Common Questions and Misconceptions About Radiation Therapy

In the wake of a cancer diagnosis, patients want answers. Unfortunately, because the internet is full of untrustworthy sources and misinformation, turning to Google isn’t always the best course of action. 

To uncover the truth about radiation therapy and discuss what patients can expect during their treatment, we sat down with SERO cancer doctor Christopher D. Corso, MD to discuss common questions and misconceptions. 

Dr. Corso is one of the top radiation oncologists in Charlotte, NC, and he treats patients at Cleveland Regional Medical Center in Shelby.

If you have additional questions or are interested in radiation therapy for cancer treatment, contact a SERO physician today.

Radiation therapy is a type of cancer treatment that uses beams of energy to damage the DNA of a cell.

When the DNA of a cancer cell is destroyed, the cell cannot continue to grow and divide. This leads to cell death.

The goal of radiation therapy is to kill the cancer cells while sparing as many healthy cells as possible. 

Radiation is typically delivered in small doses each day over the course of many weeks. Healthy cells are capable of repairing some of the damage while cancerous cells are not. This leads to preferential death of the cancer cells and relative sparing of the normal cells.

The most common form of radiation is called external beam radiation therapy. This typically involves X-rays, but electrons, protons, or other types of energy can also be used. 

X-rays are produced by a machine called a linear accelerator. This machine rotates around the patient and can deliver radiation from many beam angles.

Another common type of radiation treatment is called brachytherapy. This is a form of internal radiation that is sometimes used for specific types of cancer such as cervical, uterine, prostate cancer, and breast cancer among others. The treatment involves the use of small radioactive sources that are placed inside the body either permanently or temporarily. Sometimes this involves a surgical procedure. 

There are many different types of brachytherapy treatments. In special cases, unsealed source radiation may be used to treat cancer. This involves swallowing or injecting radioactive isotopes into the bloodstream. Your doctor will determine the best type of radiation treatment for you. In some cases, your doctor may even recommend a combination of treatments.

Though radiation therapy is a relatively safe, localized treatment, there are risks patients should be aware of.

Besides short-term side effects like fatigue and nausea, patients may experience long-term side effects including:

• Dental problems
• Diabetes
• Hormonal changes, such as early menopause 
• Anxiety and depression
• Post-traumatic stress disorder
• Incontinence
• Infertility 
• Lymphedema, or painful swelling 
• Neuropathy, or nerve pain
• Memory and cognition problems
• Heart problems like congestive heart failure
• Osteoporosis, or thinning of the bones
• Sexual dysfunction, like erectile dysfunction or vaginal dryness

Though rare, patients can also develop second cancer — a disease that is unrelated to any previous diagnoses.  

Chemotherapy is a broad category of drugs or medications that are designed to kill growing cancer cells.

There are a variety of types of chemotherapies and some are more effective for specific types of cancer than others. These drugs are typically administered through the veins, though some can be taken orally. 

As discussed above, radiation is a form of treatment that uses high-energy X-rays or electrons to treat cancers at a specific location in the body. In a sense, radiation is much more targeted than chemotherapy. Because of this, the side effects of chemotherapy and radiation are often very different. Sometimes, chemotherapy and radiation are used together to kill cancer cells.

Many patients assume that radiation therapy is incorporated into all patients’ cancer treatment plans.

However, though radiotherapy is a fairly common cancer treatment modality, it’s not appropriate for all individuals.

In fact, about 50 percent of oncology patients don’t receive any form of radiotherapy. Instead, these patients receive some combination of surgery, hormone therapy, immunotherapy, and chemotherapy. 

Chemotherapy and radiotherapy are often used together. Since chemotherapy weakens the cancer cells, it can make radiotherapy more effective.

However, this approach isn’t appropriate for all cancers. In the weeks following your cancer diagnosis, your cancer care team will determine which treatment modalities are best for you. 

Each organ in the body can only tolerate a limited amount of radiation before serious, long-term problems like second cancer occur.

With that being said, you can only receive radiotherapy in the same area once. If, for example, you have already received radiotherapy for uterine cancer but your cancer has returned, your oncologist will determine a different treatment plan. 

Radiation therapy is a completely painless cancer treatment modality. It’s much like receiving an X-ray.

Depending on your cancer type and location, you could experience some mild discomfort from holding your body in certain positions. If this occurs, your doctor might prescribe pain medication or suggest that you take an over-the-counter medication before your sessions. 

Many patients fear radiation therapy because of uncertainty. They don’t know what to expect from radiation treatment.

However, your first radiotherapy session will be similar to any other medical appointment. After checking in, you will fill out some paperwork. A radiation therapist will then call your name and move you to a room where he or she will explain your treatment plan. You can ask any questions at this time. 

Afterward, you will be asked to change into a gown and lie down on a treatment table. The radiation therapist will then place you in any immobilization devices (i.e. equipment to hold your body still) and begin the session. The machine delivering the radiation will make some loud clicking and whirring sounds, but you should never feel uncomfortable. 

If you experience stress during sessions, your doctor can prescribe anti-anxiety medications to take beforehand. You can also bring a friend or family member with you. Though they can’t be in the treatment room, they can sit with you in the waiting room.

If you are receiving external beam radiation therapy, each session will take about 30 minutes. You will likely receive treatment five days per week for three to 10 weeks, depending on your cancer type and stage. You will meet with your doctor once per week during this time.

Patients who miss radiation therapy sessions have an increased risk of their disease returning, even if they eventually complete their course of treatment. With that being said, it’s imperative that you follow your radiotherapy schedule. 

The side effects of radiation are determined by the part of the body that is receiving radiation.

If radiation is being used to treat the brain or scalp, then hair loss is possible. This can be temporary or permanent, depending on the amount of radiation required.

For radiation treatments to the neck, men may lose a portion of their facial hair.

For patients receiving pelvic radiation, there may be some hair loss in the pubic region.

Generally, the risk of a radiation-related skin reaction depends on how deep the target is located inside the body.

With breast cancer radiation, the target is typically the breast or chest wall, which is close to the skin surface. This leads to a higher dose at the skin and a higher risk of skin reaction. This is the case for head and neck cancers as well. 

In patients that do develop a skin reaction, the severity can vary from mild redness to more intense reactions like pain and peeling of the skin. This typically resolves within a few weeks after completing treatment. Your doctor may recommend applying ointments during and after treatment to minimize these risks.

The side effects of radiation vary from one patient to the next and depend on the region of the body being treated.

However, a common side effect that can occur regardless of the treatment site is fatigue. This can be minimal or severe.

Nausea and vomiting can also occur if the brain or the upper abdomen is being treated. Radiation outside of these regions generally does not cause these symptoms. Fortunately, nausea and vomiting can be managed with the use of prescription medications.

Many patients are able to work during radiation treatment.

However, whether or not you can maintain your work schedule depends on the type of radiation treatment you are receiving and whether you are receiving chemotherapy as well.

Another factor is your overall health. Your doctor can help you determine whether it is reasonable to work during treatment.

If your treatment is delivered using a radiation beam outside the body, then you won’t be radioactive. When the radiation session ends, there is no radiation left inside you and there is no risk of exposing the people around you to the side effects of radiation.

If your treatment involves internal radiation or brachytherapy, then radiation safety precautions will depend on whether the radioactive source placement is temporary or permanent.

If it is temporary, then the source will be removed before you go home and there is no risk of exposure.

If it is permanent, as is sometimes the case for prostate cancer treatment, the radioactive “seeds” remain inside you but the radiation exposure is very low. Your doctor will discuss radiation precautions in more detail.

Exercise is both safe and beneficial for most patients receiving radiotherapy.

A daily workout routine can combat fatigue caused by treatment. It can also stave off anxiety and depression.

However, since radiation therapy can irritate your skin, it’s recommended that patients wear comfortable, loose-fitting clothing when exercising. Your doctor can provide more specific advice based on your circumstances.   

Both radiation and chemotherapy can lead to secondary cancers that can form many years after treatment. Fortunately, this is extremely rare and the risk is typically outweighed by the benefit of treating the active cancer. Your doctor can provide a complete understanding of the risks and benefits of therapy before proceeding with treatment.

Cancer care does not end after you finish radiotherapy.

After your final session, your cancer care team will develop a follow-up plan that calls for regular medical checkups. Typically, your first checkup will be scheduled four to six weeks after your last session. From there, appointments are scheduled every four months for two to three years.  

Unfortunately, no cancer treatment modality is 100 percent effective.

Even if you enter complete remission — meaning no evidence of cancer can be detected — there is still the possibility that your cancer can return. Cancer recurrence happens when a small number of cancer cells survive but are not detected during screenings. Over time, these cells grow and multiply until the cancer is detectable. 

If you or a loved one has recently been diagnosed with cancer, and you are interested in exploring radiation as a treatment option, we encourage you to request a referral to SERO. This will put you in touch with one of our expert doctors who can give you all of the accurate information you need to make the best treatment decision. Call (704) 333-7376 today.