RADIOTHERAPY

Cancer is the disordered growth of cells. Normally, these develop and divide, but when there are cancer cells they do it faster than normal cells. (When reproduced in other organs, it is known as metastasis)

Today, with modern technology, many people are cured of cancer after radiation treatment alone or in combination with surgery or chemotherapy.

The choice of one or several treatments depends on several reasons: the tumor site, the type of tumor, its size and whether or not it has invaded other organs. Your doctor will tell you about the treatments that have been chosen for your particular.

There are four specialties for the treatment of cancer:
1. Oncology Surgery After the diagnosis of cancer, it is determined whether or not the tumor can be treated with surgical treatment, and if its location and type allow it, surgery is performed.
2. Medical Oncology: It is the specialty that uses drugs that are applied in a venous, muscular or oral form and that is known as chemotherapy, hormonal therapy or treatments with biomodulators. They are intended to fight cancer cells by preventing them from multiplying.
3. Radiation therapy: Is the use of different forms of radiation for cancer treatment. It is also used to cure or control the growth of benign or malignant tumors and / or relieve symptoms. It is also indicated for benign diseases such as some non-cancerous brain tumors.
4. Oncologic Support: Is the specialty that is in charge of the management of the physical and emotional symptoms that can appear as a consequence of the diseases or their treatments.

Radiation therapy uses special equipment to send high doses of radiation to cancer cells. Most of the body's cells grow and divide to form new cells. However, cancer cells do it faster than many of the normal cells around them. The radiation acts on the DNA inside the cells producing small ruptures that prevent cancer cells from growing and dividing, and often cause them to die. Normal nearby cells may also be affected by radiation, but most recover and return to normal function.

Unlike chemotherapy, which exposes the entire body to cancer-fighting drugs, in most cases, radiation therapy is a local application treatment, which only affects the organs through which it passes.

For its ability to eliminate tumors can be used as a single treatment, and / or as a combined treatment with chemotherapy and / or surgery. Even in cases of advanced disease, when it is not possible the cure can be used to reduce the size of the tumor and improve certain symptoms such as pain, bleeding, oppression, etc; Giving relief and better quality of life to the patient.

Some types of cancer are more sensitive to radiation and in some areas it is easier to treat tumors with radiation without generating serious side effects.

There are limits on the amount of radiation a person can receive in their entire lives. Physicians are informed about the amount of radiation that healthy body parts can receive without danger of irreversible damage, use this information to decide how much radiation to administer and to what extent it should be directed.

If any part of your body has received radiation before, it may not be possible for you to receive radiation in that part a second time (depending on how much radiation you received the first time). If a part of your body has already received the maximum lifetime amount of radiation, it may be possible that you still receive radiation therapy directed at another part of the body if the distance between the two is broad enough.

Radiation therapy is given as external and / or internal radiation therapy. Some patients require both treatments.

If your doctor recommends a radiation treatment, it is because you understand that the benefits you will receive will outweigh the possible side effects. Even so, this is something that you should agree with.

EXTERNAL RADIOTHERAPY

External Radiotherapy uses a machine that directs high-energy rays from outside the body to the tumor. Most people receive external radiation therapy over the course of many weeks in which the sessions are done on an outpatient basis in a treatment center or hospital.

To perform external therapy it is necessary to locate exactly the site where the tumor is located: this process is called SIMULATION.

In the simulation the treatment area is determined, to ensure that the radiation is correctly directed. The area is marked with several points, which must be preserved until the treatment is finished. Sometimes the area will be marked with permanent spots like the ones used in a tattoo.
The information obtained in the simulation is passed to the PLANNING system, a special computer that allows to see the tumor, the normal tissues and how the radiation is distributed within the patient. With this information, the best way to irradiate the tumor and decrease irradiation in nearby organs is chosen. This is called a treatment plan. Once approved by the doctor, it will start. The treatment of radiotherapy is done in a team that directs the rays from outside to the site of the tumor. Usually it is ambulatory, it attends five days to the week during the time that the doctor determines. The amount of radiation that the patient needs will depend on individual factors such as: the location of the tumor, the depth and the general condition of the patient.

After a physical examination, as well as a review of your medical history and the results of the tests that have been performed, the doctor will accurately locate the area to be treated.

The radiation is directed very precisely. A mask or plaster cast may be made from the body part to help keep you immobile during treatment. The radiation technician may mark the area with small dots of semi-permanent ink. Over time, the marks will be prone to disappear, but it is necessary that they remain until the end of their treatment. Do not use soap or rub these marks. Sometimes, the area may be marked with permanent spots like the ones used in a tattoo.

Based on information from the simulation, other tests and your type of cancer, the doctor will decide how much radiation is needed, how it will be given and how many treatment sessions it should receive.

The patient lies down on a stretcher that is located below the radiation machine, each session lasts only a few minutes.

Depending on the treatment area, you may have to undress, so it is best to wear clothes that can be removed and put easily.

It is essential that you remain very still during the time of irradiation although you do not have to hold your breath. Sometimes it is necessary to use immobilizers to always ensure the same position.

The machine that is used to give the treatment can move in different angles, directing the radiation to the treatment area; Do not be afraid since all the time you and the machine are being watched for everything to work properly.

The total dose of external radiotherapy is usually divided into smaller doses called fractions. The most common form of administration is daily, 5 days a week (Monday to Friday) for 2 to 7 weeks. Weekend breaks allow normal cells to heal. The total radiation dose and the number of treatment sessions is based on:

1. The size and location of your cancer
2. The type of cancer
3. The purpose of treatment
4. Your overall health status
5. Any other treatment you are receiving

External radiotherapy affects a group of cells in your body just for a moment. Because there is no source of radiation in your body, you will not emit radiation at any time during or after treatment.                           The goal of radiation treatment is to attack cancer cells, causing the least possible damage to adjacent healthy cells. Knowing everything you can about the possible benefits and risks can help you to be sure that radiotherapy is the best for you.

INTERNAL RADIOTHERAPY OR BRAQUITERAPY

Internal radiation is also known as Brachytherapy, which uses a radioactive source that is placed inside the body in or near the tumor.

Internal Radiotherapy uses a radiation source that is usually sealed in a container called an implant. The implant is placed very close to or inside the tumor in such a way that it damages the least amount of normal cells as possible. Internal radiation therapy allows a higher dose of radiation in a smaller area than would be possible with the treatment of external radiation.

The main types of brachytherapy are intracavitary radiation and interstitial radiation. Both methods use devices, tapes, wires, needles, capsules, small balloons or tubes. Inside these devices, the radioactive material will be sent.

This treatment is given in an armored room to contain the radiation. Sealed radioactive substances (implants) are placed in the body cavities or body tissue with applicators, which often consist of metal or plastic tubes known as catheters. You are unlikely to suffer from severe pain or indisposition while introducing radioactive implants or catheters, devices or tubes for the temporary placement of radioactive material. You may feel drowsy, faint, or nauseous for a short time if you receive anesthesia (medicines to make you sleepy) for placement of the implant or device. Tell the nurse if you have unusual side effects like burning or sweating.

The area treated with the implant may be painful or tender for some time after treatment.

The implants are left in the body only for a certain time. If the implants are to be removed for posterior placement, the applicator is often left in place until the treatment is complete (sutures may be made to hold it in place). Then the applicator is removed at the time the implants are removed during the last session.

The type of implant you receive and the scheduling of treatment sessions will depend on the type of cancer, your location in the body, your general health and other treatments you may have had.

STEREOTACTIC RADIOSURGERY (SRS) AND STEREOTACTIC RADIOSURGERY FRACTIONED

In this treatment, advanced imaging techniques are used to deliver a large and accurate dose of radiation to a small tumor that is well defined.

The term surgery can be confusing, since no incision is made. This technique is used to treat tumors that begin or spread to the brain or head and neck region. If radiation is given in a single dose, it is called stereotactic radiosurgery. Fractional stereotactic radiosurgery is called if the radiation is divided into several separate doses.

When the radiation is directed towards the head, a frame is used to keep the head immobile and to direct the radiation beams accurately.

A related term, Stereotactic Body Radiotherapy (SBRT), is used when used to stop tumors in other parts of the body, for example the spine, liver, pancreas, kidney, lung and prostate.

Once the tumor is accurately located (through imaging studies), the radiation beams are directed from a machine to the tumor from different angles for a short period of time. This process may be repeated if necessary.

This procedure can be done using a linear accelerator that moves around the patient to deliver radiation to the tumor from different angles.




Treatment Effects

Fatigue is the feeling of being exhausted physically, mentally and emotionally. This is very common in patients undergoing radiotherapy.
Experiencing this kind of tiredness (fatigue) means having less energy to do the things you normally do or want to do. It can last for a long time and become an obstacle to doing your daily activities.

¿How to describe your tiredness?

Only you know if you have tiredness and how severe it is. There are no laboratory tests that can diagnose or describe your level of fatigue. The best measure of fatigue comes from your own report to your doctor or nurse. You can describe your level of fatigue as nonexistent, mild, moderate or severe. Or you can use a scale from 0 to 10, where 0 means no fatigue and 10 is for the worst tiredness you could imagine.

¿How to handle tiredness?

1. Perform blood tests in a timely manner that your doctor requests (low red blood cell count)
2. Correction of the imbalance of liquids and minerals in the blood
3. Decreased physical activity, as well as attention to sleeping problems and good nutrition could also alleviate the problem of fatigue
4. Education and counseling are often part of treatment, as you can learn how to save energy, reduce stress and use distraction
5. Usually, fatigue fades after treatment is finished.

Recommendations

1. Make a list of things you need to do in order of importance to you. Try to do the most important activities first, when you have more energy
2. Ask for help from your loved ones and friends
3. Put things you use frequently into your reach
4. Try to calm your stress
5. Maintain a balance between rest and activities. Schedule activities so that you have enough time to rest. Most people notice that having short periods of rest is better than a prolonged one
6. Follow a healthy diet that contains proteins (meats, milk, eggs and beans), and have a sufficient daily intake of water, unless you receive other indications

The treated area of your skin may look reddish, irritated, inflamed, blistered or even as if it is tanned or sunburned. After a few weeks, your skin may become dry, scaly, or itchy or peeling. This is called radiation dermatitis.

It is important that you tell your doctor or nurse about any changes you experience on your skin. You may be able to suggest ways to relieve discomfort, perhaps reduce additional irritation and try to prevent infection.

Most skin reactions disappear slowly after treatment is finished. However, in some cases, the treated skin will become darker and may be more sensitive than it was before.

Recommendations

1. Do not wear tight, rough or stiff clothing over the treatment area
2. Do not starch your garments
3. Do not rub or scrape treated skin and do not use masking tape on it
4. If it is necessary to cover or bandage the skin, use paper tape or the type used for sensitive skin
5. Do not apply heat to the treated region without first talking to your cancer care team
6. Protect the treated area from the sun. Your skin may become hypersensitive to sunlight. If possible, cover treated skin from the sun before you leave
7. Ask your health care team if you can use sunscreen
8. Continue to protect your skin from sunlight, even after the end of radiotherapy
9. Ask your doctor or nurse before applying anything to the skin of the treated area. This includes the use of powders, creams, perfumes, deodorants, body oils, ointments, lotions, hair removal products or home remedies during treatment and several weeks later. Many skin products can leave a layer on the skin that can cause irritation and some may even alter the dose of radiation absorbed by the body.

1. Báñese normalmente todos los días pues son muy importantes los buenos hábitos de higiene

2. Use jabón suave (al no utilizar jabón las bacterias se van a propagar en su piel)

3. Proteja la piel con una crema hidratante

4. Use desodorante con bajo contenido de alcohol

5. Puede usar lociones suaves

6. Es muy importante el uso de bloqueadores solares en la piel expuesta al sol y sombrero para la cabeza

7. Cuide su alimentación, un buen estado nutricional favorece una mejor respuesta al tratamiento, las frutas y verduras deben ser consumidas en buena porción

8. Los efectos secundarios pueden incluir problemas con el apetito e intolerancias digestivas

9. Para pacientes a los que se les irradia abdomen o pelvis no es recomendable consumir verduras o lácteos

10. Es posible que durante el tratamiento se pierda por completo el interés por la comida

11. Aunque no sienta hambre es importante mantener un adecuado consumo de nutrientes y calorías

12. Se ha descubierto que los pacientes que se alimentan bien, toleran mejor el tratamiento y sus efectos secundarios

13. Prefiera una alimentación fraccionada, de 5 a 6 comidas al día en cantidades moderadas

14. Trate de estar acompañado y procure rodearse de un ambiente agradable y limpio

15. Si otras personas le pueden cocinar, permítales que lo hagan

16. Si usted consume bebidas alcohólicas, debe consultar a su médico si debe suspenderlas durante el tratamiento

17. Es posible que usted requiera de complementos nutricionales, consulte a su médico

18. Mantenga una hidratación adecuada, ingiriendo una buena cantidad de líquidos