External beam radiation (also called External Radiation) is radiation delivered by a machine directly to a tumor site under the supervision of a cancer doctor who is known as a Radiation Oncologist. 

When planning your treatment, the radiation oncologist considers a variety of factors including: the characteristics of your cancer; the sensitivity of the tumor to radiation; and the vulnerability of nearby normal tissues. These factors determine the type of external radiation therapy, the dose to be used, and the treatment schedule.

The radiation dose is normally the same for each session. However, there may be variations.

While waiting for treatment to begin, there are steps to take. For instance, see your dentist. Talk with your doctor about the drugs, vitamins etc you take in case he or she wants you to stop taking them temporarily.

Before your first session, there will be a planning session. It is advisable to take a family member of friend with you to the meeting. It is also helpful to record the session.

Don't be surprised if the start of radiation treatment makes cancer feel real.

External bream radiation is given over a period of time rather than in massive doses which gives radiated skin time to heal between sessions.

There are do's and don'ts to be aware of during treatment. For example, don't apply powder to the radiated area before treatment.

Side effects such as skin irritation and fatigue during treatment are either controllable or there are techniques to lessen the effect. There may also be long term side effects. 

Keep in mind that treatment decisions may change as treatment goes along. A change does not mean that the original treatment was wrong. Medicine is a combination of science and art.

• If needed, transportation is available to and from treatment.
• If you are uncomfortable in a hospital gown, make your own or buy a substitute.

Women: Avoid getting pregnant during radiation treatment.

For additional information, see:

EXTERNAL BEAM RADIATION

• What External Beam Radiation Is
• Questions To Ask Before Agreeing To External Beam Radiation
• Treatment
  • A Typical Treatment
  • Steps To Take Before Treatment Begins
  • What Happens During A Planning Session Before Your First Radiation Treatment
  • What Happens During A Radiation Treatment
  • What To Do And Not Do While You Undergo Radiation Treatment
  • Oral Care During Treatment
• Side effects
  • Side Effects From External Radiation During Treatment
  • Side Effects From External Radiation After Treatment Ends

RADIATION TREATMENT (IN GENERAL)

• Radiation Treatment (In General)
• How Radiation Therapy Works
• Radiation Professionals
• How To Choose A Radiation Oncologist
• What To Expect After Radiation Therapy Ends
• Glossary Of Radiation Terms To Know
• Oral Care During Treatment
• Emotions
  • How To Cope With Fear Of A Treatment
  • How To Keep A Positive Attitude During Treatment
  • How To Cope With Anxiety

External beam radiation comes from a machine.

There are many safeguards to protect you from unnecessary radiation to the parts of your body that do not need treatment.  All the machines are shielded so that the large amounts of radiation are given only to a specific area.

External radiation therapy is usually given on an outpatient basis in a hospital or clinic. Internal radiation usually requires hospitalization for a few days. 

Daily radiation doses are relatively small to prevent excessive skin burning.

Radiation treatments are spread out over several weeks to give the skin time to heal between doses. The result is less damage to the skin and other tissues while still providing the full dose. 

• Schedule a dental check up. Oral infections can worsen the effects of radiation.
  • Speak with your cancer doctor about possible oral complications from your treatment and what, if anything, your dentist should focus on prior to treatment.
  • Get an examination of your mouth, teeth and jawbone to check for potential problems that may arise during treatment. Tell the dentist you are about to have treatment for lung cancer and tell him or her the treatment(s) you have agreed to.
  • Mention to your dentist the risks for oral complications your doctor told you about.
  • If you have issues that could become a problem during treatment, take care of them now. Find out from your dentist how much time is needed for your mouth to heal properly. It is preferable for healing to be complete before treatment begins.
  • If your doctor recommends that you speak with a dental oncologist (a dentist who is trained in dental and oral care for people with cancer): Use the same technique to find the right dental oncologist as is recommended for choosing any medical specialist. See “To Learn More.” You can locate a dental oncologist through any of the following:
    • A referral from your cancer doctor.
    • National Cancer Institute  www.cancer.gov  or Tel.: 800.422.6237.
    • National Comprehensive Cancer Network, www.nccn.org , or Tel.: 215.690.0300.
• Find out if there are any medications, supplements, herbs or vitamins you take that should be discontinued during treatment. If there are, check with the doctor who prescribed them to let him or her know what is happening and find out if you should be doing something else during treatment.
• Learn about the side effects that frequently occur with radiation and how to eliminate or minimize them. Get prescriptions for medications that may minimize or help you cope with such side effects. Prescriptions don't cost anything until you have them filled. If you have the prescriptions, you can fill them without delay if the need arises. 
• If you smoke, use the treatment as a trigger to stop. 
  • Stopping can help improve the body’s response to treatment, and lessen complications and side effects.
  • If you quit permanently, stopping can decrease the risk of recurrence and enhance survival.
  • If you are constantly exposed to second hand smoke, it is the same as smoking. Distance yourself from the smoke.
• If you use recreational drugs, let your doctor know. They may interfere with treatment.
• If you want to have children in the future, ask if a treatment could affect your ability to have them. If so, consider banking your sperm before the treatment starts.
• Consider taking a tour of the area where radiation will be administered and any other location where you will be spending time. This way you will know what to expect. You'll also get a better idea of what to bring with you to make yourself comfortable.
• Think about how you will get to and fromtreatment. If needed, American Cancer Society can help arrange transportation with its group of volunteer drivers. Call 800.ACS.2345. The more notice you give the Society, the more likely it can find a volunteer to fill your needs. The Society can also point you to available public transportation in your area.
  
• It may make it easier for you if you line up a family member or friend to go with you to the first treatment. After that it may be easier if you go to treatments alone. Going alone makes going for treatment more like going to a standard doctor's appointment. You will likely find other people going through the same treatment with whom to have an informal support group.
• Speak with the radiologist about creams to purchase to reduce possible skin soreness. Test a small amount to be sure you don't have any adverse effects.
• If you are uncomfortable in institutional hospital gowns, consider creating your own or purchasing one that will be more comfortable than the one supplied by the facility. You can find gowns online(for example, through www.healingthreads.com ) or create your own. For a pattern, see the document in To Learn More.
• Ask your doctor about changes to start making in your diet to build your system with nutrients that the treatment may affect. The doctor may recommend you speak with a nutritionist/dietitian. Perhaps you should also be taking a multi-vitamin and/or supplements.
• Stock up on your comfort foods, including some in your freezer that you can defrost as needed. When you freeze foods for this period, make the portions smaller than usual for those occasions when you don't feel like eating a lot.
• If you have children, and haven't told them yet about your condition and/or treatment, now is the time to do it in an age sensitive manner. See the document in "To Learn More."

Last, but not least, check your health insurance to determine how much, if at all, you will be out of pocket and start thinking about how to pay those costs.. If you don't have health insurance, start thinking about how to pay for the treatment. For information about these subjects, see the documents in "To Learn More."

There will be a planning session at the radiation facility (generally the department of radiation oncology.) During the planning session:

• You will meet the technicians and other personnel who will be involved in giving the treatment.
• You will lie on a table. The radiation therapist will outline the treatment field and determine the settings of the machine.
• He or she will position you in the position you will be in during the therapy. Molds may be created from plastic or plaster to help you remain in position during treatment.
• The therapist will mark the skin around the treatment site with a pen to help assure the radiation is targeted to the correct area.
  • Do not wash off the mark unless it is made permanent. 
  • If the mark begins to fade, rather than make it darker yourself, tell the technician.
  • Ask if the mark can rub off on clothing and other material. If so, wear older undergarments that will cover the mark.
• The therapist may permanently tattoo tiny dots around the field to be radiated. These dots are hardly noticeable because of their small size. They are made permanent in case you need additional radiation at a later date. Other radiologists will know where the previous radiation was given so the two don't overlap.

There will also likely be a mock session (known as a simulation) when you and the technician will run through a radiation treatment. A beam of laser light substitutes for radiation. The purpose of the mock session is to make sure everything is correct (some people refer to this as a "dress rehearsal.")  A simulation can take an hour or more.

Ask your radiologist about whether you can eat and drink prior to treatment. Generally you can, except for patients who take radiation to the abdomen.

Treatment is usually given at a set time on set days of the week. 

Following is generally what happens during a radiation treatment:

• First  you change into a hospital gown. (You can bring one of your own design. Gowns designed for purchase are also available.) 
• Then you will be taken into the treatment room and assisted onto the table or into the chair in which you will receive treatment. 
• Blood may be drawn to check levels of your white cells and platelets. These cells may become abnormally low during treatment. 
• The technician will place you in position and test to be sure that the position is correct. This may take a while.  
• The technician will leave the room before the start of treatment. 
  • You will be able to communicate via an intercom. 
  • The technician will also be able to visually observe you. 
• You will be asked to remain in position and not move until the treatment is complete. You do not have to hold your breadth. You will be able to breathe the whole time.
• The actual treatment generally only takes a few minutes. 
  
• After the treatment, the technician will return to help you off the table or chair.
• You can then dress and leave.

Expect to be weighed at least once a week to see whether you are maintaining your normal weight. You may either lose or gain weight during treatment. 

• The planning session
  • Consider having someone go with you to the planning visit as well as to your first treatment. Another person can provide emotional support, help ask questions, and help you remember what was said. 
  • Consider taking a recorder to the planning visit to record the conversation so you can review it later. (Your mobile phone may have recording capability).
• Treatments
  • Before a treatment, do not apply powder, lotion or creams to the affected area before your daily radiation treatment. They can sometimes act as irritants if present during radiation. (It is better to apply these products after the treatment or at bedtime).
  • Keep your scheduled appointments. A full course of treatment is necessary to make sure all the cancer cells are destroyed. If you or a doctor miss a day, make it up so you get the entire dose that was planned for you.
• Skin care
  • The treated area may become red like a sun burn, irritated, dry, itchy or sensitive. There may even be some swelling. The possibility and severity of developing a skin reaction depends on the area being treated, the amount of radiation and whether or not you are also getting chemotherapy. 
  • Ask your radiation oncologist what to use on the treated area to reduce possible burning, dryness and discomfort. Generally a moisturizing cream such as Lubriderm, Aloe Vera gels, or Liquid Vitamin E is recommended. It would help if the oncologist gives you the name of specific products.
  • Consider wearing soft, loose clothing during the weeks you receive radiation. For instance, oversized cotton tee-shirts which you can wear inside out so the seams do not rub.
  • Wash the area gently with lukewarm water and mild soap. Run the water over the treated area. Avoid very hot or very cold temperatures and avoid lathering soap or scrubbing in the treated area.  Pat the treated area dry.
  • Do not place anything hot or cold such as ice packs or heating pads on the treated area. 
  • Do not put tape directly on the treated area.
• Do not take vitamins, minerals, herbs, antioxidants or other supplements without first asking your doctor, nurse or dietitian whether it is okay. Some of these substances can be harmful. Some may reduce the effectiveness of the radiation therapy.
• To the extent possible, avoid scratching the treated area. Scratching can cause infection or soreness.
• Clothing
  • Wear soft, loose clothing that doesn't irritate the treated area.
  • Avoid clothing that may irritate the skin such as wool.
• Do not expose treated areas to direct sunlight during treatment and for at least 6 months after the end of treatment. Do not use sunscreens on the treated area.
• Maintain your diet. It is preferable not to lose weight during treatment.
• If medical personnel suggest or allow you take vitamins, minerals, herbs, antioxidants or other supplements, do not take more than is recommended without first checking with medical personnel.
• Women: It is best to avoid getting pregnant while undergoing radiation treatment.

If A Breast Will Be Radiated

• If you need to wear a bra, it is advisable to go to a shop that has a professional fitter. Try on all the bras that could work for you. Consider buying only one of the most comfortable and trying it out for a few days or a week before buying another one. The bra can be washed every night.
• Ask which deodorants are okay to use, and which aren't.

The most common side effect of radiation therapy is fatigue. Fatigue is caused by your body using more energy to handle the demands of treatment. Fatigue is usually cumulative. It may linger for weeks after treatment ends. This type of fatigue is in addition to the fatigue that may be caused by the disease itself. (For information about dealing with fatigue, click here.) 

Other side effects that commonly occur with radiation treatment follow (in alphabetical order). As you review them, please keep in mind that we are all different and we all react differently. There is no way to predict what will happen to any individual. 

Anxiety: Radiation is generally accompanied by anxiety. The psychological burden will be easier if a person close to you goes with you to at least the first few radiation treatments. For information about coping with anxiety, click here. 

Hair loss is to be expected on the part of the body to which the radiation is targeted, but not otherwise. For information, click here 

Hard stool may be a result depending on the part of the body to which radiation is targeted. For information, see Constipation. 

Nausea/Vomiting/Dry Heaves may accompany radiation. For additional information, click here 

Pain: Radiation is generally painless when given, though the area may become tender and sore.  (For information about pain and how to relieve it, click here) 

Skin changes:

• The skin where the radiation rays enter your body may become tender and sore. Generally any pain is mild - like a sunburn.
• If a tattoo is used to help assure proper positioning, it may be permanent. However, the tattoos are usually small and not readily noticeable. Some people come to think of them as badges of courage: that you have had something and gotten through it. 
• For information about skin changes from treatment and how to deal with them, click here.

Tattoo: If a tattoo is used to help assure proper positioning, it may be permanent. However, the tattoos are usually small and not readily noticeable. Some people come to think of them as badges of courage: that you have had something and gotten through it. 

Depending on the part of your body being treated, you may also have: 

• Diarrhea
• Hair loss in the treatment area  
• Mouth problems
  • Mouth sores  
  • Dry Mouth 
• Nausea and vomiting 
• Sexual changes 
• Swelling 
• Trouble swallowing
• Urinary and bladder changes

Most of these side effects go away within two months after radiation therapy is finished

To learn about the other potential side effects of radiation depending on the area of the body treated, see The National Cancer Institute chart at:www.cancer.gov/cancertopics/radiation-therapy-and-you/page7 

NOTE: For information about oral hygiene during radiation, click here.

The effects of radiation may continue for a while after treatment ends. The effects may even return after a period of months. This is known as "radiation recall."

In general

• As a general matter, side effects that appear during radiation treatment may continue for a short while after treatment ends, but then they will gradually disappear.
• If side effects continue longer than expected, contact your doctor.

Setting the schedule

Set an appointment schedule that works for you and your life as well as for the radiologist. 

If your appointment is first thing in the morning: (a)  your appointment will likely begin on time and (b) you will not be in a waiting room with other patients in it. The empty waiting room is good for some people because sitting in a room with other people who are not in good physical shape can be depressing.

Planning Session

There will be a planning session at the radiation facility (Generally the department of radiation oncology.) During the planning session, the following generally occurs:

• You will meet the technicians and other personnel who will be involved in giving the treatment. (See the section on Radiation professionals).
• You will lie on a table. The radiation technologist will outline the treatment field and determine the settings of the machine.
• He or she will position you in the position you will be in during the therapy. Molds may be created from plastic or plaster to help you remain in position during treatment.
• The technologist will mark the skin around the treatment site with a pen to help assure the radiation is targeted to the correct area.
  • Do not wash off the mark. Likewise, if the mark begins to fade, rather than make it darker yourself, tell the technician.
  • Ask if the mark can rub off on clothing and other material. If so, wear older undergarments that will cover the mark.
• The therapist may permanently tattoo tiny dots around the field. These are hardly noticeable in size. The purpose is in case you need additional radiation at a later date. Other radiologists will know where the previous radiation was given so the two don't overlap.

In order to combat weakness during treatment and to speed recovery, consider increasing your intake of protein and calories before treatment starts.

Before starting treatment:

Tell:

• The radiation oncologist about all prescription and over-the-counter drugs, vitamins, herbs and supplements you are taking. 

Ask:

• How will I know if I am are having an adverse reaction to radiation?
• At what other times should I call? For instance, should I call if the area becomes infected?
• How should I care for the treated area before and after treatment?
• What should I use on the treated area to reduce possible burning, dryness and discomfort. Generally a moisturizing cream such as Lubriderm, Aloe Vera gels, or Liquid Vitamin E is recommended. It would help if the oncologist gives you the name of specific products.
• What should I not use on the treated area?
• What exercises are okay to do during treatment? 
  • Is there any limit on the amount of exercise I do or how often? 
  • What exercises should I not do?