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Doctors and other health professionals you may see
Internal radiotherapy (brachytherapy)
How will I know if the treatment has worked?
Radiotherapy is the use of radiation to kill or injure cancer cells so they cannot keep growing. Radiotherapy is used both with the intention to cure cancers that have not spread beyond the place where they began (are localised) and to treat the symptoms of advanced cancer. Sometimes radiotherapy is the only treatment used; in other cases it is used in combination with surgery and/or chemotherapy. While radiation affects all cells in the area being treated, normal cells can usually recover from its effects better than cancer cells. Radiotherapy does not hurt. The radiation is not hot; in fact, you will not see or feel the rays at all (just as you do not see or feel anything when you have an ordinary x-ray).
Radiotherapy does not make you radioactive. An exception to this is brachytherapy, where the radiation implants temporarily send some radiation outside the body. (See the section on Brachytherapy for more information.)
The aim of radiotherapy may be:
Cure: Many cancers can be completely cured by radiotherapy on its own or combined with other treatments.
Temporary control: When it is not possible to cure a cancer, radiotherapy may be used to keep the cancer under control for some time by making it smaller or stopping it from spreading.
Symptom relief: Radiotherapy is often able to relieve distressing cancer symptoms such as pain or bleeding to help you to feel as well as possible.
Adjuvant therapy: When radiotherapy is used with another treatment, such as surgery, to improve the chances of cure, it is called adjuvant radiotherapy. Radiotherapy may be used before surgery (preoperative radiotherapy), or after surgery (postoperative radiotherapy) to destroy cancer cells that cannot be removed surgically. In some cases, radiotherapy is used with chemotherapy to treat the cancer. Different treatments may be done at different clinics or hospitals.
Doctors and other health professionals who care for people having radiotherapy include:
Radiotherapy can be given in two ways: from outside or inside the body. External radiotherapy is the most common method. With this technique, the radiation is directed from a machine to target the cancer and surrounding tissues where the cancer may have spread. In internal radiotherapy (brachytherapy), radioactive material in sealed applicators is put into your body, on or near the cancer. In some cases, a combination of both forms of radiotherapy is used.
Different machines may be used: some are better for treating cancers near the skin, others are better for cancers deeper in the body. The radiation oncologist will know which is the best machine to treat your cancer.
Different people need different numbers of radiotherapy treatments. Some people need only one or a few treatments, but it is more likely that you will need radiotherapy five days a week for several weeks: in some cases up to six or seven weeks. Occasionally, two treatments per day may be recommended.
The number of treatments you receive depends on many things, such as the type of cancer, its location, and whether it is intended to cure the cancer or to provide symptom relief and improve quality of life. In general, treatment aimed at curing cancer requires a larger number of treatments. It is very important that you attend for all your scheduled treatments to maximise the chance of cure. Tumours usually begin to shrink during a course of radiotherapy but may take some time after treatment to go away completely. You may not notice any benefit until a while after the treatment finishes.
Your treatment will depend on what sort of cancer you have, where it is and how large it is. It will also depend on your general health and any other cancer treatments you have had.
Your radiation oncologist will examine you and may request further x-rays and other tests to find out more about your cancer. They will then decide which part of your body to treat and how much radiation to use (that is, the dose of radiation you will have) and the number of treatments required.
Your treatment must be planned in detail, to ensure that enough radiation reaches the cancer but does as little damage as possible to the surrounding normal tissues and organs. One way of achieving this is to give small bursts of radiotherapy from a number of different angles, so that each time the radiation focuses on the cancer but passes through different parts of your body on the way. The radiation oncologist will plan the technique best suited to you.
An x-ray machine called a simulator is often used to pinpoint the area of the body to be treated. This is like having ordinary x-rays, although it may take a little longer.
You may have a planning CT scan, which identifies the cancer and normal tissues and helps your doctors plan your treatment. You will lie in exactly the same position as when you have your treatment.
To be sure that you can be put in exactly the same position for simulation and each treatment session, reference marks are used. These may be made on your skin or sometimes on lightweight masks that fit over your head and neck. Other support devices that are moulded to the shape of your body may be used. If marks are made on your skin, it is important that you don't wash off the ink until your full course of treatment is finished. If the ink fades, your radiation therapist will renew it. (It will gradually wear off after your treatment is finished.) Sometimes, small permanent black dots about the size of a pinhead may be recommended.
You will probably be asked to change into a hospital gown before you are taken into the treatment room. You will usually be in the treatment room for 15 to 20 minutes, although you will only be getting radiation for about two to five minutes of that time.
The radiation therapist will position you on the treatment table. If you have had a support device made, it will be used during your treatment. The therapist will spend time getting the machines in exactly the right place and checking all the required steps.
Special shields made of thick, lead-like metal may be placed in the radiation beam, to shield parts of your body that don't need to be treated. Some machines have built-in multi-leaf collimators (MLC) for the same reason.
Once everything is in place, the radiation therapist will go to a nearby room to turn on the machine. You will be alone in the room, but you can still talk with the radiation therapist through an intercom, and they will be watching you all the time on a television screen or through a window.
You should breathe normally during treatment but it is important that you stay very still while the machine is working. Most people may need treatment from several different angles, so the radiation therapist will need to move the machine before repeating the procedure. This is usually done from outside the room and it is important that you do not move while the machine is being rotated round the treatment table. The radiation therapist will tell you when it is okay to move.
You may hear the term ‘EPID'. This means ‘electronic portal imaging device'. This makes pictures of the radiation beam as it passes through your body, and helps to ensure your treatment goes as planned.
The machines used for radiotherapy are very large. They may also make noises like a vacuum cleaner as they move around you. They are always under the radiation therapist's control, and you will not see or feel the rays.
No. You will not see or hear the radiation during treatment and it does not cause any pain at the time. However, your body's reactions to treatment may be painful or otherwise distressing (see section on Side Effects.) Also, you may find that while lying on the treatment table you experience pain due to your cancer itself. If you feel ill or uncomfortable during the treatment, tell the radiation therapist and the treatment will be paused.
While you are having your course of treatments, your doctor and nurse will keep a watch over your progress, and provide medicines and other care to maintain your overall well-being. During longer treatment courses, you may need regular physical examinations, blood tests and possibly other tests.
No. External radiotherapy does not make you radioactive. It is quite safe for you to be with other people when you are having treatments and after.
Radiotherapy with implants is most commonly used to treat cancers of the cervix and prostate but may be used in other sites. This treatment is known as brachytherapy. Thin tubes, seeds or rods containing radioactive material are placed in your body temporarily. They are either placed directly into the cancer or close to it. In some cases the implant may be permanent.
Your doctor may recommend internal radiotherapy alone, or combined with external radiotherapy. The treatment you are offered will depend on the type of cancer you have, where it is, its size, your general health, test results and previous treatments.
You will have the implant put into your body while you are under anaesthetic. This may require admission to hospital or it may be a day procedure.
Implants come in different shapes and can contain different radioactive materials. The type of implant you have depends on the type of cancer you have. To get very close to the cancer, doctors use implants in the form of needles, wires, capsules and other devices. In some cases the doctor may use a special applicator to hold the implant against the surface of the cancer.
Implants can be temporary or permanent.
Temporary implants are often left in place from one to six days and you will need to stay in hospital for this time. In other cases, the implant may be used to deliver radiation quickly (over a few minutes) in several sessions.
Permanent implants are left in place once inserted. The main advantage is that this can usually be done in a single overnight visit to hospital. The implants remain in the body but are no longer radioactive after being in place for some weeks or months.
While your radioactive implant is in place, it will send some radiation outside your body into the surrounding area. For this reason, hospitals have special rules to protect others from receiving too much radiation. There will usually be limits on visitors while your implant is in place. Most hospitals do not allow children under 18 years or pregnant women to visit people with implants.
Once the implant is removed, all radioactivity is removed from you: that is, you are not radioactive and there is no danger to anyone else.
If you have a permanent implant, you may need to stay in an isolated room for the first few days, while the radiation is most active. The implant becomes less radioactive each day, so by the time you are ready to go home the radiation in your body will be very weak and it will be safe for others to be with you.
You might have some discomfort, but you should not have any severe pain or feel ill during implant therapy. If your implant is being held in place by an applicator, it may be uncomfortable, but your doctor can prescribe medicine to relax you and relieve any pain if necessary.
You may be sore or sensitive in the treated area for some time after your implant has been removed. In some cases, your doctor might advise that you limit physical and sexual activity for a while.
In the weeks and months following your course of treatment, you will talk with your doctor, be examined and may have some tests. The examination and tests will show if the cancer has gone away. If the cancer has gone away, it is great news; however it may be several years before it is considered to be cured. This is because sometimes cancer can come back (recur) at the same place or in another part of the body.
Where radiotherapy is given for symptom relief, the relief of symptoms will tell you if the treatment has worked.
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