Frequently Asked Questions

Cancer develops when cells begin to divide rapidly and grow out of control.  Normal healthy cells within the body have regulators that initiate cell growth and death. When this mechanism is disrupted or is ineffective the cells then begin to grow at a rate that is not controlled and become abnormal. These abnormal cells can then invade surrounding tissues and potentially break away where they can travel to distant regions of the body.

Benign refers to a tumor, which is not cancerous; they remain localized meaning they do not spread to other parts of the body. These types of tumors are usually removed surgically. Malignant tumors on the other hand are cancerous. These cells are abnormal and divide rapidly and can move to other parts of the body through the lymphatic system or through the bloodstream.

This is when the cancer moves from its original origin to a different part of the body. Once this takes place these traveler cells begin to then grow and divide producing more abnormal cell and destroy healthy tissue.

No. The type of cancer you have depends on the first spot the cancer developed in. The primary site could be in blood, lymph nodes, muscle, bone, or in any organ such as the lung, liver, pancreas, or breast.

Doctors use staging techniques to determine to what extent the cancer has progressed, if at all. Staging allows us to better evaluate the size of the tumor, the location, whether or not lymph nodes are involved, and if the cancer has spread to other regions of the body. It is very important for the doctor and the patient to understand how aggressive the type of cancer is in order to develop the most promising treatment plan for each particular type of cancer and the stage of that cancer.

Treatment options vary depending on the stage and type of cancer found. Options available include; surgery, radiation, chemotherapy, hormone therapy and immunotherapy. These options may be used alone or in conjunction with one another depending on what treatment plan has shown to be effective through research and trials for your particular type of cancer.

Radiation therapy uses high energy rays to kill cancer cells. It is used for different reasons which include, shrinking the cancer prior to surgery, used after surgery to reduce the risk of cancer returning, in conjunction with chemotherapy, alone, or to reduce symptoms the cancer may be causing when the cancer is to advanced for curative measures.

A radiation oncologist is a physician with specialty training in the diagnosis and treatment of cancer and how radiation can be used to benefit cancer patients. Oncologists are physicians that specialize in cancer treatment, and there are different types of oncologists. In addition to radiation oncologists, there are also medical oncologists, who specialize in the treatment of cancer with medicines (drugs). Surgical oncologists are physicians trained in the treatment of cancer with surgery. Gynecologic oncologists are physicians trained in the treatment of gynecologic cancers with surgery and/or drugs. There are orthopedic oncologists, neuro-oncologists, and so on. There are many other physicians involved in the diagnosis and treatment of cancer even though they do not have “oncologist” in their name. Which of these specialists you may need to see depends on the type of cancer you have.

Many types of cancer can be treated by radiation alone or in combination with another form of treatment. If you have a diagnosis or suspect cancer, you should ask your physician if it could be helpful for you to have a consultation with a Radiation Oncologist. Sometimes there may be differences of opinion between cancer specialists about whether radiation could be the best treatment in a given case. These differences of opinion are best addressed by collaboration between a team of physicians, and the Radiation Oncologist is a member of every complete cancer treatment team. If radiation is a possible option, a complete opinion from the Radiation Oncologist requires a face to face consultation with the patient, including a complete evaluation.

Radiation passes into your body and into your cancer to cause damage to the cancer. The radiation cannot be seen, felt, heard, or smelled—it is like a ray of light you cannot see. You may have heard of ultraviolet light that can come from the sun and enters your body even though you cannot see it. Radiation that is used to treat cancer has a much higher energy than ultraviolet light and does more injury along its path. It injures both good cells and cancer cells, but the good cells have built-in mechanisms to repair the radiation damage, while the cancer cells do not. This advantage was discovered by chance over 100 years ago, and radiation has been used to treat cancers ever since, with many advancements and refinements along the way.

Chemotherapy is a classification of medications that are known to destroy cancer cells and slow down the progression of the disease. Chemotherapy comes in many different forms and can be administered in different ways. Some chemotherapy medications are given in a pill form, some by intravenous infusions, or in the form of an injection. The type you receive depends on the type of cancer you have.

Surgery can often be used to help determine the diagnosis of cancer. Surgery is also used to remove the cancer and the surrounding tissue affected. However surgery in the effort to remove the cancer is not an option for everyone. This decision is left up to the surgeon. Some cancers invade major organs such as the brain or lungs for example. Damage to these organs may not be permissible to life or the quality of life. Therefore it is up to the patient and the surgeon to discuss the risk of having the surgery versus not having surgery.

Certain types of cancer such as breast and prostate cancer can be treated with hormones by altering the level of hormones in the body.

Immunotherapy, also called biologic therapy, is a type of cancer treatment that boosts the body’s natural defenses to fight the cancer. It uses substances made by the body or in a laboratory to improve or restore immune system function. Immunotherapy may work in these ways:

• Stopping or slowing the growth of cancer cells
• Stopping cancer from spreading to other parts of the body
• Helping the immune system work better at destroying cancer cells

There are several types of immunotherapy, including:

• • Monoclonal antibodies
  • Non-specific immunotherapies
  • Oncolytic virus therapy
  • T-cell therapy
  • Cancer vaccines

Cancer.Net

The most common radiation therapy side effects include:

• Skin problems (dryness, itching, blistering or peeling)
• Fatigue

You may experience side effects that are specific to the radiation therapy location. For instance, head and neck radiation therapy side effects may include dry mouth, mouth and gum sores, and difficulty swallowing. Stomach and abdomen radiation therapy may cause nausea and vomiting or diarrhea. Learn more about the potential side effects of your specific type of cancer by visiting the My Healing Plan patient portal.

Tell your health care provider as soon as you start to develop any of these side effects. Prior to starting chemotherapy your health care team should advise you of possible side effects and what they recommend you do in this case. There are many medications that can be given to help alleviate these symptoms.

Radiation therapy does not cause hair loss. Not every one who receives chemotherapy will loose their hair. This depends on the type of chemo you receive. There are some agents that have demonstrated hair loss where other agents did not.

Fatigue is a symptom caused often times by anemia. Anemia is the result of a decrease in the number of circulating red blood cells in the bloodstream. Red blood cells are primarily responsible for delivering oxygen to all our organs and tissues. Oxygen is essential to carry out all of the body’s requirements. Hence when there is a reduction in the amount of oxygen being distributed to our cells the body gets easily tired.

Listen to your body do not over-exert yourself, and allow yourself time to rest throughout the day. Talk with your doctor first so the reason behind the fatigue can be evaluated. If the fatigue is anemia related, there are medications that could help correct the anemia.

Call your doctor. There are many medications that can help alleviate these symptoms. It is very important that your let you doctor know if you have been experiencing vomiting and how often. Vomiting can put you at risk for dehydration and an imbalance in essential electrolytes required by the body.

Call your doctor. Be sure to tell the doctor how often you are having loose stools. This can be treated with medications. Diarrhea can place you at risk for dehydration so do not underestimate the impact diarrhea can have on your body.

Call your doctor. Your physician can advise you on over the counter medications or provide a prescription to help alleviate your symptoms.

• Fever 100.5 F. degrees or greater
• Uncontrollable nausea, vomiting or diarrhea
• Pain is not well controlled
• Chest pain or shortness of breath
• Severe shaking or chills
• Bleeding from any location including skin, nose, gums and genital areas
• Blood in the urine or stool
• Black, tarry bowel movement
• Changes to skin at site of radiation therapy
• Constipation with intense abdominal cramping
• Changes in your vision or hearing
• Any symptom that concerns you

The most important thing to do is to quit smoking and avoid second hand smoke. Many cancers are caused by smoking. Smoking leads to many other serious diseases as well. Other things to avoid include smokeless tobacco, excessive alcohol intake, sun exposure without sunblock, and exposure to certain chemicals, drugs, and radiation. You should also eat healthy and get exercise. An excellent online resource to explore this question further is available at the American Cancer Society’s site at www.cancer.org.

Radiation treatments are given by specialists called Radiation Oncologists. These specialists are trained in the management of cancer, and are trained to determine who may or may not benefit from radiation treatment for their cancer. There are also a few types of diseases other than cancer that can benefit from radiation treatments. The Radiation Oncology physician will analyze your history, including your medical records from other physicians, and will examine you to obtain a base of information about your particular problem. He will also often discuss your case verbally with your other physicians. After this complete assessment, the Radiation Oncologist will discuss with you options and recommendations on how to best address your problem. You may have had a similar experience when you were sent to see a surgeon, who thoroughly evaluated you and discussed your options, rather than meeting you for the first time in the operating room to perform an operation that another physician recommended.

A Radiation Oncologist is a physician with specialty training in the diagnosis and treatment of cancer and how radiation can be used to benefit cancer patients. Oncologists are physicians that specialize in cancer treatment, and there are different types of Oncologists. In addition to Radiation Oncologists, there are also Medical Oncologists, who specialize in the treatment of cancer with medicines (drugs). Surgical Oncologists are physicians trained in the treatment of cancer with surgery. Gynecologic Oncologists are physicians trained in the treatment of gynecologic cancers with surgery and/or drugs. There are Orthopedic Oncologists, Neuro-oncologists, and so on. There are many other physicians involved in the diagnosis and treatment of cancer even though they do not have “oncologist” in their name. Which of these specialists you may need to see depends on the type of cancer you have.

Radiation passes into your body and into your cancer to cause damage to the cancer. The radiation cannot be seen, felt, heard, or smelled—it is like a ray of light you cannot see. You may have heard of ultraviolet light that can come from the sun and enters your body even though you cannot see it. Radiation that is used to treat cancer has a much higher energy than ultraviolet light and does more injury along its path. It injures both good cells and cancer cells, but the good cells have built-in mechanisms to repair the radiation damage, while the cancer cells do not. This advantage was discovered by chance over 100 years ago, and radiation has been used to treat cancers ever since, with many advancements and refinements along the way.

Many types of cancer can be treated by radiation alone or in combination with another form of treatment. If you have a diagnosis or suspect cancer, you should ask your physician if it could be helpful for you to have a consultation with a Radiation Oncologist. Sometimes there may be differences of opinion between cancer specialists about whether radiation could be the best treatment in a given case. These differences of opinion are best addressed by collaboration between a team of physicians, and the Radiation Oncologist is a member of every complete cancer treatment team. If radiation is a possible option, a complete opinion from the Radiation Oncologist requires a face to face consultation with the patient, including the complete evaluation discussed above.

No. Many patients and physicians are more familiar with the use of radiation to relieve pain or treat other symptoms caused by advanced incurable cancers, and perhaps not as familiar with the use of radiation with the intent to cure. Many cancers are curable, and in many of those cases radiation can provide a cure by itself or in combination with other forms of treatment. Some cancers are best treated by radiation alone to provide the best chance of cure and to maintain the best function of the area being treated. Other cancers are best treated by a combination of treatments including radiation, and some cancers do not benefit from the addition of radiation to the treatment plan.

During an operation, the surgeon makes an assessment about what tissues to remove from your body to have the greatest chance of eliminating all of your cancer. In order to determine this, he needs to see and feel your cancer, and remove all of it that he can see or feel. Sometimes there are extensions of your cancer that he cannot see or feel, and there are ways to predict when it is likely that some cancer cells may be left behind. In those cases, further treatment may be needed.

Many patients, and even some physicians, feel instinctively that radiation “causes many side effects.” It seems different to undergo radiation than other treatments, although other treatments such as surgery and chemotherapy have significant side effects themselves. Often patients who agree to an operation that carries with it life or death risks have discomfort worrying about relatively minor radiation side effects. Some radiation side effects can be very serious, but are generally uncommon. The important choice to make is whether you are better off living with the effects of the radiation or with the effects of the cancer, and this is the same choice to make if you are trying to decide about having surgery and its risks, or chemotherapy and its risks. The specific side effects you may experience with radiation are much better discussed with the Radiation Oncologist than other physicians, because the detailed information about how much area will be treated and to what level is completely known only to the Radiation Oncologist. In the surgical comparison, you should hear directly from the surgeon what the risks of an operation are rather than rely only on other physicians’ opinions on the risks of a certain operation. As with the surgeon, the Radiation Oncologist would include the concerns of your other physicians regarding your past and current medical problems and history.

Radiation Oncologists are trained in the optimal use of radiation in medical care. They are the best source of guidance on how your treatments should be given. Again, you expect your surgeon to be the best judge of what operation to perform, and all the details of the operation are dictated by the surgeon. Likewise, the Radiation Oncologist prescribes your radiation treatment program.

The amount of radiation needed in your particular case takes into account many factors, including how large your cancer is, where it is located, whether you will be getting chemotherapy at the same time, and so on. An optimal radiation plan takes these things into account, and how many days you have to come is based on how to have the most effective treatment possible while at the same time minimizing the long term side effects from the radiation. In order for your good cells to benefit from their ability to recover from radiation injury, they need to be given only a certain amount each day and there has to be an adequate amount of time between treatments to allow some recovery. In order for your treatment to get over faster, more has to be given each day, and that may be too hard on your good cells to allow them adequate recovery between treatments.

Life-threatening complications from radiation are fortunately uncommon, although they can occur. Often patients with cancer are treated with multiple forms of treatment and the cancer still survives and the patient dies from the cancer. Sometimes patients and even physicians believe when a patient gets worse after treatment that this was caused by the treatment. Sometimes unfortunately the patient gets worse due to progression of their cancer, but this can be difficult to distinguish in some cases. However, it is likely that the patient will get worse if they decline treatment because the cancer will usually grow and make the patient sicker if left untreated. This is the question the patient must ask: How will I do if I get treatment, and how will I do if I do not get treatment? In other words, what are the side effects from treatment, and what are the “side effects” of untreated cancer? There is unfortunately no choice that will leave the patient as they are today—the cancer will almost always cause problems, while the treatments may or may not cause major problems.

These films or images are taken to verify the location being treated. Sometimes small adjustments have to be made to consistently target your cancer. Your cancer usually cannot be seen on these images, so there is no information on them about your cancer itself. They only make sure that the area where your cancer is located is being treated properly.

Normally there is no information about your cancer available on a week by week basis. The purpose of the weekly visits is to evaluate and treat any possible side effects. Only after the treatments are completed can we determine how effective they were. Sometimes your cancer can be felt or seen without performing a scan or x-ray, and in those cases you and your doctor may be able to monitor its response on a continuous basis during your treatments. However, the response to radiation may be delayed, so you may not see much change during your treatments.

This depends on your particular case and will be discussed with you by your physicians. Radiation works by injuring the cancer cells, but the cancer cells sometimes may take weeks or even months to die. In addition, the effects on the normal cells can affect the appearance of any scans. For this reason, it is best to avoid doing follow-up scans too soon after treatment finishes. This will allow you to get a clearer picture of what the results are.

Interpretation of follow-up scans can be difficult after radiation, and ideally your Radiation Oncologist should be involved in the ordering and review of your follow-up scans to get the most complete interpretation. Also, managing the side effects that may appear after radiation should be largely the responsibility of the Radiation Oncologist. Once again, the surgeon usually manages the complications of the operations that he/she performs, just as the Radiation Oncologist should manage the complications of the treatment he performs. Like the other aspects of cancer care, the overall management of your follow-up is best handled by a team of cancer specialists including the treating Radiation Oncologist, and your team should work together on your behalf.

Your initial consultation will be a time that is specifically set aside for you. The physician has to look at many aspects of your health to determine the best treatment for you. This includes reviewing your previous health history and records of your current tests and procedures, as well as correspondence and input from your other physicians. Additionally, the physician will look at the images of your x-rays and scans, which can be very time consuming. Try to keep in mind that all of this is extremely important to individualizing a treatment plan that is optimal for you.

Radiation therapy treatments are technically complex and require a lot of attention to detail. The first step in planning your treatment will be a simulation session. During that session, you will have a CT scan at this facility. This scan will be used to determine the exact place in your body to aim the radiation. To help you remain still during treatment and to ensure the radiation beam is aimed accurately, an immobilization device may be custom made for you. After the scan, the radiation oncologist, radiation physicist, and the dosimetrist will use a treatment planning computer to determine how much radiation is needed, how it will be given, and how many treatments you need. When the entire planning process has been completed, you will be contacted with an appointment to begin your radiation treatments.