QUESTION: What are the main treatment options for cancer? How does radiation therapy fit into these options?
ANSWER: The main treatment options for cancer are surgery, systemic therapy (for example, chemotherapy, hormones), and radiation therapy. Radiation therapy consists of either internal or external radiation.
Sometimes, just one of the treatment types can be used to cure a cancer (for example, internal radiation for certain prostate cancers); other times, multiple treatment types are necessary together (for example surgery and radiation for certain breast cancers).
QUESTION: What is the goal of radiation therapy with respect to treating cancer?
ANSWER: Once a diagnosis of cancer is made, one of two goals of treatment is determined:
(1) Cure – to get rid of the cancer completely, and hopefully prevent the cancer from returning. “Definitive” is another word for a treatment with curative intent.
(2) Palliate – to make the patient’s symptoms better and improve quality of life, knowing that we likely will not cure the cancer. This applies to patients whose cancers have spread to different parts of the body.
Most patients who are treated with radiation therapy are treated for cure. You should discuss with your doctor the goal of treatment, and if it is for cure or for palliation.
QUESTION: What is a “tumor bed”?
ANSWER: The tumor bed is the region where a tumor used to be in, before a surgery. You can think of it like the bed of a truck — something was removed from there. This region is typically “filled up” by the normal tissues of the body.
QUESTION: What is a “positive margin”?
ANSWER: A positive margin is used in the case of a surgery that has likely left cancer cells behind in the patient. When a tumor is removed, a pathologist looks at it under a microscope. This doctor looks at the perimeter of what was removed, termed the margin. If there are cancer cells at the perimeter, this is a positive margin. You can think of this like a cookie cutter: a surgeon removes a tumor, with a cookie approach, and then another doctor looks at the sides of the cookie cutter that was removed. If there are cancer cells there, then there may be cancer cells on the other side of the cookie cutter (that is, the patient).
QUESTION: What is “adjuvant”?
ANSWER: Adjuvant means that radiation therapy is delivered after a surgery. This is sometimes done because the radiation therapy is part of a standard treatment approach for a cancer; for example, women being treated for early-stage breast cancer often have a lumpectomy followed by adjuvant radiation. In other occasions, adjuvant radiation therapy is delivered because of high-risk features of a tumor seen under the microscope after a surgery; for example, cancers remain inside of the body (as noted with a “positive margin”) usually benefit from adjuvant radiation.
QUESTION: What is “neoadjuvant”?
ANSWER: Neoadjuvant means that radiation therapy is delivered before a surgery. This is sometimes performed to shrink tumors and make them easier to remove with surgery, thereby decreasing the likelihood of a positive margin. Neoadjuvant radiation is often performed in cancers of the esophagus, rectum, and muscle (e.g. sarcomas).
QUESTION: What is “concurrent”?
ANSWER: Concurrent means that chemotherapy and radiation therapy are delivered at the same time. Concurrent chemo-radiotherapy is often used for cancers of the cervix, bladder, rectum, and esophagu.
QUESTION: What is “salvage”?
ANSWER: Salvage radiation means that a definitive approach was previously used to treat a patient, and the patient appeared to be free of cancer after the surgery (for example, they did not require adjuvant therapy). However, at some point, the cancer reappeared, either by blood tests, or on imaging studies, or because of symptoms. Salvage therapy is used to kill these growing cancer cells. A salvage approach can still have curative / definitive intent.
QUESTION: What are the types of cancers where external radiation is used? What about internal radiation?
ANSWER: External radiation therapy is the most common type of radiation used. High energy x-rays are most commonly used to treat cancers of the lung, head & neck, prostate, breast, uterus, gastrointestinal tract (for example: rectum, pancreas, esophagus), brain, and many others. Internal radiation therapy, or an “implant,” is most commonly used for prostate cancer, gynecological cancers (specifically, endometrial or cervical cancer), and certain breast cancers.
QUESTION: Can radiation therapy alone cure me (without chemotherapy or surgery)?
ANSWER: Yes. In certain cases, radiation therapy alone can be used to cure patients. You should talk to your doctor about the treatment options that are best for you.
QUESTION: Who delivers radiation therapy? Is it a radiologist? Who are the other members of the team?
ANSWER: Radiation therapy is delivered in a radiation oncology department. Your doctor will be a radiation oncologist; the radiation oncologist will work with and lead a team of many others to care for you, design and deliver your treatment. Radiologists are commonly confused with radiation oncologists. Radiologists are doctors who perform diagnostic imaging (like reading x-rays and MRIs); their input will be valuable in reviewing your scans, but they are not involved in your treatment design or delivery. Your radiation oncologist may also work closely with your other cancer doctors (like surgical oncologists or medical oncologists) to determine the treatment that is best for you.
Additionally, your radiation treatment plan may be designed by radiation physicists and dosimetrists working with the radiation oncologist. Radiation therapists are the people who give you your daily external beam radiation treatments under the supervision of the radiation oncologist. Additionally, you will see nurses, who will assess and manage your symptoms, answer your questions with respect to the treatment, and coordinate the treatment of your cancer. You will see other other medical specialists from our team, including nurses aides.
QUESTION: Am I going to start radiation therapy on the same day that I meet the radiation oncologist?
ANSWER: Most likely not. If your radiation oncologist recommends radiation therapy, it would probably start within days to weeks — we will explain more, in the coming questions. In certain cancer emergencies (for example, if the tumor is near the spinal cord, or a blood vessel that is critical), we will recommend starting radiation therapy on the same day as meeting you.
QUESTION: If I previously received radiation therapy, can I receive it again to a different part of the body? What about to the same part of the body?
ANSWER: If you previously received radiation therapy to one part of the body, you may receive it to a different part of the body. For example, a woman who had breast cancer and was treated with radiation therapy may later develop a uterine cancer and receive radiation treatments.
If a cancer comes back in the same area that was treated before, you may or may not be able to receive radiation to that same location. The body “remembers” where it received radiation, and there are limits to what the normal organs that surround the cancer can tolerate.
QUESTION: Can radiation therapy be used in children?
ANSWER: Yes. However, radiation therapy can harm a growing fetus, so if there is any chance you might be pregnant, please discuss this with your doctor.
QUESTION: Can radiation therapy cause me to develop cancer?
ANSWER: It is possible, but the risk of this is very low for most patients. We estimate the risk of a cancer forming from radiation therapy to be less than 0.2% per year. Thus, if the patient has many decades to live remaining (for example, a child), the risk builds up over time. On the other hand, for an adult, the risk is exceptionally low. If a second cancer were to develop, it would be near the region that received the treatment; so, you would not be more likely to form a brain cancer if you were treated for a prostate or breast cancer.
QUESTION: Should I be eating anything special during radiation therapy?
ANSWER: You should continue to eat a healthy diet. Sometimes, the cancer or the treatment may make eating certain types of foods difficult. Talk to your doctor for more details.
QUESTION: Should I be taking vitamins during radiation therapy? Can they affect how well the radiation works?
ANSWER: You should not take certain vitamins or supplements during radiation therapy. Take medications only as a treatment for another diagnosis, for example Vitamin D if you are deficient in Vitamin D. Otherwise, there is no reason to treat something that isn’t diagnosed. Large doses of antioxidants may make radiation work less well for certain cancers.