Radiation Therapy and You: Support for People With Cancer by National Cancer Institute. - HTML preview

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Support for People With Cancer

Radiation Therapy

and You

National Cancer Institute

U.S. DEPARTMENT

OF HEALTH AND

HUMAN SERVICES

National Institutes

of Health

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For More Information

This booklet is only one of many free booklets for people with cancer.

Here are some others you may find useful:

Biological Therapy

Chemotherapy and You: Support for People With Cancer

Eating Hints: Before, During, and After Cancer Treatment

Taking Part in Cancer Treatment Research Studies

Thinking About Complementary & Alternative Medicine: A Guide for People With Cancer

Pain Control: Support for People With Cancer

When Cancer Returns

Taking Time: Support for People With Cancer

These booklets are available from the National Cancer Institute (often called NCI). NCI is a federal agency that is part of the National Institutes of Health. Call 1-800-4-CANCER (1-800-422-6237) or visit www.cancer.gov. (See page 59 for more information.)

*For information about your specific type of cancer, see the PDQ®

database. PDQ® is NCI’s complete cancer database. You can find it at www.cancer.gov.

Product or brand names that appear in this book are for example only. The U.S.

Government does not endorse any specific product or brand. If products or brands are not mentioned, it does not mean or imply that they are not satisfactory.

1-800-4-CANCER (1-800-422-6237)

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About This Book

Rather than

Radiation Therapy and You is written for you—someone who is about read this book

to get or is now getting radiation therapy for cancer. People who are close to you may also find this book helpful.

from beginning

This book is a guide that you can refer to throughout radiation therapy.

to end—

It has facts about radiation therapy and side effects and describes how look at only

you can care for yourself during and after treatment.

those sections

you need now.

This book covers:

Later, you

Questions and Answers About Radiation Therapy. Answers to common questions, such as what radiation therapy is and how it can always

affects cancer cel s.

read more.

External Beam and Internal Radiation. Information about the two types of radiation therapy.

Your Feelings During Radiation Therapy. Information about feelings, such as depression and anxiety, and ways to cope with them.

Side Effects and Ways To Manage Them. A chart that shows problems that may happen as a result of treatment and ways you can help manage them.

Questions To Ask. Questions for you to think about and discuss with your doctor, nurse, and others involved in your treatment and care.

Lists of Foods and Liquids. Foods and drinks you can have during radiation therapy.

Words To Know. A dictionary that clearly explains medical terms used in this book.

These terms are in bold print the first time they appear.

Ways To Learn More. Places to go for more information—in print, online (Internet), and by telephone.

Talk with your doctor and nurse about the information in this book. They may suggest that you read certain sections or follow some of the tips. Since radiation therapy affects people in different ways, they may also tell you that some of the information in this book is not right for you.

www.cancer.gov

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Table of Contents

Rather than

Questions and Answers About Radiation Therapy...................... 1

read this book

External Beam Radiation Therapy .................................................... 9

from beginning

to end—

Internal Radiation Therapy .............................................................. 15

look at only

Your Feelings During Radiation Therapy ...................................... 19

those sections

Radiation Therapy Side Effects ........................................................ 21

you need now.

Radiation Therapy Side Effects At-A-Glance.........................................23

Later, you

Radiation Therapy Side Effects and Ways to Manage Them ...............24

can always

Diarrhea ..............................................................................................24

read more.

Fatigue .................................................................................................26

Hair Loss .............................................................................................28

Mouth Changes ..................................................................................30

Nausea and Vomiting ........................................................................34

Sexual and Fertility Changes ............................................................36

Skin Changes ......................................................................................40

Throat Changes ..................................................................................43

Urinary and Bladder Changes .........................................................45

Late Radiation Therapy Side Effects .......................................................47

Questions To Ask Your Doctor or Nurse ...................................... 51

Lists of Foods and Liquids ................................................................. 53

Clear Liquids ..............................................................................................53

Foods and Drinks That Are High in Calories or Protein .....................54

Foods and Drinks That Are Easy on the Stomach ................................55

Words To Know ................................................................................... 56

Resources for Learning More ........................................................... 59

www.cancer.gov

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Questions and Answers About Radiation Therapy

What is radiation

Radiation therapy (also called radiotherapy) is a cancer therapy?

treatment that uses high doses of radiation to kill cancer cel s and stop them from spreading. At low doses, radiation is used as an x-ray to see inside your body and take pictures, such as x-rays of your teeth or broken bones. Radiation used in cancer treatment works in much the same way, except that it is given at higher doses.

How is radiation

Radiation therapy can be external beam (when a machine

therapy given?

outside your body aims radiation at cancer cel s) or internal (when radiation is put inside your body, in or near the cancer cel s). Sometimes people get both forms of radiation therapy.

To learn more about external beam radiation therapy, see page 9.

To learn more about internal radiation therapy, see page 15.

Who gets

Many people with cancer need radiation therapy. In fact, more radiation therapy?

than half (about 60 percent) of people with cancer get radiation therapy. Sometimes, radiation therapy is the only kind of

cancer treatment people need.

What does

Given in high doses, radiation kil s or slows the growth of

radiation therapy

cancer cel s. Radiation therapy is used to:

do to cancer cells?

Treat cancer. Radiation can be used to cure, stop, or slow the growth of cancer.

Reduce symptoms. When a cure is not possible, radiation may be used to shrink cancer tumors in order to reduce

pressure. Radiation therapy used in this way can treat

problems such as pain, or it can prevent problems such as

blindness or loss of bowel and bladder control.

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How long does

Radiation therapy does not kill cancer cel s right away. It takes radiation therapy

days or weeks of treatment before cancer cel s start to die. Then, take to work?

cancer cel s keep dying for weeks or months after radiation

therapy ends.

What does

Radiation not only kil s or slows the growth of cancer cel s, it radiation therapy do

can also affect nearby healthy cel s. The healthy cel s almost to healthy cells?

always recover after treatment is over. But sometimes people

may have side effects that do not get better or are severe.

Doctors try to protect healthy cel s during treatment by:

Using as low a dose of radiation as possible. The

radiation dose is balanced between being high enough to kil

cancer cel s yet low enough to limit damage to healthy cel s.

Spreading out treatment over time. You may get

radiation therapy once a day for several weeks or in smaller

doses twice a day. Spreading out the radiation dose allows

normal cel s to recover while cancer cel s die.

Aiming radiation at a precise part of your body.

New techniques, such as IMRT and 3-D conformal

radiation therapy, allow your doctor to aim higher doses of radiation at your cancer while reducing the radiation to

nearby healthy tissue.

Using medicines. Some drugs can help protect certain parts of your body, such as the salivary glands that make

saliva (spit).

Does radiation

No, radiation therapy does not hurt while it is being given. But therapy hurt?

the side effects that people may get from radiation therapy can cause pain or discomfort. This book has a lot of information

about ways that you, your doctor, and your nurse can help

manage side effects.

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Is radiation therapy

Yes, radiation therapy is often used with other cancer

used with other types treatments. Here are some examples: of cancer treatment?

Radiation therapy and surgery. Radiation may be

given before, during, or after surgery. Doctors may use

radiation to shrink the size of the cancer before surgery, or

they may use radiation after surgery to kill any cancer cel s

that remain. Sometimes, radiation therapy is given during

surgery so that it goes straight to the cancer without passing through the skin. This is called intraoperative radiation.

Radiation therapy and chemotherapy. Radiation may

be given before, during, or after chemotherapy. Before or

during chemotherapy, radiation therapy can shrink the

cancer so that chemotherapy works better. Sometimes,

chemotherapy is given to help radiation therapy work

better. After chemotherapy, radiation therapy can be used

to kill any cancer cel s that remain.

Who is on my

Many people help with your radiation treatment and care. This radiation therapy

group of health care providers is often called the “radiation

team?

therapy team.” They work together to provide care that is just right for you. Your radiation therapy team can include:

Radiation oncologist. This is a doctor who specializes in using radiation therapy to treat cancer. He or she

prescribes how much radiation you will receive, plans how

your treatment will be given, closely follows you during

your course of treatment, and prescribes care you may

need to help with side effects. He or she works closely with

the other doctors, nurses, and health care providers on

your team. After you are finished with radiation therapy,

your radiation oncologist will see you for follow-up visits.

During these visits, this doctor will check for late side

effects and assess how well the radiation has worked.

Nurse practitioner. This is a nurse with advanced

training. He or she can take your medical history, do

physical exams, order tests, manage side effects, and closely

watch your response to treatment. After you are finished

with radiation therapy, your nurse practitioner may see you

for follow-up visits to check for late side effects and assess how well the radiation has worked.

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Radiation nurse. This person provides nursing care during You are

radiation therapy, working with all the members of your

the most

radiation therapy team. He or she will talk with you about

your radiation treatment and help you manage side effects.

important part

of the radiation

Radiation therapist. This person works with you during therapy team.

each radiation therapy session. He or she positions you for

treatment and runs the machines to make sure you get the

dose of radiation prescribed by your radiation oncologist.

Other health care providers. Your team may also include a dietitian, physical therapist, social worker, and others.

You. You are also part of the radiation therapy team.

Your role is to:

• Arrive on time for all radiation therapy sessions

• Ask questions and talk about your concerns

• Let someone on your radiation therapy team know

when you have side effects

• Tell your doctor or nurse if you are in pain

• Follow the advice of your doctors and nurses about how

to care for yourself at home, such as:

- Taking care of your skin

- Drinking liquids

- Eating foods that they suggest

- Keeping your weight the same

Be sure to arrive on time for ALL

radiation therapy sessions.

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Is radiation therapy

Yes, radiation therapy costs a lot of money. It uses complex

expensive?

machines and involves the services of many health care

providers. The exact cost of your radiation therapy depends on the cost of health care where you live, what kind of radiation therapy you get, and how many treatments you need.

Talk with your health insurance company about what services

it will pay for. Most insurance plans pay for radiation therapy for their members. To learn more, talk with the business office where you get treatment. You can also contact the National

Cancer Institute’s Cancer Information Service and ask for the

“Financial Assistance for Cancer Care” fact sheet. See page 59

for ways to contact the National Cancer Institute.

Should I follow

Your body uses a lot of energy to heal during radiation therapy.

a special diet

It is important that you eat enough calories and protein to keep while I am getting

your weight the same during this time. Ask your doctor or

radiation therapy?

nurse if you need a special diet while you are getting radiation therapy. You might also find it helpful to speak with a dietitian.

To learn more about foods and drinks that are high in calories or protein, see the chart on page 54. You may also want to read Eating Hints, a book from the National Cancer Institute.

You can order a free copy online at http://www.cancer.gov/

publications or 1-800-4-CANCER.

Ask your doctor, nurse,

or dietitian if you need a

special diet while you are

getting radiation therapy.

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Can I go to work

Some people are able to work full-time during radiation

during radiation

therapy. Others can only work part-time or not at al . How

therapy?

much you are able to work depends on how you feel. Ask your

doctor or nurse what you may expect based on the treatment

you are getting.

You are likely to feel well enough to work when you start

radiation therapy. As time goes on, do not be surprised if

you are more tired, have less energy, or feel weak. Once you

have finished your treatment, it may take a few weeks or many

months for you to feel better.

You may get to a point during your radiation therapy when

you feel too sick to work. Talk with your employer to find

out if you can go on medical leave. Make sure that your health insurance will pay for treatment when you are on

medical leave.

What happens

Once you have finished radiation therapy, you will need

when radiation

follow-up care for the rest of your life. Follow-up care refers to therapy is over?

checkups with your radiation oncologist or nurse practitioner

after your course of radiation therapy is over. During these

checkups, your doctor or nurse will see how well the radiation therapy worked, check for other signs of cancer, look for late side effects, and talk with you about your treatment and care.

Your doctor or nurse will:

Examine you and review how you have been feeling.

Your doctor or nurse practitioner can prescribe medicine or

suggest other ways to treat any side effects you may have.

Order lab and imaging tests. These may include blood tests, x-rays, or CT, MRI, or PET scans.

Discuss treatment. Your doctor or nurse practitioner may suggest that you have more treatment, such as extra

radiation treatments, chemotherapy, or both.

Answer your questions and respond to your concerns.

It may be helpful to write down your questions ahead

of time and bring them with you. You can find sample

questions on pages 51 and 52.

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After radiation

You have gone through a lot with cancer and radiation therapy.

therapy is over,

Now you may be even more aware of your body and how you

what symptoms

feel each day. Pay attention to changes in your body and let

should I look for?

your doctor or nurse know if you have:

■ A pain that does not go away

■ New lumps, bumps, swellings, rashes, bruises, or bleeding

■ Appetite changes, nausea, vomiting, diarrhea, or constipation

■ Weight loss that you cannot explain

■ A fever, cough, or hoarseness that does not go away

■ Any other symptoms that worry you

See “Resources for Learning More” on page 59 for ways to learn more about radiation therapy.

Make a list of questions and problems

you want to discuss with your doctor

or nurse. Be sure to bring this list

to your follow-up visits. See pages

51 and 52 for sample questions.

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External Beam Radiation Therapy

What is external beam External beam radiation therapy comes from a machine that radiation therapy?

aims radiation at your cancer. The machine is large and may be noisy. It does not touch you, but rotates around you, sending radiation to your body from many directions.

External beam radiation therapy is a local treatment, meaning that the radiation is aimed only at a specific part of your body.

For example, if you have lung cancer, you will get radiation to your chest only and not the rest of your body.

External beam radiation therapy comes from a machine that aims radiation at your cancer.

How often will I

Most people get external beam radiation therapy once a day,

get external beam

5 days a week, Monday through Friday. Treatment lasts for

radiation therapy?

2 to 10 weeks, depending on the type of cancer you have and

the goal of your treatment. The time between your first and last radiation therapy sessions is called a course of treatment.

Radiation is sometimes given in smaller doses twice a day

(hyperfractionated radiation therapy). Your doctor may prescribe this type of treatment if he or she feels that it will work better. Although side effects may be more severe, there

may be fewer late side effects. Doctors are doing research to see which types of cancer are best treated this way.

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Where do I go for

Most of the time, you will get external beam radiation therapy external beam

as an outpatient. This means that you will have treatment at a radiation therapy?

clinic or radiation therapy center and will not have to stay in the hospital.

What happens

You will have a 1- to 2-hour meeting with your doctor or nurse before my first

before you begin radiation therapy. At this time, you will have a external beam

physical exam, talk about your medical history, and maybe have radiation treatment?

imaging tests. Your doctor or nurse will discuss external beam radiation therapy, its benefits and side effects, and ways you can care for yourself during and after treatment. You can then choose whether to have external beam radiation therapy.

If you agree to have external beam radiation therapy, you will be scheduled for a treatment planning session called a simulation.

At this time:

■ A radiation oncologist and radiation therapist will define

your treatment area (also called a treatment port or

treatment field). This refers to the places in your body that will get radiation. You will be asked to lie very still while x-rays or scans are taken to define the treatment area.

■ The radiation therapist will then put small marks (tattoos

or dots of colored ink) on your skin to mark the treatment

area. You will need these marks throughout the course of

radiation therapy. The radiation therapist will use them

each day to make sure you are in the correct position.

Tattoos are about the size of a freckle and will remain on

your skin for the rest of your life. Ink markings will fade

over time. Be careful not to remove them and make sure to

tell the radiation therapist if they fade or lose color.

Tell your radiation therapist if your

ink marks begin to fade or lose color.

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■ You may need a body mold. This is a plastic or plaster form that helps keep you from moving during treatment. It also

helps make sure that you are in the exact same position each

day of treatment.

■ If you are getting radiation to the head, you may need a

mask. The mask has air holes, and holes can be cut for your

If you are getting radiation to

eyes, nose, and mouth. It attaches to the table where you

the head, you may need a mask.

will lie to receive your treatments. The mask helps keep

your head from moving so that you are in the exact same

position for each treatment.

If the body mold or mask makes you feel anxious, see page 13

for ways to relax during treatment.

What should I

Wear clothes that are comfortable and made of soft fabric,

wear when I get

such as cotton. Choose clothes that are easy to take off, since external beam

you may need to change into a hospital gown or show the area

radiation therapy?

that is being treated. Do not wear clothes that are tight, such as close-fitting col ars or waistbands, near your treatment

area. Also, do not wear jewelry, BAND-AIDS®, powder, lotion,

or deodorant in or near your treatment area, and do not use

deodorant soap before your treatment.

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What happens during ■ You may be asked to change into a hospital gown or robe.

treatment sessions?

■ You will go to a treatment room where you will receive

radiation.

■ Depending on where your cancer is, you will either sit in

a chair or lie down on a treatment table. The radiation

therapist will use your body mold and skin marks to help

you get into position.

■ You may see colored lights pointed at your skin marks.

These lights are harmless and help the therapist position

you for treatment each day.

■ You will need to stay very still so the radiation goes to the exact same place each time. You can breathe as you always

do and do not have to hold your breath.

The radiation therapist will leave the room just before your

treatment begins. He or she will go to a nearby room to

control the radiation machine and watch you on a TV screen

or through a window. You are not alone, even though it may

feel that way. The radiation therapist can see you on the screen or through the window. He or she can hear and talk with you

through a speaker in your treatment room. Make sure to tell

the therapist if you feel sick or are uncomfortable. He or she can stop the radiation machine at any time. You cannot feel,

hear, see, or smell radiation.

Your entire visit may last from 30 minutes to 1 hour. Most of that time is spent setting you in the correct position. You will get radiation for only 1 to 5 minutes. If you are getting IMRT, your treatment may last longer. Your visit may also take longer if your treatment team needs to take and review x-rays.

Your radiation therapist can see, hear, and

talk with you at all times while you are

getting external beam radiation therapy.

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Will external beam

No, external beam radiation therapy does not make people

radiation therapy

radioactive. You may safely be around other people, even

make me radioactive? babies and young children.

How can I relax

■ Bring something to read or do while in the waiting room.

during my treatment

sessions?

■ Ask if you can listen to music or books on tape.

■ Meditate, breathe deeply, use imagery, or find other ways

to relax. To learn more about ways to relax, see Facing

Forward: Life After Cancer Treatment, a book from the National Cancer Institute. You can order a free copy at

http://www.cancer.gov/publications or 1-800-4-CANCER.

For ways to learn more about external beam radiation therapy,

see the Resources for Learning More on page 59.

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Internal Radiation Therapy

What is internal

Internal radiation therapy is a form of treatment where a source radiation therapy?

of radiation is put inside your body. One form of internal

radiation therapy is called brachytherapy. In brachytherapy, the radiation source is a solid in the form of seeds, ribbons, or capsules, which are placed in your body in or near the cancer

cel s. This allows treatment with a high dose of radiation to a smaller part of your body. Internal radiation can also be in a liquid form. You receive liquid radiation by drinking it, by swallowing a pil , or through an IV. Liquid radiation travels throughout your body, seeking out and killing cancer cel s.

Brachytherapy may be used with people who have cancers of

the head, neck, breast, uterus, cervix, prostate, gall bladder, esophagus, eye, and lung. Liquid forms of internal radiation

are most often used with people who have thyroid cancer or

non-Hodgkin’s lymphoma. You may also get internal radiation

along with other types of treatment, including external beam

radiation, chemotherapy, or surgery.

What happens

You will have a 1- to 2-hour meeting with your doctor or nurse before my first internal before you begin internal radiation therapy. At this time, you radiation treatment?

will have a physical exam, talk about your medical history, and maybe have imaging tests. Your doctor will discuss the type

of internal radiation therapy that is best for you, its benefits and side effects, and ways you can care for yourself during and after treatment. You can then choose whether to have internal radiation therapy.

How is

Most brachytherapy is put in place through a catheter, which brachytherapy

is a smal , stretchy tube. Sometimes, it is put in place through put in place?

a larger device called an applicator. When you decide to have brachytherapy, your doctor will place the catheter or applicator into the part of your body that will be treated.

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What happens when

You will most likely be in the hospital when your catheter or

the catheter or

applicator is put in place. Here is what to expect:

applicator is

put in place?

■ You will either be put to sleep or the area where the catheter or applicator goes will be numbed. This will help prevent

pain when it is put in.

■ Your doctor will place the catheter or applicator in your body.

■ If you are awake, you may be asked to lie very still while

the catheter or applicator is put in place. If you feel any

discomfort, tell your doctor or nurse so he or she can give

you medicine to help manage the pain.

Tell your doctor or nurse if you are in pain.

What happens

Once your treatment plan is complete, radiation will be placed after the catheter or

inside the catheter or applicator. The radiation source may be applicator is placed

kept in place for a few minutes, many days, or the rest of your in my body?

life. How long the radiation is in place depends on which type of brachytherapy you get, your type of cancer, where the cancer is in your body, your health, and other cancer treatments you have had.

What are the types

There are three types of brachytherapy:

of brachytherapy?

Low-dose rate (LDR) implants. In this type of brachytherapy, radiation stays in place for 1 to 7 days. You are likely to be in the hospital during this time. Once your treatment is finished, your doctor will remove the radiation sources and your catheter or applicator.

High-dose rate (HDR) implants. In this type of

brachytherapy, the radiation source is in place for 10 to

20 minutes at a time and then taken out. You may have

treatment twice a day for 2 to 5 days or once a week for

2 to 5 weeks. The schedule depends on your type of cancer.

During the course of treatment, your catheter or applicator

may stay in place, or it may be put in place before each

treatment. You may be in the hospital during this time,

or you may make daily trips to the hospital to have the

radiation source put in place. Like LDR implants, your

doctor will remove your catheter or applicator once you

have finished treatment.

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Permanent implants. After the radiation source is put in place, the catheter is removed. The implants always stay in

your body, while the radiation gets weaker each day. You

may need to limit your time around other people when

the radiation is first put in place. Be extra careful not to

spend time with children or pregnant women. As time goes

by, almost all the radiation will go away, even though the

implant stays in your body.

What happens

■ Your body will give off radiation once the radiation source is while the radiation

in place. With brachytherapy, your body fluids (urine, sweat, is in place?

and saliva) will not give off radiation. With liquid radiation, your body fluids will give off radiation for a while.

■ Your doctor or nurse will talk with you about safety

measures that you need to take.

■ If the radiation you receive is a very high dose, safety

measures may include:

• Staying in a private hospital room to protect others from

radiation coming from your body

• Being treated quickly by nurses and other hospital staff.

They will provide all the care you need, but they may

stand at a distance and talk with you from the doorway

to your room.

■ Your visitors will also need to follow safety measures, which may include:

• Not being allowed to visit when the radiation is first

put in

• Needing to check with the hospital staff before they go

to your room

• Keeping visits short (30 minutes or less each day). The

length of visits depends on the type of radiation being

used and the part of your body being treated.

• Standing by the doorway rather than going into your

hospital room

• Not having visits from children younger than 18 and

pregnant women

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You may also need to follow safety measures once you leave

the hospital, such as not spending much time with other

people. Your doctor or nurse will talk with you about the safety measures you should follow when you go home.

What happens when

■ You will get medicine for pain before the catheter or

the catheter is taken

applicator is removed.

out after treatment

with LDR or HDR

■ The area where the catheter or applicator was might be

implants?

tender for a few months.

■ There is no radiation in your body after the catheter or

applicator is removed. It is safe for people to be near you—

even young children and pregnant women.

■ For 1 to 2 weeks, you may need to limit activities that take a lot of effort. Ask your doctor what kinds of activities are safe for you.

For ways to learn more about internal radiation therapy, see

Resources for Learning More on page 59.

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Your Feelings During Radiation Therapy

At some point during radiation therapy, you may feel:

■ Anxious

■ Depressed

■ Afraid

Having cancer and

going through treatment

■ Angry

is stressful.

■ Frustrated

■ Helpless

■ Alone

It is normal to have these kinds of feelings. Living with cancer and going through treatment is stressful. You may also feel

fatigue, which can make it harder to cope with these feelings.

How can I cope

There are many things you can do to cope with your feelings

with my feelings

during treatment. Here are some things that have worked for

during radiation

other people:

therapy?

Relax and meditate. You might try thinking of yourself in a favorite place, breathing slowly while paying attention to

each breath, or listening to soothing music. These kinds of

activities can help you feel calmer and less stressed.

Exercise. Many people find that light exercise (such as walking, biking, yoga, or water aerobics) helps them feel

better. Talk with your doctor or nurse about types of

exercise that you can do.

Talk with others. Talk about your feelings with someone you trust. You may choose a close friend, family member,

chaplain, nurse, social worker, or psychologist. You may

also find it helpful to talk to someone else who is going

through radiation therapy.

Join a support group. Cancer support groups are meetings for people with cancer. These groups allow you

to meet others facing the same problems. You will have a

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chance to talk about your feelings and listen to other people

talk about theirs. You can learn how others cope with

cancer, radiation therapy, and side effects. Your doctor,

nurse, or social worker can tell you about support groups

near where you live. Some support groups also meet over

the Internet, which can be helpful if you cannot travel or

find a meeting in your area.

Talk to your doctor or nurse about things that

worry or upset you. You may want to ask about seeing

a counselor. Your doctor may also suggest that you take

medicine if you find it very hard to cope with these feelings.

Ways to

To learn more about ways to cope with your feelings, read

Learn More

Taking Time: Support for People with Cancer, a book from the National Cancer Institute. You can get a free copy at

http://www.cancer.gov/publications or 1-800-4-CANCER

(1-800-422-6237).

CancerCare, Inc.

Offers free support, information, financial assistance, and

practical help to people with cancer and their loved ones.

Toll-free: 1-800-813-HOPE (1-800-813-4673)

E-mail:

info@cancercare.org

Online: http://www.cancercare.org

The Wellness Community

Provides free psychological and emotional support to people

with cancer and their families.

Toll-free: 1-888-793-WELL (1-888-793-9355)

Phone: 202-659-9709

Online: http://www.thewellnesscommunity.org

E-mail:

help@thewellnesscommunity.org

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1-800-4-CANCER (1-800-422-6237)

Radiation Therapy Side Effects

Side effects are problems that can happen as a result of

treatment. They may happen with radiation therapy because

the high doses of radiation used to kill cancer cel s can also damage healthy cel s in the treatment area. Side effects are

different for each person. Some people have many side effects; others have hardly any. Side effects may be more severe if

you also receive chemotherapy before, during, or after your

radiation therapy.

Talk to your radiation therapy team about your chances of

having side effects. The team will watch you closely and ask if you notice any problems. If you do have side effects or other problems, your doctor or nurse will talk with you about ways to manage them.

Common

Many people who get radiation therapy have skin changes and

Side Effects

some fatigue. Other side effects depend on the part of your

body being treated.

Skin changes may include dryness, itching, peeling, or

blistering. These changes occur because radiation therapy

damages healthy skin cel s in the treatment area. You will need to take special care of your skin during radiation therapy. To learn more, see page 40.

Fatigue is often described as feeling worn out or exhausted.

There are many ways to manage fatigue. To learn more, see

page 26.

Depending on the part of your body being treated, you may

also have:

■ Diarrhea

■ Sexual changes

■ Hair loss in treatment area

■ Swelling

■ Mouth problems

■ Trouble swallowing

■ Nausea and vomiting

■ Urinary and bladder changes

Most of these side effects go away within 2 months after

radiation therapy is finished.

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index-28_1.jpg

Late side effects may first occur 6 or more months after

radiation therapy is over. They vary by the part of your body that was treated and the dose of radiation you received.

Late side effects may include infertility, joint problems, lymphedema, mouth problems, and secondary cancer.

Everyone is different, so talk to your doctor or nurse about

whether you might have late side effects and what signs to look for. See page 47 for more information on late side effects.

Radiation Therapy Side Effects and Ways To Manage Them,

starting on page 24, explains each side effect in more detail and includes ways you and your doctor or nurse can help

manage them.

Radiation Therapy

Radiation therapy side effects depend on the part of your body Side Effects

being treated. You can use the chart on page 23 to see which

At-A-Glance

side effects might affect you. Find the part of your body being treated in the column on the left, then read across the row to see the side effects. A checkmark means that you may get this side effect. Ask your doctor or nurse about your chances of

getting each side effect.

To learn more about each side effect, see the page listed in the top row of the table on page 23.

Talk to your radiation therapy team

about your chances of getting side effects.

Show them the chart on the next page.

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1-800-4-CANCER (1-800-422-6237)

index-29_1.jpg

Radiation Therapy Side Effects At-A-Glance

■ Find the part of your body being treated in the column on the left.

■ Read across the row.

■ A checkmark means you may get the side effect listed.

Diarrhea Fatigue

Hair Loss Mouth

Nausea Sexual

Skin

Throat

Urinary

Other

(on the

Changes

and

and

Changes Changes and

Side

part of

Vomiting Fertility

Bladder

Effects

the body

Changes

Changes

being

treated)

See

See

See

See

See

See

See

See

See

page 24 page 26

page 28

page 30

page 34

page 36

page 40

page 43

page 45

Brain

4

4

4

4

Headache

Blurry vision

Breast

4

4

4

Tenderness

Swelling

Chest

Cough

4

4

4

4

Shortness

of breath

Head and

Earaches

Neck

4

4

4

4

4

Taste

changes

Pelvic

4

4

4

4

4

4

4

Area

Rectum

4

4

4

4

4

4

Stomach

and

4

4

4

4

4

4

Abdomen

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index-30_2.jpg

Radiation Therapy Side Effects and Ways to Manage Them

Diarrhea

What it is

Diarrhea is frequent bowel movements which may be soft,

formed, loose, or watery. Diarrhea can occur at any time

during radiation therapy.

Why it occurs

Radiation therapy to the pelvis, stomach, and abdomen

can cause diarrhea. People get diarrhea because radiation

harms the healthy cel s in the large and small bowels.

These areas are very sensitive to the amount of radiation

Radiation to the shaded area may

cause diarrhea.

needed to treat cancer.

Ways to manage

When you have diarrhea:

Drink 8 to 12 cups of clear liquid per day. See page 53 for ideas of drinks and foods that are clear liquids.

If you drink liquids that are high in sugar (such as fruit juice, sweet iced tea, Kool-Aid®, or Hi-C®) ask your nurse or dietitian if you should mix them with water.

Eat many small meals and snacks. For instance, eat 5 or 6 small meals and snacks rather than 3 large meals.

Eat foods that are easy on the stomach (which means foods that are low in fiber, fat, and lactose). See page 55 for other ideas of foods that are easy on the stomach. If your diarrhea is severe, your doctor or nurse may suggest the BRAT diet, which stands for bananas, rice, applesauce, and toast.

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1-800-4-CANCER (1-800-422-6237)

Take care of your rectal area. Instead of toilet paper, use a baby wipe or squirt of water from a spray bottle to clean

yourself after bowel movements. Also, ask your nurse about

taking sitz baths, which is a warm-water bath taken in a sitting position that covers only the hips and buttocks. Be sure to tell your doctor or nurse if your rectal area gets sore.

Stay away from:

• Milk and dairy foods, such as ice cream, sour cream, and cheese

• Spicy foods, such as hot sauce, salsa, chili, and curry dishes

• Foods or drinks with caffeine, such as regular coffee, black tea, soda, and chocolate

• Foods or drinks that cause gas, such as cooked dried beans, cabbage, broccoli, soy milk, and other soy products

• Foods that are high in fiber, such as raw fruits and vegetables, cooked dried beans, and whole wheat breads and cereals

• Fried or greasy foods

• Food from fast food restaurants

Talk to your doctor or nurse. Tell them if you are having diarrhea. He or she will suggest ways to manage it. He or she may also suggest taking medicine, such as Imodium®.

To learn more about dealing with diarrhea during cancer treatment, see Eating Hints: Before, During, and After Cancer Treatment, a book from the National Cancer Institute. You can get a free copy at http://www.cancer.gov/publications or 1-800-4-CANCER (1-800-422-6237).

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index-32_1.jpg

Radiation Therapy Side Effects and Ways to Manage Them

Fatigue

What it is

Fatigue from radiation therapy can range from a mild to

Fatigue is a common

an extreme feeling of being tired. Many people describe

fatigue as feeling weak, weary, worn out, heavy, or slow.

side effect, and there

is a good chance that

you will feel some

Why it occurs

level of fatigue from

Fatigue can happen for many reasons. These include:

radiation therapy.

Anemia

■ Anxiety

■ Depression

■ Infection

■ Lack of activity

■ Medicines

Fatigue can also come from the effort of going to radiation therapy each day or from stress.

Most of the time, you will not know why you feel fatigue.

How long it lasts

When you first feel fatigue depends on a few factors, which include your age, health, level of activity, and how you felt before radiation therapy started.

Fatigue can last from 6 weeks to 12 months after your last radiation therapy session. Some people may always feel fatigue and, even after radiation therapy is over, will not have as much energy as they did before.