Your first visit to CTI is for a consultation. You will meet with the
radiation oncologist, a physician who has been trained to use radiation
in the treatment of disease. The radiation oncologist will review your
entire medical history and the results of all of your tests that have
taken place to this point. You may need additional studies after this
review that will be ordered at this time. The radiation oncologist will
then meet with you and your family to discuss whether radiation therapy
is an option for you. After the decision is made, you will receive instructions
on the course of treatment outlined by your physician. Click on the links
below to read about what to expect.
After radiation therapy is chosen as the right method of treatment for
you, the treatment planning begins. You will have a procedure performed
that is called CT simulation. This process involves having x-rays taken
on a specialized CT machine to assist the radiation therapists in localizing
the area that will be treated. When you are placed on the CT simulation
table, the treatment area will be outlined using small permanent marks
(no larger than a very tiny mole) that will be placed using a needle and
ink. This will assure that the same treatment area is targeted daily throughout
the course of your treatment. The simulation procedure can last from thirty
to ninety minutes depending on the treatment plan.
After the CT simulation is complete, the radiation oncologist, the dosimetrist
and the medical physicist will take this information and plan the course
of treatment with the aid of a treatment planning computer. All of the
information gathered will be entered into the computer to assist the team
in determining the optimum method of delivering the treatment.
With the planning complete and the course of therapy determined, you will
be treated on the linear accelerator. This machine uses high-energy photons
and/or electrons to destroy the tumor with minimal effects on the area surrounding
the tumor. You will lie on a procedure table during your therapy, each treatment
generally lasts only a couple of minutes. You may have anywhere from one
to four or more treatment fields during each session and they are usually
given daily over a period of two to eight weeks. During your course of treatment,
the radiation oncologist will examine you every week to ensure that everything
is proceeding as planned. You will also be monitored daily by the radiation
therapist and/or radiation oncology nurse. Your referring physician will
be kept informed about your progress during treatment. Occasionally, you
may also need further diagnostic tests to monitor your response to the treatments.
Once you have completed your treatments, you will be given a follow-up appointment
to return to see the radiation oncologist. The physician may choose to continue
to monitor you periodically following your therapy.
Even if the planning session went smoothly and everything is ready for
you to start your treatment, you will probably feel uneasy on the first
day of radiation therapy. To give you a sense of what to expect, this
list walks you through a typical visit to the treatment center:
When you arrive at the treatment center you'll change into a gown or robe
provided by the center. You'll also need to remove clothing on the upper
half of your body as well as any jewelry that might get in the way of
the treatment (such as long necklaces).
- A radiation therapist will bring you to a treatment
room where you will be placed in the treatment position. Most treatment
centers use an immobilization device to secure your position and make
you more comfortable. The therapist may place a bolus (a flat piece
of rubberlike material) on top of your skin, which increases the radiation
dose to your skin and to the tissues right below it.
- Next, the technician will carefully line up the linear
accelerator to treat each treatment field. Most of the time in the treatment
room will be spent waiting for the technician to move the linear accelerator
into position. After the machine is positioned, the technician will
leave the room. Although you may feel alone, you are not. The technician
can see you through a window or on a television screen and can hear
through an intercom at all times.
- The technician will then turn on the machine to deliver
the dose of radiation. Since you cannot feel radiation, the only way
you will know when you are exposed is by the whirring sound of the machine.
During this time, you must remain completely still, though you don't
have to hold your breath. It only takes between thirty seconds and a
few minutes to deliver the radiation (depending on the equipment being
used).
- The technician will then return to find your position
for the second field that will be treated that day. Typically, you will
have two different fields treated each day.
- Although there are individual differences, all radiation
oncology centers try to work efficiently so that the daily treatment
process takes between fifteen and thirty minutes.
- Each week, you will have CT’s taken of the treatment
field. Your doctor uses these to double-check that the radiation is
precisely hitting the correct areas of your body. (Because the tattoos
on your skin can move from side to side, it’s important to have
one more way of making sure that the treatment is precise.)
The most uncomfortable side effect of radiation therapy involve the skin
of the area being treated. In many ways your skin reaction will be similar
to sunburn, with a mild to moderate pink color, or redness, and with itching,
burning, soreness, and possible peeling. But unlike a sunburn, your skin
will react to radiation much more gradually, and perhaps only in patches.
The first thing you'll notice will be a change in the color of your skin,
from pink to red. Some areas of your skin may turn redder than others.
Your skin reaction may be mild, and limited just to small areas.
Your skin might have a more dramatic reaction to radiation, covering more
of the area. This is more likely to occur if:
- Your complexion is fair and susceptible to sunburn.
- You are receiving radiation after mastectomy, and
the treatment is designed to give a high dose to the skin.
- You've had recent chemotherapy.
As with sunburn, the skin may also become dry, sore, and more sensitive
to the touch. Irritation may increase. The skin can start to peel in a dry
way, like an old sunburn, or in a wet way, like a blister. This peeling
will probably be limited to a few areas of the involved skin. If the blister
opens, the exposed raw area can be quite painful and weepy. Your skin reaction
can become more serious if the exposed area is not treated, and infection
develops. Your radiation oncologist can work with you to help you manage
any of these signs or symptoms.
Eventually, pearly patches of new skin will grow in and cover the exposed
areas. As the new skin grows back in, it is protected by the top of the
blister or the overlying old, dry, flaky skin. Your radiation oncologist
or nurse will need to see you more often than once a week to help you through
this tough (but temporary) time. If problems become especially troublesome,
your doctor or nurse might suggest taking a short break in treatment to
allow your skin to recover.
All of these skin changes happen gradually, and can be predicted in your
weekly examinations by your radiation oncologist and nurse. You should be
aware of the range of possible skin reactions so that you're not taken by
surprise. Fortunately, radiation–induced skin irritation is temporary.
If you find that the pain and irritation are not getting better, you should
consult your doctor and nurse.
After you complete radiation therapy, the effects on your skin may continue
to worsen for another week or so after treatment has ended. Your skin will
then begin to improve. The deep redness and the sensitivity should go away
over the first weeks after treatment. The skin will take somewhat longer
to completely return to its natural color. You may find that the treated
area has a tanned or slightly pinkish look to it for up to six months after
your last session of radiation.
If you are African-American, your skin may be tanner and less red. Your
skin can become very dark, and it may take longer for changes to go away.
Over the long term, some women may retain a slightly pinkish or tannish
hue. And a few women may notice a small patch of tiny blood vessels on the
skin of the radiated breast area. These vessels—called telangiectasias—look
like a tangle of thin red lines similar to spider legs. They are not a sign
of cancer recurrence, but they are a less-than-attractive cosmetic side
effect of radiation, without an easy remedy.
The skin that has been exposed to radiation therapy may be more sensitive
to the sun over the years than it was in the past. This area is especially
vulnerable with some bathing suit styles. You can go out in the sun and
have fun, but be sure to use a sunblock that is rated SPF 30 or higher on
the area of concern. A strong sunblock is actually a good policy for every
inch of your body, as a general recommendation from dermatologists. |
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