as soon as possible.
• Do not wash the ink marks off the skin or retouch them.
• You will be expected to begin preventative skin care after your first treatment day. Apply a small amount of pure aloe vera gel or radiation therapy gel three times a day. One application should always be right after your radiation treatment. Bring it with you to your session! Do not use your topical skin care products just before treatment. This is very important.
• Keep the skin dry whenever possible. Wash the treated skin carefully with lukewarm water and a soft cloth. Air-dry skin when possible or gently pat it dry with a soft cloth.
• Protect the area from rubbing, irritation, or pressure. If there are open sores on the treated area, dressing attached with paper tape may be used. Minimize the amount of treated skin under the tape. Do not use adhesive tape on any part of the skin being treated.
• Do not use deodorant if the underarm is treated. Do not use powders, lotions, ointments, or cosmetics on treated areas unless the doctor approves them. These products may leave a film that could interfere with the radiation treatment.
• An electric shaver may be used.
• Do not expose the skin to extreme hot or cold. Avoid electric heating pads, hot water bottles, heat-producing ointments, and ice packs. Electric blankets with controllable settings are acceptable.
• Do not sunbathe. Remember to protect the treated area from sun exposure.

During radiation therapy, it is very important for the patient to have a high calorie, high protein, and nutritionally sound diet. It is recommended that the patient try to maintain his or her present weight throughout treatment, even if the patient is overweight. Patients may feel unwell or too tired to eat during treatment, however.

Tips to help increase appetite and caloric intake during radiation therapy:

• Eat whenever hungry, not just at mealtimes. Eat several smaller meals instead of three normal sized ones.
• Keep healthy snacks readily available. Good snacks are yogurt, cheese, muffins, peanut better, and bread.
• Eat with family and friends. If alone, turn on the radio or T.V. Meals brought to the house may be available.
• Mix milk or half and half in cream soups, instead of using water. If milk is not tolerated, ask the dietitian for milk substitutes.
• Drink non-alcoholic eggnog, milkshakes, or liquid supplements between meals. Or try ice cream mixed with ginger ale or another carbonated drink.
• Enrich liquids with powered milk, yogurt, eggs, honey, or prepared liquid supplements.
• Special diets (i.e., low sodium, low cholesterol, diabetic) may need to be modified during radiation treatment. ASK the dietitian or doctor before changing anything, however!

A dietitian is available to help these and other dietary concerns. Radiation side effects may necessitate certain changes in cooking. If the patient has the following symptoms and does not feel like eating, try these suggestions:

• Nausea: Take anti-nausea medicine, if prescribed, about ½ to 1 hour before eating. Avoid high fat foods and very sweet or spicy ones. Eat dry foods like toast after waking up. Eat frequently (every 2-3 hours) but in small amounts. Take clear beverages and foods like 7-up, Popsicles, and simple soups.
• Mouth and Throat Soreness: Use baking soda/salt mouthwash before eating. Eat soft foods-gravy helps-and use the blender to make liquid foods. Avoid hot spices and rough foods. Eliminate tobacco and alcohol.
• Diarrhea: Avoid high fiber foods like bran, berries, and fresh vegetables. Avoid fatty foods. Eat foods high in potassium, such as bananas, apricot or peach nectar, fish, potatoes, and meat. Drink plenty of liquids.
• Constipation: Do not use laxatives without a doctor’s permission. Light exercise such as walking may help. Add bran to cereals, eggs, and casseroles. High fiber snacks like oatmeal cookies, sesame bread sticks, fig newtons, and prunes also are encouraged.

Our dietitian, physicians and nurses are always available to talk with you about your concerns.