What to expect
Referral
When you are referred to Perth Radiation Oncology, you will be given the first available appointment with your chosen doctor. You may wish to consider seeing him or her at one of our satellite clinics if they offer earlier appointments.
Make sure you collect all relevant X-rays, CT/MRI scans and other medical reports from your GP and other specialists, or arrange to have them sent to Perth Radiation Oncology. You will need these for your first appointment. You will also require a letter of referral - a GP referral is valid for 12 months; specialist referrals are valid for 3 months. Valid referrals are required to receive medicare rebates.
1st Appointment
Your first consultation with the Radiation Oncologist will take approximately half an hour. The purpose of this consultation is to decide whether radiation therapy is appropriate for you - to help in decision making, the doctor will need to see all relevant X-rays, CT/MRI scans, blood test or biopsy reports. They may also do a physical examination, as well as asking a number of questions about the history of your disease.
Questions you can expect to be asked include:
- History of your disease
- When did you first notice symptoms of your disease?
- What were those symptoms?
- When did you first see a doctor about those symptoms?
- What other treatments have you received? How effective were they?
- Other Medical History
- What other significant illnesses or injuries have you suffered in the past?
- Do you have other current medical conditions or concerns?
- What medications/supplements are you taking? What doses?
- Do you have any allergies or intolerances?
- Family History
- Does your family have a history of cancer? Who and what type?
- Social and Occupational History
- Who looks after you?
- What is your occupation?
- Do you have children?
- What sort of lifestyle do you lead?
- Do you smoke? How much alcohol do you drink?
This information will help the doctor come to a decision about which treatment is most appropriate for you, and what risks are associated (if any) for you personally.
You should take the opportunity to ask your doctor any questions of your own.
Some questions you may consider include:
- What is the purpose of radiation treatment for my type of cancer?
- Will it prevent or stop the spread of cancer?
- Will it destroy or shrink the tumour?
- If radiation therapy follows surgery, will it destroy any remaining cancer cells? Could radiation alone be used instead of surgery?
- What are the chances that radiation therapy will work?
- Are there other ways to achieve the same goals?
- How will the radiation directly affect the cancer and the area surrounding it?
- What side effects are likely to occur?
- Will any of these side effects affect my ability to function normally, for example my ability to eat or drink, exercise, work, etc.?
- Will side effects change my appearance?
- Will they be temporary or permanent? If temporary, how long will they last?
- What is the chance that the cancer will spread or come back if I do or do not have radiation therapy?
Your doctor will also give you information about costs and transport issues (if relevant).
During Treatment - Simulation
To be most effective, radiation therapy must be aimed precisely at the same target or targets each and every time treatment is given. Simulation is the process of making scans and measurements of your anatomy to help your team direct the beams of radiation safely and exactly to their intended locations.
During simulation, your radiation therapists will place you on the simulation machine (an X-ray device used to localise your cancer in the same was as the treatment machines) in the exact position you will be in during the actual treatment. They will then mark the area to be treated directly on your skin or on immobilization devices. Immobilization devices are molds, casts, headrests or other devices that are constructed and placed on a certain part of your body to help you remain in the same position during the entire treatment. The radiation therapist marks your skin and/or the immobilization devices either with a bright, temporary paint or a set of tiny permanent tattoos. X-rays may be taken, or you may be sent for CT scans to further guide your treatment team in planning your treatment. These X-rays and CT scans are separate to and different from your diagnostic scans.
Depending on the location of your cancer, you may be required to be undressed. Gowns are provided to ensure your privacy as much as possible, but may need to be removed while you are on the simulation machine bed. During the appointment, the simulation room will be darkened, and two radiation therapists will be present. As Perth Radiation Oncology is a training facility, there may also be one or two students present. You are never left alone in the simulation room, although the therapists may stand behind a screen when taking X-rays.
Although simulation is typically only one session, your physician may schedule additional sessions depending on the type of cancer you have and the type of radiation therapy that is being used. A standard simulation appointment takes approximately 30-60 minutes.
After simulation, your radiation oncologist and other members of the treatment team review the information they obtained during simulation along with your previous medical tests to develop a treatment plan. Frequently, sophisticated treatment-planning computer software is used to help design the best possible treatment plan. After reviewing all of this information, your doctor writes a prescription that outlines the exact course of your radiation therapy treatment.
Treatment Administration
External beam radiation therapy is administered differently from brachytherapy. You may receive one or both of these treatments. The following sections describe what you may experience during treatment administration.
External Beam Radiation Therapy Treatments
When you undergo external beam radiation therapy treatment, each session is painless, like getting an X-ray. The radiation is directed to your tumor from a machine located outside of your body. One of the benefits of radiation therapy is that it is usually given as a series of outpatient treatments and you may not need to miss work or experience the type of recuperation period that can follow other treatments.
Treatments are usually scheduled five days a week, every day except Saturday and Sunday, and continue for three to 10 weeks. Some patients receive hyper-fractionated radiation therapy, in which radiation treatments are given more than once a day. Other times, only one or a few treatments are required, such as for the treatment of cancer that has spread to the bone. This is called hypo-fractionated radiation therapy. The number of radiation treatments you will need depends on the size, location and type of cancer you have, your general health and other medical treatments you may be receiving.
You will be informed prior to starting treatment if you should follow any special preparatory instructions before or after each treatment dose. In general, it is fine to eat, shower, exercise and sleep as normal before and after each appointment - there is no need to disrupt your lifestyle. Comfortable, loose clothing is recommended, however most normal clothing is sufficient. Some patients will need to be undressed during treatment, and as with simulation appointments, gowns are provided.
The radiation therapist will administer your external beam treatment following your radiation oncologist's instructions. It will take about five to 15 minutes for you to be positioned for treatment and for the equipment to be set up. If an immobilization device was made during simulation, it will be used during every treatment to make sure that you are in the exact same position every day. As in simulation, the treatment room is darkened to facilitate the positioning lights of the machine.
Once you are positioned correctly, the therapist will leave the room and go into an adjoining control room to closely monitor you on a television screen while administering the radiation. They are within calling range, should you have any concerns. The machine can be stopped at any time if you are feeling ill or uncomfortable. Your ability to relax and stay still aids in the efficiency of your treatment. Treatment itself usually takes only a few minutes, once you are in position and the machine is set up.
The radiation therapist may move the treatment machine and treatment table to target the radiation beam to the exact area of the tumor. The machine might make noises during treatment that sound like clicking or whirring. These noises are nothing to be afraid of, and the radiation therapist is in complete control of the machine at all times.
The radiation therapy team carefully aims the radiation to decrease the dose to the normal tissues surrounding the tumor. Still, radiation will affect some healthy cells. The time in between daily treatments allows your healthy cells to repair much of the radiation damage. Most patients are treated on an outpatient basis, and many can continue with normal daily activities.
Sometimes a course of treatment is interrupted for a day or more. This may happen if you develop side effects that require a break in treatment. These missed treatments may be made up by adding treatments at the end. Try to arrive on time and not miss any of your appointments.
Your radiation oncologist monitors your daily treatment and may alter your radiation dose based on these observations. Also, your doctor may order blood tests, X-ray examinations and other tests to see how your body is responding to treatment. If the tumor shrinks, another simulation may be done. This allows your radiation oncologist to change the treatment to destroy the rest of the tumor and spare even more normal tissue.
Brachytherapy Treatments
Brachytherapy, also called internal radiation or seed implants, is the placement of radioactive sources in or just next to a tumor. The radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used.
There are two main types of brachytherapy: intracavity treatment and interstitial treatment. With intracavity treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.
Devices called high dose rate remote afterloading machines (HDR machines) allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You should be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.
Most patients feel little or no discomfort during brachytherapy. The HDR machine makes a quiet whirring or buzzing sound, but aside from this you will not be able to tell that anything is happening. Peaceful music can be played during your treatment if you would like this. During your treatment, the radiation therapists and physicists operating the HDR machine will be in an adjoining room with the controls, and will be able to see you on a television screen. Depending on the location of the area being treated, you may need to be partially undressed during treatment. Gowns and covering sheets are provided for your privacy. As with external beam radiation therapy, you should try to continue your normal daily life whilst undergoing brachytherapy, unless you are given specific instructions otherwise.
Weekly Status Checks
During radiation therapy, your radiation oncologist and nurse will see you regularly to follow your progress, evaluate whether you are having any side effects, recommend treatments for those side effects (such as medication or diet changes) and address any concerns you may have. As treatment progresses, your doctor may make changes in the schedule or treatment plan depending on your response or reaction to the therapy.
Weekly Port Films
During treatment, your treatment team will routinely use the treatment machines to take special X-rays called port films. Your treatment team routinely reviews these films to be sure that the treatment beams remain precisely aimed at the proper target. These X-rays are not used to evaluate your tumor.
After Treatment Follow-Up
After treatment is completed, follow-up appointments will be scheduled so that your radiation oncologist can make sure your recovery is proceeding normally and can continue to monitor your health status. Your radiation oncologist may also order additional diagnostic tests. Reports on your treatment can be sent to your other doctors.
As time goes on, the frequency of your visits will decrease. However, you should know that your radiation oncology team will always be available should you need to speak to someone about your treatment. In particular, if you experience ongoing side-effects, you should not hesitate to contact the clinic. It is generally possible that you will be able to consult with the nurses at any time during or after your treatment without an appointment - if they believe your concerns should be addressed by a doctor, an appointment will be made for you as soon as possible.