Radiation Oncology – Farrer Park Hospital
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What is Radiation Oncology?
Radiation oncology is a medical specialty that treats a wide variety of cancers with radiation. Using high energy radiation carefully targeted at tumours with just the right dose, the aim is to destroy cancer cells by damaging their DNA so that they are killed or can no longer divide. Normal cells may also be damaged by Radiation Therapy (RT) resulting in side-effects but they can usually repair themselves and recover while cancer cells cannot.
Smoking greatly increases your chances of developing lung cancer. Other risk factors are exposure to second-hand smoke, air pollution and tuberculosis.
Symptoms of lung cancer include:
- Persistent cough, coughing blood or shortness of breath
- Chest pain
- Recurring pneumonia or bronchitis
- Swelling of the neck and face
- Loss of appetite or fatigue
A chest X-ray will often reveal the location of a tumor. Other tests, such as CT scans and PET scans, can provide more detailed information. To be certain that it is lung cancer, tissue from your lung will be removed and analyzed in a test called a biopsy.
Lung cancer usually begins in one lung. If left untreated, it can spread to lymph nodes or other parts of the chest, including the other lung. Lung cancer can also spread throughout the body to bones, the brain, liver or other organs.
Lung cancer treatment depends on the type and size of the cancer, its location and your overall health. Your doctor may also suggest radiation therapy, chemotherapy or surgery either alone or in combination.
Possible side effects include skin irritation, difficulty or pain when swallowing, shortness of breath, and fatigue.
The breast is made up of ducts and lobules, surrounded by fatty tissue. A lobule is the part of the breast that makes milk. Cancer can affect a duct or the cells of a lobule. Tumors that break through the wall of the duct or lobule are called infiltrating ductal or infiltrating lobular carcinomas. Inflammatory breast cancer may involve the entire breast with changes in the skin and swelling.
While most breast cancers are diagnosed after self detection of a breast lump, screening with mammography results in early diagnosis with better prognosis. Studies have shown that women with early-stage breast cancer who have a lumpectomy to remove just the cancer followed by radiation live just as long as patients who have the whole breast removed. Treatment after the lumpectomy is by external beam radiation therapy. Often, this is after chemotherapy.
In cases where the breast is surgically removed, your oncologist may suggest radiation therapy for the chest wall and nearby lymph node areas to ensure all cancer cells are cleared.
Colorectal cancer can affect the colon which extends from the end of the small intestine to the rectum, or the rectum itself. Signs and symptoms of colorectal cancer could include:
- Change in bowel frequency, such as alternating episodes of diarrhea and constipation
- Blood in feces or rectal bleeding
- Abdominal discomfort
- Unexplained weight loss
- Fatigue
- Bloating
- Pale complexion
For cancers of the colon and rectum that have not spread and were detected early, surgery alone could be the solution. In other cases, your doctor may recommend chemotherapy and/or radiation therapy either before or after surgery depending on the location and stage of your cancer. For rectal cancer, radiation is usually combined with chemotherapy either before surgery or after surgery.
Side effects from radiation may include more frequent bowel movements, diarrhea, abdominal cramps, discomfort in the rectal area, urinating more often, a burning sensation during urination, skin irritation, nausea and fatigue. These are usually temporary and will end after your treatment ends. Chemotherapy side effects will depend on the specific drug you receive but can affect your whole body.
The incidence of prostate cancer increases with age and signs and symptoms include:
- Changes in urinary flow- frequency, urgency, hesitancy
- Frequent night time urination
- Painful urination
- Blood in urine
Early-stage prostate cancer can be treated with surgery, RT or even with ‘watchful waiting/active surveillance’ for some elderly patients. Radiation therapy treatment options to cure prostate cancer include external beam radiotherapy, and internal beam therapy using permanent implants or high-does temporary implants to deliver radiation to the cancerous areas. Certain patients may also benefit from hormone therapy in addition to radiation. In some patients, hormone therapy works well with radiation therapy to cure their cancers.
Gynecologic cancers include cancer of the uterus, ovaries, cervix, vagina, vulva and Fallopian tubes. The increasing use of the Pap test has allowed doctors to find pre-cancerous changes in the cervix and vagina and has helped in stopping the growth of such cancers. Common symptoms of gynecologic cancers include:
- Abnormal bleeding, such as postmenopausal bleeding, bleeding after sex or bleeding between periods
- Itching of the vulva or a sore near it that doesn't heal
- Feeling of pain or pressure in the pelvis
- Frequent vaginal discharge
Gynecologic cancers are often detected through a series of screening examinations such as a PAP smear of the cervix or a D&C procedure of the uterus. Early detection confers better prognosis and higher chance of cure with surgery, radiation or chemotherapy depending on the specific site of cancer. In some cases, a combination of the above treatment modalities including brachytherapy is used to improve tumour control.
Potential Side Effects include fatigue, skin irritation, vaginal irritation, frequent urination, a burning sensation during urination and/or diarrhea.
Cancer can arise in the regions of the nose, mouth, throat and the thyroid gland. The use of tobacco and alcohol greatly increases your chances of developing head and neck cancer.
Common symptoms include:
- A lump or sore that does not heal
- Persistent sore throat
- Difficulty or pain when swallowing
- Change in your voice or hoarseness
- Nose bleed or blood in your saliva
- Ear pain or loss of hearing
X-rays, computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scan scans are often needed to show the location and extent of the cancer. Some tissue will also be removed and analyzed in a test called a biopsy.
Head and neck cancers can arise from the cells in the face, mouth and throat. Because cancers in different locations behave differently, treatment depends on the cancer type and the extent of damage. Some common locations include the nose, mouth, throat and thyroid. However, your doctor will check the areas to make sure the cancer has not spread.
​Why is Radiation Therapy needed?
As some tumours are highly radiosensitive, RT is often used in the curative treatment of these cancers, either alone or in combination with chemotherapy. After surgery to remove the tumour, RT may be recommended to reduce your risk of cancer relapse. For advanced cancers, RT is also often used for the relief of symptoms such as pain and bleeding.
How is Radiation Therapy given?
RT can be given both externally and internally, usually in the outpatient setting:
- External beam radiotherapy (or EBRT) delivers high-energy X-rays to the affected tumour-site using a modern machine called the Linear Accelerator (Linac)
- Internal radiotherapy (or brachytherapy) involves having radioactive material placed within the body, usually through a temporary clinical procedure
Most cancer patients will require EBRT only though some would need brachytherapy or both depending on the type of cancer. A detailed discussion of these RT techniques relevant for your treatment as well as the risk of side-effects with your Radiation Oncologist will be essential before proceeding with the specific treatment.
In addition, you may also be recommended some of the more specialized and advanced techniques of EBRT/brachyherapy suited for certain cancers:
1. 3D Conformal RT (3DCRT)
2. Intensity Modulated/Image Guided RT (IMRT/IGRT)
3. Volumetric Modulated Arc RT (VMAT)
4. Active-Breath-Coordinator RT (ABC-RT)
5. Stereotactic Radiosurgery/RT (SRS/SRT)
6. 3D high dose-rate brachytherapy (3D-HDRBT)
External beam radiation therapy with IMRT/IGRT is often used involving a series of daily outpatient treatments over 6-7 weeks to accurately deliver radiation to the affected site as well as the neck region with careful avoidance of the normal tissues. Radiation may also be given at the same time as chemotherapy with or without prior surgery.
Common side effects of the radiation treatment to the Head & Neck region include include temporary redness of the skin, sore throat, dry mouth, pain when swallowing  and possible hair loss in the treated area.
Our team of radiation oncologists, dosimetrists, physicists, therapists, and nurses are all specially trained to work alongside other cancer specialists including surgical and oncologist oncologists to ensure the best coordinated care and individualized RT is delivered for each patient at FPH.
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