Radiation Oncology Team

The radiation oncology team includes:

• Radiation Oncologists
• Radiation Oncology Nurses
• Radiation Therapists
• Medical Radiation Physicists
• Medical Dosimetrists
• Other Healthcare Professionals

Radiation Oncologists

Radiation oncologists are the doctors who will oversee your radiation therapy treatments. These physicians work with the other members of the radiation therapy team to develop your treatment plan and ensure that each treatment is given accurately. Your radiation oncologist will also monitor your progress and adjust the treatment as necessary to make sure the radiation is hitting its target while minimizing side effects. Before, during and after your radiation therapy treatments, your radiation oncologist works closely with other cancer doctors, such as medical oncologists and surgeons, to maximize the radiation’s effectiveness.

Radiation oncologists have completed at least four years of college, four years of medical school, one year of general medical training, and four years of residency or specialty training in radiation oncology. They have extensive training in cancer medicine and the safe use of radiation to treat disease. If they pass a special examination, they are certified by the American Board of Radiology. You should ask if your doctor is board certified.

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Radiation Oncology Nurses

Radiation oncology nurses work together with radiation oncologists and radiation therapists to care for you and your family during your radiation treatments. They will explain the possible side effects you may experience and describe how you can manage them. They will assess how you are doing throughout treatment and will help you cope with the changes you may experience. They will also provide support and counseling to you and your family.

Radiation oncology nurses are licensed registered nurses or licensed practical nurses. Many registered nurses in radiation therapy have additional accreditation in the specialty of oncology nursing. Advanced practice nurses, including clinical nurse specialists and nurse practitioners, have completed a master's degree program.

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Radiation Therapists

Radiation therapists work with radiation oncologists to administer the daily radiation treatment under the doctor's prescription and supervision. They maintain daily records and regularly check the treatment machines to make sure they are working properly.

Radiation therapists go through a two- to four-year educational program following high school or college. They take a special examination and may be certified by the American Registry of Radiologic Technologists. In addition, many states require radiation therapists to be licensed.

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Medical Radiation Physicists

Qualified medical physicists work directly with the radiation oncologist during treatment planning and delivery. They oversee the work of the dosimetrist and help ensure that complex treatments are properly tailored for each patient. Medical physicists are responsible for developing and directing quality control programs for equipment and procedures. Their responsibility also includes making sure the equipment works properly by taking precise measurements of the radiation beam and performing other safety tests on a regular basis.

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Medical Dosimetrists

Medical dosimetrists carefully calculate the dose of radiation to make sure the tumor gets enough radiation. Using computers, they work to develop a number of treatment plans that can best destroy the tumor while sparing normal tissue. Treatment plans are often very complex and dosimetrists work with the radiation oncologist and the medical physicist to choose the treatment plan that is right for you.

Many dosimetrists start as radiation therapists and then, with very intensive training, become dosimetrists. Others are graduates of one to two year dosimetry programs and may have degrees in science related fields. They are certified by the Medical Dosimetrist Certification Board.

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Other Healthcare Professionals

You may work with a number of other healthcare professionals while undergoing radiation therapy. These specialists ensure that all of your physical and psychological needs are met during your treatment.

Social Workers

Social workers are available to provide a variety of supportive services to you and your family. They can provide counseling to help you and your family cope with the diagnosis of cancer and with your treatment. They may also help arrange for home healthcare and other services.

Nutritionists

Nutritionists or dietitians work with patients to help them maintain their diet during their treatments. They will help you modify your eating plan if the side effects of treatment are affecting your appetite, will determine what you can eat, and can provide recipes, menu suggestions and information on ready-to-use nutritional supplements. They address dietary issues and current developments that may affect cancer treatment outcomes.

Physical Therapists

Physical therapists use therapeutic exercises to ensure that your body functions properly while you are undergoing treatment. These exercises are used to help manage side effects, alleviate pain and keep you healthy.

Dentists

Dentists may be involved in the care of patients who are receiving radiation for oral or head and neck cancers. They will help prevent the radiation from damaging the healthy areas of your mouth and oral cavity, and may recommend that you have preventive dental work prior to radiation. They will also help you manage oral complications of cancer therapy, such as dry mouth. A dental hygienist may also perform these services under the supervision of a dentist.

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What to Expect

Before Treatment

Consultation

If you are considering radiation therapy, you must first schedule a visit with a radiation oncologist to see if radiation therapy is right for you. During your initial visit, the doctor will evaluate your need for radiation therapy and its likely results. This includes reviewing your current medical problems, past medical history, past surgical history, family history, medications, allergies and lifestyle. The doctor will also perform a physical examination to assess the extent of your disease and judge your general physical condition. Depending on where your radiation oncologist practices, you may also be seen by a medical student, a resident (radiation oncologist in training), a nurse practitioner, a physician assistant or a nurse.

After reviewing your medical tests, including CT scans, MR scans and positron emission tomography scans (PET scans) and completing a thorough examination, your radiation oncologist will fully discuss with you the potential benefits and risks of radiation therapy and answer your questions.

Simulation and Treatment Planning

To be most effective, radiation therapy must be aimed precisely at the same target or targets each and every time treatment is given. The process of measuring your anatomy and marking your skin to help your team direct the beams of radiation safely and exactly to their intended locations is called simulation.

During simulation, your radiation oncologist and radiation therapist place you on the simulation machine in the exact position you will be in during the actual treatment. Your radiation therapist, under your doctor’s supervision, then marks the area to be treated directly on your skin or on immobilization devices.

Immobilization devices are molds, casts, headrests or other devices that are constructed and placed on a certain part of your body to help you remain in the same position during the entire treatment. The radiation therapist marks your skin and/or the immobilization devices either with a bright, temporary paint or a set of small permanent tattoos.

Your radiation oncologist may request that special blocks or shields be made for you. These blocks or shields are put in the external beam therapy machine before each of your treatments and are used to shape the radiation to your tumor and keep the rays from hitting normal tissue. Some treatment machines have built-in blocks or shutters called multileaf collimators, which also help shape the radiation.

Although simulation is typically only one session, your physician may schedule additional sessions depending on the type of cancer you have and the type of radiation therapy that is being used.

After simulation, your radiation oncologist and other members of the treatment team review the information they obtained during simulation along with your previous medical tests to develop a treatment plan. Often, a special treatment planning CT scan is done to help with the simulation and treatment planning. This CT scan is in addition to your diagnostic CT scan. Frequently, sophisticated treatment-planning computer software is used to help design the best possible treatment plan. After reviewing all of this information, your doctor writes a prescription that outlines the exact course of your radiation therapy treatment.

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During Treatment

Treatment Administration

External beam radiation therapy is administered differently from brachytherapy. You may receive one or both of these treatments. The following sections describe what you may experience during treatment administration.

External Beam Radiation Therapy Treatments

When you undergo external beam radiation therapy treatment, each session is painless, like getting an X-ray. The radiation is directed to your tumor from a machine located outside of your body. One of the benefits of radiation therapy is that it is usually given as a series of outpatient treatments and you may not need to miss work or experience the type of recuperation period that can follow other treatments.

Treatments are usually scheduled five days a week, every day except Saturday and Sunday, and continue for three to 10 weeks. Some patients receive hyperfractionated radiation therapy, in which radiation treatments are given more than once a day. Other times, only one or a few treatments are required, such as for the treatment of cancer that has spread to the bone. This is called hypofractionated radiation therapy. The number of radiation treatments you will need depends on the size, location and type of cancer you have, your general health and other medical treatments you may be receiving.

The radiation therapist will administer your external beam treatment following your radiation oncologist’s instructions. It will take roughly five to 15 minutes for you to be positioned for treatment and for the equipment to be set up. If an immobilization device was made during simulation, it will be used during every treatment to make sure that you are in the exact same position every day.

Once you are positioned correctly, the therapist will leave the room and go into an adjoining control room to closely monitor you on a television screen while administering the radiation. There is a microphone in the treatment room so you can always talk with the therapist if you have any concerns. The machine can be stopped at any time if you are feeling ill or uncomfortable.

The radiation therapist may move the treatment machine and treatment table to target the radiation beam to the exact area of the tumor. The machine might make noises during treatment that sound like clicking or whirring. These noises are nothing to be afraid of, and the radiation therapist is in complete control of the machine at all times.

The radiation therapy team carefully aims the radiation to decrease the dose to the normal tissues surrounding the tumor. Still, radiation will affect some healthy cells. The time in between daily treatments allows your healthy cells to repair much of the radiation damage. Most patients are treated on an outpatient basis, and many can continue with normal daily activities.

Sometimes a course of treatment is interrupted for a day or more. This may happen if you develop side effects that require a break in treatment. These missed treatments may be made up by adding treatments at the end. Try to arrive on time and not miss any of your appointments.

Your radiation oncologist monitors your daily treatment and may alter your radiation dose based on these observations. Also, your doctor may order blood tests, X-ray examinations and other tests to see how your body is responding to treatment. If the tumor shrinks, another simulation may be done. This allows your radiation oncologist to change the treatment to destroy the rest of the tumor and spare even more normal tissue.

Brachytherapy Treatments

Brachytherapy, also called internal radiation or seed implants, is the placement of radioactive sources in or just next to a tumor. The radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used.

There are two main types of brachytherapy: intracavity treatment and interstitial treatment. With intracavity treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.

Often these procedures require anesthesia and brief hospitalization. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities. Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will need to take special precautions to limit their exposure to radiation.

Devices called high dose rate remote afterloading machines allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You may be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.

Most patients feel little discomfort during brachytherapy. If the radioactive source is held in place with an applicator, you may feel discomfort from the applicator. There are medications that can help this. If you feel weak or queasy from the anesthesia, your radiation oncologist can give you medication to make you feel better.

Weekly Status Checks

During radiation therapy, your radiation oncologist and nurse will see you regularly to follow your progress, evaluate whether you are having any side effects, recommend treatments for those side effects (such as medication or diet changes) and address any concerns you may have. As treatment progresses, your doctor may make changes in the schedule or treatment plan depending on your response or reaction to the therapy.

Your radiation therapy team may gather on a regular basis with other healthcare professionals to review your case to ensure your treatment is proceeding as planned. During this session, all the members of the team discuss your progress as well as any concerns.

Weekly Beam Films

During treatment, your treatment team will routinely use the treatment machines to take special X-rays called beam or port films. Your treatment team routinely reviews these films to be sure that the treatment beams remain precisely aimed at the proper target. These X-rays are not used to evaluate your tumor.

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After Treatment

Follow-Up

After treatment is completed, follow-up appointments will be scheduled so that your radiation oncologist can make sure your recovery is proceeding normally and can continue to monitor your health status. Your radiation oncologist may also order additional diagnostic tests. Reports on your treatment can be sent to your other doctors.

As time goes on, the frequency of your visits will decrease. However, you should know that your radiation oncology team will always be available should you need to speak to someone about your treatment.

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Radiation Therapy for Brain Tumors

About Brain Tumors

The brain is the center of thought, memory, emotion, speech, sensation and motor function. The spinal cord and special nerves in the head called cranial nerves carry and receive messages between the brain and the rest of the body.

• Primary — a tumor that starts in the brain. Primary brain tumors can be benign (noncancerous) or malignant.
• Metastatic — a tumor caused by cancer elsewhere in the body that spreads to the brain. Metastatic brain tumors are always cancerous.
• Primary tumors in the brain or spinal cord rarely spread to distant organs.
• Brain tumors cause damage because as they grow they can interfere with surrounding cells that serve vital roles in our everyday life.

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General Risk Factors for Brain Tumors

Most brain and spinal cord tumors have no known risk factors and occur for no apparent reason. There are no known proven ways to prevent these tumors.

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Facts About Brain Tumors

• The Central Brain Tumor Registry of the United States estimates that more than 40,000 Americans will be diagnosed with a primary brain tumor this year.
• This year, an estimated 170,000 Americans will be diagnosed with a brain or spinal cord tumor that has spread from another part of the body.

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Signs of Brain Tumors

No blood test or other screening exam can detect brain tumors, but there are often some outward signs. While tumors in different parts of the central nervous system disrupt different functions, some symptoms include:

• Headaches.
• Nausea/vomiting.
• Seizures.
• Weakness or numbness on one side of the body.
• Changes in vision, hearing or sensation.
• Difficulty with speech.
• Lack of coordination.
• A change in mood or personality.
• Memory loss.

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Diagnosing Brain Tumors

If you suffer from any of the initial signs of a brain tumor, your doctor will likely conduct some or all of the following tests:

• A physical exam to determine your overall health.
• A neurologic exam to evaluate brain and spinal cord function.
• Imaging studies, such as CT, MRI or PET scans, to look for signs of a brain tumor.
• If studies or scans indicate you might have a brain tumor, some tissue may be taken from the tumor to make an exact diagnosis. This test is called a biopsy.
• A spinal tap may also be performed to look for tumor cells. During this test, a needle is placed in the lower back to obtain a sample of cerebrospinal fluid. This fluid is then examined to see if tumor cells are present.

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Treating Brain Tumors

If doctors determine that you have a tumor, the treatment options and prognosis are based on the following factors:

• Tumor type.
• Location and size of tumor.
• Tumor grade (how abnormal the cells are).
• Your age, medical history and general health.

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Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat many different kinds of tumors.

• Doctors called radiation oncologists use radiation therapy to try to kill tumors, to control tumor growth or to relieve symptoms.
• Radiation therapy works within tumor cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
• Healthy cells near the tumor may be affected by radiation, but they are able to repair themselves in a way tumor cells cannot.

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Radiation Therapy Options for Brain Tumors

People with brain tumors should discuss treatment options with several cancer specialists, including a radiation oncologist. A radiation oncologist is a doctor who will help you understand the types of radiation therapy available to treat your tumor. Conventional radiation therapy treatment options for brain tumors include:

• External beam radiation therapy.
• Brachytherapy or internal radiation therapy

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External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments over several weeks to accurately deliver radiation to the brain. Radiation is often given after surgery, and sometimes it is used instead of surgery.

• 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the brain. Tailoring each of the radiation beams to the patient's tumor allows coverage of the brain tumor while keeping radiation away from nearby organs, such as the eyes.
• Intensity modulated radiation therapy (IMRT) is the most recent advance in the delivery of radiation. IMRT differs from 3D-CRT by modifying the intensity of the radiation within each of the radiation beams.
• Stereotactic radiotherapy, sometimes called radiosurgery, is a type of external beam radiation therapy that pinpoints high doses directly on the tumor, in some cases in only one treatment.
• Proton therapy is given much the same way as external beam therapy, but it uses proton particles rather than X-rays to kill brain tumor cells. This treatment is only available in a few regions of the country.

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Internal Radiation Therapy

Internal radiation therapy, or brachytherapy, works by placing radioactive sources in or just next to a tumor.

• During brachytherapy, a tube or balloon called a catheter will be inserted into the brain. The radiation will then be carried to the tumor using this catheter.
• The radioactive source will then be left in place from several hours to several days to kill the tumor cells.
• In some cases, the radiation is permanently placed directly into the tumor or the area where the tumor was before surgery.

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Newer Techniques

Doctors are constantly exploring new and better ways to treat primary brain tumors.

• Drugs that make tumor cells more sensitive to radiation are called radiosensitizers. Combining radiation with radiosensitizers may allow doctors to kill more tumor cells.
• Chemotherapy is used with radiation to treat some brain tumors. Your doctor may recommend that you consult with a medical oncologist (chemotherapy doctor) before starting radiation

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Potential Side Effects

The effects of brain radiation can vary depending on your tumor and the technique used to treat it.

• Before treatment, your radiation oncologist will discuss any side effects — however rare — you may experience.
• Possible side effects can include fatigue, change in appetite, headaches, visual changes, hair loss, skin irritation, nausea, vomiting and/or unsteadiness.

Some side effects can be treated with steroids or other medications. Talk to your doctor about any problems you experience.

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Radiation Therapy for Breast Cancer

Facts About Breast Cancer

Breast cancer is the most common type of cancer in American women, according to the American Cancer Society.

• Each year, nearly 216,000 women and 1,500 men learn they have breast cancer.
• Another 59,000 women learn they have in situ or noninvasive breast cancer.
• Nearly 40,000 women will die from breast cancer each year.

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Risk Factors for Breast Cancer

Most women who develop breast cancer do not have known risk factors, but some factors may increase the chance of developing this disease. One of these risk factors is age — more than 75 percent of women diagnosed with breast cancer are over age 50. Other factors include:

• Early onset of menstruation.
• Family history of breast cancer in your mother or sister.
• Hormone replacement therapy with estrogen and progesterone.
• Alcohol consumption.
• A personal history of breast cancer or prior breast biopsy for benign disease.

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Diagnosing Breast Cancer

Breast tumors are typically, but not always, painless, so it is important to have any breast or underarm lump checked. Swelling, discoloration, thickening of the skin or nipple discharge also should be checked immediately.

• In some cases, a biopsy to determine if you have breast cancer will be done in an office setting using a needle to remove cells from the lump.
• A stereotactic biopsy uses mammography targeting to pinpoint smaller tumors and permit a small amount of tissue to be removed by a needle for diagnosis.
• Your surgeon may suggest removing the lump to see if you have cancer.

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Types of Breast Cancer

The breast is made up of ducts and lobules surrounded by fatty tissue.

• Cancer confined within a duct is called ductal carcinoma in situ (DCIS). Lobular carcinoma in situ (LCIS) is cells confined to a lobule.
• Tumors that break through the wall of the duct or lobule are called infiltrating ductal or infiltrating lobular carcinomas.
• Inflammatory breast cancer may involve the entire breast with specific skin changes and swelling.

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Breast Conserving Surgery

Studies have shown that women with early-stage breast cancer who have a lumpectomy to remove the cancer followed by radiation live just as long as women who have a mastectomy and may be preferred by many women. The standard of care after breast-conserving surgery is external beam radiation therapy. Often, this follows chemotherapy.

• Your surgeon will perform an operation called a lumpectomy, also called a partial mastectomy, excisional biopsy or tylectomy, to remove the tumor. In some cases, a second operation called a re-excision may be needed if microscopic examination finds tumor cells at or near the edge of the tissue that was removed (called a positive or close margin).
• To see if your cancer has spread, your doctor may remove several lymph nodes from under your arm (axilla). If any of these nodes contain cancer cells, more nodes may be removed.
• Breast-conserving surgery is not suitable for all breast cancer patients. Talk with your surgeon to see if this is the best procedure for you.

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External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast.

• Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks.
• The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.
• 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.
• Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of the radiation beams. It is currently being studied for treating breast cancer.
• Side effects might include skin irritation, like a mild to moderate sunburn, mild to moderate breast swelling and fatigue.

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Partial Breast Irradiation

Doctors are studying ways to deliver radiation to only part of the breast.

• Available in a few clinics for a very select group of patients, these techniques are used after a lumpectomy to deliver radiation to the tumor site rather than the entire breast.
• Breast brachytherapy involves placing flexible plastic tubes called catheters or a balloon into the breast. Over one to five days, the catheters or the balloon are connected to a brachytherapy machine so high doses of radiation can treat the nearby breast tissue.
• Other techniques include 3-D conformal partial breast irradiation and intra-operative radiation therapy (IORT).
• The long-term results of these techniques are still being studied. Talk with your radiation oncologist if you would like more information.

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After Mastectomy Radiation

In cases where the breast is surgically removed, your doctor may suggest radiation therapy for the chest wall and nearby lymph node areas.

• Whether or not radiation therapy should be used after removal of the breast depends on several factors, including the number of lymph nodes involved, tumor size and surgical margins.

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Radiation Therapy for Colorectal Cancer

About Colorectal Cancer

Colorectal cancer includes malignant or cancerous tumors of the colon and/or the rectum.

• The colon extends from the end of the small intestine to the rectum. It consists of ascending, transverse and descending segments.
• The sigmoid colon is roughly S-shaped and is the lower portion of the descending colon, leading into the rectum.
• The rectum is part of the digestive system. It makes up the final five inches of the colon.
• Colorectal cancer can affect any of these areas.

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Facts About Colorectal Cancer

• This year, about 147,000 Americans will be diagnosed with colorectal cancer.
• The disease affects men and women equally.

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General Risk Factors for Colorectal Cancer

The majority of colorectal tumors are found in patients over age 50. However, the disease can happen at any age so it is important to know your family history and the following risk factors.

• Diet high in fat and red meat and low in fruits and vegetables.
• Personal history of colon cancer.
• History of polyps in the colon, ulcerative colitis or Crohn's Disease.

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Screening for Colorectal Cancer

The American Cancer Society recommends that, beginning at age 50, both men and women be screened for colorectal cancer according to one of the following schedules:

• A yearly fecal occult blood test where your stool will be checked for blood.
• A double-contrast barium enema every five years. During this test, your colon is filled with a fluid containing barium. The barium is then drained out and air is put into the intestine. X-rays of the area are then taken to look for abnormalities.
• Every 10 years, a colonoscopy where the doctor uses a long, lighted tube to look inside the rectum and the entire colon for polyps or other abnormal areas that may be cancerous.

People who have any of the colorectal cancer risk factors should consult with their doctor about earlier, more frequent screening.

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Signs of Colorectal Cancer

Often there are no obvious signs of colorectal cancer, but some symptoms can include:

• Change in bowel frequency, such as alternating episodes of diarrhea and constipation.
• Bloody bowel movements or rectal bleeding.
• General abdominal discomfort.
• Unexplained weight loss.
• Chronic fatigue.
• Bloating.
• Unexplained anemia.

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Diagnosing Colorectal Cancer

Special tests to evaluate the colon and rectum are used to detect and diagnose colorectal cancer.

• A physical exam to assess your overall health, including a digital rectal exam (DRE) to evaluate the rectum for abnormal masses.
• Fecal occult blood test.
• A sigmoidoscopy to look inside the rectum and sigmoid colon for polyps or other abnormal areas that may be cancerous using a thin, lighted tube.
• A double-contrast barium enema.
• A colonoscopy.

To determine for sure if you have cancer, some tissue will be removed during sigmoidoscopy or colonoscopy and examined under a microscope. This test is called a biopsy. Your doctor may also request a CT or PET scan to see if other body parts are affected.

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Treating Colorectal Cancer

The primary treatment for cancers of the colon and rectum is surgery. For cancers that have not spread, surgery alone may cure your cancer.

• Depending on the location and stage of your cancer, your doctor may recommend chemotherapy and/or radiation therapy either before or after surgery.
• For rectal cancer, radiation is usually given with chemotherapy. It can be given before surgery (called preoperative or neoadjuvant therapy) or after surgery (called postoperative or adjuvant therapy). Depending on the location and stage of your tumor, preoperative therapy may allow the surgeon to spare your anal sphincter. This would avoid the need for a permanent colostomy and may reduce the chance of the cancer coming back.

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Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

• Cancer doctors called radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
• Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
• Healthy cells are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.

After a diagnosis of colorectal cancer has been established, it's important to talk about your treatment options with a radiation oncologist.

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External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the area at risk.

• Before beginning treatment, you will be scheduled for a simulation to map out the area being treated. This will involve having X-rays and/or a CT scan. You will also receive tiny tattoo marks on your skin to help the therapists precisely position you for daily treatment.
• Treatment is given once a day, Monday through Friday, for about six weeks.
• Newer technologies like 3-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT) are being evaluated for use in treating colorectal cancer. Ask your radiation oncologist for more information on these treatments.

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Possible Side Effects

People with colorectal cancer often get chemotherapy while they are receiving radiation. Side effects during treatment result from both the local effects of radiation to the pelvic area and the systemic effects of chemotherapy throughout the body.

• Possible side effects from radiation include more frequent bowel movements, diarrhea, abdominal cramping, pressure or discomfort in the rectal area, urinating more often, burning with urination, skin irritation, nausea and fatigue. These are usually temporary and resolve after your treatment ends.
• Chemotherapy side effects will depend on the specific drug you receive.
• Side effects are not the same for all patients. Ask your doctor what you can expect from your specific treatment.
• Many of these side effects can be well controlled with medications and changes to your diet. Tell your doctor or nurse if you experience any discomfort so it can be treated.

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Radiation Therapy for Gynecologic Cancers

Facts About Gynecologic Cancers

Gynecologic cancers include cancer of the uterus, ovaries, cervix, vagina, vulva and Fallopian tubes.

• According to the American Cancer Society, nearly 83,000 women per year are diagnosed with some form of gynecologic or GYN cancer.
• The most common gynecologic cancer is uterine cancer with more than 40,000 cases diagnosed each year.
• Every year, more than 28,000 women die from a type of gynecologic cancer.
• Widespread screening with the Pap test has allowed doctors to find pre-cancerous changes in the cervix and vagina. This has helped prevent the development of some invasive cancers.

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Risk Factors for Gynecologic Cancers

While all women are at risk for gynecologic cancers, some factors can increase a woman's chances of developing the disease.

• Uterine cancer: Never pregnant, beginning menstruation early, late menopause, diabetes, use of estrogen alone (called unopposed estrogen) for hormone replacement therapy, family history of uterine cancer, high blood pressure and complex atypical hyperplasia. Tamoxifen, a drug frequently used to treat breast cancer, increases the risk of uterine cancer slightly. A genetic syndrome called hereditary nonpolyposis colon cancer (HNPCC) may also increase a woman's risk.
• Cervical cancer: Strongly associated with sexually transmitted diseases, especially several strains of human papilloma virus (HPV), sexual activity at an early age, multiple sexual partners, smoking and obesity.
• Ovarian cancer: Obesity, never pregnant, unopposed estrogen, personal or family history of breast or ovarian cancer, genetic mutations in the BRCA1 or BRCA2 gene, HNPCC.
• Vaginal cancer: History of genital warts or an abnormal Pap test. There is an increased risk of clear cell carcinoma in women whose mothers took the drug diethylstilbestrol (DES) while pregnant. Women previously treated for carcinoma in-situ or invasive cervical cancer also have a higher risk of developing vaginal cancer.

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Signs and Symptoms of Gynecologic Cancers

There are often no outward signs of gynecologic cancers. However, some common symptoms include:

• Unusual bleeding, such as postmenopausal bleeding, bleeding after intercourse or bleeding between periods.
• A sore in the genital area that doesn't heal or chronic itching of the vulva.
• Pain or pressure in the pelvis.
• Persistent vaginal discharge.

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Screening for Gynecological Cancer

Gynecologic cancers are often detected through a series of screening exams.

• Your doctor will first perform a pelvic exam to evaluate your vulva, vagina, cervix, uterus, Fallopian tubes, ovaries and rectum.
• During the pelvic exam, your doctor will gently scrape some cells from the cervix and vagina to examine under a microscope. This is called a Pap test.
• If the Pap test is abnormal, your doctor may perform a test called a colposcopy to closely examine the cervix. Scraping cells from the cervical canal (endocervical curettage) may also be necessary.
• A small sample of tissue may be taken from any suspicious area. This test is called a biopsy.
• Occasionally, doctors need to examine a larger sample of cervical tissue. It is obtained during a procedure called conization or cone biopsy.
• In some situations, your doctor may recommend an exam under anesthesia to better evaluate the extent of a cancer. Tests requiring anesthesia include examination of the bladder (cystoscopy) and rectum (sigmoidoscopy).
• Abnormal uterine bleeding, a common symptom of uterine cancer, is usually evaluated by performing a dilatation and curettage, also called a D and C.
• Your doctor may also ask for MRI, CT, PET or ultrasound scans of the abdomen and pelvis to better evaluate areas that cannot be directly viewed, such as the ovaries.

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Treatment Options for Gynecologic Cancers

Treatment for gynecologic cancers depends on several factors, including the type of cancer, its extent (stage), its location and your overall health. It is important to talk with several cancer specialists before deciding on the best treatment for you, your cancer and your lifestyle.

• A gynecologic oncologist is a doctor who specializes in surgically removing gynecologic cancers.
• A radiation oncologist is a doctor specially trained to treat cancer with radiation therapy.
• A medical oncologist is a doctor who specializes in treating cancer with drugs (chemotherapy).

Sometimes, your cancer may be cured by using only one type of treatment. In other cases, your cancer may be best cured using a combination of surgery, radiation therapy and chemotherapy.

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Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

• Radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
• Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
• Healthy tissues are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.

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External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the cancer. Each treatment is painless and is similar to getting an X-ray. They are often given in a series of daily sessions, each taking less than half an hour, Monday through Friday, for five to six weeks. In some cases, you may receive more than one treatment in a day, often several hours apart.

• 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the affected area. Tailoring each of the radiation beams to focus on the tumor delivers a high dose of radiation to the tumor and avoids nearby healthy tissue.
• Intensity modulated radiation therapy (IMRT) is the most recent advance in the delivery of radiation. IMRT improves on 3D-CRT by modifying the intensity of the radiation within each of the radiation beams. This allows more precise adjustment of radiation doses to the tissues within the target area.

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Brachytherapy

Brachytherapy (also called internal or intracavitary radiotherapy) involves placing radioactive sources in or next to the cancer. This is usually done at the same time or after external beam radiation therapy. Brachytherapy is very important in the treatment of vaginal, cervical and uterine cancers.

There are two main types of brachytherapy:

• Low-dose rate brachytherapy is delivered over the course of 48 to 72 hours. You will be admitted into the hospital to receive this treatment.
• High-dose rate brachytherapy is given over the course of several minutes, but the entire procedure typically takes a few hours. You may be able to go home immediately after this treatment.

Depending of the type of cancer you have, you may need to have several sessions of brachytherapy to cure your cancer.

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Potential Side Effects

The side effects you may experience will depend on the area being treated, the type of radiation used and whether or not you also received chemotherapy. Before treatment, your doctor will describe what you can expect.

• Some patients experience minor or no side effects and can continue their normal routines.
• Some patients may notice fatigue, skin irritation, vaginal irritation, frequent urination, burning with urination and/or diarrhea. These will all resolve after treatment ends.
• Some patients will have sexual changes, such as changes in the vagina.
• If at any time you develop side effects, tell your doctor or nurse. He or she can give you medicine to help.

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Radiation Therapy for Head and Neck Cancer

Facts About Head and Neck Cancer

This year, about 62,000 Americans will be diagnosed with cancer of the oral cavity, pharynx, larynx and thyroid.

• More than 25 percent of oral cancers occur in people who do not smoke or have other risk factors.
• Rates of head and neck cancer are nearly twice as high in men and are greatest in men over age 50.

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Risk Factors for Head and Neck Cancer

The use of tobacco and alcohol greatly increases your chances of developing head and neck cancer. Risk factors include:

• Alcohol consumption.
• Smoking or use of smokeless tobacco, such as chew or dip.
• Exposure to wood or nickel dust or asbestos.
• Plummer-Vinson syndrome (disorder from nutritional deficiencies).
• Exposure to viruses, including the human papillomavirus (HPV) and Epstein-Barr.

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Quitting Smoking

If you quit smoking, the health benefits begin immediately.

• For patients with head and neck cancer, quitting smoking reduces the risks of infections and developing other cancers.
• To learn how to quit, ask your doctor or visit www.smokefree.gov.

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Symptoms of Head and Neck Cancer

Although there are sometimes no symptoms of head and neck cancer, common complaints include:

• Lump or sore that does not heal.
• Sore throat that does not go away.
• Difficulty or pain with swallowing.
• Change in your voice or hoarseness.
• Blood in your saliva or from your nose.
• Ear pain or loss of hearing.
• Lump in the neck.
• Nasal stuffiness that does not resolve.

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Diagnosing Head and Neck Cancer

To look for cancer, your doctor will examine all the areas of your head and neck.

• Your doctor will first feel for lumps on the neck, mouth and throat. He or she may also use a flexible endoscope, a thin, lighted tube that is passed through the nose, to obtain a more comprehensive assessment of the head and neck area.
• X-ray, CT, MR and PET scans are often needed to show the location and extent of the cancer.
• To confirm if you have cancer, some tissue will be removed and analyzed. This test is called a biopsy.

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Types of Head and Neck Cancer

Head and neck cancers arise from the cells that make up the face, mouth and throat. Because cancers in different locations behave differently, treatment depends on the cancer type and extent. Some common locations include:

• Nasal cavity/paranasal sinuses.
• Nasopharynx.
• Oral cavity (lips, gums, floor of mouth, oral tongue, cheek mucosa, hard palate, retromolar trigone).
• Oropharynx (base of tongue, tonsils, soft palate, oropharyngeal wall).
• Larynx (vocal cords and supraglottic larynx).
• Hypopharynx (pyriform sinuses, post-cricoid area, posterior pharyngeal wall).
• Salivary glands (parotid, submandibular, sublingual and minor salivary glands).
• Thyroid.

Cancers arising in the brain or eyes are considered different from head and neck cancers. However, your doctor will check the areas to make sure the cancer has not spread.

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Head and Neck Cancer Treatment

Treatment for head and neck cancer depends on several factors, including the type of cancer, the size and stage, its location, and your overall health.

• Surgery, radiation therapy and chemotherapy are the mainstays of treating head and neck cancer.
• For many head and neck cancers, combining two or three types of treatments may be most effective. That’s why it is important to talk with several cancer specialists about your care, including a surgeon, a radiation oncologist and a medical oncologist.
• An important concept in treating head and neck cancer is organ preservation. Rather than relying on major surgery, an organ preservation approach first uses radiation and chemotherapy to shrink the tumor. This allows for a less extensive surgery and may even allow some patients to avoid surgery altogether.

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External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the cancer.

• Painless radiation therapy treatments are delivered in a series of daily sessions. Radiation treatments take only a few minutes, but each session takes about half an hour to get checked in, change clothes, get into position and receive the radiation. For some conditions, radiation is given twice a day, with a four to six hour gap between treatments.
• Treatments are usually scheduled Monday through Friday, for five to eight weeks. However, your radiation oncologist may schedule your treatments more or less often depending on your cancer.
• 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the affected area. Tailoring each of the radiation beams to accurately focus on the patient's tumor allows coverage of the cancer while at the same time keeping radiation away from nearby healthy tissue.
• Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of each radiation beam. This technique allows a precise adjustment of radiation doses to the tissue within the target area. IMRT may allow doctors to direct a higher radiation dose to the affected area and keep more radiation away from nearby healthy tissue.
• To help you keep still during treatment, your doctor may use a plastic head or shoulder mask. These devices are specially fitted for you and are painless to use.

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Internal Radiation Therapy

Also called brachytherapy, internal radiation therapy involves surgically implanting radioactive material into a tumor or surrounding tissue. For head and neck cancers, brachytherapy is often used in conjunction with external beam radiation therapy, but may be used alone.

• During low-dose-rate brachytherapy, your radiation oncologist implants thin, hollow, plastic tubes in and around a tumor.
• These tubes are loaded with tiny radioactive seeds that remain in place for one or several days to kill the cancer. The seeds and the tubes are then removed. Sometimes, tiny radioactive seeds are implanted directly into the tumor and remain permanently.
• For high-dose-rate brachytherapy, your doctor implants hollow tubes in and around the tumor site.
• After these tubes are implanted, they are then connected to a special brachytherapy machine that houses a high activity radioactive source. According to your doctor's specifications, the seed is automatically delivered from the machine and into the tubes, delivering localized radiation over several minutes to kill the cancer.

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Possible Side Effects

Side effects of radiation therapy are limited to the area that is receiving treatment.

• Side effects can include redness of the skin, sore throat, dry mouth, alteration of taste, pain on swallowing and possible hair loss in the treated area. Fatigue is also very common.
• Side effects are different for each patient. Medications and nutritional supplements may be prescribed to make you as comfortable as possible.
• If at any time during your treatment you feel discomfort, tell your doctor or nurse. They may be able to alter the treatment or prescribe a drug to help you feel better.

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Mouth Care

It is important to take care of your mouth, teeth and gums during radiation.

• Careful brushing of your teeth can help prevent tooth decay, gum disease, mouth sores and jaw infections.
• Be sure to tell your dentist that you received radiation to the head and neck area.
• Talk to your doctor or dentist about any problems you are having.

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Radiation Therapy for Hodgkins Lymphoma

Facts About Hodgkins Lymphoma

The lymphatic system is a network of thin tubular vessels that branches out to almost all parts of the body. Scattered in between these vessels are lymph nodes. The job of the lymphatic system is to fight infection and disease. Cancer of the lymphatic system is called lymphoma. Hodgkins is one of two main types of lymphoma with non-Hodgkins being the other.

• Hodgkins lymphoma (Hodgkins disease) commonly affects lymph nodes in the neck or in the area between the lungs behind the breastbone. It can also begin in groups of lymph nodes under the arms, in the abdomen or in the groin.
• It's named after the British doctor Thomas Hodgkin who first described the disease in 1832.
• According to the American Cancer Society, nearly 64,000 new cases of lymphoma will be diagnosed this year. This includes 7,350 cases of Hodgkins lymphoma.
• Hodgkins lymphoma is very treatable and often curable. Eighty-five percent of patients with Hodgkins live longer than five years after diagnosis.

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Risk Factors for Hodgkins Lymphoma

The cause of Hodgkins lymphoma is unknown. However, doctors believe immune system problems as well as age may increase a person's chance of developing this disease.

• Hodgkins lymphoma has two peak time frames: between the ages of 15 and 40 and in people over age 55. However, the disease can affect anyone.
• Males are typically more at risk of developing Hodgkins lymphoma.
• Those who have been infected with the Epstein-Barr virus are more likely to develop Hodgkins lymphoma.
• Having a parent or sibling with Hodgkins lymphoma also increases risk of the disease.

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Signs and Symptoms of Hodgkins Lymphoma

The signs and symptoms of lymphoma are not specific and may also be associated with other, noncancerous conditions. Talk to your doctor if you have any of these problems.

• Swollen lymph nodes in the neck, underarm or groin.
• Unexplained fevers.
• Drenching night sweats.
• Unexplained weight loss.
• Constant fatigue.
• Skin rash or itchy skin.

Unexplained fevers, night sweats and weight loss are known as “B” symptoms. Ask your doctor about their significance in your case.

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Diagnosing Hodgkins Lymphoma

To see if you have Hodgkins lymphoma, your doctor will first examine you to assess your overall health and look for anything unusual. He or she may also perform some or all of the following tests.

• The doctor will order blood tests to evaluate a variety of factors, including the number of blood cells in your blood and how well your liver and kidneys are working.
• During a lymph node biopsy, your doctor will perform surgery to take out a lymph node. It will then be examined under a microscope to look for cancer.
• Several imaging tests will be performed to see if lymphoma has spread to other organs. These tests may include CT, PET or gallium scans.

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Staging of Hodgkins Lymphoma

The stage of cancer is a term used to describe its size and whether it has spread.

Knowing this helps doctors plan the best treatment.

• Stage I: Single lymph node or non-lymph node region is affected.
• Stage II: Two or more lymph node or non-lymph node regions are affected on the same side of the diaphragm (the muscle under the lungs).
• Stage III: Lymph node or non-lymph node regions above and below the diaphragm are affected.
• Stage IV: The cancer has spread outside the lymph nodes to organs such as the liver, bones or lungs. Stage IV can also refer to a tumor in another organ and/or tumors in distant lymph nodes.

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Treatment Options for Hodgkins Lymphoma

Treatment options depend on the type of lymphoma, its stage and your overall health. Treatment may include chemotherapy or radiation therapy, either alone or in combination. It may help to talk to several cancer specialists before deciding on the best course of treatment for you, your cancer and your lifestyle

• A radiation oncologist is a doctor who specializes in destroying cancer cells with high energy X-rays or other types of radiation.
• A medical oncologist is a doctor who is an expert at prescribing special drugs (chemotherapy) to treat cancer. Some medical oncologists are also hematologists, meaning they have experience treating blood problems.

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Understanding Radiation Therapy

Radiation therapy, also called radiotherapy, is the careful use of radiation to safely and effectively kill cancer cells while avoiding nearby healthy tissue.

• Radiation oncologists use radiation therapy to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
• Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells are destroyed by the radiation, the body naturally eliminates them.
• Healthy tissues can also be affected by radiation, but they are usually able to repair themselves in a way cancer cells cannot.

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External Beam Radiation Therapy

External beam radiation therapy is a series of outpatient treatments to accurately deliver radiation to the cancer cells. Radiation therapy has been proven to be very successful at treating and curing Hodgkins lymphoma.

• Radiation oncologists deliver external beam radiation therapy to the lymphoma from a machine called a linear accelerator.
• Each treatment is painless and is similar to getting an X-ray. Treatments last less than 30 minutes each, every day except for Saturday and Sunday, for three to four weeks.
• Involved field radiation is when your doctor delivers radiation only to the parts of your body known to have cancer. It is often combined with chemotherapy. Radiation above the diaphragm to the neck, chest and/or underarms is called mantle field radiation. Treatment below the diaphragm to the abdomen, spleen and/or pelvis is called inverted-Y field radiation.
• Your radiation oncologist may deliver radiation to all the lymph nodes in the body to destroy cancer cells that may have spread to other lymph nodes. This is called total nodal irradiation.
• Your radiation oncologist may also deliver radiation to the entire body. This is called total body irradiation. It is often done before chemotherapy and a stem cell or bone marrow transplant to eliminate any remaining cancer cells and create space for the new stem cells.

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Possible Side Effects

The side effects you may experience will depend on the part of the body being treated, the dose of radiation given and if you also receive chemotherapy. Ask your doctor before treatment begins about possible side effects, and how best to manage them.

• You may experience very few or no side effects and can continue your normal routine during treatment.
• You may experience mild skin irritation, hair loss, sore throat, upset stomach, loose bowel movements, nausea and/or fatigue. Most side effects will go away after treatment ends.
• Tell your doctor or nurse if you experience any discomfort. They may be able to prescribe medication or change your diet to help.
• Hodgkins lymphoma is often curable, allowing many people with the disease to live long lives after treatment. In some very rare cases, the treatments that cured the cancer may lead to significant after effects. Talk to your doctor about the risks of your treatment.

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Radiation Therapy for Lung Cancer

Facts About Lung Cancer

• According to the American Cancer Society, this year nearly 175,000 Americans will learn they have lung cancer.
• The one-year survival rate for lung cancer has increased from 34 percent in 1975 to 42 percent in 1998.

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Risk Factors for Lung Cancer

Smoking greatly increases your chances of developing lung cancer.

• Other risk factors include exposure to substances like second-hand smoke, arsenic, some organic chemicals, radon, asbestos, air pollution and tuberculosis.

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Quitting Smoking

If you quit smoking, the health benefits begin immediately.

• For patients with lung cancer, quitting smoking makes treatment more effective.
• Quitting smoking also reduces the risks of infections, such as pneumonia, improves breathing, and reduces the risks associated with surgery.
• To learn how to quit, talk to your doctor or visit www.smokefree.gov.

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Symptoms of Lung Cancer

Some signs and symptoms of lung cancer include:

• Persistent cough, coughing blood or shortness of breath.
• Chest pain.
• Recurring pneumonia or bronchitis.
• Swelling of the neck and face.
• Unexplained weight loss, loss of appetite or fatigue.

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Diagnosing Lung Cancer

• A chest X-ray will often reveal a tumor and where it is located. Other tests, such as CT scans and PET scans, can provide more detailed information.
• To be certain if you have lung cancer, tissue from your lung will be removed and analyzed. This is called a biopsy.
• The biopsy may be done during a bronchoscopy, a test where a flexible tube with a light is inserted into your nose or mouth to look at the airways of the lungs.
• A biopsy may also be done with a needle inserted through the skin directly into the tumor under CT guidance.

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Types of Lung Cancer

Non-small cell lung cancer and small cell lung cancer are the two main types of lung cancer.

• Non-small cell lung cancer is the most common type of lung cancer. It often grows and spreads less rapidly than small cell lung cancer. There are three types of non-small cell lung cancer — squamous cell carcinoma, adenocarcinoma and large cell carcinoma.
• Small cell lung cancer is less common than non-small cell lung cancer. It grows more rapidly and is more likely to spread to other organs in the body.
• Lung cancer usually begins in one lung. If left untreated, it can spread to lymph nodes or other parts of the chest, including the other lung. Lung cancer can also metastasize (or spread) throughout the body to the bones, brain, liver or other organs.

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Treatment for Lung Cancer

Lung cancer treatment depends on several factors, including the type and size of the cancer, its location, and your overall health. Typically, several different treatments and combinations of treatments will be used to combat lung cancer. During treatment, a team of doctors may be involved in your care, including a radiation oncologist, a medical oncologist and a surgeon.

• Non-small cell lung cancer may be treated first with surgery. Your doctor may also suggest radiation therapy or chemotherapy either alone or in combination.
• Small cell lung cancer is often treated with chemotherapy and radiation therapy either at the same time or one right after the other.

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Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

• Cancer doctors called radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
• Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
• Healthy cells are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.

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External Beam Radiation Therapy

External beam radiation therapy involves a series of daily radiation treatments targeting your lung tumor.

• Radiation therapy treatments are delivered in a series of daily sessions. Each treatment itself is painless and will last less than 30 minutes, Monday through Friday, for several weeks.
• 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the lung tumor. Tailoring each of the radiation beams to accurately focus on the tumor targets the cancer while protecting nearby healthy tissue.
• Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that modifies the radiation by varying the intensity of each radiation beam. This technique allows a precise adjustment of radiation doses to the tissues within the target area, possibly allowing a higher radiation dose to the tumor and keeping more radiation away from nearby normal tissues. IMRT is still being studied for lung cancer.
• Your radiation oncologist may recommend applying radiation to the brain after successfully treating small cell lung cancer. Called prophylactic cranial irradiation, or PCI, this treatment is not recommended for all patients.

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Internal Radiation Therapy

In some cases, your doctor may recommend brachytherapy. Also called internal radiation, brachytherapy involves placing radioactive material into a tumor or its surrounding tissue.

• During bronchoscopy, one or two thin plastic tubes called catheters will be placed down your nose and into the airways of the lung.
• The tube or tubes are then connected to a brachytherapy machine. This holds the radioactive source, which is in the form of a ribbon with radioactive seeds. Your doctor slides the ribbon into the tube in your lung so the seeds are next to the tumor.
• The ribbon will be left in place from a few minutes to a few days.

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Possible Side Effects

Patients often experience little or no side effects from radiation therapy and are able to continue normal routines.

• Side effects are temporary and usually limited to the area that received radiation.
• Possible problems include skin irritation, difficulty or pain when swallowing, shortness of breath, and fatigue.
• Talk to your doctor about any discomfort you feel. He or she may be able to provide drugs and other treatments to help.

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Radiation Therapy for Non-Hodgkins Lymphoma

Facts About Non-Hodgkins Lymphoma

The lymphatic system is a network of thin tubular vessels that branches out to almost all parts of the body. Scattered in between these vessels are lymph nodes. The job of the lymphatic system is to fight infection and disease. Cancer involving the lymphatic system is called lymphoma. Non-Hodgkins is one of two main types of lymphoma with Hodgkins lymphoma (or Hodgkins disease) being the other.

• Non-Hodgkins lymphoma (or NHL) refers to a variety of cancers involving the lymph system. Non-Hodgkins lymphoma can begin in any part of the body, not just the lymph nodes.
• According to the American Cancer Society, nearly 64,000 new cases of lymphoma will be diagnosed this year.
• Survival rates vary widely by cell type and stage of disease. More than 75 percent of patients with NHL live longer than a year after diagnosis; nearly 60 percent of patients live longer than five years.

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Risk Factors for Non-Hodgkins Lymphoma

Risk factors for developing lymphoma are unknown. However, doctors believe immune system problems as well as age may increase a person's chance of developing this disease.

• Non-Hodgkins is most commonly found in people in their 60s and 70s. However, the disease can affect anyone.
• People with auto-immune disorders, including HIV and AIDS, are more likely to develop non-Hodgkins lymphoma.
• People who have received an organ transplant have a high risk of developing non-Hodgkins. This is because they must take drugs that suppress the immune system.

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Signs and Symptoms of Non-Hodgkins Lymphoma

The signs and symptoms of lymphoma are general and may also be associated with other, noncancerous conditions. Talk to your doctor about any of these problems.

• Swollen lymph nodes in your neck, underarm or groin.
• Unexplained fevers.
• Unexplained weight loss.
• Constant fatigue.
• Skin rash or itchy skin.
• Unexplained pain in the chest, abdomen, pelvis or bones.
• Drenching night sweats.

Unexplained fevers, night sweats and weight loss are known as “B” symptoms. Ask your doctor about their significance in your case.

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Diagnosing Non-Hodgkins Lymphoma

Lymphoma is not just one disease. Rather, it is more than 30 types of cancer that act differently and may need special treatment. To see if you have lymphoma and what kind it is, your doctor may order some or all of the following tests.

• The doctor may order blood tests to evaluate a variety of factors, including the number of blood cells in your blood and how well your liver and kidneys are working.
• During a lymph node biopsy, your doctor will perform surgery to take out a lymph node. It will then be examined under a microscope to look for cancer.
• A bone marrow biopsy may help determine if lymphoma has spread to that part of the body.
• Your doctor may order imaging tests to see if lymphoma has spread to other organs. These tests may include X-rays or CT, PET or MRI scans.

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Staging of Non-Hodgkins Lymphoma

The stage of cancer is a term used to describe its size and whether it has spread. Knowing this helps doctors plan the best treatment.

• Stage I: Single lymph node or non-lymph node region is affected.
• Stage II: Two or more lymph node or non-lymph node regions are affected on the same side of the diaphragm (the muscle under the lungs).
• Stage III: Lymph node or non-lymph node regions above and below the diaphragm are affected.
• Stage IV: The cancer has spread outside the lymph nodes to organs such as the liver, bones or lungs. Stage IV can also refer to a tumor in another organ and/or tumor in distant lymph nodes.

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Treatment of Non-Hodgkins Lymphoma

Treatment options depend on the type of lymphoma you have, the stage of the lymphoma and your overall health. Treatment may include radiation therapy or chemotherapy, either alone or in combination. Other treatments include watchful waiting and biologic therapy. It may help to talk to several cancer specialists before deciding on the best course of treatment for you, your cancer and your lifestyle

• A radiation oncologist is a doctor who specializes in destroying cancer cells with high energy X-rays or other types of radiation.
• A medical oncologist is a doctor who is an expert at prescribing special drugs (chemotherapy) to treat cancer. Some medical oncologists are also hematologists, meaning they have experience treating blood problems.

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Understanding Radiation Therapy

Radiation therapy, also called radiotherapy, is the careful use of radiation to safely and effectively kill cancer cells while avoiding nearby healthy tissue.

• Radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth and to relieve symptoms, such as pain.
• Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells are destroyed by the radiation, the body naturally eliminates them.
• Healthy tissues can also be affected by radiation, but they are usually able to repair themselves in a way cancer cells cannot.

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External Beam Radiation Therapy

External beam radiation therapy is a series of daily outpatient treatments to accurately deliver radiation to the cancer cells.

• Radiation oncologists usually deliver external beam radiation therapy to the lymphoma from a machine called a linear accelerator.
• Each treatment is painless and is similar to getting an X-ray. Treatments last less than 30 minutes each and are every day, except for Saturday and Sunday for three to four weeks.
• Involved field radiation is when your doctor delivers radiation only to the parts of the body known to have cancer. It is often combined with chemotherapy.
• Your radiation oncologist may deliver radiation to all the lymph nodes in the body to destroy cancer cells that may have spread to other lymph nodes. This is called total nodal irradiation.
• Your radiation oncologist may also deliver radiation to the entire body. This is called total body irradiation. It is often done before chemotherapy and a stem cell or bone marrow transplant to destroy any remaining cancer cells and create a space for the new stem cells.

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Biologic Therapy

Also called immunotherapy, biologic therapy works with your immune system to fight cancer. Biologic therapy is like chemotherapy. The difference is that chemotherapy attacks the cancer directly and biologic therapy helps your immune system better fight the disease

• Monoclonal antibodies work by targeting certain molecules in the body and attaching themselves to those molecules. This causes some lymphoma cells to die and makes others more likely to be destroyed by radiation and chemotherapy.
• Radiolabeled antibodies are monoclonal antibodies with radioactive particles attached. These antibodies are designed to attach themselves directly to the cancer cell and damage it with small amounts of radiation without injuring nearby healthy tissue. Presently, radiolabeled antibodies are being used to treat non-Hodgkins lymphoma that has come back after treatment.

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Possible Side Effects

The side effects you may experience will depend on the part of the body being treated, the amount of radiation you are given, and whether or not you have received chemotherapy. Ask your doctor before treatment begins about possible side effects and how best to manage them. Most side effects go away once you finish treatment.

• You may experience very few or no side effects and can continue your normal routine during treatment.
• You may notice mild skin irritation, upset stomach, hair loss, sore throat, loose bowel movements, nausea and fatigue.

Tell your doctor or nurse if you experience any discomfort during treatment. They may be able to prescribe medication or change your diet to help.

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Radiation Therapy for Skin Cancer

General Risk Factors for Skin Cancer

There are many risk factors for developing skin cancer ranging from sun exposure to moles to family history:

• Exposure to ultraviolet rays and sunburn: People who have experienced prolonged exposure to sunlight and tanning booths are at an increased risk to develop skin cancer. The amount of exposure depends on the intensity of the light, length of time the skin was exposed, and whether the skin was protected with either clothing or sunscreen. In addition, severe sunburn in childhood or teenage years can increase the risk of skin cancer.
• Skin coloring/pigmentation: People with fair skin are 20 times more likely to develop skin cancer than people with darker skin. Caucasian people with red or blonde hair and fair skin that freckles or burns easily are at the highest risk. People with darker pigmentation can also develop skin cancer, more likely on the palms of the hands, soles of the feet, under the nails or inside the mouth.
• Moles: Individuals with moles may be at increased risk of developing melanoma, especially if the moles are unusual, large or multiple.
• Family history: Risk of developing melanoma is higher if one or more members of a person's immediate family have been diagnosed.
• Immune suppression: People who have illnesses affecting their immune system (such as HIV) or who are taking medicines to suppress their immune system (such as after an organ transplant) are at an increased risk of skin cancer.
• Occupational exposure: Individuals exposed to coal tar, pitch, creosote, arsenic compounds or radium are at increased risk to develop skin cancer.

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Facts About Skin Cancer

• More than 1 million cases of basal and squamous cell skin cancers will be diagnosed in the United States this year. These cancers can usually be cured.
• Nearly 60,000 cases of melanoma are diagnosed annually. Nearly 5,000 men and 2,900 women will die from the disease this year.
• Skin cancer usually occurs in adults but can sometimes affect children and teenagers.

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About Skin Cancer

The skin is the body's largest organ. Its job is to protect internal organs against damage, heat and infection. The skin is also the most exposed organ to sunlight and other forms of harmful ultraviolet rays. There are three major types of skin cancer.

• Basal cell carcinoma: The most common form of skin cancer. These cancers begin in the outer layer of skin (epidermis).
• Squamous cell carcinoma: The second most common type of skin cancer. These cancers also begin in the epidermis.
• Melanoma: The most serious skin cancer, it begins in skin cells called melanocytes that produce skin color (melanin).

If caught and treated early, most skin cancers can be cured. Be sure to talk to your doctor about anything unusual on your skin.

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Signs of Skin Cancer

Skin cancer can be detected early and it is important to check your own skin on a monthly basis. You should take note of new marks or moles on your skin and whether or not they have changed in size or appearance.

The American Cancer Society's "ABCD rule" can help distinguish a normal mole from melanoma:

• Asymmetry: The two halves of a mole do not match.
• Border irregularity: The edges of the mole are ragged and uneven.
• Color: Differing shades of tan, brown or black and sometimes patches of red, blue or white.
• Diameter: The mole is wider than a quarter inch in size.

The American Cancer Society recommends a skin examination by a doctor every three years for people between 20 and 40 years of age and every year for anyone over the age of 40.

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Diagnosing Skin Cancer

If initial test results show abnormal skin cells, your doctor may refer you to a skin specialist called a dermatologist. If the dermatologist thinks that skin cancer may be present, a biopsy, or sample of skin from the suspicious area, will be checked for cancer. There are three types of biopsies to test for skin cancer.

• Shave biopsy: The doctor "shaves" or scrapes off the top layers of the skin with a surgical blade.
• Punch biopsy: This type removes a deeper skin sample with a tool that resembles a tiny cookie cutter.
• Incisional and excisional biopsies: For an incisional biopsy, a surgeon cuts through the full thickness of skin and removes a wedge for further examination. An excisional biopsy is when the entire tumor is removed.

Other tests such as a chest X-ray, CT scan or MRI may be used to see if the cancer has spread to other parts of the body.

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Treating Skin Cancer

The treatment you receive depends on several factors including your overall health, stage of the disease and whether the cancer has spread to other parts of your body. Treatments are often combined and can include:

• Radiation therapy where the cancer cells are killed by X-rays.
• Surgery where the cancer cells are cut out and removed.
• Electrodessication where the cancer is dried with an electric current and removed.
• Cryosurgery where the cancer is frozen and removed.
• Laser surgery where the cancer cells are killed by laser beams.
• Chemotherapy where the cancer cells are attacked by a drug that is either taken internally or applied on the skin.
• Photodynamic therapy where the cancer is covered with a drug that becomes active when exposed to light.
• Biologic therapy where doctors help your immune system better fight the cancer.

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Understanding Radiation Therapy

Radiation therapy, also called radiotherapy, is the careful use of radiation to treat many different kinds of cancer.

• Cancer doctors, called radiation oncologists, use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms such as pain.
• Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
• Healthy cells that grow and divide quickly are also harmed by radiation, but they are able to repair themselves in a way cancer cells cannot.

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External Beam Radiation Therapy

External beam radiation therapy may be used to treat skin cancer and to relieve pain from cancer that has spread to the brain or bone.

• Treatments are usually scheduled every day, Monday through Friday, for several weeks to accurately deliver radiation to the cancer.
• Treatments are painless and take less than half an hour each, start to finish.
• Radiation therapy is often given in addition to surgery, chemotherapy or biologic therapy.
• Skin cancer is often treated with superficial forms of radiation that penetrate only a short distance below the surface.
• Doctors will target the radiation beams at your tumor to give more radiation to the skin cancer while keeping it away from underlying organs.

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Potential Side Effects

You may have little or no side effects from radiation therapy and be able to keep up your normal activities.

• Side effects are usually limited to the part of your body that receives radiation.
• Skin changes such as redness, dryness or itching are common side effects.
• You will also likely lose your hair in the area treated.
• Side effects should go away when the treatment ends.

Talk to your doctor or nurse about any discomfort you feel. He or she may be able to provide drugs or other treatments to help.

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Radiation Therapy for Prostate Cancer

Facts About Prostate Cancer

Prostate cancer is the most common malignancy in American men.

• In 2003, more than 220,000 men were diagnosed as having prostate cancer, making it the number one type of cancer in men.
• Nearly 29,000 men died from prostate cancer in 2003.
• More than 75 percent of prostate cancer is diagnosed in men over age 65.

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Risk Factors for Prostate Cancer

Incidence of prostate cancer increases with age.

• Median age at diagnosis in Caucasian males is 71.
• African-American men have the highest incidence of prostate cancer in the world.
• Heredity accounts for 5 to 10 percent of cases.

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Screening for Prostate Cancer

According to the American Cancer Society, men aged 50 or older should be offered a digital rectal exam (DRE) and a PSA blood test. However, it is a good idea to visit your doctor earlier to establish a baseline PSA level so you can monitor changes.

• Prostate specific antigen (PSA) is a valuable marker for prostate cancer although BPH or infection may also cause a rise in PSA.
• Normal range is 0-4, however, a PSA above 3 in men younger than 60 may be considered abnormal.
• African-American men and men with a family history of prostate cancer should be examined beginning at an earlier age.

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Diagnosing Prostate Cancer

Prostate cancer is most often diagnosed through a blood test measuring the amount of prostate specific antigens (PSA) in the body. However, signs and symptoms of prostate cancer can include:

• Changes in urinary flow: Frequency, urgency, hesitancy.
• Frequent nighttime urination.
• Painful urination.
• Blood in urine.

Other conditions that may cause these symptoms include an enlarged prostate (benign prostatic hypertrophy or BPH) or infection.

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Radiation Therapy for Prostate Cancer

After a diagnosis of prostate cancer has been established with a biopsy, the patient should discuss the treatment options with a radiation oncologist and a urologist. Radiation therapy treatment options to cure prostate cancer include:

• External beam radiotherapy.
• Prostate brachytherapy.

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External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the prostate.

There are two principal methods for delivering external beam radiation.

• 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the prostate. Tailoring each of the radiation beams to accurately focus on the patient's tumor allows coverage of the prostate cancer while at the same time keeping radiation away from nearby organs such as the bladder or rectum.
• Intensity modulated radiation therapy (IMRT) is the most recent advance in the delivery of radiation. IMRT improves on 3D-CRT by modifying the intensity of the radiation within each of the radiation beams. This technique allows more precise adjustment of radiation doses to the tissues within the target area, potentially allowing an increased radiation dose to the prostate and reduced doses to nearby normal tissues. Higher doses to the prostate translate into a greater chance for cure, while lower doses to surrounding organs mean fewer side effects.

Both types of external beam radiotherapy are acceptable treatment; IMRT offers advantages for some but not all prostate cancer patients. With either type of therapy, painless radiation treatments are delivered in a series of daily sessions, each under half-hour in duration, Monday through Friday, for seven to ten weeks overall.

Potential side effects, including fatigue, increased frequency or discomfort of urination, and loose stools, typically resolve within a few weeks after completing treatments. Impotence is also a potential side effect of any treatment for prostate cancer. However, many patients who receive radiation therapy for prostate cancer are able to maintain sexual function.

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Prostate Brachytherapy

Prostate brachytherapy, better known as a seed implant, is often done in the operating room.

There are two methods of delivering internal radiation for prostate cancer:

• Permanent seed implants.
• High-dose rate temporary seed implants.

These treatments are designed to deliver a very high dose of radiation to the tumor by inserting radioactive seeds directly into the prostate gland under ultrasound guidance while the patient is under anesthesia. Isotopes of iodine or palladium are most commonly used. The seeds are approximately four millimeters long and less than a millimeter in diameter. In certain situations, both prostate brachytherapy and external radiation may be recommended to combat the tumor.

The side effects from seed implants are similar to those experienced with external beam radiotherapy. Patients usually experience urinary frequency and discomfort in urination. These effects may be lessened with medication and usually dissipate over the course of three to six months.

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Proton Beam Therapy

In a few parts of the country, proton beam therapy is being used to treat prostate cancer.

Proton therapy is administered much the same way as external beam therapy, but it uses protons rather than x-rays to irradiate cancer cells.

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Hormone Therapy

Certain patients may benefit from hormone therapy in addition to radiation. In some patients, hormone therapy works with radiation therapy to improve cure rates.

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Tomotherapy

TomoTherapy in the News

A new radiation treatment method called TomoTherapy - an image-guided (IGRT) modality safely delivers a high radiation dose to small, targeted areas while limiting radiation dose to surrounding normal tissue.

Tomotherapy Treatment Plans

Palliative treatment to sciatic pain from a bony metastasis. Bowel and spinal cord are spared from radiation.

Treatment to the chest wall and regional lymph nodes after a mastectomy in a breast cancer patient.

Treatment to multiple lung metastasis from kidney cancer.

Definitive treatment to an early lung cancer with minimal dose to normal lung, heart and spinal cord.

Definitive treatment to a pancreatic cancer with sparing of kidney, spinal cord, liver and bowel.

High dose to an aggressive Head and Neck cancer with sparing of the parotid glands, mandible and spinal cord.

Definitive treatment of an early stage breast cancer with sparing of lung and heart.

Treatment of prostate, periprostatic tissue and seminal vesicles with sparing of the bladder and rectum.

Definitive high dose treatment of a solitary bone metastasis in a prostate cancer patient previously thought to be incurable.

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External Beam Radiation Therapy

The goal of radiation therapy is to get a high enough dose of radiation into the body to kill the cancer cells while sparing the surrounding healthy tissue from damage. Several different radiation therapy techniques have been developed to accomplish this. Depending on the location, size and type of your tumor or tumors, you may receive one or a combination of these techniques. Your cancer treatment team will work with you to determine which treatment and how much radiation is best for you.

During external beam radiation therapy, a beam of radiation is directed through the skin to a tumor and the immediate surrounding area in order to destroy the main tumor and any nearby cancer cells. To minimize side effects, the treatments are typically given every day for a number of weeks.

The radiation beam comes from a machine located outside of your body that does not touch your skin or the tumor. Receiving external beam radiation is similar to having an X-ray taken. It is a painless, bloodless procedure. The most common type of machine used to deliver external beam radiation therapy is called a linear accelerator, sometimes called a “linac.” It produces a beam of high-energy X-rays or electrons. Using sophisticated treatment planning software, your radiation oncology treatment team plans the size and shape of the beam, as well as how it is directed at your body, to effectively treat your tumor while sparing the normal tissue surrounding the cancer cells.

Several special types of external beam therapy are discussed below. These are used for particular types of cancer, and your radiation oncologist will recommend one of these treatments if he or she believes it will help you.

Three-Dimensional Conformal Radiation Therapy (3D-CRT)
Tumors usually have an irregular shape. Three-dimensional conformal radiation therapy (3D-CRT) uses sophisticated computers and computer assisted tomography scans (CT or CAT scans) and/or magnetic resonance imaging scans (MR or MRI scans) to create detailed, three-dimensional representations of the tumor and surrounding organs. Your radiation oncologist can then shape the radiation beams exactly to the size and shape of your tumor. The tools used to shape the radiation beams are multileaf collimators or blocks. Because the radiation beams are very precisely directed, nearby normal tissue receives less radiation exposure.

Intensity Modulated Radiation Therapy (IMRT)

Intensity modulated radiation therapy (IMRT) is a specialized form of 3D-CRT that allows radiation to be more exactly shaped to fit your tumor. With IMRT, the radiation beam can be broken up into many “beamlets,” and the intensity of each beamlet can be adjusted individually. Using IMRT, it may be possible to further limit the exact amount of radiation that is received by normal tissues that are near the tumor. In some situations, this may also allow a higher dose of radiation to be delivered to the tumor, increasing the chance of a cure.

Proton Beam Therapy

Similar to external beam therapy, proton beam therapy is a form of radiation treatment that uses protons rather than X-rays to treat certain types of cancer and other diseases. The physical characteristics of the proton therapy beam allow doctors to better focus the dose on the tumor with the potential to reduce the dose to nearby healthy tissues.

Neutron Beam Therapy

Like proton therapy, neutron beam therapy is a specialized form of radiation therapy that can be used to treat certain tumors that are radioresistant, meaning that they are very difficult to kill using conventional radiation therapy. Neutron therapy can also be used to treat certain inoperable tumors.

Stereotactic Radiotherapy

Stereotactic radiotherapy is a technique that allows your radiation oncologist to precisely focus beams of radiation to destroy certain types of tumors. Since the beam is so precise, your radiation oncologist may be able to spare more normal tissue than with conventional external beam therapy. This additional precision is achieved through rigid immobilization, such as with a head frame as is used in the treatment of brain tumors. Although often performed in a single treatment, fractionated radiotherapy, where patients receive up to five treatments, is sometimes necessary. Stereotactic radiotherapy may be the only treatment if a very small area is affected. In addition to treating tumors, it can also be used to treat malformations in the brain’s blood vessels and certain noncancerous (benign) brain tumors.

Image-Guided Radiation Therapy (IGRT)

In some facilities, radiation oncologists are using image-guided radiation therapy (IGRT) to help them better deliver the radiation dose to the cancer. Normal structures and tumors can move between treatments due to differences in organ filling or movements while breathing. IGRT is conformal radiation treatment guided by imaging equipment, such as CT, ultrasound or stereoscopic X-rays, taken in the treatment room just before the patient is given the radiation treatment. All patients first undergo a CT scan as part of the planning process. The digital information from the CT scan is then transmitted to console in the treatment room to allow doctors to compare the earlier image with the images taken just before treatment. During IGRT, doctors “fuse” these images to see if the treatment needs to be changed. This allows doctors to better target the cancer while avoiding nearby healthy tissue. In some cases, doctors will implant a tiny piece of material called a fiducial marker near or in the tumor to help them localize the tumor during IGRT

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Brachytherapy

Brachytherapy, also called internal radiation or seed implants, is the placement of radioactive sources in or just next to a tumor. The radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used. Because the radiation sources are placed so close to the tumor, your doctors can deliver a large dose of radiation directly to the cancer cells with minimal exposure to normal tissue.

The radioactive sources used in brachytherapy, such as thin wires, ribbons, capsules or seeds, come in small sealed containers. Some sources are placed permanently and are referred to as implants. These radioactive sources remain in the body after their radiation has been expended and the source is no longer radioactive. Other sources are placed temporarily inside the body, and the radioactive sources are removed after the prescribed dose of radiation has been delivered.

There are two main types of brachytherapy: intracavity treatment and interstitial treatment. With intracavity treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.

Often these procedures require anesthesia and brief hospitalization. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities. Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will need to take special precautions to limit their exposure to radiation.

Devices called high dose rate remote afterloading machines allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You may be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.

Most patients feel little discomfort during brachytherapy. If the radioactive source is held in place with an applicator, you may feel discomfort from the applicator. There are medications that can help this. If you feel weak or queasy from the anesthesia, your radiation oncologist can give you medication to make you feel better.

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Understanding Clinical Trials

What Are Clinical Trials?
Clinical trials are research studies involving people.

• They test ways to treat and prevent cancer.
• All of today’s standard cancer treatments are a result of clinical trials completed many years ago.

Who Organizes a Clinical Trial?
Organizations or individuals looking for better treatments for cancer or new ways to prevent or detect cancer may sponsor clinical trials. Individual doctors at cancer centers or other medical institutions can also conduct trials.

• The National Cancer Institute sponsors numerous clinical trials covering a variety of cancers.
• Other sponsors include drug makers, technology companies and groups like the American Cancer Society.
• Each trial has a person in charge, usually a doctor, who is called the protocol chair or principal investigator (also called the PI).
• Before enrolling in a trial, ask whether the trial has been approved by an Institutional Review Board or IRB. IRBs exist at most hospitals to help safeguard patient rights.

How Are Clinical Trials Conducted?
Clinical trials testing new treatments are carried out in phases.

Phase I — Is the Treatment Safe?
As the first step in testing the research, doctors gather information about the side effects of the treatment and decide on the safe dose. Only a few patients in a few places take part in a Phase I trial.

Phase II — Does the Treatment Work?
In this step, doctors test the treatment to see how well it works. Most of the time, fewer than 100 patients are involved in Phase II trials.

Phase III — Is the Treatment Better?
Phase III trials compare the new treatment against the current standard therapy and randomly assign patients into one of the two groups. Many people from all over the country take part in these trials.

Phase IV — Are There Better Ways to Use the Treatment?
In this final step, treatments are tested to make sure they are safe and work well over a long period of time. This phase most often occurs once the new treatment has been approved for standard use. Anywhere from several hundred to several thousand people are enrolled in a Phase IV trial.

Where Are Clinical Trials Conducted?
Clinical trials are available through oncologists everywhere — not just in major cities or in large hospitals.

• Clinical trials take place in teaching hospitals, outpatient clinics, community hospitals and doctors’ offices.

What Are the Types of Clinical Trials?

Prevention
These trials test new approaches that doctors believe may reduce your chance of developing cancer. Most involve healthy people who have not had cancer. Some studies are conducted with people who have had cancer in the past to try to find ways to prevent second cancers.

Screening
Since cancer is often easier to cure when it is found early, screening trials test methods to better detect cancer, especially in the early stages. These studies also help find out whether finding cancer before it causes symptoms will lessen a patient's chances of dying from the disease.

Diagnostic
Diagnostic trials help answer whether or not there are new approaches that could be used to find certain types of cancer and at an earlier stage.

Treatment
The purpose of these trials is to find out if a new treatment or technique is better than the standard treatment. This can include new approaches to radiation therapy, new drugs, vaccines and different combinations of treatment.

Supportive Care/Quality of Life
These studies explore ways to improve the comfort and quality of life of people with cancer or survivors. These trials also study ways to better combat the side effects of some treatments.

Genetics Studies
These are generally done with another clinical trial and focus on how genetic makeup can affect detection, diagnosis or response to cancer treatment.

Who Can Participate in a Clinical Trial?
Each clinical trial calls for certain criteria that a patient must meet to be included in that trial.

• Your age, gender, medical history, current health, what type and stage of cancer all factor into eligibility.

It’s important to remember that clinical trials are completely voluntary. Patients can leave a trial at any time.

What Is Informed Consent?
Informed consent is the process by which you agree to take part in a clinical trial after receiving information about the purpose of the study, the treatment that will be given, the tests that will be taken, and the risks and benefits of treatment.

• You must sign a written consent form before being enrolled into a clinical trial. This form says that you understand the study and agree to take part.

What Are the Benefits?
Although there are risks with any treatment, there are also many benefits of taking part in a clinical trial. For example:

• Access to promising new treatments that are not available outside of the clinical trial setting.
• The treatment being studied may be better than the standard approach.
• You are followed very closely by a research team that is made up of doctors and other health professionals.
• You may be the first to benefit from the new method.
• Results from the study may help others in the future.

What Are the Risks?
Before taking part in a clinical trial, talk to your doctor about some of the risks involved with your treatment. For example:

• New drugs or treatments may not be any better than the standard care they are being compared to.
• New treatments may have side effects that are not expected.
• If you are in a randomized trial, you will not be able to choose if you are getting the new treatment or the standard approach.
• Health insurance may not cover all your costs.
• You may be required to make more frequent visits to the doctor.

Questions to Ask Your Doctor
Before joining a clinical trial, you may want to ask your doctor questions about the study and your treatment.

• What are you trying to learn from the study?
• What do doctors know already about the treatments being studied?
• What treatments and tests will I get during this trial?
• Who will be in charge of my care during the study?
• What are the differences between what I would get on this treatment and the standard treatment you would recommend?
• What are the benefits and risks?
• How will this affect my daily life?
• How long will the study last?
• What will I be asked to pay?
• How will I know if the study was successful?

How Can I Join a Clinical Trial?
If you are interested in joining a clinical trial, talk to your doctor. He or she can help you find out if a trial is right for you.

• The National Cancer Institute can give you information on current trials. Call 1-800-4-CANCER or visit www.cancer.gov to learn more.

Who Pays for a Clinical Trial?
Before taking part in a clinical trial, it's important to ask what your costs will be.

• In some cases, the sponsor of the study (such as the government, drug makers or technology companies) will provide the new treatment at no cost and pay for any special testing or extra doctor visits. Some sponsors may pay more than this, such as covering travel time and mileage expenses. However, other trials may pay very little of your treatment costs.
• If you have private insurance, check with your provider before you begin treatment. It may be willing to pay for some or all of the costs of your treatment, depending on the type of trial.
• Medicare will pay for the routine costs for some government sponsored clinical trials. Ask your doctor or call your local Medicare provider to find out what Medicare will pay for your treatment.

Facts About Clinical Trials

• More than 25,000 cancer patients enroll each year in clinical trials through the National Cancer Institute. Many more patients are enrolled in clinical trials sponsored by other groups.
• About 60 percent of the adults enrolled in clinical trials are women.
• Lung, breast, prostate and colon cancers have the highest number of clinical trials dedicated to them — more than 40 percent of the total number of trials.
• Only a small percentage of all cancer patients enroll in clinical trials. Their participation may benefit them as well as future cancer patients

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Managing Side Effects

Patients often experience little or no side effects from the radiation therapy and are able to continue their normal routines. However, some patients do feel some discomfort from the treatment. Be sure to talk to a member of your radiation oncology treatment team about any problems you may have.

Many of the side effects of radiation therapy are related to the area that is being treated. For example, a breast cancer patient may notice skin irritation, like a mild to moderate sunburn, while a patient with cancer in the mouth may have soreness when swallowing. These side effects are usually temporary and can be treated by your doctor or other members of the treatment team.

Side effects usually begin by the second or third week of treatment, and they may last for several weeks after the final radiation treatment. In rare instances, serious side effects develop after radiation therapy is finished. Your radiation oncologist and radiation oncology nurse are the best people to advise you about the side effects you may experience. Talk with them about any side effects you are having. They can give you information about how to manage them and may prescribe medicines that can help relieve your symptoms.

The side effect most often reported by patients receiving radiation is fatigue. The fatigue patients experience is usually not very severe, and patients can often continue all or some of their normal daily activities with a reduced schedule. Many patients continue to work full time during radiation therapy.

Many patients are concerned that radiation therapy will cause another cancer. In fact, the risk of developing a second tumor because of radiation therapy is very low. For many patients, radiation therapy can cure your cancer. This benefit far outweighs the very small risk that the treatment could cause a later cancer. If you smoke, the most important thing you can do to reduce your risk of a second cancer is quit smoking.

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How to Care for Yourself During Treatment

Get plenty of rest. Many patients experience fatigue during radiation therapy, so it is important to make sure you are well rested.

Eat a balanced, nutritious diet. A nutritionist, nurse or physician may work with you to ensure you are receiving the right calories, vitamins and minerals from the foods you eat and that you are eating the proper type of foods. With certain types of treatment, it may be necessary to modify your diet to minimize side effects. You should not attempt to lose weight during radiation therapy, since you require more calories due to your cancer and treatment.

Treat the skin that is exposed to radiation with extra care. The skin in the area receiving treatment may become red and sensitive. Your radiation oncology nurse will review specific instructions for caring for your skin with you. Some guidelines include:

Seek out emotional support. There are many emotional demands that you must cope with during your cancer diagnosis and treatment. It is common to feel anxious, depressed, afraid or hopeless. At times, it may help to talk about your feelings with a close friend, family member, nurse, social worker or psychologist. To find a support group in your area, ask your radiation oncology nurse.

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Questions to Ask Your Doctor

It is important that you fully understand the potential benefits, side effects and goals of radiation therapy. Your radiation oncologist and radiation oncology nurses are available to answer any questions you may have during treatment. They are the best source of accurate information about your particular case.

Coping with a diagnosis of cancer and researching the various treatment options can be a stressful experience. To assist you in this process, below is a list of questions you may want to ask your radiation oncologist if you are considering radiation therapy.

• What type and stage of cancer do I have?
• What is the purpose of radiation treatment for my type of cancer?
• How will the radiation therapy be administered? Will it be external beam or brachytherapy? Will the treatments hurt?
• For how many weeks will I receive radiation? How many treatments will I receive per week?
• What are the chances that radiation therapy will work?
  What is the chance that the cancer will spread or come back if I do not have radiation therapy?
• Will I need chemotherapy, surgery or other treatments? If so, in what order will I receive these treatments, and how soon after radiation therapy can I start them?
• How can I expect to feel during treatment and in the weeks following radiation therapy?
• Can I drive myself to and from the treatment facility?
• Will I be able to continue my normal activities?
• What side effects may occur from the radiation and how are they managed?
• Will radiation therapy affect my sex life or my ability to have children?
• Do I need to take any special precautions, like staying out of the sun or avoiding people with infectious diseases?
• Do I need a special diet during or after my treatment?
• Can I exercise?
• Will side effects change my appearance? If so, will the changes be permanent or temporary? If temporary, how long will they last?
• How often do I need to return for checkups?
• How and when will you know if I am cured of cancer?
• What are the chances that the cancer will come back?
• How soon can I go back to my regular activities? Work? Sexual activity? Aerobic exercise?
• Do you take my insurance?
• How should I prepare for this financially?
• What are some of the support groups I can turn to during treatment?

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