Radiation Therapy

Radiation Therapy

If you or a loved one has been advised to have radiation therapy, it is natural to feel anxious about what lies ahead. The idea of radiation can seem daunting, but it has been used to treat cancer for well over a century and is one of the most common and effective cancer treatments available today.

Advances in technology mean that treatment can now be delivered with remarkable precision, targeting cancer cells while protecting surrounding healthy tissue as much as possible.

What is Radiation Therapy?

Radiation therapy, also known as radiotherapy, is a common treatment for cancer that uses high doses of radiation to kill cancer cells or shrink tumours. It works by damaging the DNA inside cells. Since cancer cells grow and divide more quickly than normal cells, they are especially vulnerable to this damage. Once their DNA is too severely affected, these cells can no longer divide and eventually die. Normal cells can usually repair themselves, which is one of the reasons why treatment is carefully planned and given in small daily doses.

The overall goal is to destroy cancer cells while preserving as much healthy tissue as possible, improving survival rates and quality of life for patients.

How Radiation Therapy is Used

Radiation therapy may be used alone or in combination with other treatments such as surgery, chemotherapy, or immunotherapy. Your cancer care team will decide the role it plays in your treatment, based on the type and stage of your cancer and your overall health.

It may be used:

• Before surgery: To shrink a tumour so that it is easier to remove.
• After surgery: To kill any remaining cancer cells and lower the chance of the cancer returning.
• As the main treatment: When surgery is not an option, or when radiation offers the best chance of controlling the cancer.
• To relieve symptoms: In situations when the cancer cannot be fully cured, radiation therapy can help to ease symptoms such as pain, bleeding, or pressure, improving comfort and quality of life.

Types of Radiation Therapy

There are two main ways radiation can be delivered. Your doctor will recommend the one, or the combination, that is best for your cancer.

• External Beam Radiation Therapy: Radiation beams are directed from a machine outside the body to the tumour. You lie on a treatment couch while the machine moves around you, and the treatment itself is painless. It is the most common form of radiation therapy.
• Internal Radiation (Brachytherapy): Radioactive material is placed inside the body, either in or very close to the tumour. This allows a high dose of radiation to be delivered directly to the cancer, with less effect on the tissues around it.

With advancements in medical technology, radiation can now be delivered with high precision, targeting cancer cells while limiting damage to surrounding healthy tissues.

Your Treatment Journey

Radiation therapy is carefully planned before it begins. Here is what you can usually expect.

1. Consultation: You will meet your radiation oncologist, who will review your scans and medical history, explain how radiation therapy fits into your treatment plan, and discuss the benefits and possible side effects. This is a good time to ask questions.

2. Simulation scan: You will have a planning scan, using a CT simulator, to map out exactly where the treatment needs to go. Special equipment may be used to keep you in the same position at each session, and small marks may be placed on your skin as guides. Four-dimensional CT simulation can account for movement, such as breathing, to improve the precision of treatment.

3. Treatment planning: Your care team uses the scans to design a personalised plan that targets the tumour while sparing healthy tissue. Quality checks are carried out before your first session to make sure that the plan is accurate and safe.

4. Treatment sessions: External beam radiation is usually given in daily sessions on weekdays over several weeks, although the schedule depends on your condition. Each visit is typically brief, and much of the time is spent positioning you carefully. You will be alone in the room during the treatment, but the team can see and hear you throughout.

5. Reviews: You will be seen regularly during treatment to check how you are feeling, manage side effects, and make sure that you are comfortable.

6. Follow-up: After treatment, you will have follow-up appointments, and scans or tests if needed, to monitor your recovery and response.

Please note that after external beam radiation therapy, you are not radioactive, and it is safe to be around family, friends, and children. If you are having brachytherapy, your team will explain any special precautions that apply to your treatment.

Preparing for Treatment

• Wear comfortable clothing: Loose-fitting, soft clothing makes it easier to be positioned, and to avoid irritating the treated skin.
• Tell your team about your health: Let your doctor know about any medications, implanted devices such as pacemakers, previous radiation, or the possibility of pregnancy.
• Follow any preparation instructions: Depending on the area being treated, you may be given specific instructions, such as about drinking water before sessions, or about bladder or bowel preparation, or a dental check-up before treatment to the head and neck.
• Plan your schedule: Because treatment usually takes place every weekday for several weeks, it helps to arrange your work, transport, and family commitments in advance.
• Bring someone along: If you feel anxious, you may wish to bring a family member or friend to your consultation, and to keep notes of what is discussed.

Possible Side Effects

The side effects of radiation therapy depend on the part of the body being treated. Some people may experience fatigue or skin irritation, while others may have side effects specific to the treatment area, such as difficulty swallowing if the throat is targeted. Most side effects are temporary and can be managed with supportive care. Not everyone has the same experience, and many people are able to continue with much of their daily routine during treatment.

The side effects you may notice depends on the area treated:

• General: Tiredness that builds up gradually over the course of treatment, and mild redness, dryness, or itching of the skin in the treated area, similar to sunburn.
• Head and neck (including nose cancer): A sore mouth or throat, difficulty or discomfort with swallowing, a dry mouth, changes in taste, and skin soreness in the neck.
• Breast: Redness, tenderness, or swelling of the breast and chest wall, and tiredness.
• Pelvis (prostate and gynaecological cancers): Bladder irritation, needing to pass urine more often, bowel changes such as loose stools, and tiredness. Your doctor will also discuss any possible effects on sexual health and fertility.

Looking After Yourself During Treatment

• Care for your skin: Wash the treated area gently with lukewarm water and mild soap, pat it dry, and avoid scrubbing. Use only the creams recommended by your team, and avoid hot or cold packs on the skin. In Singapore’s warm and humid climate, loose, breathable cotton clothing can help to keep the skin comfortable.
• Protect the treated area from the sun: The skin in the treated area is more sensitive, so cover it with clothing, or use shade, and ask your team about suitable sun protection.
• Eat and drink well: Good nutrition and hydration help your body to cope with treatment and to recover. If eating becomes difficult, our Dietetics and Nutrition service can offer personalised advice.
• Rest, and keep gently active: Listen to your body, and rest when you are tired. Light activity, such as walking, can help with fatigue and mood.
• Look after your emotional wellbeing: It is common to feel anxious, low, or overwhelmed. Talk to your care team, family, and friends, and ask about counselling or support services if you need them.
• Keep your appointments: Missing sessions can affect how well the treatment works, so let your team know early if you have difficulty attending.