Before Surgery Or Radiotherapy
The aim of chemotherapy before surgery is to shrink a tumour so that you need less surgery, or to make it easier to get all the cancer out. Shrinking the cancer with chemotherapy might also mean that you can have radiotherapy to a smaller area of your body.
Having chemotherapy before other treatments in this way is called neoadjuvant treatment. Sometimes doctors may call it primary treatment.
What Questions Should I Ask My Doctor
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.
Questions to ask before treatment
- 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 given? Will it be external beam or brachytherapy? What do the treatments feel like?
- 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?
- Can I participate in a clinical trial? If so, what is the trial testing? What are my benefits and risks?
- 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? How soon after radiation therapy can I start them?
- How should I prepare for this financially?
- What are some of the support groups I can turn to during treatment?
- If I have questions after I leave here, who can I call?
- Will radiation therapy affect my ability to have children?
- Do you take my insurance?
Questions to ask during Treatment
Questions to ask After Treatment Ends
What The Research Shows About Radiation Vs Surgery
The ProtecT trial was a 10-year, randomized clinical study designed to compare radical prostatectomy, external-beam radiotherapy and active surveillance for the treatment of localized prostate cancer.
The results, published in 2016, showed that the rate of disease progression among men assigned to radiotherapy or radical prostatectomy was less than half the rate among men assigned to active monitoring. However, there was no significant difference in survival at the median 10-year follow-up for radiation therapy, surgery or active surveillance.
If youre interested in directly comparing treatment outcomes by treatment method and risk group , the Prostate Cancer Free Foundation provides an interactive graph on its website with information from data obtained from over 129,000 prostate cancer patients over a 15-year period.
As discussed earlier in the sections on the side effects of radiation therapy and surgery, the researchers conducting the ProtecT trial also looked at side effects and quality-of-life issues and found that the three major side effects of these two treatment options that affect quality of life after prostate cancer treatment are urinary incontinence, sexual dysfunction and bowel health.
The trial found that urinary leakage and erectile dysfunction were more common after surgery than after radiation therapy. Gastrointestinal bowel problems were more common after radiation therapy.
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What Is Radiation Therapy
Radiation therapy is a cancer treatment that uses high-energy waves to damage or destroy cancer cells.
The waves stop cancer cells from growing and making more cancer cells by affecting the DNA inside of them. However, it can sometimes damage noncancerous cells.
Radiation therapy targets an affected area with high-energy waves, often the location of a tumor or the place where a tumor was removed during surgery to destroy any remaining cancer cells.
This type of treatment is sometimes ideal because it allows doctors to only affect specific parts of your body, unlike other cancer treatments like chemotherapy that can affect cells in your entire body.
You see lower doses of radiation used in other parts of medicine like X-rays.
According to the
- the proximity of cancer to other tissues sensitive to radiation
- your overall health and well-being
- whether youll need other cancer treatment
Benefits And Risks Of Chemotherapy
Chemotherapy is an essential treatment option for many cancers. The drugs used in chemotherapy are often given so that they can reach and kill cancer cells system-wide, outside of the primary tumor your doctor may have discovered.
When cancer spreads, it can be challenging to treat. So chemotherapy is an important treatment option to help kill cancer cells that may have escaped the primary tumor and spread to other parts of the body but are too small to see these are called micrometastases.
Chemotherapy can also help treat any tumor pieces or cells left over after other treatment approaches, like surgery or radiation therapy.
But because the drugs used in chemotherapy can be nonspecific to cancers and impact other healthy tissues of the body, they cause some side effects. These side effects are typically limited to when youre actively being treated with chemotherapy and will rapidly improve after treatment is discontinued.
Youll also likely feel exhausted by the treatments and need to take time off work the day of and the day after your treatments.
Chemotherapy is often given in cycles. For example, you may receive one week of treatment and then have a few weeks off to allow your body to heal before the next treatment.
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Can You Live A Normal Life After Chemo
When treatment ends, you may expect life to return to the way it was before you were diagnosed with cancer. But it can take time to recover. You may have permanent scars on your body, or you may not be able to do some things you once did easily. Or you may even have emotional scars from going through so much.
Why Chemotherapy Might Not Be Suitable For You
Some cancers are very sensitive to chemotherapy. So it can work very well for them.
But some types of cancer don’t tend to respond well to chemotherapy. In that case, your doctor isn’t likely to suggest it as a treatment for you.
Chemotherapy can be a difficult treatment to have, and you need to be well enough to have it. Some people worry they may be too old to have chemotherapy.
No one is automatically too old. But older people may have other health issues that make them more likely to get severe or long term side effects.
Some treatments can put a strain on organs such as the heart. Doctors make sure you are fit enough by checking your heart, lungs, kidneys and liver before starting treatment.
They look at the benefits and risks of any treatment when deciding your treatment plan, and will discuss this with you.
Cancer and its Management
J Tobias and D Hochhauser
Wiley Blackwell, 2015
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Is Proton Therapy Safer Than Traditional Radiation
Traditional radiation therapy delivers radiation to the tumor and to healthy tissues around the tumor. With proton therapy , the majority of the radiation is delivered to the tumor.
A type of radiation treatment called proton beam radiation therapy may be safer and just as effective as traditional radiation therapy for adults with advanced cancer. That finding comes from a study that used existing patient data to compare the two types of radiation.
Traditional radiation delivers x-rays, or beams of photons, to the tumor and beyond it. This can damage nearby healthy tissues and can cause significant side effects.
Plus, proton therapy is more expensive than traditional radiation, and not all insurance companies cover the cost of the treatment, given the limited evidence of its benefits. Nevertheless, 31 hospitals across the country have spent millions of dollars building proton therapy centers, and many advertise the potential, but unproven, advantages of the treatment.
In the new study, patients treated with proton therapy were much less likely to experience severe side effects than patients treated with traditional radiation therapy. There was no difference in how long the patients lived, however. The results were published December 26 in JAMA Oncology.
These results support the whole rationale for proton therapy, said the studys lead investigator, Brian Baumann, M.D., of the Washington University School of Medicine in St. Louis and the University of Pennsylvania.
What Are Additional Treatment Options
Systemic Radiation Therapy
Certain cancers may be treated by swallowing radioactive pills or receiving radioactive fluids in the vein . This type of treatment is called systemic radiation therapy because the medicine goes to the entire body. For example, radioactive iodine capsules are given to treat some types of thyroid cancer. Another example is the use of intravenous radioactive material to treat pain due to cancer that has spread to the bone. 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.
Cancer doctors now know much more about how cancer cells function. New cancer therapies use this information to target cancer cell functions and stop them. Called targeted therapies, they can be more specific in stopping cancer cells from growing and may make other treatments work better. For example, some medicines work to prevent cancers from growing by preventing the growth of new blood vessels that would nourish the cancer. Other targeted therapies work more directly on cancer cells by blocking the action of molecules on the surface of cancer cells called growth factors.
Some medicines called radioprotectors can help protect healthy tissue from the effects of radiation.
Intraoperative Radiation Therapy
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Side Effects Of Radiation For Prostate Cancer
The primary potential side effects of radiation treatment for prostate cancer include bowel problems, urinary problems and sexual function issues.
According to patient-reported outcomes measuring quality of life from men who participated in the 10-year, randomized Prostate Testing for Cancer and Treatment trial, men who were treated with radiation reported little increase in urinary leakage after radiation therapy. They also reported less sexual dysfunction when compared to men who were treated with surgery. However, men treated with radiation reported a higher incidence of bowel problems, such as loose and bloody stools. These side effects are often short-term for most patients, but some experience long-term side effects.
Side Effects Of Radiotherapy
As well as killing cancer cells, radiotherapy can damage some healthy cells in the area being treated.
This can cause some side effects, such as:
- sore skin that might change colour to red, lighter or darker than your usual skin tone
- hair loss in the area being treated
Many of these side effects can be treated or prevented and most will go away after treatment stops.
External radiotherapy does not make you radioactive, as the radiation passes through your body.
The radiation from implants or injections can stay in your body for a few days, so you may need to stay in hospital and avoid close contact with other people for a few days as a precaution.
Read more about the side effects of radiotherapy.
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Managing The Side Effects Of Cancer Treatment
Many of the side effects of cancer treatment can be effectively managed or lessened. Palliative care is an important part of any cancer treatment plan.
Suffering through debilitating or distressing side effects of your treatments doesnt make your battle against cancer more heroic. Nor does it mean that your chemotherapy will work better.
Tell your doctor about the side effects youre experiencing and get holistic help from your care team to ensure your treatment goes as smoothly as possible. Your doctor may be able to tweak your cycle schedule or dosage of radiation or chemotherapy to help improve your side effects.
If youre worried about taking time off work, make sure to talk to your employer. Many employers are legally required to give time off work or adjust your workload or schedule while youre undergoing cancer treatment. A social worker on your care team can help you navigate this sometimes tricky situation.
To Treat Cancer That Has Returned
If a person’s cancer has returned , radiation might be used to treat the cancer or to treat symptoms caused by advanced cancer. Whether radiation will be used after recurrence depends on many factors. For instance, if the cancer has come back in a part of the body that has already been treated with radiation, it might not be possible to give more radiation in the same place. It depends on the amount of radiation that was used before. In other instances, radiation might be used in the same area of the body or a different area. Some tumors do not respond as well to radiation, so radiation might not be used even if they recur.
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Is Chemo Worse Than Radiation
In terms of side effects, radiation therapy differs from chemotherapy in that it only induces side effects in the region being treated and has a higher risk for both early and late adverse effects. Radiation therapy is usually administered over several weeks to months while chemotherapy can be used to treat cancer at any stage of development and can cause side effects even after treatment has ended.
Chemotherapy causes its effect by killing cells that divide rapidly, such as cancer cells. It does this by removing essential proteins from cells or by blocking their ability to divide. Cancer cells cannot reproduce themselves nor can they produce the hormones or other substances that help normal cells reproduce themselves. So over time they stop producing these proteins and hormones and instead start making chemicals to signal nearby healthy cells to grow and reproduce themselves. These signals are called growth factors. Chemotherapy removes these growth factors from the surrounding tissue allowing this new tissue to mature into healthy bone and muscle.
Cancer patients often worry about the long-term health effects of chemotherapy and radiotherapy. However, most people who receive these treatments appear to recover fully after going through multiple cycles of therapy. Some evidence suggests that radiation may increase the risk of developing certain types of cancer later in life but this remains controversial.
What Is Brachytherapy
Also known as internal radiation, brachytherapy involves placing radioactive material into a tumor or its surrounding tissue. Because the radiation sources are placed so close to the tumor, your radiation oncologist can deliver a large dose of radiation directly to the cancer cells. The radioactive sources used in brachytherapy, such as thin wires, ribbons, capsules or seeds, come in small sealed containers. These sources may be implanted permanently or temporarily. A permanent implant remains in the body after the sources are no longer radioactive. Other radioactive sources are placed temporarily inside the body and are removed after the right amount of radiation has been delivered.
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How Do They Work
Chemotherapy uses medicines that travel through the blood, going throughout your body. It is called a systemic therapy because it can kill cells throughout your body, not just in one area of the body. Chemotherapy targets cells that grow and divide quickly. Cancer cells grow more rapidly than many healthy cells. Because of this, chemotherapy has a greater effect on cancer cells. However, the medicines are powerful and can damage healthy cells too. Chemotherapy is delivered as an infusion into a vein through an IV needle or port, by mouth in a pill or in an injection, like a shot would be given.
Radiation therapy uses high-energy beams instead of medicines. Radiation is a local treatment. This means that, unlike chemotherapy, it treats a specific area of the body where the cancer is located. Radiation therapy is delivered using a machine that produces high-energy beams directed at the tumor or internally with radioactive material placed inside your body, close to the tumor.
How Does It Work
Cancer occurs when one cell begins to divide and replicate uncontrollably. These rapidly dividing cells form tumors in the body.
Traditional chemotherapy travels through the bloodstream and destroys all rapidly dividing cells, healthy and unhealthy. Newer agents, sometimes called targeted therapies, can attack specific molecules that cancer cells use to grow and divide.
Some cancers require several chemo medications to fight cancer more effectively and prevent the disease from returning.
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How Prostate Cancer Staging And Risk Group Affect Treatment Options
Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.
Prostate cancer staging
Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.
Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.
- Localized: Theres no indication that the cancer has spread beyond the prostate.
- Regional: Theres evidence of cancer cells in nearby lymph nodes or tissue.
- Distant: Theres evidence the cancer has spread to other organs or body parts farther from the prostate.
Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.
Prostate cancer risk assessment
Treatment guidelines for prostate cancer
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