http___ljubavnadjelu.hr_stranica.php_str_radioterapija_jezik_HRV_1.xml
1.1 2.1 3.1 3.2 4.1 5.1 6.1 7.1 8.1 9.1 10.1 10.2 11.1 12.1 12.2 13.1 13.2 14.1 14.2 14.3 15.1 15.2 15.3 16.1 16.2 17.1 18.1 18.2 18.3 18.4 19.1 19.2 19.3 20.1 21.1 21.2 21.3 21.4 22.1 23.1 23.2 23.3 23.4 23.5 24.1 24.2 24.3 24.4 25.1 25.2 26.1 27.1 27.2 27.3 28.1 28.2 28.3 29.1 29.2 29.3 29.4 30.1 30.2 30.3 31.1 31.2 31.3 32.1 33.1 34.1 34.2 34.3 35.1 35.2 36.1 37.1 37.2 38.1 38.2 38.3 38.4 39.1 39.2 39.3 40.1 40.2 40.3 40.4 41.1 42.1 42.2 42.3 43.1 43.2 43.3 43.4 43.5 43.6 44.1 45.1 46.1 46.2 47.1 47.2 48.1 48.2 49.1 50.1 51.1 51.2 51.3 52.1 52.2 53.1 53.2 54.1 55.1 55.2 55.3 55.4 55.5 56.1 57.1 58.1 59.1 59.2 59.3 59.4 60.1 61.1 61.2 61.3 61.4 62.1 62.2 62.3 63.1 63.2 64.1 64.2 65.1 66.1 66.2 66.3 67.1 68.1 68.2 68.3 69.1 70.1 70.2 70.3 71.1 71.2 72.1 72.2 72.3 72.4 73.1 74.1 74.2 75.1 76.1 76.2 76.3 76.4 76.5 77.1 77.2 78.1 79.1 80.1 80.2 80.3 80.4 81.1 81.2 82.1 82.2 83.1 84.1 84.2 84.3 84.4 85.1 86.1 86.2 87.1 88.1 88.2 88.3 88.4 88.5 89.1 90.1 91.1 92.1 92.2 93.1 93.2 93.3 94.1 94.2 95.1 96.1 96.2 96.3 97.1 98.1 98.2 98.3 98.4 98.5 99.1 100.1 100.2 101.1 101.2 102.1 103.1 103.2 103.3 104.1 105.1 105.2 105.3 106.1 106.2 107.1 108.1 109.1 110.1 111.1 112.1 113.1 113.2 114.1 115.1 115.2 115.3 116.1 117.1 118.1 118.2 119.1 119.2 120.1 120.2 121.1 122.1 123.1 124.1 125.1 126.1 126.2 127.1 128.1 128.2 128.3 129.1 130.1 130.2 130.3 130.4 130.5 130.6 130.7 131.1 132.1 133.1 134.1 135.1 136.1 137.1 138.1 138.2 138.3 139.1 140.1 140.2 140.3 141.1 142.1 143.1 143.2 143.3 144.1 145.1 146.1 147.1 148.1 149.1 150.1 151.1 151.2 152.1 153.1 154.1 155.1 155.2 156.1 156.2 157.1 158.1 159.1 160.1 160.2 160.3 161.1 162.1 163.1 163.2 163.3 163.4 164.1 164.2 165.1 166.1 166.2 167.1 168.1 168.2 168.3 169.1 170.1 170.2 170.3 170.4 171.1 171.2 171.3 171.4 172.1 173.1 173.2 173.3 174.1 174.2 175.1 176.1 176.2 176.3 177.1 178.1 179.1 180.1 180.2 180.3 181.1 182.1 183.1 184.1 185.1 186.1 187.1 188.1 189.1 190.1 190.2 191.1 192.1 193.1 193.2
Radiation Therapy Aim of Radiation in Cancer Treatment The aim of radiation therapy is to cure cancer, where possible whilst maintaining acceptable function. Radiation can be used alone or which chemotherapy or surgery. Where cure is not possible, radiation may be given for the relief of symptoms (Palliation) of cancer, thereby improving the person’s well being. Radiation therapy is the principal form of treatment for various cancer of the mouth, nasal cavity, pharynx and larynx; brain tumors and many gynecological, lung cancers, prostate cancers and skin cancers. Radiation therapy plays a leading role in conjunction with surgery and/or chemotherapy in breast cancer, bowel cancer, bladder cancer, Hodgkin’s disease, leukemia and lymphomas, thyroid cancer, childhood cancers, gynecological and testis tumors, as well as many other cancers and certain benign condition. What is radiation therapy ? Radiation therapy (sometimes called radiation therapy, x-ray therapy, or irradiation) is the treatment of disease using penetrating beams of high energy waves or streams of particles called radiation. The radiation used for cancer treatment comes from special machines or from radioactive substances. Radiation therapy equipment aims specific amounts of the radiation at tumors or areas of the body where there is disease. How does radiation therapy Work? Radiation in high doses kills cells or keeps them from growing and dividing. Because cancer cells grow and divide more rapidly than most of the normal cells around them, radiation therapy is successful in treating many kinds of cancer. To protect normal cells, doctors carefully limit the doses of radiation and spread the treatment out over time. They also shield as much normal tissue as possible while they aim the radiation at the site of the cancer. Radiation treatment, like surgery, is a local treatment it affects the cancer cells only in a specific area of the body. Sometimes doctors add radiation therapy to treatments that reach all parts of the body (systemic treatment) such as chemotherapy, or improve treatment results. You may hear your doctor use the term, adjuvant therapy, for a treatment that is added to, and given after, the primary therapy. Radiation therapy is often used with surgery to treat cancer. Doctors may be use radiation before surgery to shrink a tumor. This, ask it easier to remove the cancerous tissue and many allow the surgeon to perform less radical surgery. Radiation therapy may be used after surgery to stop the growth of cancer cells that may remain. Your doctor may choose to use radiation therapy and surgery at the same time. In some cases, instead of surgery, doctors use radiation along with anticancer drugs (chemotherapy) to destroy the cancer. Radiation may be given before, during, or after chemotherapy. Doctors carefully tailor combination treatment to each patient’s needs depending on the type of cancer, its location, and its size. The purpose of radiation treatment before or during chemotherapy is to make the tumor smaller and thus improve the effectiveness of the anticancer drugs. Doctors sometimes recommend that a patient complete chemotherapy and then have radiation treatment to kill any cancer cells that might remain. When curing the cancer is not possible, radiation therapy can be used to shrink tumors and reduce pressure, pain, and other symptoms of cancer. This is called palliative care or palliation. Many cancer patients find that they have a better quality of life when radiation is used for this purpose. What are the risks of radiation therapy? The brief high doses of radiation that damage or destroy cancer cells can also injure or kill normal cells. These effects or radiation on normal cells cause treatment side effects. The risk of side effects is usually less than the benefit of killing cancer cells. Your doctor will not advise you to have any treatment unless the benefits control of disease and relief from symptoms are greater than the known risks. How is radiation therapy given? Radiation therapy can be given in one of two ways: external or internal. Some patients have both, one after the other. Most people who receive radiation therapy for cancer have external radiation. It is usually given during outpatient visits to a hospital or treatment center. In external radiation therapy, a machine direct the high energy rays at the cancer and a small margin of normal tissue surrounding it. When internal radiation therapy is used, the radiation source is placed inside the body. This type of treatment is called brachytherapy or implant therapy. An implant may be place directly into a tumor or inserted into a body cavity. Sometimes, after a tumor has been removed by surgery, the implant is placed in the ‘tumor bed’ (the area from which the tumor was removed) to kill any tumor cells that may remain. Another type of internal radiation therapy uses unsealed radioactive materials which may be taken by mouth or injection into the body. If you have this type of treatment, you may need to stay in the hospital for several days. How does the doctor plan your treatment? The various machines used for external radiation work in slightly different ways. Some are better for treating cancers near the skin surface; others work best on cancers deeper in the body. The most common type of machine used for radiation therapy is called a linear accelerator. The high energy rays used for radiation therapy can come from a variety of sources. Your doctor may choose to use x-rays, an electron beam, or cobalt 60 gamma rays. The type of radiation your doctor decides to use depends on what kind of cancer you have and how far into your body the radiation should go. After a physical exam and a review of your medical history, the doctor plans your treatment. In a process called simulation, the radiation therapist defines your treatment port or field. This is the exact place on your body where the radiation will be aimed. Depending on the location of your cancer, you may have more than one treatment post. Simulation may also involve CT scans. Depending on the type of treatment you will be receiving, body molds or other devices that keep you from moving during treatment (immobilization device) may be made. They will be used each time you have treatment to be sure that you are positioned correctly. The radiation therapist often will mark the treatment area on your skin with tattoos or tiny dots of colored, permanent ink. It’s important that the radiation be targeted at the same area each time. If the dots appear to be fading, tell your radiation therapist who will darken them so that they can be seen easily. Once simulation has been done, based on the results of your medical history, lab tests, x-rays, other treatments you may have had, and the location and kind of cancer you have, the doctor will decide how much radiation is needed, what kind of machine to use to deliver it, and how many treatments you should have. How long does the treatment take? For most types of cancer, radiation therapy usually is given 5 days a week for 6 or 7 weeks. (When radiation is used for palliative care, the course of treatment is shorter, usually 2 to 3 weeks.) The total does of radiation and the number of treatments you need will depend on the size, location, and kind of cancer you have, your general health, and other medical treatments you may be receiving. It’s very important that you have all of your scheduled treatments to get the most benefit from your therapy. Missing or delaying treatments can lessen the effectiveness of your radiation treatment. What happens during the treatment? Before each treatment, you may need to change into a hospital gown or robe. It’s best to were clothing that is easy to take off and put on again. In the treatment room, the radiation therapist will use the marks on your skin to locate the treatment are and to position you correctly on a treatment area and to position you correctly on a treatment table. For each external radiation therapy session, you will be in the treatment room about 15 to 30 minutes, but you will be getting radiation for only about 1 to 5 minutes of that time. Receiving external radiation treatments is painless, just like having an x-ray taken. You will not hear, see, or smell the radiation. The radiation therapist may put special shields between the machine and certain parts of your body to help protect normal tissues and organs. You need to remain very still during the treatment so that the radiation reaches only the area where it’s needed and the same area is treated each time. You don’t have to held your breath just breath normally. The radiation therapist will leave the treatment room before your treatment begins. The radiation machine is controlled from a nearly area. You will be watched on a television screen or through a window in the control room. Although you may feel alone, keep in mind that the therapist can see and hear you and even talk with you in the treatment room. What are the side effects of treatment? External radiation therapy does not cause your body to become radioactive. There is no need to avoid being with other people because you are undergoing treatment. Even hugging, kissing, or having sexual relation with others poses no risk of radiation exposure. Most side effects of radiation therapy are related to the area that is being treated. Many patients have no side effects at all. The side effects of radiation therapy, although unpleasant, are usually not serious and can be controlled with medication or diet. They usually go away within a few weeks after treatment ends, although some side effects can last longer. Throughout your treatment, your doctor will regularly check on the effects of the treatment. Your doctor may recommend periodic tests and physical exams to be sure that the radiation is causing as little damage to normal cells as possible. What can you do to take care of yourself during therapy? Nearly all cancer patients receiving radiation therapy need to take special care of themselves to protect their health and to help the treatment succeed. - Before starting treatment, be sure your doctor knows about any medicines you are taking and if you have any allergies. Do not start taking any medicine (whether prescription or over the counter) during your radiation therapy without first telling your doctor. - Fatigue is common during radiation therapy. Be sure to get plenty or rest and sleep as often as you feel the need. - Good nutrition is very important. Try to eat a balanced diet that will prevent weight loss. - Check with your doctor before taking vitamin supplements or herbal preparations during treatment. - Be extra kind of your skin in the treatment area: do not use soaps, lotions, deodorants, sun blocks, medicines, perfumes, cosmetics, talcum powder, or other substances in the treated area, without checking with your doctor - Wear loose, soft cotton clothing over the treated area. Do not wear starched of stiff clothing over the treated area. Do not scratch, rub, or scrub treated skin. - Do not apply heat or cold (heating pad, ice pack, etc.) to the treated area. Use only lukewarm water for bathing there. - Use an electric shaver if you must shave the treated area but only after checking with your doctor. Do not use a lotion or hair removal products on the treated area. How will you know if radiation is working for you ? This answer varies, depending on the type of cancer being treated. Many patient’s will have radiology studies (CT scans, MRI scans, PET scans) periodically to see if the tumor has responded (shrunk, stayed the same, or grown). Some types of tumors are able to measure in the blood with a “tumor marker”. This is a substance that is either produced by the tumor or by the body in response to the tumor, and can be measured by a blood test. In some cases, a decrease in a patient’s symptoms may be able to signal if the medications are shrinking the tumor or not. Internal Radiation When is internal radiation therapy Used? Internal radiation therapy allows the doctor to give a higher total does of radiation in a shorter time than is possible with external treatment. Internal radiation therapy places the radiation source as close as possible to the cancer cells. Instead of using a large radiation machine, the radioactive material, sealed in a thin wire, catheter, or tube (implant), is placed directly into the affected tissue. This methods of treatment concentrates the radiation on the cancer cells and lessens radiation damage to some of the normal tissue near the cancer. Some of the radioactive substances used for internal radiation treatment include cesium, iridium, iodine, phosphorus, and palladium. How is the implant placed in the body? The type of implant and the method of placing it depend on the size and location of the cancer. Implants may be put right into the tumor (interstitial radiation), in special applicators inside a body cavity (intracavitary radiation) or passage (intraluminal radiation), on the surface of a tumor, or in the area from which the tumor has been removed. Implants may be removed after a short time or left in place permanently. If they are to be left in place, the radioactive substance used will lose radiation quickly and become non-radioactive in a short time. When interstitial radiation is given, the radiation source is placed in the tumor in catheters, seeds, or capsules. When intracavitary radiation is used, a container or applicator of radioactive material is placed in a body cavity such as the uterus, in surface brachytherapy the radioactive source is sealed in a small holder and placed in or against the tumor. In intraluminal brachytherapy the radioactive source is placed in a body lumen or tube, such as the bronchus or esophagus. Internal radiation also may be given by injecting a solution of radioactive substance into the bloodstream or a body cavity. This form of radiation therapy may be called unsealed internal radiation therapy. For most types of implants, you will need to be in the hospital. You will be given general or local anesthesia so that you will not feel any pain when the doctor places the holder for the radioactive material in your body. How are other people protected from radiation while the implant is in place? Sometimes the radiation source in your implant sends its high energy rays outside your body. To protect others while you are having implant therapy, the hospital will have you stay in a private room. Although the nurses and other people caring for you will not be able to spend a long time in your room, they will give you all of the care you need. What are the side effects of internal radiation therapy? The side effects of implant therapy depend on the area being treated. You are not likely to have severe pain or feel ill during implant therapy. However, if an applicator is holding your in place, it may be somewhat uncomfortable. How long does the implant stay in place? Your doctor will decide the amount of time that an implant is to be left in place. It depends on the does (amount) of radioactivity needed for effective treatment. Your treatment schedule will depend on the type of cancer, where it is located, your general health, and other cancer treatments you have had. Temporary implants may be either low dose rate (LDR) or high dose rate (HDR). Low dose rate implants are left in place for several days; high dose rate implants are removed after a few minutes. For some cancer sites, the implant is left in place permanently. If your implant is permanent, you may need to stay in your hospital room away from other people for a few days while the radiation is most active. The implant becomes less radioactive each day; by the time you are ready to go home, the radiation in your body will be much weaker. Your doctor will advise you if there are any special precautions you need to use at home. In remote brachytherapy, a computer sends the radioactive source through a tube to a catheter that has been placed near the tumor. The radioactivity remains at the tumor for only a few minutes. In some cases, several remote treatments may be required and the catheter may stay in place between treatments. What happens after the implant is removed? Usually, an anesthetic is not needed when the doctor removes a temporary implant. Most can be taken out right in the patient’s hospital room. Once the implant is removed, there is no radioactivity in your body. Most patients are allowed to do as much as they feel like doing. You may need some extra sleep or rest breaks during your days at home, but you should feel stronger quickly. The area that has been treated with an implant may be sore or sensitive for some time. If any particular activity such as sports or sexual intercourse cause irritation in the treatment area, your doctor may suggest that you limit these activities for a while. Managing Side Effects Are side effects the same for everyone? The side effects of radiation treatment vary from patient to patient. You may have no side effects or only a few mild ones through your course of treatment. The side effects that you have depend mostly on the radiation does and the part of your body that is treated. You general health also can affect how your body reacts to radiation therapy and whether you have side effects. The most common early side effects of radiation therapy are fatigue and skin changes. Appetite can be altered if treatment affects the mouth, stomach, or intestine. Fortunately, most side effects will go away in time. Be sure to tell your doctor, about any side effects that you notice. Will side effects limit your activity? Not necessarily. It will depend on which side effects you have. Many patients are able to work, prepare meals, and enjoy their usual leisure activities while they are having radiation therapy. Try to continue doing the things you enjoy as long as you don’t become too tired. What causes fatigue? Most people begin to feel tired after a few weeks of radiation therapy. During radiation therapy, the body uses a lot of energy for healing. You also may be tired because of stress related to your illness, daily trips for treatment, and the effects of radiation on normal cells, Feelings of weakness or weariness will go away gradually after your treatment has been completed.] If you do feel tired, limit your activates and use your leisure time in a restful way. Save your energy for doing the things that you feel are most important. Do not feel that you have to do everything you normally do. Try to get more sleep at night, and plan your day so that you have time to rest if you need it. Several short naps or breaks may be more helpful than a long rest period. Sometimes, light exercise such as walking may combat fatigue. Whether you’re going to work or not, it’s a good idea to ask family members or friends to help with daily chores, shopping, child care, housework, or driving. How are skin problems treated? Sometimes, radiation irritates the skin, causing it to become red, sore, and/or dry. Ask your doctor doe advice on how to relive itching or discomfort. During radiation therapy you will need to be very gentle with the skin in the treatment are. Ask your doctor to recommend skin care products that will not cause skin irritation. Do not use any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you’re being treated and foe several weeks afterward unless approved by your doctor. The majority of skin reactions to radiation therapy go away a few weeks after treatment is completed. In some cases, though, the treated skin will remain slightly darker than it was before and it may continue to be more sensitive to sun exposure. What can be done about hair loss? Radiation therapy can cause hair loss, also known as alopecia, but only in the area being treated. For example, radiation of your head may cause you to lose some or all of the hair on your scalp. Many patients find that their hair grows back again after the treatments are finished. How are side effects on the blood managed? Radiation therapy can cause low levels of white blood cells and platelets. These blood cells normally help your body fight infection and prevent bleeding. If large areas of active bone marrow are treated, your red blood cells count may be low as well. If your blood tests show these side effects, your doctor may wait until your blood counts increase to continue treatments. Your doctor will check your blood counts regularly and change your treatment schedule if it is necessary. Will eating be a problem? Sometimes radiation treatment causes loss of appetite and interferes with eating, digesting, and absorbing food. Try to eat enough to help damaged tissues rebuild themselves. It is very important to eat a balanced diet. You may find it helpful to eat small meals often and to try to eat a verity of different foods. Your doctor can tell you whether you should eat a special diet, if it’s painful to chew and swallow. Even if you’re not very hungry, it’s important to keep your protein and calorie intake high. Doctors have found that patients who eat well can better cope with having cancer and with the side effects or treatment. You are recommended to: - Eat several small meals during the day rather than three large ones. - Vary your diet and try new recipes. If you enjoy company while eating, try to have meals with family or friends. It may be helpful to have the radio or television on while you eat. - If other people offer to cook for you, let them. Don’t be shy about telling them what you’d like to eat. - Keep healthy snacks close by for nibbling when you get the urge. - If you are able to eat only small amounts of food, you can increase the calories per serving by: - Adding butter or margarine. - Mixing canned cream soups with milk or half and half rather that water. - Drinking eggnog, milkshakes, or prepared liquid supplements between meals. - Adding cream sauce or melted cheese to your favorite vegetables. Some people find they can drink large amounts of liquids even when they don’t feel like eating solid foods. If this is the case for you, try to get them most from each glassful by making drinks enriched with powdered milk, yogurt, honey, or prepared liquid supplements. Will radiation therapy affect you emotionally? Nearly all patients being treated for cancer report feeling emotionally upset at different times during their therapy. It’s not unusual to feel anxious, depressed, afraid, angry, frustrated, alone, or helpless. Radiation therapy may affect your emotions indirectly through fatigue or changes in hormone balance, but the treatment itself is not a direct cause of mental distress. You may find that it’s helpful to talk about your feeling with a close friend, family members, social worker, psychologist or a volunteer of V Care (+919821949401 / 02 ). What side effects occur with radiation therapy to the stomach and abdomen? Some people who receive radiation to the head and neck experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Try not to let these symptoms keep you from eating. You may experience earaches (caused by hardening of ear wax), your jaw may also feel stiff and you may be unable to open your mouth as wide as before treatment. Jaw exercises may help ease this problem. When receiving radiation therapy to the head and neck, you need to take especially care of your teeth, gums, mouth and throat. Avoid spices and coarse foods such as raw vegetables, dry crackers, and nuts. - Remember that acidic foods and liquids can cause mouth and throat irritation. - Don’t smoke, chew tobacco, or drink alcohol. - Stay away from sugary snacks because they can promote tooth decay. - Clean your mouth and teeth often, using the method recommended by your doctor Mouth care Radiation treatment for head and neck cancer can increase your chances of getting cavities in your teeth. Before starting radiation therapy, make an appointment for a complete dental/oral checkup. - Clean your teeth and gums thoroughly with a soft brush at least 4 times a day (after meals and at bedtime). - Rinse your mouth gently and frequently with a salt and baking soda solution especially after each meal. Use1/2 teaspoon of salt and ½ teaspoon of backing soda in a large glass of warm water. Follow with a plain after rinse. Dealing with Mouth or Throat Problems soreness in your mouth pr throat may appear in the second or third week of external radiation therapy and it will most likely have disappeared within a mouth or so after your treatments have ended. If you wear dentures you may notice that they no longer fit well. This occurs if the radiation causes your gums to swell. You may need to stop wearing your dentures until your radiation therapy is over. Your salivary glands may produce less saliva than usual, making your mouth feel dry. It’s helpful to sip cool drinks throughout the day. Moisten food with gravies and sauces to make eating easier. Tips on Eating - Avoid highly spiced foods and textures that are dry and rough, such as crackers. - Eat small meals, and eat more frequently than usual. - Cut your food into small, bite sized pieces. - Ask your doctor about liquid food supplements that are easier to swallow than solids. - If you are being treated for lung cancer, it’s important to keep mucus and other secretions thin and manageable; drinking extra fluids can help. What side effects occur with radiation therapy to the chest? When receiving Radiation treatment to the chest you may develop a cough or a fever. You may notice that when you cough the amount and color of the mucus is different Shortness of breath is also common. Be sure to let your doctor know right away if you have any of these symptoms. Are there side effects with radiation therapy for breast cancer? The most common side effects with radiation therapy for breast cancer are fatigue and skin changes. However you may notice that your shoulder feels stiff, ask your doctor effects about exercises to keep your arm moving freely. Other side effects include breast or nipple soreness, swelling from fluid buildup in the treated area, and skin reddening, these side effects will most likely disappear in 4 to 6 weeks. If you are being treated for breast cancer and you are having radiation therapy after a lumpectomy or mastectomy, it’s a good idea to go without your bra whenever possible or, if this makes you more uncomfortable, were a soft cotton bra without underwire. What side effects occur with radiation therapy to the stomach and abdomen? If you are having radiation treatment to the stomach or some portion of the abdomen, you may have an upset stomach, nausea, or diarrhea. Your doctor can prescribe medicines to relive these problems. Do not take any medications for these symptoms unless you first check with your doctor or nurse. - Here are some other tips to help an unsettled stomach. - Stick to any special diet that your doctor gives you. - Eat small meals. - Eat often and try to eat and drink slowly. - Avoid foods that are fried or are high in fat. - Drink cool liquids between meals. - Eat foods that have only a mild aroma and can be served cool or at room temperature. For severe nausea and vomiting, try a clear liquid diet (broth and clear juices) or bland foods that are easy to digest. Try increasing the following in your diet; toast, crackers, curbs, sherbet, cream of wheat ( Dalia ), rice, oatmeal, and grits, boiled potatoes, rice, and noodles, skinned chicken that is baked or broiled, not fried, soft, bland fruits and vegetables, clear liquids, such as bouillon, clear carbonated beverages, fruit juice, popsicles water and ice chips And avoid the following types of foods: fatty, greasy, or fried foods, very sweet foods, such as candy or cooking, or cake with icing, spicy hot foods, foods with a strong odor It will help, if you eat small amounts, often and slowly, eat more of the foods that appeal to you, Drink liquids a half hour before or after meals but not with your meals and drink slowly or sip liquids throughout the day. What to do About Diarrhea You may be able to prevent diarrhea by eating a low fiber diet when you start therapy: avoid foods such as raw fruits and vegetables high in fiber such as broccoli, corn, dried beans, cabbage, peas, and cauliflower beans, and whole grain breads and cereals. The following changes in your diet may help. - Try a clear liquid diet (water, weak tea, apple juice, clear broth, rice kanji) as soon as diarrhea starts. And consider foods such as the following: yogurt and cottage cheese, rice, noodles, and potatoes, farina and cream of wheat, eggs (cooked until the whites are solid, not fried), white bread, canned, peeled fruits, and well-cooked vegetables, skinned chicken or turkey, lean beef, and fish (broiled or baked, not fried) - Avoid coffee and other beverages that contain caffeine, beans, cabbage, whole grain breads and cereals, sweets, and spicy foods. - Eat frequent small meals. - If milk and milk products irritate your digestive system, avoid them or use lactose-free dairy products. - Continue a diet that is low in fat and fiber and lactose-free for 2 weeks after you have finished your radiation therapy. Gradually re-introduce other foods. You may want to start with small amounts of low-fiber foods such as rice, bananas, applesauce, mashed potatoes, low-fat cottage cheese, and dry toast. Be sure your diet includes foods that are high in potassium (bananas, potatoes, apricots), an important mineral that you may lose through diarrhea. What side effects occur with radiation therapy to the pelvis? If you are having radiation therapy to any part of the pelvis (the area between your hips), you might have some of the digestive problems already described. You also may have bladder irritation which can cause discomfort or frequent urination. Drinking a lot of fluid can help relieve some of this discomfort. Avoid caffeine and carbonated beverages. Depending on the radiation dose, women having radiation therapy in the pelvic area may stop menstruating and have other symptoms of menopause such as vaginal itching, burning, and dryness. You should report these symptoms to your doctor who can suggest treatment. Effect on fertility If you are a woman in your childbearing year, it’s important to discuss birth control and fertility issues with your doctor. You should not become pregnancy during radiation therapy because radiation treatment during pregnancy may injure the fetus, especially in the first three months. If you are pregnant before your therapy begins, be sure to tell your doctor so that the fetus can be protected from radiation, if possible. Radiation therapy to the area that includes the testes can reduce both the number of sperm and their effectiveness. This does not mean that conception cannot occur. Ask your doctor. Sexual relations With most types of radiation therapy, neither men nor women are likely to notice any change in their ability to enjoy sex. Both sexes, however, may notice a decrease in their level of desire. This is more likely to be due to the stress of having cancer than to the effects of radiation therapy. Once the treatment ends, sexual desire is likely to return to previous levels. During radiation treatment to the pelvis, some women are advised not to have intercourse. Others may find that intercourse is uncomfortable or painful. Within a few weeks after treatment ends, these symptoms usually disappear. If shrinking of vaginal tissues occurs as a side effect of radiation therapy, your doctor can explain how to use a dilator, a device that gently stretches the tissues of the vagina. Follow-up care Once you have completed your radiation treatments, it is important for your doctor to monitor the results of your therapy at regularly scheduled visits. These checkups are necessary to deal with radiation side effects and to detect any signs of recurrent disease. During these checkups your doctor will examine you and may order some lab tests It’s a good idea to write down the questions you want to ask your doctor and take them with you when you have your appointment with the doctor. Some patients find that it’s helpful to take a family members with them to help remember what the doctor says. What if pain is a problem? Radiatin therapy is not painful. However, when radiation is used for palliation some discomfort or pain may remain. Sometimes patient need help to manage cancer pain. Remember that you should not use a heating pad or a warm compress to relive pain in any area treated with radiation. If your pain is severe, ask the doctor about prescription drugs or other methods of relief so you can get the best pain management When should you call the doctor? After treatment for cancer, you’re likely to be more aware of your body and to notice even slight changes in how you feel from day to day. The doctor will want to know if you are having any unusual symptoms. Promptly tell your doctor about: - A pain that doesn’t go away, especially if it’s always in the same place. - New or unusual lumps, bumps, or swelling. - Nausea, vomiting, diarrhea, or loss of appetite. - Unexplained weight loss. - A fever or cough that doesn’t go away. - Unusual rashes, bruises, or bleeding. - Any symptoms that you are concerned about. - Any other warning signs mentioned by your doctor or nurse. What about returning to work? Many people find that they can continue to work during radiation therapy because treatment appointments are short. If you have stopped working, you can return to your job as soon as you feel up to it. V care information resources: V care provides helping booklet about cancer their treatments and coping with these include chemotherapy radiation therapy and diet for cancer patients. At any stage of disease, supportive care is available to relieve the side effects of treatment, and to ease emotional concerns. Further information you can meet with one our volunteers or call out troll free help line-
1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 2.1 3.1 4.1 5.1 6.1 7.1 8.1 8.2 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 10.1 10.2 10.3 10.4 10.5 11.1 11.2 11.3 11.4 11.5 12.1 12.2 12.3 12.4 12.5 12.6 12.7 13.1 14.1 14.2 14.3 14.4 14.5 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8 16.1 17.1 17.2 17.3 17.4 18.1 18.2 18.3 19.1 19.2 19.3 20.1 20.2 20.3 21.1 21.2 21.3 21.4 21.5 21.6 21.7 22.1 22.2 22.3 22.4 22.5 22.6 22.7 23.1 23.2 23.3 24.1 24.2 24.3
Grana medicine koja se bavi korištenjem zračenja u svrhe liječenja naziva se kod nas radioterapija, a u svijetu još i radijacijska onkologija. Radioterapija je metoda liječenja koja upotrebljava prodorne snopove ionizirajućih zraka (energetski valovi ili snopovi čestica-elektrona, protona, neutrona) koje prodiru u tijelo na zadanom mjestu i u ciljnoj željenoj dubini, odnosno lokalizaciji izazivaju uništenje i umiranje bolesnog tkiva. Najčešće se primjenjuje u liječenju oboljelih od zloćudnih tumora. Zračenje na taj način može umanjiti ili kompletno uništiti tumorski čvor, odnosno umanjiti neugodne pojave vezane uz pritisak tumora na okolinu (bol, oticanje i sl.). Mnoge vrste raka mogu biti posve izliječene samo radioterapijom, kao što su početni tumori glasnica, lokalizirana Hodgkinova bolest, tj. limfomi i neki drugi, što je dobro znati jer se na taj način izbjegavaju neka od nepovratnih oštećenja koja bi se desila pri operacijskom zahvatu (npr. gubitak sposobnosti govora kod operacije grla). Kod drugih se radioterapijom može postići smanjenje tumora i istovremeno redukcija opsežnosti planiranog operativnog zahvata. Zračenje se može primijeniti i u uznapredovalom stadiju bolesti, za privremeno, odnosno palijativno liječenje - smanjenje neugodnih ili bolnih pojava (koštane metastaze, gušenje zbog pritiska na bronhe, krvarenja). Zračenje se može primijeniti na gotovo svakom dijelu ljudskoga tijela, može se upotrebljavati prije, za vrijeme ili nakon operacije, ili kemoterapije. Kako nastaje zračenje koje se koristi u liječenju? Radioaktivno zračenje koje se primjenjuje u liječenju, za razliku od onog u dijagnostici, nastaje na dva načina: iz uređaja koji proizvode rendgensko zračenje, ali puno veće energije nego što je ono koje se koristi u dijagnostici, ili iz prirodnih izvora zračenja - radioaktivnih elemenata. Uređaji koji se koriste u radioterapiji spadaju po svojoj složenosti i vrijednosti među najskuplje uređaje u medicini. Stoga se takva terapija primjenjuje samo u specijaliziranim centrima koji posjeduju odgovarajuću opremu, zaštitna sredstva i gdje radi specijalno obučen tim ljudi. Od uređaja koji se primjenjuju u radioterapiji najčešći su linearni akcelerator i kobalt-bomba. Postoje i drugi uređaji, koji se koriste rjeđe i samo u istraživačkim centrima, kao što su protonske i neutronske bombe i slično. Kobalt-bomba je uređaj koji koristi prirodan izvor zračenja, radioaktivni kobalt. Zanimljivo je znati da je kobaltni izvor izrazito malen, to je kapsula veličine oko 1 do najviše 2 cm2, koja je smještena unutar posebnog zaštitnog kontejnera. Unutar složenih mehanizama glave uređaja u kojem je kapsula smještena nalazi se otvor čiju veličinu i oblik možemo regulirati i tuda se tijekom seanse emitira snop zračenja. Aktivnost kobalta jako je velika, tako da se u vremenu od približno jedne minute, na udaljenosti od 80 cm od izvora uglavnom postiže standardna dnevna doza zračenja. Radioaktivnost kobalta s vremenom se smanjuje (radioaktivni elementi se kroz vrijeme razgrađuju) i za 5,26 godina pada na polovicu od početnih vrijednosti. Stoga izvor treba obnavljati svakih 6-7 godina. Uz to, izvor koji se koristi trajni je izvor zračenja pa kao takav zahtijeva poseban oprez pri rukovanju i održavanju uređaja, a i pri kasnijem odlaganju u posebne institucije. Linearni akcelerator je suvremen uređaj koji danas u većini institucija sve više zamjenjuje kobalt bombe. Tu se ne koristi prirodan trajan izvor radioaktivnosti, nego se zračenje proizvodi u uređaju, i to samo dok je uređaj u pogonu. Dva su oblika tako proizvedenog zračenja - fotonsko i elektronsko zračenje. Energije takvog zračenja visoke su. Fotonske se zrake upotrebljavaju za tumore smještene dublje u tijelu, a elektronsko zračenje upotrebljava se za površnije smještene tumore. Postoje dva načina liječenja zračenjem - izvana i iznutra. Uređaji koji se primjenjuju u radioterapiji (linearni akcelerator, kobalt-bomba) koriste se za zračenje izvana, koje se još naziva teleradioterapija. U teleradioterapiji se, iz uređaja u kojem zračenje nastaje, snop nevidljivih zraka usmjeruje prema tijelu od izvana, preko kože, u dubinu, na tumor i nešto okolnog tkiva. Izbor uređaja ovisi o opremljenosti i mogućnostima centra koji primjenjuje terapiju te o lokalizaciji, odnosno dubini na kojoj je tumor smješten u tijelu. Većina se ljudi liječi na taj način, i ta se vrsta terapije može provoditi bolnički i ambulantno. Druga je vrsta liječenja brahiterapija - zračenje na blizinu ili, danas najčešće, unutrašnje zračenje. Pri toj se metodi koriste izvori radioaktivnog zračenja koji su napravljeni u obliku igala, tuba ili žica, odnosno zrnaca ili tekućine. Budući da je u prirodi količina radioaktivnih elemenata mala i skupljanje potrebne količine gotovo nemoguće, oni se proizvode u nuklearnim reaktorima, po potrebama i narudžbi. Neaktivni elementi, izlaganjem nuklearnim reakcijama u reaktoru, pretvaraju se u svoje radioaktivne izotope. Tako stvoreni izvori zračenja smještaju se pri brahiterapiji u tjelesne šupljine ili direktno u tumor («implantiraju»). Takva se terapija obavlja isključivo dok pacijent leži u bolnici. Najčešće se primjenjuje u liječenju raka maternice, rodnice, prostate, ponekad jednjaka, nosne šupljine. Doze zračenja U radioterapiji se upotrebljavaju visoke doze zračenja za uništenje tumorskog tkiva. Rizik uništenja i zdravog tkiva u okolini tumora uvijek je prisutan i realan. Očekivana učinkovitost liječenja zračenjem mora stoga biti veća nego rizik oštećenja da bi se zračenje odabralo kao metoda izbora u liječenju. Nepravilno ili netočno primijenjeno zračenje može biti po život opasno, prvenstveno za osobu koju se liječi, ali i za osoblje koje radi s izvorima zračenja. Stoga je potrebno da takvu terapiju planiraju i izvode posebno izučeni liječnici-specijalisti radioterapije, zajedno sa suradnicima koji su također posebno obučeni za rad sa zračenjem i koji poznaju dobre i loše strane zračenja. uspojave se mogu i ne moraju pojaviti. Mnoge bolesnice nemaju gotovo nikakvih tegoba, osobito ako se pridržavaju uputa. Najčešće nastupaju dva, tri tjedna od početka zračenja i nestaju kroz tjedan, dva nakon završetka zračenja - umor i iscrpljenost, gubitak apetita, gubitak po nekoliko kilograma na tjelesnoj težini. Tijekom zračenja kontrolira se krvna slika i ponekad se može uočiti smanjenje broja krvnih stanica, najčešće leukocita, što se nakon završetka zračenja obično normalizira. Ponekad su uz dijetalne i higijenske mjere potrebni lijekovi kako bi se tegobe smirile. Ako su nuspojave osobito teške, katkad treba na kraće vrijeme prekinuti zračenje da bi došlo do oporavka. Kod zračenja zdjelice najčešće nuspojave su proljev i smetnje mokrenja (učestalo mokrenje, pečenje ili bolovi). Stoga je uputno tijekom zračenja pridržavati se propisane dijetalne prehrane i obilno piti tekućine, jer se često samo tim postupcima mogu izbjeći nuspojave. Najčešće popratne pojave koje treba očekivati: suhoća ili pretjerana pojava sline u ustima, pečenje u ustima ili po koži vrata, pojava gljivičnih naslaga na sluznici usne šupljine, otežano i bolno gutanje. Kod zračenja vlasišta dolazi do pada kose, o kojem će bolesnika njegov liječnik - radioterapeut obavijestiti prije početka liječenja. Važno je ovdje napomenuti da kosa pada samo ako je vlasište u polju (volumenu) zračenja. Pad kose češće je trajan jer je uzrokovan uništenjem korijena kose. Ponekad kosa ponovno izraste, ali se eventualna mogućnost ponovnog rasta kose ne očekuje neposredno nakon liječenja (kao što je kod pada kose pri kemoterapiji). Najčešće popratne pojave koje treba očekivati: pri prolasku hrane kroz jednjak javljaju se, pri kraju zračenja pluća i jednjaka, često osjećaj pečenja, zapinjanja zalogaja, bola iza grudne kosti. Ako se zrači dojku nakon poštedne operacije, može se javiti oticanje dijela ili cijele dojke, pritisak ili bolna nadraženost kože i posebice područja bradavice. Koža pazušnog prostora i ispod dojke može se zacrvenjeti, postati nježna, vlažna i ranjiva te peći. Najčešće popratne pojave koje treba očekivati: gubitak apetita, mučnina, ponekad i povraćanje. Pokušat ćemo ih suzbiti uzimanjem malih obroka hrane; ponekad godi suha hrana. Nakon nekoliko tjedana zračenja mogu se javiti učestalije stolice (ili proljev), a ako se zrači i dio ispod pupka, ponekad se javljaju i pečenje i bol pri mokrenju. Za vrijeme terapije često je prisutna nezainteresiranost za spolni život, pa čak i neugoda i bol pri odnosu. Kao posljedica zračenja spolnih organa javlja se naknadno kod muškaraca sterilitet (najčešće trajnog karaktera), a kod žena prestanak menstruacija i rana menopauza. Oštećenja spolnih stanica neminovna su, tako da za vrijeme i nakon terapije zračenjem nije preporučljivo ostati trudan, odnosno imati djecu. Koža u zračenom području s obje strane tijela postaje crvena, nadražena i suha. Kasnije, osobito u naborima, može se javiti i vlažna reakcija. Važno je kožu ne izlagati dodatnim nadražajima. Kožu zračenog područja prati samo čistom mlakom vodom, ne koristiti sapune i ne trljati kožu, a brisati je samo nježno mekim ručnikom. Ne nositi sintetske tkanine nego samo čisti pamuk, i ne previše tijesnu odjeću. Ne stavljati na kožu ni vruće ni ledene obloge, kreme ili losione, osim neutralnih (Bepanthen krema, Wolf basis krema ili Belobaza). Važno je dva sata prije i poslije zračenja ništa ne stavljati na kožu, a tijekom zračenja koža treba biti čista. Da se izbjegne proljev, treba izbjegavati integralni kruh sa sjemenkama, masnoće, kupus, grah, sirovo voće i povrće, slatkiše te mlijeko, vrhnje, kavu i jake začine. Hrana treba biti raznolika, a obroci hranjivi. Treba jesti češće manje obroke, kuhano nemasno meso, ribu, kuhano povrće, krumpir, rižu, tijesto, bijeli kruh, štapiće, kompot, banane, svježi sir, jogurt i sl. Ako se javi proljev, najbolji su tekuća dijeta (nemasne juhe, čajevi) i dvopek. Nakon završetka zračenja treba se pridržavati dijetalne ishrane još tjedan, dva, a potom postupno prijeći na normalnu prehranu. Da se izbjegne nadražaj mokraćnog mjehura, treba piti puno tekućine, najbolje čaj i negaziranu mineralnu vodu. Kavu izbjegavati. Zračenje mijenja ciljna tkiva, a i tkiva kroz koja prolazi, posebno ako se radi o tkivima osjetljivijim na zračenje. Takve promjene u većini se tkiva ne dešavaju odmah, nego kroz određeno vrijeme, koje može biti od više mjeseci, pa i do nekoliko godina, i naziva se kasnim reakcijama na zračenje. Pažljivim planiranjem, novim tehnikama i visokosofisticiranim uređajima za terapiju, uz poznavanje osjetljivosti različitih tkiva, posljedice te vrste sve su rjeđe, no nemoguće ih je suzbiti u potpunosti. Zrake X i gama-zrake mogu biti uzročnici raka, kao i nekih drugih bolesti i oštećenja, ali to se najčešće dešava u osoba koje su im bile izložene duže vrijeme. Stoga su ljudi koji rade sa zračenjem posebno školovani da prepoznaju moguće rizike i primjenjuju propisana zaštitna sredstva, a obvezni su i provoditi redovite godišnje preventivne preglede. Rizik nastanka drugog raka u osoba koje su liječene zračenjem također postoji, ali uglavnom su takvi slučajevi opisani kad je prvo zračenje bilo u djetinjstvu ili u ranoj mladosti.