Research Assessment #6

Date:​ October 25, 2019

Subject:​ Oncology

MLA Citation:

“Radiation Therapy Basics.” American Cancer Society, 2 July 2018,

https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/radiation/b

asics.html.

Assessment:

There are three main types of cancer treatments commonly used on patients. Those three

are chemotherapy, radiation, and surgery. These types of treatments are either administered by

one Oncologist or three separate Oncologists that may specialize in administering one of these

common treatment methods. A Surgical Oncologist is one that focuses on treatment that uses

surgery to remove or diminish the size of the tumor. A Medical Oncologist focuses more on

treating the patient using medicinal methods (ie. chemotherapy). A Radiation Oncologist focuses

on shrinking the tumor using radiation. Radiation therapy is a newer type of treatment method

used for cancer because when first discovered radiation was deemed as only a substance that

harms the human body and a direct cause of cancer. Over the years, radiation was adapted into

radiation therapy, which can shrink the size of the tumor. The general public tends to be quite

hesitant of radiation as they have only seen it portrayed in a negative and dangerous light in the

media. The team at the American Cancer Society published an article entitled “Radiation
Therapy Basics” to help the general public understand how radiation can be beneficial to cancer

patients in terms of helping them beat cancer.

This article provided me with a plethora of useful information that helped me to gain a

better understanding of how radiation therapy works. I need to understand how radiation therapy

works as being a Radiation Oncologist is my backup plan if I find that I am unsuited for Medical

Oncology. Understanding the basics of how radiation therapy works will be vital for me in the

future if I were to choose to go this route. From this article, I learned that radiation therapy works

by destroying cancer cells using either high-energy particles or waves. These waves can include

gamma rays, x-rays, protons, or electrons. These waves or particles break the DNA in cancer

cells into such small pieces that make them unable to grow or divide. The cancer cells will

thereafter eventually just die off. This information about the exact way that radiation therapy

works is important because it helps me to understand on the cellular level how radiation is

useful. I can use this information in the future to not only reassure my patients of the safety and

benefit of radiation but also for myself to understand how my treatment is truly helping my

patients. I can also use this information now during ISM to help me decide if I am interested in

focusing my career on administering this type of treatment only as opposed to chemotherapy.

Furthermore, I also learned from this article that radiation therapy can be used to not only treat

cancer cells but the symptoms that go along with its advanced stages. This information surprised

me as I was unaware that there was an option to help treat my patients' symptoms. Up until this

point, I believed that the only type of relief I could provide my patients from the symptoms were

analgesic medicines (relieves pain) and antiemetic medicines (stops vomiting). I will use this

information in the future to understand that I can administer radiation therapy in a way that can
relieve my patients' unwanted symptoms. This can help me to be able to improve the overall

quality of life of my patients through their cancer journeys. I can even use this information now

in ISM as information to include on my winter presentation to help my audience see the

often-overlooked benefits of radiation therapy.

Additionally, I learned from this article how chemotherapy is administered to a patient.

There are three methods: external radiation/beam therapy radiation, internal radiation, and

systemic radiation. External radiation uses an outside machine to administer the radiation from

the outside into the specific localized area of the tumor. External radiation is done in an

outpatient setting. Internal radiation uses a radioactive source inserted into the localized area of

the tumor to shrink it. Finally, systemic radiation uses radioactive drugs given by mouth or vein

to travel to the area of the tumor and shrink it. This information was quite surprising as the only

type of radiation administering I knew before this article was a large machine that went around

the patient's body. I can use this newly gained knowledge about the different ways to administer

radiation to give both my future patients and myself options to best go about treating their

tumors. This can help me to better comfort my patients by giving them the type of treatment that

they are comfortable with that still effectively gets the job done. If my patient is terrified of the

machine I can give them a radioactive drug or insertion instead, so that they are as comfortable

as possible with the treatment. I also learned from this article that alongside the Radiation

Oncologist and nurses a Dosimetrist also helps with radiation therapy by supervising the

treatment. This information was surprising because I had never heard of such a position before.

This information about the Dosimetrist will help me in the future as I gain a better understanding

of who I will possibly be working alongside with if I chose to become a Radiation Oncologist. I
also learned from this article the difference between chemotherapy and radiation therapy.

Chemotherapy exposes the whole body to cancer-fighting medicine, while radiation therapy is

more localized. This information about how the different types of treatments compare can help

me in the future as I choose which type of treatment will be best suited for each patient's unique

cancer situation. The second to last vital piece of information that I acquired from this article is

that radiation is safe when administered correctly to patients who are not in a situation where

even a small amount of exposure to radiation would hurt them. I can use this information in the

future to help reassure my patients about the safety of chemotherapy. Lastly, I learned that

overall the benefits of radiation far outweigh the side effects, but a patient should still ask their

Oncologist if this is truly the best option for them to undergo. This means that in the future I

need to be prepared to explain exactly why radiation therapy would be the best option and

answer any questions the patient may have about the treatment.

In conclusion, from this article, I learned valuable information about how radiation

works, how it is administered, the goals of this type of treatment, who works with the Radiation

Oncologist, the difference between radiation therapy and chemotherapy, and why radiation is

safe for patients. All of the information I gathered from this article is important because it will

help in the future if I choose to go my backup route of becoming a Radiation Oncologist as

opposed to a Medical Oncologist. I will use this information in the future to help me understand

how radiation therapy works, how to administer it and to address any concerns my patients may

have about this type of treatment. I can also use this information I learned in this article now

during my ISM journey during my winter presentations to give my audience a better

understanding of how oncology uses the often feared radiation to treat cancer effectively.
Article: *​All annotations are bold and italicized.*

Radiation Therapy Basics

Radiation is one of the most common treatments for cancer. Other names for
radiation treatment are radiation therapy, radiotherapy, irradiation, or x-ray
therapy.

What is radiation therapy?

Radiation therapy uses high-energy particles or waves, such as x-rays,

gamma rays, electron beams, or protons to destroy or damage cancer cells.

Your cells normally grow and divide to form new cells. But cancer cells grow
and divide faster than most normal cells. ​Radiation works by making small
breaks in the DNA inside cells. These breaks keep cancer cells from
growing and dividing and cause them to die.​ ​How radiation therapy
works. ​Nearby normal cells can also be affected by radiation, but most
recover and go back to working the way they should.

Unlike ​chemotherapy​, which usually exposes the whole body to

cancer-fighting drugs, radiation therapy is usually a local treatment.
Difference between radiation and chemotherapy.​ In most cases, it’s aimed
at and affects only the part of the body being treated. Radiation treatment is
planned to damage cancer cells, with as little harm as possible to nearby
healthy cells.
Some radiation treatments (systemic radiation therapy) use radioactive
substances that are given in a vein or by mouth. ​Even though this type of
radiation does travel throughout the body, the radioactive substance mostly
collects in the area of the tumor, so there’s little effect on the rest of the body.
Why radiation therapy is safe.

Who gets radiation therapy?

More than half of people with cancer get radiation therapy. Sometimes,
radiation therapy is the only cancer treatment needed.

What are the goals of radiation therapy?

Most types of radiation therapy don’t reach all parts of the body, which means
they’re not helpful in treating cancer that has spread to many places within the
body. Still, radiation therapy can be used to treat many types of cancer either
alone or in combination with other treatments. Here are some of the reasons
radiation therapy may be used:

To cure or shrink early-stage cancer

Some cancers are very sensitive to radiation. Radiation may be used by itself
in these cases to make the cancer shrink or completely go away. In some
cases, a few cycles of chemotherapy may be given first. For other cancers,
radiation may be used before surgery to shrink the tumor (this is called
pre-operative​ ​therapy​ or ​neoadjuvant therapy​), or after ​surgery​ to help
keep the cancer from coming back (called ​adjuvant therapy​).

For certain cancers that can be cured either by radiation or by surgery,

radiation may be the preferred treatment. This is because radiation can cause
less damage and the organ may be more likely to work the way it should after
treatment.

For some types of cancer, radiation and chemotherapy might be used

together. Certain chemo drugs (called radiosensitizers) help radiation work
better by making cancer cells more sensitive to radiation. The drawback of
getting chemo and radiation together is that side effects are often worse.

If you’ll need more than one kind of cancer treatment, your cancer care team
will work with you to plan your treatment.

To stop cancer from coming back (recurring) somewhere else

Cancer can spread from where it started to other body parts. Doctors often
assume that a few cancer cells might already have spread even when they
can’t be seen on imaging scans like CT scans or MRIs. In some cases, the
area where the cancer most often spreads to may be treated with radiation to
kill any cancer cells before they grow into tumors. For instance, people with
certain kinds of lung cancer may get preventive (prophylactic) radiation to the
head because their type of lung cancer often spreads to the brain.
Sometimes, radiation to prevent future cancer can be given at the same time
radiation is given to treat existing cancer, especially if the area the cancer
might spread is close to the tumor itself.

To treat symptoms caused by advanced cancer

Sometimes cancer has spread too much to be cured. But some of these
tumors can still be treated to make them smaller so that the person can feel
better. ​Radiation might help relieve problems like pain, trouble swallowing or
breathing, or bowel blockages that can be caused by ​advanced cancer​. This
is often called palliative radiation. ​How radiation is used to help relieve
cancer symptoms.

To treat cancer that has returned (recurred)

If a person's cancer has returned (recurred), 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 and for these
cancers radiation might not be used to treat recurrence.

How is radiation therapy given?

Radiation therapy can be given in 3 ways:

● External radiation (or external beam radiation)​:​ uses a machine that

directs high-energy rays from outside the body into the tumor. Most people
get external radiation therapy over many weeks. It’s done during outpatient
visits to a hospital or treatment center.
● Internal radiation​:​ Internal radiation is also called brachytherapy. A
radioactive source is put inside the body into or near the tumor.
● Systemic radiation​:​ Radioactive drugs given by mouth or put into a vein are
used to treat certain types of cancer. These drugs then travel throughout the
body. ​The different ways to administer radiation therapy.

The type of radiation you might get depends on the kind of cancer you have and
where it is. In some cases, more than one type is used.

Who gives radiation therapy treatments?

During your radiation therapy, a team of highly trained medical professionals will
care for you. Your team may include these people:

● Radiation oncologist:​ This doctor is specially trained to treat cancer with

radiation. This person oversees your radiation treatment plan.
● Radiation physicist:​ This is the person who makes sure the radiation
equipment is working as it should and that it gives you the exact dose
prescribed by your radiation oncologist.
● Dosimetrist:​ This person is supervised by the radiation physicist and helps
the radiation oncologist plan the treatment.
● Radiation therapist or radiation therapy technologist:​ This person
operates the radiation equipment and positions you for each treatment.
 ● Radiation therapy nurse:​ This nurse has special training in cancer treatment
and can give you information about radiation treatment and managing side
effects.​ The healthcare professionals that administer radiation therapy.

You may also need the services of a dietitian, physical therapist, medical or clinical
social worker, dentist or dental oncologist, or other health care providers.

Does radiation therapy cause cancer?

It has long been known that radiation therapy can slightly raise the risk of getting
another cancer. It’s one of the possible side effects of treatment that doctors have to
think about when they weigh the benefits and risks of each treatment. ​For the most
part, the risk of a second cancer from these treatments is small and is outweighed
by the benefit of treating the cancer, but the risk is not zero. This is one of the many
reasons each case is different and each person must be part of deciding which kind
of treatment is right for them​. ​Addressing if radiation therapy causes cancer or
not.

If your cancer care team recommends radiation treatment, it’s because they believe
that the benefits you’ll get from it will outweigh the possible side effects. Still, this is
your decision to make. Knowing as much as you can about the possible benefits and
risks can help you be sure that radiation therapy is best for you.

Does radiation therapy affect pregnancy or

fertility?
Women:​ ​It’s important not to become pregnant while getting radiation – it can harm
the growing baby.​ ​Why you cannot undergo radiation therapy if you are
pregnant.​ If there’s a chance you might become pregnant, be sure to talk to your
doctor about birth control options.

If you are or might be pregnant, let your doctor know right away.

Men:​ ​Not much is known about radiation’s effect on the children conceived by men
while getting radiation therapy.​ ​Radiation therapy effect on men’s fertility.
Because of this, doctors often advise men to not get a woman pregnant during and
for some weeks after treatment. Talk to your doctor to find out more about this.

Questions to ask about radiation therapy

Before treatment, you’ll be asked to sign a consent form saying that your doctor has
explained how radiation therapy may help, the possible risks, the type of radiation to
be used, and your other treatment options. Before signing the consent form, be sure
that you have had a chance to get all your questions answered. Here are some of
the things you may want to ask about:

● What’s the purpose of radiation treatment for my type of cancer? To destroy

or shrink the tumor? To prevent or stop cancer spread? To lower the chance
the cancer may come back?
● If radiation is to be done after surgery, what are the chances it will kill any
cancer cells left behind? Could radiation be used instead of surgery?
● What’s the chance that the cancer will spread or come back if I do – or don’t –
get radiation therapy?
● What type of radiation therapy will I get?
● Are there other treatment options?
 ● What can I do to be ready for treatment?
● Can I eat before treatment or do I need to avoid certain foods before getting
treatment?
● What will radiation treatment be like? How often is it given? How long will it
take?
● How will the radiation affect the area near the cancer?
● How will I feel while I’m getting treatment? Will I be able to work? Go to
school? Take care of my family?
● What side effects am I likely to have, when will they start, and how long will
they last?
● Will any of these side effects affect how I do things, such as eat or drink,
exercise, work, etc.?
● Will treatment and/or side effects change how I look?
● What long-term side effects might I have?
● Will I be at higher risk for any other health problems in the future?​ Important
questions to ask your oncologist before you go through radiation
therapy.

Will I be radioactive during or after external

radiation treatment?

External radiation therapy affects cells in your body only for a moment. ​Because
there’s no radiation source in your body, you are not radioactive at any time during
or after treatment.​ Addressing a false common belief about radiation therapy.