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What is radiation?

Radiation is energy moving from one place to another. The energy may move through waves or particles. High-
energy radiation, like x-rays, can change or destroy cells. Radiation therapy uses high-energy x-rays or proton
beams to destroy cancer.

Goals of radiation therapy

Doctors called radiation oncologists oversee radiation therapy. They use this treatment to destroy cancer cells and
slow tumor growth, without harming nearby healthy tissue.

Sometimes, doctors recommend radiation therapy as the primary cancer treatment. Other times, patients receive
radiation therapy after surgery or chemotherapy. This is called adjuvant therapy. It targets cancer cells remaining
after the primary treatment.

When it is not possible to destroy all of the cancer, doctors may use palliative radiation therapy to shrink tumors
and relieve symptoms. This may reduce pressure, pain, and other symptoms. The goal is to improve a persons
quality of life.
More than half of people with cancer receive some type of radiation therapy. For some cancers, radiation therapy
alone is an effective treatment. Other types of cancer respond best to combination treatments. This may include
radiation therapy plus surgery, chemotherapy, or immunotherapy.

External-beam radiation therapy (Teletherapy)

This is the most common type of radiation therapy. It delivers radiation from a machine outside the body. And it
can treat large areas of the body, if needed.

A machine called a linear accelerator, or linac, creates the radiation beam for x-ray or photon radiation therapy.
Special computer software adjusts the beams size and shape. This helps target the tumor while avoiding healthy
tissue near the cancer cells.

Most treatments are given every weekday for several weeks. Form-fitting supports or plastic mesh masks (for
radiation therapy to the head, neck, or brain) help patients stay still during treatment.

The types of external-beam radiation therapy are:

Three-dimensional conformal radiation therapy (3D-CRT). Detailed 3-dimensional pictures of the cancer are
created, typically from computed tomography (CT) or magnetic resonance imaging (MRI) scans. This allows the
treatment team to aim the radiation more precisely. It often means they can safely use higher doses of radiation
while reducing damage to healthy tissue. This lowers the risk of side effects. For instance, dry mouth is common
after radiation therapy for head and neck cancer. But 3D-CRT can limit salivary gland damage that causes it.
Intensity modulated radiation therapy (IMRT). This a more complex form of 3D-CRT. The radiation intensity is
varied within each beam in IMRT unlike conventional 3D-CRT, which uses the same intensity in each beam. IMRT
targets the tumor and avoids healthy tissue better than conventional 3D-CRT.
Proton beam therapy. This treatment uses protons rather than x-rays. A proton is a positively charged particle. At
high energy, protons can destroy cancer cells. The protons go to the targeted tumor and deposit the specific dose
of radiation therapy. Unlike with x-ray beams, the radiation does not go beyond the tumor. This limits damage to
nearby healthy tissue. Currently, doctors use proton therapy to treat certain cancer types. This therapy is relatively
new and requires special equipment. Therefore, it is not available at every medical center. Learn more
about proton therapy.
Image-guided radiation therapy (IGRT). This type of therapy allows the doctor to take images of a patient
throughout treatment. These images can then be compared to the images used to plan treatment. It allows better
targeting of the tumor and helps reduce damage to healthy tissue.
Stereotactic radiation therapy. This treatment delivers a large, precise radiation dose to a small tumor area. The
patient must remain very still. Head frames or individual body molds help limit movement. This therapy is often
given as a single or a few treatments. However, some patients may need several treatments.

Safety Procedures
During external-beam radiation therapy, the patient does not become radioactive. And the radiation remains in
the treatment room.

Nursing Responsibilities
Inform patient that they are not radioactive after the procedure
Wash area with warm water or very mild soap
Pat dry and inform the client not to remove the markings
Never apply any medications unless prescribed
Avoid irritation

Internal radiation therapy (Brachytherapy)


This type of radiation therapy is also called brachytherapy. Radioactive material is placed into the cancer or
surrounding tissue. Implants may be permanent or temporary and may require a hospital stay.

Types of internal radiation therapy include:

Permanent implants. These are tiny steel seeds that contain radioactive material. The capsules are about the size
of a grain of rice. They deliver most of the radiation around the implant area. However, some radiation may exit
the patients body. This requires safety measures to protect others from radiation exposure. Over time, the
implants lose radioactivity. And the inactive seeds remain in the body.
Temporary internal radiation therapy. Radiation therapy is given in one of these ways:
Needles

Tubes, called catheters, that carry fluid in or out of the body

Special applicators

The radiation stays in the body for anywhere from a few minutes to a few days. Most people receive radiation
therapy for just a few minutes. Sometimes, people receive internal radiation therapy for more time. If so, they stay
in a private room to limit others exposure to the radiation.

Safety procedures

Please note that all these safety guidelines are not relevant to every internal radiotherapy treatment. It is helpful
to run through this list with your doctor or specialist nurse to see which apply to you.

While having treatment

You might be in a special side room, away from the main ward for 1 or 2 days.
The doctors and nurses looking after you only stay in your room for short periods at a time.
Staff wear badges that monitor their exposure to radiation and make sure they keep to a safe level.
Staff and visitors need to stay a little way away from your bed the further away they are, the less
exposure they have to the radiation.
The nurses might use an instrument called a scintillation counter to monitor radiation levels in anything
taken out of the room, such as bed linen.
You can only have a limited number of visitors.
Visitors are asked to stay a short time and may need to sit some distance away from you or talk to you
from the doorway.
Children under 16 and pregnant women are not allowed to visit.
You can take books, magazines, and some electronic devices into the room.
If you had a radioactive drink, your urine might be slightly radioactive for a few days you may need to
use the toilet sitting down and wear gloves when you wipe yourself.

After your treatment

You might be given a card to keep with you for a certain period of time in case of medical emergency.
If a medical emergency occurs, let your doctor know that you have had internal radiotherapy treatment.
For a few days after a radioactive drink you might need to flush the toilet twice, each time you use it.
If you had internal radiotherapy seeds for prostate cancer and one comes out when you empty your
bladder, don't touch it. Use tongs to pick it up and flush it down the toilet. Tell your doctor.
You might need to wear a condom during sex for a few months after internal radiotherapy for prostate
cancer. This is in case a seed comes out during sex but this very rarely happens.

Permanent implants remain radioactive after the patient leaves the hospital. Because of this, the patient should
not have close or more than 5 minutes of contact with children or pregnant women for 2 months.

Similarly, patients who have had systemic radiation therapy should use safety precautions. For the first few days
after treatment, take these precautions:

Wash hands thoroughly after using the toilet.

Use separate utensils and towels.

Drink plenty of fluids to flush the remaining radioactive material from the body.

Avoid sexual contact.

Minimize contact with infants, children, and pregnant women.

Nursing Responsibilities

Before the Patient is Loaded

1. Place the lead shields by the patients bed.

2. Get a radiation badge to wear while caring for the patient. Write your name on the badge and also indicate
which one you are using on the form.
After the Patient is Loaded

1. Radiation safety will put a Caution, Radioactive Materials sign on the door of the

2. Put your badge on before entering the room. If you take care of the patient on more than one day, use the
same badge each time.

3. If a sealed source comes out of the catheter or fixture that is holding it in place in the patient, immediately
contact the Health Physicist on Call and Radiation Oncology. Use tongs to pick up the source and place it in the
lead container that has been left in the room.

4. After the radiation oncology physician removes the sources from the patient, radiation safety will monitor
to verify that the radiation sources are gone. Radiation Safety will then remove the Caution, Radioactive
Materials door sign.

Visitors

1. Visitors may visit a patient after he or she is dosed for one hour in a 24-hour period. They can divide up that
time into 4 fifteen-minute visits or however they would like to, but the total time must not exceed one hour.

2. Encourage visitors to call the patient on the telephone.

3. Once they are in the room, they must stay 6 feet or more away from the patient.

4. Visitors cannot enter the room if they are pregnant.

5. Visitors must be at least 18 years old.

Interventions by cancer type or radiation site


Breast radiation: Advise the patient to avoid bras with underwires, nylon, or lace. Instead, recommend a
breathable cotton bra or camisole. Tell patients they may use deodorant but should avoid shaving the armpits to
avoid skin irritation.
Head or neck: If the patient complains of dry mouth, suggest an oral mouthwash, such as a solution of 1 qt of
water, 1 tsp of salt, and 1 tsp of baking soda. Instruct the patient to swish it in the mouth and spit it out, repeating
several times a day. Some patients may need a prescription mouthwash. If appropriate, advise patients to see a
dentist before radiation treatment starts to check for severely decayed teeth or an oral infection, as these could be
a source of infection during treatment.
Brain tumor: Assess the patient for neurologic impairment, such as a change in level of consciousness, speech,
vision, balance, or strength. Check for numbness, tingling, and seizures. Recognize that any change from baseline
assessment findings requires intervention.
Bone involvement: Assess the patients pain level; effectiveness of pain management interventions; and extremity
strength, numbness, tingling, and range of motion. Caution patients that a bone tumor impairs bone integrity,
setting the stage for fractures.
Pelvic cancer: For younger patients with pelvic cancers (both male and female), provide information about
sexuality and possible infertility before radiation treatment begins. As appropriate, teach them about banking
sperm or egg-harvesting options.
What is chemotherapy?
Also called chemo, its a way to treat cancer that uses drugs to kill cancer cells.

How does chemotherapy work?

It targets cells that grow and divide quickly, as cancer cells do. Unlike radiation or surgery, which target specific areas,
chemo can work throughout your body. But it can also affect some fast-growing healthy cells, like those of
the skin, hair, intestines, and bone marrow. Thats what causes some of the side effects from the treatment.

What does chemotherapy do?

It depends on the kind of canceryou have and how far along it is.

Cure: In some cases, the treatment can destroy cancer cells to the point that your doctor can no longer detect
them in your body. After that, the best outcome is that they never grow back again, but that doesnt always
happen.
Control: In some cases, it may only be able to keep cancer from spreading to other parts of your body or slow
the growth of cancer tumors.
Ease symptoms: In some cases, chemotherapy cant cure or control the spread of cancer and is simply used to
shrink tumors that cause pain or pressure. These tumors often continue to grow back.

How is chemotherapy used?

Sometimes, it treats cancer by itself, but more often its used in combination with:

Surgery: A doctor removes cancerous tumors or tissue, or organs contaminated with cancerous cells.
Radiation therapy: A doctor uses invisible radioactive particles to kill cancer cells. It may be delivered by a
special machine that bombards parts of your body from the outside, or by putting radioactive material on,
near, and even inside your body.
Biological therapy: Living material in the form of bacteria, vaccines, or antibodies are carefully introduced to kill
cancer cells.

Chemotherapy may be used to:

Shrink a tumor before radiation therapy or surgery -- called neoadjuvant chemotherapy


Destroy any remaining cancer cells after surgery or radiation therapy -- called adjuvant chemotherapy
Make other therapies (biological or radiation) more effective
Destroy cancer cells that return or spread to other parts of your body.

How is chemotherapy given?

Injection: The drugs are delivered with a shot directly into muscle in your hip, thigh, or arm, or in the fatty part
of your arm, leg, or stomach, just beneath the skin.
Intra-arterial (IA): The drugs go directly into the artery that is feeding the cancer, through a needle, or soft, thin
tube (catheter).
Intraperitoneal (IP): The drugs are delivered to the peritoneal cavity, which contains organs such as
your liver, intestines, stomach, and ovaries. It is done during surgery or through a tube with a special port that
is put in by your doctor.
Intravenous (IV): The chemotherapy goes directly into a vein.
Topical: You rub the drugs in a cream form onto your skin.
Oral: You swallow a pill or liquid that has the drugs.
Nursing Intervention
MAINTAIN TISSUE INTEGRITY

Handle skin gently

Do NOT rub affected area

Lotion may be applied

Wash skin only with SOAP and Water

MANAGEMENT OF STOMATITIS

Use soft-bristled toothbrush

Oral rinses with saline gargles/ tap water

Avoid ALCOHOL-based rinses

MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy

Regrowth within 8 weeks of termination

Encourage to acquire wig before hair loss occurs

Encourage use of attractive scarves and hats

Provide information that hair loss is temporary BUT anticipate change in texture and color.

PROMOTE NUTRITION

Serve food in ways to make it appealing

Consider patients preferences

Provide small frequent meals

Avoids giving fluids while eating

Oral hygiene PRIOR to mealtime

Vitamin supplements

RELIEVE PAIN

Mild pain- NSAIDS Moderate pain- Weak opiods

Severe pain- Morphine

Administer analgesics round the clock with additional dose for breakthrough pain
DECREASE FATIGUE

Plan daily activities to allow alternating rest periods

Light exercise is encouraged

Small frequent meals

IMPROVE BODY IMAGE

Therapeutic communication is essential

Encourage independence in self-care and decision making

Offer cosmetic material like make-up and wigs

ASSIST IN THE GRIEVING PROCESS

Some cancers are curable

Grieving can be due to loss of health, income, sexuality, and body image

Answer and clarify information about cancer and treatment options

Identify resource people

Refer to support groups

MANAGE COMPLICATION: INFECTION

Fever is the most important sign (38.3)

Administer prescribed antibiotics

Maintain aseptic technique

Avoid exposure to crowds

Avoid giving fresh fruits and veggie

Handwashing

Avoid frequent invasive procedures

MANAGE COMPLICATION: Septic shock

Monitor VS, BP, temp

Administer IV antibiotics

Administer supplemental O2
A stem cell or bone marrow transplant replaces damaged blood cells with healthy ones. It can be used to treat
conditions affecting the blood cells, such as leukaemia and lymphoma.
-Stem cells are special cells produced by bone marrow (a spongy tissue found in the centre of some bones) that
can turn into different types of blood cells.

The three main types of blood cell they can become are:
red blood cells which carry oxygen around the body
white blood cells which help fight infection
platelets which help stop bleeding

A stem cell transplant involves destroying any unhealthy blood cells and replacing them with stem cells removed
from the blood or bone marrow.

Why are stem cell transplants carried out?


Stem cell transplants are used to treat conditions in which the bone marrow is damaged and is no longer able to
produce healthy blood cells.
Transplants can also be carried out to replace blood cells that are damaged or destroyed as a result of intensive
cancer treatment.
Conditions that stem cell transplants can be used to treat include:
severe aplastic anaemia (bone marrow failure)
leukaemia a type of cancer affecting white blood cells
lymphoma another type of cancer affecting white blood cells
myeloma cancer affecting cells called plasma cells
certain blood, immune system and metabolic disorders examples include sickle cell anaemia, thalassaemia,
severe combined immunodeficiency (SCID) and Hurler syndrome

A stem cell transplant will usually only be carried out if other treatments haven't helped, the potential benefits of a
transplant outweigh the risks and you're in relatively good health, despite your underlying condition.

What does a stem cell transplant involve?


A stem cell transplant can involve taking healthy stem cells from the blood or bone marrow of one person ideally
a close family member with the same or similar tissue type (see below) and transferring them to another person.
This is called an allogeneic transplant.
It's also possible to remove stem cells from your own body and transplant them later, after any damaged or
diseased cells have been removed. This is called an autologous transplant.
A stem cell transplant has five main stages. These are:
1. Tests and examinations to assess your general level of health.
2. Harvesting the process of obtaining the stem cells to be used in the transplant, either from you or a donor.
3. Conditioning treatment with chemotherapyand/or radiotherapy to prepare your body for the transplant.
4. Transplanting the stem cells
5. Recovery
Having a stem cell transplant can be an intensive and challenging experience. You'll usually need to stay in hospital
for a month or more until the transplant starts to take effect and it can take a year or two to fully recover

Risks of a stem cell transplant


Stem cell transplants are complicated procedures with significant risks. It's important that you're aware of both the
risks and possible benefits before treatment begins.
Possible problems that can occur during or after the transplant process include:
graft versus host disease (GvHD) this occurs in allogeneic transplants when the transplanted cells start to attack
the other cells in your body
reduced number of blood cells this can lead to anaemia, excessive bleeding or bruising, and an increased risk of
infections
chemotherapy side effects including sickness, tiredness, hair loss and infertility