What to Expect Before Starting Radiation

Nobody walks in and gets treated. Before external beam radiation begins, the National Cancer Institute (NCI) says to expect "a 1- to 2-hour meeting with your doctor or nurse." It covers the treatment, its benefits, its side effects, and self-care.

NCI explains that radiation "kills cancer cells or slows their growth by damaging their DNA." That damage adds up. "It takes days or weeks of treatment before DNA is damaged enough for cancer cells to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends."

So the daily grind has a reason, and the last session is not the end of the effect.

Simulation is the planning session. NCI describes it simply: "your radiation oncologist (a doctor) and radiation therapist will figure out your treatment area. You may also hear the treatment area referred to as the treatment port or treatment field."

You will lie still while images are taken. NCI notes planning uses "images from CT, MRI, and PET scans to precisely plan the treatment area."

Simulation is not treatment. No radiation is given for the cancer that day. It produces a map that must match your body exactly, every day, for weeks.

The position you are put in at simulation is the position you will hold at every session. If something is uncomfortable, say so then. Arms above your head or a turned neck gets much harder by day 20.

To keep you in the same place each time, the team may make a device.

NCI describes both kinds. "A body mold may be made of the part of the body that is being treated." And "you may be fitted for a mask if you are getting radiation to the head and neck area."

A mask fits closely over the face and is fixed to the table. Many people find that harder than expected. If enclosed spaces are difficult for you, raise it before the mask is made. Ask whether you can see one first, whether medicine to help you relax is an option, and whether staff can talk to you during treatment.

Positioning also needs marks. NCI describes small dots put on your skin so that the therapist can "make sure you are in exactly the same position for every treatment."

The two kinds are different, and the difference is permanent.

• Tattoos: "The dots are about the size of a freckle. If the dots are tattooed, they will remain on your skin for the rest of your life."
• Ink: "Ink markings will fade over time. Be careful not to remove them and tell the radiation therapist if they fade or lose color."

Ask which one your center uses before simulation day. If a permanent mark matters to you, raise it while there is still a choice.

There is usually a wait between simulation and the first treatment. It unsettles people.

The gap exists because a plan has to be built. Images are turned into a dose plan, beams are shaped and angled, the dose to nearby healthy organs is calculated, and the whole thing is checked. Some centers also run a dry run on the machine.

The wait is work, not delay. Still, ask before you leave simulation: what date is my first session, and who do I call if I have not heard?

NCI states that "most people have external beam radiation therapy once a day, five days a week, Monday through Friday."

Now the number that catches people out. The radiation itself takes "1 to 5 minutes." But "most visits last from 30 minutes to an hour, with most of that time spent placing you in the correct position."

Plan your life around the hour, not the five minutes. Five days a week for several weeks is a transport and work problem too. Sort out parking, rides, and time off before you start.

Not everyone is on a daily schedule. With stereotactic radiosurgery, NCI notes that "treatment is usually given in one dose. In some cases, you may receive up to five doses, given once per day."

You may hear several. NCI describes 3D conformal radiation therapy as using scan images to shape beams to the tumor. IMRT "uses many more smaller beams than 3-D conformal and the strength of the beams in some areas can be changed." IGRT "uses imaging scans not only for treatment planning before radiation therapy sessions but also during radiation therapy sessions."

Ask which one you are getting.

NCI's advice is specific. "Be gentle when you shower or take a bath." Whether you shower or bathe, "use a mild soap. Dry yourself with a soft towel by patting, not rubbing, your skin." And critically: "Be careful not to wash off the ink markings that you need for radiation therapy."

Ask before starting which lotion, deodorant, or soap you may use on treated skin. That list comes from your team.

NCI is direct: "Many people who get radiation therapy have fatigue." It varies. "People feel fatigue in different ways and you may feel more or less fatigue than someone else who is getting the same amount of radiation therapy to the same part of the body."

Other effects depend on the area treated, and NCI publishes a chart by body area. Its advice: "discuss this chart with your doctor or nurse."

Ask about late effects too. NCI notes that "other side effects may show up months or years after radiation therapy is over. These are called late effects." Healthy cells damaged during treatment "usually recover within a few months after treatment is over."

NCI answers this plainly: "No, external beam radiation therapy does not make people radioactive. You may safely be around other people, even pregnant women, babies, and young children."

Internal radiation, where a source is placed inside the body, follows different rules. If that is your treatment, ask for its safety instructions.

• How many sessions, over how many weeks, and on what days?
• What is the exact treatment area, and which healthy organs are nearby?
• Will I need a mold or mask, and can I try it first?
• What date is my first treatment, and who do I call if it slips?
• Which side effects should I expect from this area, and when do they usually start?
• What late effects should I watch for years from now?

• National Cancer Institute — External Beam Radiation Therapy for Cancer.
• National Cancer Institute — Radiation Therapy to Treat Cancer.
• National Cancer Institute — Radiation Therapy Side Effects.
• National Cancer Institute — Radiation Therapy and You: Support for People With Cancer.

Helpful next pages include What Happens During Radiation Simulation?, What to Expect During a Radiation Therapy Session, The Radiation Therapy Timeline: What to Expect, Radiation Dermatitis: Skin Care Questions, What to Expect at a Survivorship Visit, What to Expect When Cancer Treatment Is Delayed.