Sophia Edwards Bennett

Dear Friend of Cancer Patient,Thank you for your correspondence and thoughtfulness for your friend.The side effects of radiation are site-specific. Therefore, I would need to know where (organ/part of the body)your friend is being treated, to accurately inform you of the side effects. Sincerely Dr. EB

Dear Patient,The treatment duration for stomach cancer varies depending on the histology i.e. the type of stomach cancer.For example, Lymphoma of the stomach typically requires 15 treatments, delivered 5 days per week over the course of 3 weeks. If you are diagnosed with a different histology, such as adenocarcinoma of the stomach, then the recommended number of treatments is typically 25 fractions delivered 5 days per week over the course of 5 weeks. There are other variations; but the specified treatment courses are the most commonly employed for the cancer types referenced above.I hope that the above explanation adequately addresses your question.Best Regards,Dr. EB

Dear Friend of Cancer Patient,
Palliative radiation is a radiotherapeutic approach that is often employed when cure is not clinically attainable or medically feasible; but the cancer site in question remains treatable with conservative outcomes.The spectrum of the goal and outcome of palliative radiation is dictated by the primary diagnosis, and the site of disease (primary or metastatic) requiring palliation. 
Palliative radiotherapy is recommended in several clinical scenarios, including but not limited to, alleviating intractable cancer-induced pain, hemostasis (to halt bleeding caused by the tumor), and relieving tumor obstruction of critical structures such as the lung and esophagus.Palliative radiation is also prescribed to gain local control by decreasing the size of  tumor encroaching  on critical structures in the CNS (central nervous system) such as the spinal cord and/or brain; to halt further neurological compromise. 

I hope this response has been helpful and informative.Sincerely,Dr. EB

Preparation for radiation is generally minimal. However, if recommended, it is usually dictated by the site of disease and, necessarily, the adjacent normal structures (organs in close proximity to the site of treatment). For example, in the setting of radiation for prostate cancer, there are specific instructions for bladder and rectal preparation. For patients undergoing radiation to, or target sites close to, the stomach; an antiemetic (a medication to prevent nausea/vomiting) is usually prescribed. The patient is then advised to take this medication prior to radiation as a prophylactic measure. Your Radiation Oncology team will/should provide you with detailed pre-radiation preparatory instructions correlating to the cancer site that will be treated, if applicable. 

This is a very interesting question. It is understood that chemotherapy more commonly affects the immune system by decreases white blood cell counts (cells that are primed to maintain the immune system, combat or address infections). Conversely, radiation therapy is not known to significantly decrease blood counts. However, its effect is site specific, and is most pronounced when radiation therapy is directed to the pelvis. The latter observation is attributed to the large reservoir of bone marrow in the pelvic bones such as iliac bones (‘hip bones’).
Other sites of the body certainly host bone and thus contain bone marrow; but comparatively less percent than the pelvic bones. Thus, these bones are less likely to be related to any significant radiation-induced decrease in blood counts and, as such, are less associated with a compromised or weakened immune response.
I hope this response has been helpful and informative.

Sincerely,

Dr. EB 

In order to render the most accurate response to your question, specific  information regarding the type of breast imaging utilized will be necessary. Usually, the breast is imaged with a mammogram. Your question stem describes a "breast X-ray." Did you undergo a mammogram? 

Sophia Edwards-Bennett, MD PhD Radiation Oncologist

Dear 39-year-old female,

In general, the effects of radiation therapy can lag behind the treatment course, for approximately1-2 weeks thereafter. After this lag period, symptoms should start to dissipate, albeit slowly. However, every patient is different, with unique recovery rate. In addition, other factors, such as the site treated, and receipt of concurrent chemotherapy with radiation, may influence the rate of recovery from the effects of radiation.
I hope that the explanation herein provides an adequate response.

Sincerely,

Dr. EB

Thank you for your very interesting and probing question. Radiation and chemotherapy are effective treatment interventions that are utilized to treat cancer. In some cases, they are prescribed concurrently (together) because they act synergistically (help each other) to kill cancer cells. One approach is not necessarily better or worse than the other. However, because chemotherapy is either taken by mouth (as a pill), or is administered through the veins, it is distributed throughout the body. As such, it is systemic and may cause side effects/symptoms in more organs/areas or the body. Whereas, radiation therapy is directed to the tumor. Thus, the side effects are local and only result from exposure of the organs close to the tumor being treated with radiation. However, both are effective when applied in the clinically appropriate setting. In addition, most side effects can be treated to alleviate symptoms, and most will resolve after treatment.
I hope that this explanation answers your question sufficiently.

Sincerely,

Dr. EB 

Thank you for submitting your question.

Certain tumors have characteristic features on images studies such as a CT scan (frequently performed with IV contrast dye) that may help to differentiate between benign versus malignant disease. However, to establish a definitive diagnosis, pathological sampling is usually obtained by performing a biopsy of the tumor. 

Sincerely,

Dr. EB

As you’ve probably surmised, every treatment intervention is associated with side effects. Chemotherapy is referred to as systemic treatment, because it is routed through the body, after being administered either via the veins as a fluid, or by mouth as a pill. Because of this systemic distribution, chemotherapy can affect more areas in the body, thus generally causing a wider range of side effects. Radiation Therapy is local treatment, i.e., it is directed to the site of the cancer only. Thus, other parts of the body that are not in close proximity to the cancer site, are not affected by radiation. However, there is one radiation therapy side effect that is not localized to the site of treatment; and that is fatigue (tiredness). So, in response to your question, I would not ascribe ‘worse’ or ‘better.’ Rather, it is accurate to state that chemotherapy generally causes more side effects because of its systemic capacity. 
I hope that the above response adequately addresses your question.

Sincerely, 

Dr. EB

Addressing Concerns regarding  interaction with others after radiation treatment. There are essentially two (2) types of radiation therapy-1) external beam radiation therapy and 2) ‘internal’ radiation which, as the name suggests, is delivered internally via radioactive agents called radioactive isotopes. One such example of ‘internal radiation’ is radioactive seed implantation,  referred to as brachytherapy; utilized as clinically indicated, in the treatment of some prostate cancer patients. In the case of external beam radiation, the treatment is being delivered by high energy X-rays. Thus, similar to other X-rays, used for example in dental evaluation, or a simple chest -x-ray,  there is no residual radiation after each treatment. Therefore, you can interact with your family and loved ones without reticence or trepidation. I hope the information imparted herein, provides  ample clarity and allays your concerns.Regards,Dr. EB.

Dear Concerned Patient,

The acute side effects of radiation are largely site-specific. This means that radiation to different areas of the body induces select side effects. Thus, the acute radiation side effects will be dictated by the cancer site, and the normal structures/organs adjacent to the target/tumor. However, there are certain acute side effects that can result from radiation, regardless of the site of treatment. These are, namely, radiation dermatitis including skin irritation, erythema (redness), folliculitis/pruritus (rash/itching), possible desquamation/skin peeling), and fatigue. These are cumulative, and thus become more prominent as the treatment progresses. However, it is important to note that the rate of progression varies. For example, some patients may develop fatigue at the end of the second week of radiation, while others may detect some level of fatigue earlier, or later, in their treatment course. In addition, systemic treatment such as chemotherapy, may augment, worsen or accelerate the timing of side effects. Again, other acute side effects may occur, but are more specific to the treatment site. Thus, treatment to the abdomen may result in nausea (with or without vomiting), diarrhea and flatulence (gas). Radiation to the lung or chest area may result in cough, difficulty and/or pain on swallowing; while radiation to the prostate may result in increased urinary frequency, pain on urination (dysurea) and/increased nocturia (urination multiple times during the night). I would encourage you to call your Radiation Oncology team for further discussion, and recommended interventions for side effects.Telemedicine is an option in some clinical practices. 

Regards,

Dr. EB

Thank you for your question. It is quite valid, and usually evokes much concern among cancer patients. However, the answer is not simple.The time for tumor to respond to radiation depends on several factors.1) the type/histology of the tumor, which dictates its sensitivity to radiation therapy.2) the size of the tumor and whether or not the treatment guidelines dictate that the tumor burden/size be reduced by surgery prior to radiation.3) the use of chemotherapy in conjunction with radiation, especially if the chemotherapy agent is a radiosensitizer (i.e. helps radiation to be more effective).4).compliance with radiation as prescribed  i.e. completing the recommended course of treatment, which requires avoiding any treatment breaks, unless absolutely necessary. Thus, the time to response varies due to the factors highlighted above.However, it is reassuring to note that radiation therapy continues to work weeks beyond completion of the prescribed radiation treatment course.This is one of the reasons that your doctor may advise tarrying  6 -12 weeks after completion of treatment to obtain the appropriate imaging study (CT scan, PET scan, MRI etc), in order to ascertain an accurate assessment of treatment response. I hope this response amply addresses your question, and clarifies any lingering uncertainties. Sincerely,Dr. EB

This is a common concern among the general populace. However, the radiation dose exposure from a CT scan is quite minimal.The CT dose is usually reported in units of mSv or rads, and  typically ranges from 1-10 mSV, which is equivalent to 0.1-1 rad. These doses are minimal and thus unlikely to induce cancer.  The actual dose exposure within the referenced range, is dependent on the site of the body of interest/investigation eg. chest, abdomen or pelvis etc. If your doctor recommends a CT scan, it is usually warranted, to elucidate suspicious findings detected on a less sensitive scan such as an X-ray. A CT scan is also recommended at specific intervals after cancer treatment, in order to monitor treatment response, to query or correlate new symptoms, and/or for early detection of possible cancer recurrence. Thus, the benefits of the CT scan in the scenarios presented, far outweigh any risk of radiation exposure.I hope that this explanation is clear and allays your concerns. Sincerely,Dr.EB

Dear Patient,

This is a valid and common question from patients undergoing radiation therapy.Radiation is simply high energy X-rays delivered from a radiation machine, with the sole goal of ablating/killing cancer cells.However, these high energy X-rays (referred to as external beam radiation therapy) must pass through the skin in order to reach the target—the cancer site.The skin ‘houses’ the hair follicles, which are responsible for hair growth.Therefore, the hair follicles in the skin over the target  site (the site of the cancer), are damaged during radiation, thus causing hair loss. It is important to note that radiation therapy causes hair loss at the site of radiation only. This local hair loss effect is attributed to the fact that radiation is delivered directly to the site of the cancer.This is distinct from chemotherapy, which can cause general hair loss, because it is delivered through the blood stream to the body. Thus, radiation can only cause hair loss on the head/scalp, if the scalp, the skull or the brain is receiving radiation treatment. Likewise, if you are receiving radiation to the axilla (underarm), you will lose your underarm hair; but you will not experience hair loss from your scalp/head. 
I sincerely hope that this response is helpful and informative.

Regards,

Dr. EB

Lung cancer can be detected on an x-ray.However, additional imaging studies such as a CT scan and/or a PET scan are necessary for further elucidation.These more advanced imaging modalities/techniques will not only characterize the mass, but will also delineate its contours/borders, confirm its size, determine its metabolic activity (as in the case of a PET scan), identify associated lesions such as local lymph node metastasis, highlight invasion of adjacent (nearby) structures, and detect impending or existing obstruction of the airways.However, it is important to understand that not all lung lesions represent cancer. Thus, a biopsy must be performed in order to establish the definitive diagnosis of cancer.I hope this explanation is clear and informative. Regards,Dr. EB

Dear Concerned Patient, An MRI (magnetic resonance imaging) machine does not induce pain. However, it can be somewhat intolerable, not due to physical pain, but the unpleasant, irritating, repetitive, even perceived to some as a cacaphonic sound, that persists throughout the entire imaging procedure.Patients who have a diagnosis of baseline anxiety, and/or claustrophobia, are generally unable to endure these daunting effects of the sound and/or confining nature of an MRI machine.For such patients, a detailed discussion with the physician should be entered regarding either (1) the consideration of possible alternative imaging studies -without compromising the results/detection of the abnormality in question and thus the clinical management thereof, or (2) premedication prior to MRI, if not contraindicated, and is deemed clinically safe and appropriate. I hope the response presented is informative, and provides a framework for further discussion with your physician. Sincerely,Dr.EB

Dear Concerned Friend,

Radiation and chemotherapy are both utilized to kill cancer cells. However, they represent different modalities of treatment, with differential characteristics. While chemotherapy is systemic treatment, i.e., administered intravenously (via the blood stream) or orally (in tablet form), radiation therapy is delivered directly to the site of the cancer, thus rendering a more anatomically targeted/focal treatment. As a result, chemotherapy-induced side effects can be more diffuse (general), affecting other tissues not limited to the cancer site or its adjacent organs. Alternatively, the side effects of radiation are only associated with the cancer site and the organs in close proximity to the target/tumor. It is important to note that, while the route and mechanism of chemotherapy and radiation are different, they function synergistically, as they co-augment their ability to kill cancer cells.
I hope that this explanation lends more clarity to the subject in question.

Sincerely,

Dr. EB

Dear Concerned Cousin,

I am not privy to your cousin’s complete medical history, or the details of her total cancer treatment regimen, i.e., other modalities such as chemotherapy, etc. However, I can state that radiation therapy is certainly (at least) contributing to your cousin’s diarrhea. Radiation, when administered to treat cancer in the abdomen usually causes diarrhea because the bowel, which is located in the abdomen, is quite sensitive to radiation.When the bowel is exposed to radiation, the lining of the bowel is affected such that it is less effective and less efficient at absorbing fluids/water. This results in the loss of more fluid (and other nutrients), which in turn produces frequent ‘liquid’ excretory product, referred to as diarrhea.Your cousin’s cancer care team will encourage adequate hydration during this period. Other recommended dietary modifications include: the intake of foods rich in soluble fibers such as banana, rice, applesauce; and the avoidance of insoluble fibers such as raw vegetables. Other recommended interventions include anti-diarrhea medications such as Imodium. However, I would encourage your cousin to discuss, in detail, the recommended interventions and management of radiation-induced diarrhea with her oncology team. Lastly, for some reassurance, in most cases the episodes of diarrhea decrease after the course of radiation is complete. Admittedly, we cannot predict the exact interval for resolution of diarrhea post completion of treatment; as this varies with each patient, the extent of the treatment field, and other confounding factors. However, it is reassuring to note that most radiation- induced cases of diarrhea are not chronic, and thus will dissipate with time.  
I sincerely hope that the explanation provided above is both helpful and informative.

Regards,

Dr. EB

Dear Concerned Family Friend,

Thank you for posting the question regarding your friends mother’s diagnosis of Stage II breast cancer. The stages of breast cancer are assigned based on several factors 1) the size of the breast tumor 2) the nodal status (the presence or absence of positive nodes) and 3) metastasis to other sites such as the contralateral breast (the opposite breast), bone, liver, lung or brain. Thus, stages I-III are localized to the breast and regional nodes, while stage IV has spread to other sites.Stages I-III can be further subdivided based on several criteria such as the size of the breast tumor and nodal status. This, of course, is also true for stage II breast cancer (the stage of your friend’s mother-as stated in your inquiry). Stage II breast cancer could signify a tumor size of 2-5 cm and positive nodes, or a tumor size greater than 5 cm without involvement of nodes.In both scenarios, chemotherapy would be recommended after surgery, as prescribed by her medical oncologist. If she elects to undergo breast conservation surgery (excision of the tumor without removing the entire breast), regardless of the subset of stage II, adjuvant radiation therapy (radiation therapy after surgery) is recommended as the standard of care. In the setting of mastectomy (removal of the entire breast), if her stage II breast cancer is attributed to tumor size 2-5 cm and positive nodes, adjuvant post-mastectomy radiation therapy is certainly recommended. However, if her stage II disease denotes tumor size > 5 cm with negative nodes (nodes not involved with cancer), then adjuvant radiation therapy after mastectomy (post-mastectomy radiation therapy) is usually recommended. However, your radiation oncologist will likely enter a detailed discussion with your friend’s mother and family, during which all factors will be considered, including patient age and medical comorbidities, and pathological features including, but not limited to, margin status and tumor grade. I hope that the explanation herein amply addresses your question and provides information for further discussion with the oncology team participating in the care of your friend’s mother.

Best Regards,

Dr. EB