Doses A Delay In Radiation Increases Risk Of Breast Cancer Recurrence
Some but not all research suggests that for women who choose to undergo breast-conserving surgery for treatment of early stage breast cancer, a longer interval between surgery and the start of radiation therapy may increases the risk of local cancer recurrence.
Among women who undergo breast-conserving therapy, prompt treatment with radiation therapy after surgery may result in better outcomes than delayed radiation therapy. To explore this issue, researchers evaluated information from a large U.S. database that links cancer registry data with Medicare claims data. Information was available for more than 18,000 women over the age of 65 who had undergone breast-conserving therapy for Stage 0-II breast cancer and did not receive chemotherapy.
The average time from surgery to start of radiation therapy was 34 days and 30% of women started radiation therapy more than six weeks after surgery.
Longer intervals between surgery and the start of radiation therapy were linked with an increased risk of local cancer recurrence. For example, women who started radiation therapy more than six weeks after surgery were 19% more likely to experience local cancer recurrence than women who had a shorter interval between surgery and radiation.
These results suggest that starting radiation therapy as soon as possible after lumpectomy may reduce the risk of local cancer recurrence.
How Long Will The Consultation Take
Your initial visit with the radiation oncologist will take 1 to 1-1/2 hours. At this time, he or she will review your records and discuss treatment options. The risks, benefits, and alternatives to radiotherapy will also be discussed at this time. If desired, your spouse and/or family member may be present during your visit and may ask questions or take notes.
When Do You Have Physical Energy
I had my radiation treatments at 2:45 in the afternoon. I quickly discovered that I had more physical energy in the mornings. I would try to prioritize my day to get the most important things done in the morning. If I had lessons that I needed to go over with the boys, it was best that I did it when I had the physical energy to work with them. This was not after my treatments in the afternoon.
If you have your treatment in the morning, your energy cycle might be different. Perhaps you get more physical energy in the evenings. I would encourage you to note the time of day that you feel like you have more energy. Then, plan the most important things when you might feel the best.
Radiation Therapy And Sun Exposure
During radiation treatment, its best to keep the treated area completely out of the sun. This can be especially difficult if youre having radiation therapy in areas or seasons with warmer weather. To help avoid sun exposure:
Wear clothing or a bathing suit with a high neckline, or wear a rash guard top.
Try to keep the area covered whenever you go outside. An oversized cotton shirt works well and allows air to circulate around the treated area.
Avoid chlorine, which is very drying and can make any skin reactions youre having worse. Chlorine is used to disinfect most pools and hot tubs.
If you do want to swim in a pool, you might want to spread petroleum jelly on the treated area to keep the chlorine away from your skin.
After your radiation treatment is completed, the treated skin may be more sensitive to the sun than it was in the past, so you might need to take extra protective steps when you go out in the sun:
Frequent Or Loose Poo
Your bowel movements might be looser or more frequent than before your treatment.
You might need to take anti diarrhoea medicines, such as loperamide . Bulking agents, such as Fybogel might also help. Your doctor or nurse can prescribe these for you, talk to your doctor before taking these.
You might find that you need to avoid high fibre foods. Although we normally think that a high fibre diet is the most healthy, it might make long term diarrhoea worse. Some people find it best to avoid high fibre vegetables, beans and pulses .
Let your doctor know if you have ongoing problems with frequent bowel movements or bleeding. They can refer you to a specialist team. The team includes cancer doctors, digestive system specialists, bowel surgeons, dietitians and specialist nurses.
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Day Of Your Simulation
What to expect
A member of your radiation therapy team will check you in. Youll be asked to state and spell your full name and birth date many times. This is for your safety and part of our standard identification process. Patients with the same or similar names may be having care on the same day as you.
Youll be greeted by your radiation therapist. Theyll take a photograph of your face. This picture will be used to identify you throughout your treatment.
Your therapist will then explain the simulation to you. If you havent already signed a consent form, your radiation oncologist will review everything with you, and ask for your signature.
During your simulation
For your simulation, you may need to get undressed and change into a gown. You should keep your shoes on. If you wear a head covering, such as a wig, turban, or cap, you may have to remove it. Your therapists will help you lie down on a table and make every effort to ensure your comfort and privacy.
Although the table will have a sheet on it, its hard and has no cushion. If you havent taken pain medication and think you may need it, tell your therapists before your simulation begins. Also, the room is usually cool. If you feel uncomfortable at any time, let your therapists know.
To help pass the time, your therapists can play music for you. You may bring a CD of your own from home, if you wish.
Figure 1. Mask for your radiation
Figure 2. Chin strap for your radiation
What Are Clinical Trials
Cancer specialists regularly conduct studies to test new treatments. These studies are called clinical trials. Clinical trials are available through cancer doctors everywhere- not just in major cities or in large hospitals.
Some clinical studies try to determine if a therapeutic approach is safe and potentially effective. Many large clinical trials compare the more commonly used treatment with a treatment that cancer experts think might be better. Patients who participate in clinical trials help doctors and future cancer patients find out whether a promising treatment is safe and effective. All patients who participate in clinical trials are carefully monitored to make sure they are getting quality care. It is important to remember that clinical trials are completely voluntary. Patients can leave a trial at any time. Clinical trials testing new treatments are carried out in phases:
Only you can make the decision about whether or not to participate in a clinical trial. Before making your decision, it is important to learn as much as possible about your cancer and the clinical trials that may be available to you. Your radiation oncologist can answer many of your questions if you are considering taking part in a trial or contact the National Cancer Institute at 1-800-4-CANCER or www.cancer.gov.
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Urinary And Bladder Changes
Radiation therapy to the pelvis can cause urinary and bladder problems by irritating the healthy cells of the bladder wall and urinary tract. These changes may start 35 weeks after radiation therapy begins. Most problems go away 28 weeks after treatment is over. You may experience:
- Burning or pain when you begin to urinate or after you urinate
- Trouble starting to urinate
- Bladder spasms, which are like painful muscle cramps
Ways to manage include:
- Drink lots of fluids. Aim for 68 cups of fluids each day, or enough that your urine is clear to light yellow in color.
- Avoid coffee, black tea, alcohol, spices and all tobacco products.
- Talk with your doctor or nurse if you think you have urinary or bladder problems. You may need to provide a urine sample to check for infection.
- Talk with your doctor or nurse if you have incontinence. He/she may refer you to a physical therapist to assess your problem. The therapist may recommend exercises to help you improve your bladder control.
- Your doctor may prescribe medications to help you urinate, reduce burning or pain, and ease bladder spasms.
How Is The Treatment Planned
Every course of radiation therapy is designed to suit the particular needs of the person receiving it, so you will usually be asked to make a preliminary visit to the treatment center to have your course of treatment planned. The radiation oncologist and radiation therapists will do this . Your skin will be marked with coloured pens to define where you will have your treatment. In addition, some minute permanent marks will be made using a special dye and a tiny pin prick.
These marks will enable the radiation therapists to identify exactly the right area at every treatment session. If a head shell has been made for you the guidance marks will be put on the shell rather than on your skin.
If you are having radiation therapy to your mouth and/or throat you will need a dental assessment at this stage as you may require some dental treatment before you start your radiation therapy.
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What Can I Do To Stop Or Lessen The Diarrhea
- Take a fiber supplement, such as Metamucil , Benefiber, or Citrucel. There are store brand versions of these products, which may cost less.
- Eat bland and easy-to-digest foods such as chicken, fish, eggs, puddings, mashed potatoes, noodles, rice, yogurt, cottage cheese, cream of wheat, farina, smooth peanut butter, white bread, bananas, applesauce, canned fruit, and well-cooked vegetables.
- Soluble fiber is a type of fiber found in some foods that soak up fluid and can help ease diarrhea. Foods high in soluble fiber are:
- Fruits: Applesauce, bananas , canned fruit, orange, and grapefruit.
- Vegetables: Boiled potatoes.
- Breads & pastas: White rice and products made with white flour.
- Cereals: Oatmeal, cream of rice, cream of wheat and farina.
Yogurt and Kefir may be helpful, but if you are lactose intolerant you should avoid dairy.
Are Side Effects The Same For Everyone
The side effects of radiation treatment vary from patient to patient. You may have no side effects or only a few mild ones through your course of treatment. Some people do experience serious side effects, however. The side effects that you are likely to have depend primarily on the radiation dose and the part of your body that is treated. Your general health also can affect how your body reacts to radiation therapy and whether you have side effects. Before beginning your treatment, your doctor and nurse will discuss the side effects you might experience, how long they might last, and how serious they might be.
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What Happens During External
What happens during your radiation therapy treatment depends on the kind of radiation therapy you receive. External-beam radiation therapy delivers radiation from a machine outside the body. It is the most common radiation therapy treatment for cancer.
Each session is generally quick, lasting about 15 minutes. Radiation does not hurt, sting, or burn when it enters the body. You will hear clicking or buzzing throughout the treatment and there may be a smell from the machine.
Typically, people have treatment sessions 5 times per week, Monday through Friday. This schedule usually continues for 3 to 9 weeks, depending on your personal treatment plan.
This type of radiation therapy only targets the tumor. But it will affect some healthy tissue surrounding the tumor. While most people feel no pain when each treatment is being delivered, effects of treatment slowly build up over time and may include discomfort, skin changes, or other side effects, depending on where in the body treatment is being delivered. The 2-day break in treatment each week allows your body some time to repair this damage. Some of the effects may not go away until after the treatment period is complete. Let your health care team know if you are experiencing any side effects so they can help relieve them. Read more about the side effects of radiation therapy.
Planning Your Radiotherapy Treatment
You will have a hospital appointment to plan your treatment. You will usually have a CT scan of the area to be treated. During the scan, you need to lie in the position that you will be in for your radiotherapy treatment.
Your radiotherapy team use information from this scan to plan:
- the dose of radiotherapy
- the area to be treated.
You may have some small, permanent markings made on your skin. The marks are about the size of a pinpoint. They help the radiographer make sure you are in the correct position for each session of radiotherapy.
These marks will only be made with your permission. If you are worried about them, talk to your radiographer.
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Side Effects Of Brachytherapy
Brachytherapy causes the same types of side effects that external beam radiation therapy does, such as erectile dysfunction.
In some instances, side effects to the bowels may be less severe than those caused by EBRT. Side effects that impact the bladder, however, may be more severe.
High-dose brachytherapy may cause temporary pain and swelling. It may also cause your urine to look red or brown for a short period of time.
Brachytherapy presents with some risks that external beam radiation therapy does not. If you have permanent brachytherapy, you may emit radiation to others for several weeks or months. Your doctor may advise you to stay away from pregnant people and small children during this time.
Occasionally, the seeds may migrate away from their original placement. For this reason, you may also be instructed to wear condoms during sexual activity, to protect your partner.
How Is Cancer Fatigue Diagnosed
Your healthcare provider will assess your symptoms. You may be asked to complete a questionnaire or rate your fatigue level. Your provider may ask you to keep a journal to track your level of fatigue and factors that might contribute to fatigue.
Blood tests can check for anemia, signs of infection or other problems that cause fatigue.
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What Happens During Internal Radiation Therapy
Internal radiation therapy is also called brachytherapy. This includes both temporary and permanent placement of radioactive sources at the site of the tumor.
Typically with this treatment approach, you will have repeated treatments across a number of days and weeks. These treatments may require a brief hospital stay. You may need anesthesia to block the awareness of pain while the radioactive sources are placed in the body. Most people feel little to no discomfort during this treatment. But some may experience weakness or nausea from the anesthesia.
You will need to take precautions to protect others from radiation exposure. Your radiation therapy team will provide these instructions. The need for such precautions ends when:
The permanent implant loses its radioactivity
The temporary implant is removed.
What Should I Avoid If I Have Diarrhea
- Avoid dried fruits, cruciferous vegetables , raw vegetables, whole grains, beans, and legumes.
- Avoid caffeine , alcohol, milk or milk products, chocolate, dried fruits, beans, or popcorn, as well as fatty, fried, greasy, or spicy foods.
- Avoid very hot and cold drinks.
- Avoid sugar free gum, candy, and foods that have sorbitol, mannitol, or xylitol.
If you are having problems with diarrhea after radiation, make sure to speak with your provider.
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How Does The Team Confirm Delivery Of The Correct Dose
The UC Davis team performs thorough quality assurance for every single plan and every single patient before treatment. For patients receiving Intensity Modulated Radiation Therapy , the team radiates a phantom with radiation detectors inside to confirm that the radiation dose delivered is correct. This procedure is done before the first treatment is delivered.
Cancer Fatigue Is Different From Fatigue That Healthy People Feel
When a healthy person is tired from day-to-day activities, their fatigue can be relieved with sleep and rest. Cancer fatigue is different. People with cancer get tired after less activity than people who do not have cancer. Also, cancer fatigue is not completely relieved by sleep and rest, interferes with daily activities, and may last for a long time. Fatigue usually decreases after cancer treatment ends, but some people may still feel fatigue for months or years.
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What Happens During My Consultation
At this time, you will have a physical examination by your radiation oncologist and a resident. All of your records, including x-rays and test results, will be reviewed. Please remember to bring what medical records you are hand-carrying as these are essential to your evaluation. Treatment options, including the risks, benefits and outcomes will be explained. Bringing a spouse, and /or family member or friend is strongly encouraged as they may help with questions or take notes. Please expect to be here several hours for this initial visit.